As coronavirus spreads, many questions and some answers
The rapid spread of the virus that causes COVID-19 has sparked alarm worldwide. The World Health Organization (WHO) has declared this rapidly spreading coronavirus outbreak a pandemic, and countries around the world are grappling with a surge in confirmed cases. In the US, social distancing to slow the spread of coronavirus has created a new normal. Meanwhile, scientists are exploring potential treatments and are beginning clinical trials to test new therapies and vaccines. And hospitals are ramping up their capabilities to care for increasing numbers of infected patients.
Below, you'll find answers to common questions all of us are asking. We will be adding new questions and updating answers as reliable information becomes available. Also see our podcasts featuring experts discussing coronavirus and COVID-19.
Symptoms, spread, and other essential information
What is coronavirus and how does it spread? What is COVID-19 and what are the symptoms? How long does coronavirus live on different surfaces? Take a moment to reacquaint yourself with basic information about this virus and the disease it causes.
Click here to read more about COVID-19 symptoms, spread, and other basic information.
Social distancing, hand washing, and other preventive measures
By now, many of us are taking steps to protect ourselves from infection. This likely includes frequent handwashing, regularly cleaning frequently touched surfaces, and social distancing. How do each of these measures help slow the spread of this virus, and is there anything else you can do?
Click here to read more about what you can do to protect yourself and others from coronavirus infection.
If you are at higher risk
Though no one is invulnerable, we've seen that older adults are at increased risk for severe illness or death from COVID-19. Underlying conditions, including heart disease, lung disease, and diabetes, increase risk even further in those who are older. In addition, anyone with an underlying medical condition, regardless of their age, faces increased risk of serious illness.
Click here to read more about what you can do if you are at increased risk for serious illness.
If you've been exposed, are sick, or are caring for someone with COVID-19
Despite your best efforts, you may be exposed to coronavirus and become ill with COVID-19. Or you may be in a position where you are caring for a loved one with the disease. It's important to know what to do if you find yourself in any of these situations. Stock up with medications and health supplies now, and learn the steps you can take to avoid infecting others in your household and to avoid getting sick yourself if you are caring for someone who is ill.
Click here to read more about what to do you if you have been exposed, are sick, or are caring for someone with COVID-19.
Treatments for COVID-19: What helps, what doesn't, and what's in the pipeline
While there are no specific treatments for COVID-19 at this time, there are things you can do to feel better if you become ill. In the meantime, researchers around the globe are looking at existing drugs to see if they may be effective against the virus that causes COVID-19, and are working to develop new treatments as well.
Click here to read more about measures that can help you feel better and treatments that are under investigation.
Coronavirus and kids:
So far, the vast majority of coronavirus infections have afflicted adults. And when kids are infected, they tend to have milder disease. Still, as a parent, you can't help but worry about the safety of your children. Many parents are also trying to find a balance between answering their children's questions about the pandemic and enforcing health-promoting behaviors and social distancing rules without creating an atmosphere of anxiety. Not to mention keeping kids engaged and entertained with schools closed and playdates cancelled.
Click here to read more about kids and the coronavirus outbreak.
Coping with coronavirus:
The news about coronavirus and its impact on our day-to-day lives has been unrelenting. There's reason for concern and it makes good sense to take the pandemic seriously. But it's not good for your mind or your body to be on high alert all the time. Doing so will wear you down emotionally and physically.
Click here to read more about coping with coronavirus.
New questions and answers
What is convalescent plasma? How could it help people with COVID-19?
When people recover from COVID-19, their blood contains antibodies that their bodies produced to fight the coronavirus and help them get well. Antibodies are found in plasma, a component of blood.
Convalescent plasma — literally plasma from recovered patients — has been used for more than 100 years to treat a variety of illnesses from measles to polio, chickenpox, and SARS. In the current situation, antibody-containing plasma from a recovered patient is given by transfusion to a patient who is suffering from COVID-19. The donor antibodies help the patient fight the illness, possibly shortening the length or reducing the severity of the disease.
Though convalescent plasma has been used for many years, and with varying success, not much is known about how effective it is for treating COVID-19. There have been reports of success from China, but no randomized, controlled studies (the gold standard for research studies) have been done. Experts also don't yet know the best time during the course of the illness to give plasma.
On March 24th, the FDA began allowing convalescent plasma to be used in patients with serious or immediately life-threatening COVID-19 infections. This treatment is still considered experimental.
Who can donate plasma for COVID-19?
In order to donate plasma, a person must meet several criteria. They have to have tested positive for COVID-19, recovered, have no symptoms for 14 days, currently test negative for COVID-19, and have high enough antibody levels in their plasma. A donor and patient must also have compatible blood types. Once plasma is donated, it is screened for other infectious diseases, such as HIV.
Each donor produces enough plasma to treat one to three patients. Donating plasma should not weaken the donor's immune system nor make the donor more susceptible to getting reinfected with the virus.
Should parents take babies for initial vaccines right now? What about toddlers and up who are due for vaccines?
The answer depends on many factors, including what your doctor's office is offering. As with all health care decisions, it comes down to weighing risks and benefits.
Getting early immunizations in for babies and toddlers — especially babies 6 months and younger — has important benefits. It helps to protect them from infections such as pneumococcus and pertussis that can be deadly, at a time when their immune system is vulnerable. At the same time, they could be vulnerable to complications of COVID-19 should their trip to the doctor expose them to the virus.
For children older than 2 years, waiting is probably fine — in most cases. For some children with special conditions, or those who are behind on immunizations, waiting may not be a good idea.
The best thing to do is call your doctor's office. Find out what precautions they are taking to keep children safe, and discuss your particular situation, including not only your child's health situation, but also the prevalence of the virus in your community and whether you have been or might have been exposed. Together, you can make the best decision for your child.
When do you need to bring your child to the doctor during this pandemic?
Anything that isn't urgent should be postponed until a safer time. This would include checkups for healthy children over 2 years (many practices are postponing checkups even for younger children if they are generally healthy). It would also include follow up appointments for anything that can wait, like a follow-up for ADHD in a child that is doing well socially and academically. Your doctor's office can give you guidance about what can wait — and when to reschedule. Many practices are offering phone or telemedicine visits, and it's remarkable how many things can be addressed that way.
Some things, though, do require an in-person appointment, including:
- Illness or injury that could be serious, such as a child with trouble breathing, significant pain, unusual sleepiness, a high fever that won't come down, or a cut that may need stitches or a bone that may be broken. Call your doctor for guidance as to whether you should bring your child to the office or a local emergency room.
- Children who are receiving ongoing treatments for a serious medical condition such as cancer, kidney disease, or a rheumatologic disease. These might include chemotherapy, infusions of other medications, dialysis, or transfusions. Your doctor will advise you about any changes in treatments or how they are to be given during the pandemic. Do not skip any appointments unless your doctor tells you to do so.
- Checkups and visits for children with certain health conditions. This might include children with breathing problems whose lungs need to be listened to, children who need vaccinations to protect their immune system, children whose blood pressure is too high, children who aren't gaining weight, children who need stitches out or a cast off, or children with abnormal blood tests that need rechecking. If your child is being followed for a medical problem, call your doctor for advice. Together you can figure out when and how your child should be seen.
Bottom line: Talk to your doctor. The decision will depend on a combination of factors including your child's condition, how prevalent the virus is in your community, whether you have had any exposures or possible exposures, what safeguards your doctor has put into place, and how you would get to the doctor.
I've heard that high-dose vitamin C is being used to treat patients with COVID-19. Does it work? And should I take vitamin C to prevent infection with the COVID-19 virus?
Some critically ill patients with COVID-19 have been treated with high doses of intravenous (IV) vitamin C in the hope that it will hasten recovery. However, there is no clear or convincing scientific evidence that it works for COVID-19 infections, and it is not a standard part of treatment for this new infection. A study is underway in China to determine if this treatment is useful for patients with severe COVID-19; results are expected in the fall.
The idea that high-dose IV vitamin C might help in overwhelming infections is not new. A 2017 study found that high-dose IV vitamin C treatment (along with thiamine and corticosteroids) appeared to prevent deaths among people with sepsis, a form of overwhelming infection causing dangerously low blood pressure and organ failure. Another study published last year assessed the effect of high-dose vitamin C infusions among patients with severe infections who had sepsis and acute respiratory distress syndrome (ARDS), in which the lungs fill with fluid. While the study's main measures of improvement did not improve within the first four days of vitamin C therapy, there was a lower death rate at 28 days among treated patients. Though neither of these studies looked at vitamin C use in patients with COVID-19, the vitamin therapy was specifically given for sepsis and ARDS, and these are the most common conditions leading to intensive care unit admission, ventilator support, or death among those with severe COVID-19 infections.
Regarding prevention, there is no evidence that taking vitamin C will help prevent infection with the coronavirus that causes COVID-19. While standard doses of vitamin C are generally harmless, high doses can cause a number of side effects, including nausea, cramps, and an increased risk of kidney stones.
Is the antiviral drug remdesivir effective for treating COVID-19?
Scientists all over the world are testing whether drugs previously developed to treat other viral infections might also be effective against the new coronavirus that causes COVID-19.
One drug that has received a lot of attention is the antiviral drug remdesivir. That's because the coronavirus that causes COVID-19 is similar to the coronaviruses that caused the diseases SARS and MERS — and evidence from laboratory and animal studies suggests that remdesivir may help limit the reproduction and spread of these viruses in the body. In particular, there is a critical part of all three viruses that can be targeted by drugs. That critical part, which makes an important enzyme that the virus needs to reproduce, is virtually identical in all three coronaviruses; drugs like remdesivir that successfully hit that target in the viruses that cause SARS and MERS are likely to work against the COVID-19 virus.
Remdesivir was developed to treat several other severe viral diseases, including the disease caused by Ebola virus (not a coronavirus). It works by inhibiting the ability of the coronavirus to reproduce and make copies of itself: if it can't reproduce, it can't make copies that spread and infect other cells and other parts of the body.
Remdesivir inhibited the ability of the coronaviruses that cause SARS and MERS to infect cells in a laboratory dish. The drug also was effective in treating these coronaviruses in animals: there was a reduction in the amount of virus in the body, and also an improvement in lung disease caused by the virus.
The drug appears to be effective in the laboratory dish, in protecting cells against infection by the COVID virus (as is true of the SARS and MERS coronaviruses), but more studies are underway to confirm that this is true.
Remdesivir was used in the first case of COVID-19 that occurred in Washington state, in January 2020. The patient was severely ill, but survived. Of course, experience in one patient does not prove the drug is effective.
Two large randomized clinical trials are underway in China. The two trials will enroll over 700 patients, and are likely to definitively answer the question of whether the drug is effective in treating COVID-19. The results of those studies are expected in April or May 2020. Studies also are underway in the United States, including at several Harvard-affiliated hospitals. It is hard to predict when the drug could be approved for use and produced in large amounts, assuming the clinical trials indicate that it is effective and safe.
Is a lost sense of smell a symptom of COVID-19? What should I do if I lose my sense of smell?
Increasing evidence suggests that a lost sense of smell, known medically as anosmia, may be a symptom of COVID-19. This is not surprising, because viral infections are a leading cause of loss of sense of smell, and COVID-19 is a caused by a virus. Still, loss of smell might help doctors identify people who do not have other symptoms, but who might be infected with the COVID-19 virus — and who might be unwittingly infecting others.
A statement written by a group of ear, nose and throat specialists (otolaryngologists) in the United Kingdom reported that in Germany, two out of three confirmed COVID-19 cases had a loss of sense of smell; in South Korea, 30% of people with mild symptoms who tested positive for COVID-19 reported anosmia as their main symptom.
On March 22nd, the American Academy of Otolaryngology–Head and Neck Surgery recommended that anosmia be added to the list of COVID-19 symptoms used to screen people for possible testing or self-isolation.
In addition to COVID-19, loss of smell can also result from allergies as well as other viruses, including rhinoviruses that cause the common cold. So anosmia alone does not mean you have COVID-19. Studies are being done to get more definitive answers about how common anosmia is in people with COVID-19, at what point after infection loss of smell occurs, and how to distinguish loss of smell caused by COVID-19 from loss of smell caused by allergies, other viruses, or other causes altogether.
Until we know more, tell your doctor right away if you find yourself newly unable to smell. He or she may prompt you to get tested and to self-isolate.
Are chloroquine and hydroxychloroquine effective for treating COVID-19?
Recently, there has been considerable discussion of whether two related drugs — chloroquine and hydroxychloroquine — that have been available for decades to treat other illnesses might also be effective in treating COVID-19.
The drugs are primarily used to treat malaria and several inflammatory diseases, including systemic lupus erythematosus (lupus) and rheumatoid arthritis. No drug is perfectly safe, but these drugs are quite safe when used for just the several days they might be needed to treat COVID-19. They are also cheap, already available at our local drug stores, and relatively free of side effects.
The question, of course, is whether they are effective against the coronavirus that causes COVID-19. Are they effective in killing the virus in a laboratory dish? And are they effective in killing the virus in people? If the answer to the first question is "no," there's no point in getting an answer to the second question.
There is strong evidence that both drugs kill the COVID-19 virus in the laboratory dish. The drugs appear to work through two mechanisms. First, they make it harder for the virus to attach itself to the cell, inhibiting the virus from entering the cell and multiplying within it. Second, if the virus does manage to get inside the cell, the drugs kill it before it can multiply.
But do the drugs work in people with COVID-19? Many studies are underway to get an answer to this question, but as of March 24, 2020, only two have issued preliminary results.
One report, published in February 2020, claimed that chloroquine had been used in more than 100 patients in China who had COVID-19. The scientists stated that their results demonstrated that chloroquine is superior to the control treatment in inhibiting the worsening of pneumonia, improving lung imaging findings, eliminating the virus from the body, and shortening the duration of the disease.
These claims are exciting. However, the report provided virtually no evidence in support of the claims. First of all, this was not a randomized, double-blind controlled trial, the gold standard for research studies. Second, no evidence was presented as to how severe the pneumonia was, nor whether findings on lung x-rays or CT scans really improved. Third, although they claim the drug made the virus disappear, they didn't report what the levels of the virus were before versus after the treatment. In short, not much evidence.
Another small study was conducted by a group of scientists in southern France, a region hard hit by COVID-19. This, also, was not a randomized trial. Instead, the scientists compared 26 patients who received hydroxychloroquine to 16 who did not: after six days, the virus was gone from the body in 70% of those given the treatment, compared to only 12.5% of those who weren't. The drug appeared to be as effective in the sickest patients as in the least sick, but the study was too small to be sure about that. The study also was too small to say that people who received the treatment were protected against a prolonged illness or death.
There are many studies underway, and we should have more solid answers within a few months.
More about COVID-19 and how to protect yourself
- Coping with the coronavirus pandemic for people with anxiety disorders
- Strategies to promote better sleep in these uncertain times
- Is it safe to see the pediatrician for vaccines and medical visits?
- COVID-19: If you're older and have chronic health problems, read this
- How does cardiovascular disease increase the risk of severe illness and death
- Recovering from addiction during a time of uncertainty and social distancing
Podcast: How to conquer your anxieties during the COVID-19 outbreak (recorded 3/23/20)
Your feelings arise from a misaligned ratio of stress to resiliency. The more resilient you become the less stress you'll feel. Dr. Greg Fricchione, director of the Benson-Henry Mind Body Institute at Massachusetts General Hospital, describes the tools and techniques for building resilience into your life during stressful times so we can better manage our anxieties.
Podcast: The front lines of COVID-19: A doctor's eye view (recorded 3/20/20)
Dr. Todd Ellerin is an infectious diseases physician at South Shore Health in Weymouth Massachusetts, and an instructor in medicine at Harvard Medical School. He also serves as an associate physician at Boston's prestigious Brigham and Women's Hospital. He offers insight—and practical information-- from the front lines in the battle to stem COVID-19.
Podcast: Coronavirus status report: Harvard public health expert Dr. Ashish K. Jha fills us in on where we are headed (recorded 3/19/20)
The COVID-19 outbreak has caused markets to collapse and worldwide health systems to become overwhelmed. When there's a global pandemic, it's nice to hear from the steady, transparent and yes even reassuring voice of experts on the front lines. We spoke to Dr. Ashish K. Jha, faculty director of the Harvard Global Health Institute. Dr. Jha's recent appearance on the PBS Newshour caused reverberations throughout the federal and state response system. Here's his update.
- Centers for Disease Control and Prevention
- World Health Organization
- Johns Hopkins University COVID-19 Interactive Map
- Harvard Medical School's HMX Online Learning team is offering a selection of immunity-related videos and interactive materials to help with understanding how the body reacts to threats like the coronavirus that causes COVID-19.
Terms to know:
community spread (community transmission): is said to have occurred when people have been infected without any knowledge of contact with someone who has the same infection
contact tracing: a process that begins with identifying everyone a person diagnosed with a given illness (in this case COVID-19) has been in contact with since they became contagious. The contacts are notified that they are at risk, and may include those who share the person's home, as well as people who were in the same place around the same time as the person with COVID-19 — a school, office, restaurant, or doctor's office, for example. Contacts may be quarantined or asked to isolate themselves if they start to experience symptoms, and are more likely to be tested for coronavirus if they begin to experience symptoms.
containment: refers to limiting the spread of an illness. Because no vaccines exist to prevent COVID-19 and no specific therapies exist to treat it, containment is done using public health interventions. These may include identifying and isolating those who are ill, and tracking down anyone they have had contact with and possibly placing them under quarantine.
epidemic: a disease outbreak in a community or region
flattening the curve: refers to the epidemic curve, a statistical chart used to visualize the number of new cases over a given period of time during a disease outbreak. Flattening the curve is shorthand for implementing mitigation strategies to slow things down, so that fewer new cases develop over a longer period of time. This increases the chances that hospitals and other healthcare facilities will be equipped to handle any influx of patients.
incubation period: the period of time between exposure to an infection and when symptoms begin
isolation: the separation of people with a contagious disease from people who are not sick
mitigation: refers to steps taken to limit the impact of an illness. Because no vaccines exist to prevent COVID-19 and no specific therapies exist to treat it, mitigation strategies may include frequent and thorough handwashing, not touching your face, staying away from people who are sick, social distancing, avoiding large gatherings, and regularly cleaning frequently touched surfaces and objects at home, in schools, at work, and in other settings.
pandemic: a disease outbreak affecting large populations or a whole region, country, or continent
presumptive positive test result: a positive test for the virus that causes COVID-19, performed by a local or state health laboratory, is considered "presumptive" until the result is confirmed by the CDC. While awaiting confirmation, people with a presumptive positive test result will be considered to be infected.
quarantine: separates and restricts the movement of people who have a contagious disease, have symptoms that are consistent with the disease, or were exposed to a contagious disease, to see if they become sick
SARS-CoV-2: short for severe acute respiratory syndrome coronavirus 2, SARS-CoV-2 is the official name for the virus responsible for COVID-19.
social distancing: refers to actions taken to stop or slow down the spread of a contagious disease. For an individual, it refers to maintaining enough distance between yourself and another person to reduce the risk of breathing in droplets that are produced when an infected person coughs or sneezes. In a community, social distancing measures may include limiting or cancelling large gatherings of people.
virus: a virus is the smallest of infectious microbes, smaller than bacteria or fungi. A virus consists of a small piece of genetic material (DNA or RNA) surrounded by a protein shell. Viruses cannot survive without a living cell in which to reproduce. Once a virus enters a living cell (the host cell) and takes over a cell's inner workings, the cell cannot carry out its normal life-sustaining tasks. The host cell becomes a virus manufacturing plant, making viral parts that then reassemble into whole viruses and go on to infect other cells. Eventually, the host cell dies.
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Harvard Health Publishing Coronavirus Resource Center Experts
The Harvard Health Publishing team would like to acknowledge the Harvard Medical School experts who have contributed their time and expertise: Suzanne Bertisch, MD, MPH; Todd Ellerin, MD; Huma Farid, MD; Anthony Komaroff, MD; Douglas Krakower, MD; Howard E. LeWine, MD; Luana Marques, PhD; Claire McCarthy, MD; Babar Memon, MD, MSc; John Sharp, MD; Robert H. Shmerling, MD; Jacqueline Sperling, PhD.
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.