Coronavirus: What are the facts?
Michael Doney MD, MS, MPH
March 9, 2020
Michael Doney MD, MS, MPH is Color’s Head of Medical Affairs. Before joining Color, Michael worked at the US Centers for Disease Control & Prevention (CDC), where he served as Associate Division Director, Preparedness & Response in the Division of Global Migration and Quarantine and as a Medical Officer in the Emergency Preparedness and Response Branch, Division of Preparedness & Emerging Infections. Michael also has experience working on seasonal and pandemic influenza vaccines.
As the situation around Covid-19, the disease caused by SAR-CoV-2 (also referred to as “the Coronavirus”), continues to evolve, we’re sharing some suggestions on where to find timely and reliable information about this ongoing global outbreak.
The situation with regard to the global, regional and community spread of SARS-CoV-2 is evolving rapidly. Federal, State and local public health agencies are the best resources for information on current disease-related statistics and recommendations for personal and community-level preparedness and response.
Background and Situational Update
Typical coronaviruses are a common cause of seasonal respiratory infections. These infections are mainly common mild ‘head colds’ although coronavirus infection may result in more serious but far less common lung infections. Covid-19, the disease caused by SARS-CoV-2 infection, also seems to range from milder upper respiratory tract infection with fever and typical influenza-like symptoms (most commonly) to more severe disease such as pneumonia (lung infection), which may cause fever, cough, respiratory distress and hospitalization. While some disagreement exists as to whether public health authorities have accurately estimated the numbers of individuals with milder disease, the risk factors for more severe disease are becoming increasingly evident–including older age (greater than 50 years old) and the presence of co-existing illness, such as cardiovascular disease, chronic lung disease and diabetes.
Reliable Updates and Special Conditions
The World Health Organization (WHO) hosts a dedicated Covid-19 website with daily updates of global and regional case counts and worldwide spread. The Johns Hopkins Center for Systems Science & Engineering hosts a similar website with up-to-date case counts at the country and regional level. More specific information on spread within the United States (US), including case counts and illness and mortality statistics is available from the CDC at their ‘Coronavirus Disease 2019 (COVID-19) Situation Summary’ website. As well, the CDC website provides links to specific recommendations for individuals, workplaces, schools and colleges and universities to prepare for a community outbreak, including guidelines for special populations such as travelers, children and pregnant women.
The CDC has posted information for special populations including children and pregnant women. At this time, there is limited evidence to suggest that pregnant women have increased risk for SARS-CoV-2 infection or greater risk of complicated Covid-19 disease. However, in general, it is known that pregnant women undergo changes in their body in response to pregnancy which may make them more susceptible to respiratory virus infections. As well, evidence from prior coronavirus outbreaks due to SARS-CoV and MERS-CoV (Middle East Respiratory Syndrome), as well as influenza virus, suggests that pregnant women may be at increased risk of developing more severe illness and complications with Covid-19 disease. At this time, available information suggests that children are not uniquely susceptible to SARS-CoV-2 infection. Covid-19 disease in children has presented with typical ‘cold’ symptoms such as fever, runny nose and cough. Severe disease in children has been encountered but appears to be uncommon. Careful attention to posted CDC guidelines for personal and household readiness for Covid-19 disease are important precautions to limit the impact of community and household transmission on the health of children and pregnant women.
Personal health habits and practices are of critical importance in limiting the spread of respiratory infections. These actions, collectively termed cough etiquette / respiratory hygiene, are recommended for all persons with symptoms of respiratory illness whether in homes or healthcare settings and include:
– Cover your mouth and nose with a tissue when coughing or sneezing;
– Dispose of the tissue in the nearest waste receptacle after use; and
– Perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic handwash for at least 20 seconds)
Note: If a tissue is not available, use upper sleeve to contain cough or sneeze
The CDC has posted recommended actions for members of the public and healthcare workers who are caring for those with signs and symptoms suggestive of Covid-19 as well as for individuals with close contact with someone with confirmed or suspected Covid-19 disease. This guidance includes:
– Updated recommendations on selection and testing of sick individuals for SARS-CoV-2 infection,
– taking care of a sick or exposed person in the home and suggestions for when a sick person may safely stay at home,
– when to schedule an appointment at the doctor’s office, and
– when to go to the hospital.
The CDC and public health authorities recommend notifying your doctor’s office or the hospital before your arrival to ensure they have adequate infection control measures in place (but do not delay seeking care if you are having serious signs or symptoms).
Community Response Recommendations
Planning now in the home and workplace is important to anticipate and prepare for the anticipated follow-on effects such as childcare needs in the event of facility closures, requirements for working from home for extended periods and isolation and/or quarantine in the home. Public Health authorities have posted a toolbox of measures that community members (like event planners, community- and faith-based organizations, workplaces, healthcare facilities and first responder organizations) may use to plan for a local outbreak. Current tools include:
– isolation of those with known or suspected Covid-19
– quarantine of those exposed to individuals with known or suspected Covid-19
– cancellation of large gatherings
– early closure of school and childcare facilities.
The use of these interventions may be important to limit spread within the community in a situation with large numbers of sick persons or outbreaks to lessen the impacts on individuals, the healthcare system and community resilience.