The Flu Shot and Coronavirus

Should I get the flu shot this year? Will it help against coronavirus?

It is well documented now that there is a surge of COVID-19 across dozens of states while at the same time the incidence is decreasing in others.

However as we approach flu season when it is normally recommended to get the flu shot - it is highly likely than individuals who succumb to both viruses will suffer more severe illness and a higher number of deaths - particularly in those most susceptible to either.

Due to seasonality, a return to school and indoor activities the spread of flu will occur as it does every year this fall. We know that the flu vaccine works better some years than others and we know that it decreases sickness, hospitalisations severity and death. This year however the risks are higher as folks infected by both COVID-19 and the flu are highly likely to experience greater negative impacts.

While we know that in a typical year less than 50% of adults receive the flu vaccine vs a recommended 70% as set by the Department of Health and Human Services for 2020. Additionally we know that annually typically hundreds of thousands are hospitalised and tens of thousands die - the two together however could bring significantly more disastrous results. Given that flu shots are lower historically in black and Hispanic populations in the US - and that they have had a higher rate of coronavirus infection, sickness and death than the rest of the population - this can further exacerbate the demographic differences we will see.

In addition to masks, handwashing and social distancing reducing the spread of coronavirus fortunately these same factors reduce the spread of flu infections also. This can be further enhanced by a broader vaccination of the US population particularly susceptible sub-groups such as minorities and the elderly as well as health care workers who have a much higher chance of exposure to both viruses.

Does the flu vaccine work?

Yes. It works but not 100%. That is to say that the flu vaccine is imperfect and does not cover all strains of flu (which vary annually) it has a massive impact on reducing not only the severity of flu infections but also hospitalizations and death. Furthermore side-effects are generally mild with a fleeting headache and soreness around the injection site being relatively minor and infrequent side effects. Also as the vaccine is not a live virus - it cannot cause influenza itself though people may feel some mild flu symptoms due to the body’s response to the shot.

It is strongly recommended that vaccines should be especially considered in high risk environments such as classrooms and at work for those working in dense, high-contact environments in addition to those who normally are at high risk of sickness and death from the flu.

Who pays for the flu shot?

Federal law requires health insurers to pick up the cost of annual flu vaccination, as Medicare does. Medicaid vaccine coverage varies by state. Given the massive numbers of unemployed who have lost insurance - it is therefore more important than ever this year that states and the federal government to work together to make shots free or at least very inexpensive for the uninsured.

Where and when did Coronavirus start?

The coronavirus pandemic caused by the COVID-19 virus was first identified in Wuhan, China, in December 2019 and on the 31st of December 2019 China reported to the World Health Organization a cluster of viral pneumonia in Wuhan with cases of which the cause was not known.

The World health organization investigated and by the 30th of January 2020 the World Health Organization declared the outbreak a Public Health Emergency of International Concern on 30 January 2020, and officially a pandemic on the 11th of March.

Evidence showed that the most likely area in which the outbreak occurred was at the Huanan Seafood Market and that the origin of the virus was from another species of animal - also known as zoonotic transmission.

Early investigations determined that the virus that caused the outbreak, known as SARS-CoV-2, was a newly discovered virus and related closely to bat and pangolin coronaviruses. While there are those that speculate otherwise the general agreement in the scientific community is that the virus was a natural one which may have been transmitted to humans by bats that were being processed for traditional Chinese medicine.

The earliest known person with Coronavirus is unknown though several cases can be traced as far back as the 17th of November 2019.

People are understandably worried as to whether or not their dogs and cats can get coronavirus and get sick and also whether they can get coronavirus and transmit that to other humans and pets.

According to the Centers for Disease Control, "there is no evidence that pets play a role in spreading the virus in the United States. Therefore, there is no justification in taking measures against companion animals that may compromise their welfare."

So what are the facts about coronavirus and can dogs get infected?

While it is known that dogs can contract other forms of coronaviruses with the most commonly known one being the canine respiratory coronavirus. COVID-19 however is a specific and novel coronavirus and it is not believed to be a health threat to dogs even though dogs have tested positive to the virus. Like in humans that can be infected but show no signs or negative symptoms - this is the likely case in dogs.

• A pug named Winston who was believed to have tested positive for COVID-19 was later concluded to not be the case. Of note human family members were tested positively for COVID-19.
• In Hong Kong two dogs living in a home with COVID-19 positive owners did test positive. Again neither dog showed any symptoms.

In terms of getting infected from a dog the World Health Organization states, "There is no evidence that a dog, cat or any pet can transmit COVID-19"

Further testing by Hong Kong authorities has found infection in dogs to be infrequent and they have concluded that these findings indicate that dogs and cats are not infected easily with this virus, and there is no evidence that they play a role in the spread of the virus.

Can cats contract COVID-19?

• It is known that several cats have tested positive for COVID-19 with some displaying mild respiratory symptoms.
• In almost all cases the cats who tested positive lived with individuals who had tested positive themselves.

It was also well publicized in the media that Nadia, a 4 year old Malayan tigress at New York's Bronx Zoo was the first known case of COVID-19 in an animal in the United States. Since then as many as eight big cats have been confirmed to test positive. The transmission to the cats is believed to have been from a staff member and there is no evidence of infection from cats to humans.

Dr. Jane Rooney, a veterinarian and USDA official, tells the Associated Press, There doesn't appear to be, at this time, any evidence that suggests that the animals can spread the virus to people or that they can be a source of infection in the United States.

I'm Sick with Covid-19. How Do I Prevent the Spread?

In order to care for yourself and to help protect other people in your home and community if you think you have COVID-19 or if it has been confirmed and you are sick there are many things you can do to help prevent the spread of the disease.

Stay home except as required for medical care

• Most people with COVID-19 have mild illness that does not require medical care and as such most can recover at home. In order to stop the spread of this very contagious disease it is recommended that you do not visit public areas or leave your home, except to get medical care.
• Self care is important and you need to get rest and stay hydrated. Smoking should be avoided. You can use over-the-counter medicines, such as acetaminophen or ibuprofen to control symptoms. Please follow the instructions carefully and do not use more than the recommended dosage.
• Symptoms that indicate a possible emergency include but are not limited to:
  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion
  • Inability to wake or stay awake
  • Bluish lips or face
• If have any other warning signs or if you think it is an emergency then contact your medical provider as soon as possible or 911 if severe.
• Public transportation, ride-sharing and taxis should be avoided.
• Separate yourself from others to avoid spread.

As the likelihood of spreading the disease increases dramatically with the length and proximity of exposure - it is vital that as much as possible you stay in a designated specific room and away from other people and even pets in your home. The use a separate bathroom is also recommended if that is feasible. In cases where you cannot avoid being around others or if you leave your home - a cloth face covering should be worn at all times.

I need to see a doctor. What should I do?

Firstly it is important that you call ahead prior to visiting your doctor as you may be able to have your care provided by phone or telemedicine. If you think you have COVID-19 but cannot postpone a visit to the physicians office then call and inform them so they can be better prepared for their and their patients protection.

Using masks

Wearing a mask which covers both nose and mouth is both critical and responsible for those with COVID-19

Even if you are at home in the presence of others it is recommended you wear masks. Even in front of pets. This is not necessary if you are alone.

However if you cannot tolerate masks due to e.g. lung disease - then coughs and sneezes still need covering and maintaining a distance of 6ft becomes even more important.

How to best cover coughs and sneezes

• Cover your mouth and nose with a tissue when you cough or sneeze.
• Throw away used tissues in a lined trash can.
• Immediately after it is important that you wash your hands with soap and water for at least 20 seconds. If soap and water are not available an alcohol-based hand sanitizer with at least 60% alcohol should be used.
• Soap and water are the best option, especially if hands are visibly dirty.

General tips:

• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Avoid sharing personal household items such as cups, glasses, utensils etc.
• Clean and disinfect areas that may have blood, stool, or body fluids on them.
• If you are sick you should try daily to disinfect the most high-touch surfaces in your room and bathroom.
• Gloves are suggested. High-touch surfaces include
  • phones,
  • remote controls,
  • counters, tabletops,
  • doorknobs,
  • bathroom fixtures,
  • toilets,
  • keyboards,
  • tablets, and
  • bedside tables

Using Disinfectants

• When using disinfectants be sure to follow the instructions on the label to ensure safe and effective use of the product. Several products recommend keeping the surface wet for several minutes to ensure germs are killed. Many also recommend precautions such as wearing gloves and making sure you have good ventilation during use of the product.
• Most EPA-registered household disinfectants should be effective.

Can I Be Immune to Covid-19?

Aside from durability, not all vaccines have complete protection, for example, the annual flu shot ranges in effectiveness and works better for children than for the rest of the population. In 2019, it was less than 50% effective in preventing the flu, but there were still major benefits.

While our hopes for a return to a ’ normal world" lie in a vaccine primarily and progress is being made in that regard with over 150 vaccines being investigated worldwide - we still have major questions that remain unanswered.

What is immunity?

When the general public uses the term immunity - it is thought of as an almost absolute protection. However in many cases immunity is anything but absolute. The flu vaccine, for example reduces the risk of more severe disease for example rather than infer absolute immunity.

How does immunity work?

In the case of COVID-19 the main mechanism is through the production of antibodies. But it should be noted that one study has found that as many as 8.5% of those infected had zero detectable antibodies. Additionally it is thought as survivors tend to be younger - there are also cell-mediated arms of the immune system that can neutralize the virus through white blood cells and cytokines.

As Charles Cairns, the dean of Drexel University College of Medicine has said: “those who have inflammation mount an immune response that’s more detectable and potentially more robust.” This further points to the potential importance of cell-mediated immune response in the case coronavirus.

How long does immunity last?

We do not know yet. However we do know of cases of patients who had a recurrent infection with COVID-19 and we also know that some other coronavirus infections confer only temporary immunity, in some cases as few as a few months. More data is required.

What factors affect immunity?

Essentially the level and duration of immunity from an infectious disease are highly correlated with the severity and duration of the immune response to the infection. As such infections with more severe symptoms tend to a stronger immune response thus inferring a higher level and duration of immunity. Conversely, mild or asymptomatic cases lead to generally lower antibody levels and thus potentially lower levels of, and duration of immunity. However we do not yet know if that is in fact valid for COVID-19.

What does immunity data imply re a potential vaccine?

Simply said - there is insufficient data to answer this with any degree of certainty.

"Obviously, a vaccine that works 100% of the time would be ideal, but that is not realistic," said Dr. John Mascola, director of the National Institutes of Health Vaccine Research Center.

The level of response to a vaccine may vary from a slight reduction in severity of the disease in some populations or people, to a very high level of protection in most individuals. With so many vaccines in development it is likely that the results will also vary.

Until we have the results of phase III trials which will measure the actual efficacy of the vaccine we won’t know for sure for any individual vaccine. We will thereafter have a better understanding of the relationship and degree thereof between antibody levels and immunity.

It should be noted however than in the case of the influenza vaccine which can have an effectiveness of only 50% in preventing the flu - still confers major benefits not only to those protected but the community as a whole by decreasing the number of infections, and deaths while also decreasing the number of those who become severely ill and require hospitalization, intubation and admission to intensive care.

How do the different vaccines being investigated work?

Different approaches are being used by various institutions to create a COVID-19 vaccine. The group from Oxford and its partner AstraZeneca for example are using the more traditional approach of an attenuated virus which is a virus that doesn’t make people sick but infers immunity. Yet others with Moderna and Pfizer being well known examples are using proteins that can "trick the immune system into mounting an effective response against future infection.”

Once there is a vaccine - who should get it?

Again we don’t know yet until results from the trials come in at the very least. However if as may be the case - previous infection with COVID-19 does not infer as strong or as long a level of immunity - then most people would likely be recommended to be vaccinated.

Additionally like in the case of the flu vaccine, a coronavirus vaccine might also work better for certain sub-groups.

What if the COVID-19 virus mutates?

The structure and biology of this virus is such that it is covered in tiny spikes called surface proteins. Most experts indicate that most vaccines being developed currently are likely to work into the future as sufficient mutation to incur lack of efficacy is unlikely - though a finite possibility does exist.

Is COVID-19 different from the seasonal flu for Diabetics?

Yes - COVID-19 is a more serious illness with a higher rate of death and complications than the seasonal flu in - not only diabetics but everyone.

Recommended safety precautions for people with diabetes are no different than for the flu with frequent hand washing, covering coughs and sneezes.

Where can I go to learn more about Covid-19?

Our understanding and awareness of Covid 19 is ongoing, so as we learn more about this virus it will be important to keep up to date from sources you can trust and verify. Check with your doctor or public health official to get the most updated information about how to protect yourself and others.

You can find more online information about Covid 19 from:

• The CDC at CDC.GOV
• The WHO, the World Health Organization, at WHO.int
• Your state and local government offices

General Tips

Clean Your Phone

This is important. Always wipe down your phone. You know not to touch your face and to wash your hands, but your phone is likely with you at every step of your day, exposed to an endless stream of germs and a high risk for transmission. And chances are while you’ve learned not to touch your face, you touch your phone and then your phone touches your face.

• • Wipe it down thoroughly, at least once a day
  • Take the case off and sanitize it with a wipe or a paper towel with hand sanitizer.
  • Avoid any ports so you don’t get liquids inside.
  • Take the case off and wipe that down separately, inside and out.
  • Let it air dry for a few minutes before putting it back on.
  • Use speakerphone whenever possible to avoid face contamination (but don’t be rude in public)
  • Use a head phone for private calls
  • Wipe down the surface regularly
  • Don’t take your phone into the bathroom

Public and Shared Bathrooms

• • Use toilet seat covers
  • Don’t touch anything with an uncovered hand, use a paper towel to open stall doors, flush.
  • Don’t place items on flat surfaces.
  • Use you’re the back of your hand to turn the faucet on or off whenever possible, more importantly turning it off, and use soap and water to wash your hands.
  • If there is an option, choose the paper towels to dry your hands, not the air blowers.
  • Never use reuseable towels in a public bathroom.
  • When opening the door to leave, use your foot or use a paper towel on the door handle.

Your Home & Car

You know to clean your house but pay particular attention to those areas where people are entering after being in the public, possibly exposed.

• • Wipe down outside and inside door handles
  • Wipe down counters after groceries or deliveries have been put away
  • Wash all new clothing that is delivered
  • Wipe down all surfaces in your car that you touched, inside and out, including door handles, gear shifts, steering wheel, radio knobs, trunk latches, etc
  • If you live in a building with public spaces, avoid touching shared spaces as much as possible, and if you have to, use a tissue or paper towel that you can dispose of between each touch point. Wash or sanitize your hands as soon as possible after using these. That includes:
    • Elevator buttons (use your knuckles if possible)
    • Stair railings
    • Door handles (when possible use your hip or leg to gently push doors open)
    • Mail boxes
  • Deliveries
    • If you’re ordering food or groceries, use no contact delivery options whenever possible
    • Wash your hands after receiving the deliveries
    • Always tip and tip well
    • If you’ve ordered take out food, use your own plates, don’t eat out of the containers the food came in.
    • Pay online by credit card whenever possible
    • If you have to pay by cash, put the money in an envelope so they aren’t touching it directly.
    • If you cannot do no contact delivery, wear a face mask and stay at least 6 feet apart.
  • Curbside Pick up
    • Pay online by credit card whenever possible
    • Wear a mask when picking up just in case they need to speak with you.
    • Have your trunk ready so they don’t have to wait and break social distancing
    • Tip, and tip well
    • Be patient and understanding
    • Show up at the scheduled time, on time.
    • If necessary, communicate through the open passenger-side window, not the driver’s side, to protect them from oncoming traffic, and to maintain social distance.
  • If you encounter resistance – Just walk away.
    Anyone resisting social distancing or flouting the recommendations isn’t likely someone who would be open to discussion or convincing. Engaging in discussions will only escalate the tension and risk exposure. If you are uncomfortable, notify management if possible, and get to safety.

General Health: Maintain your general health during this pandemic.

• Continue to take all medications
• Eat healthy
• Maintain healthy sleep habits
• Exercise regularly
• Relax
• Understand that this is a stressful time and we are all unsure and need reassurances. Don’t be too hard on yourself.
• Don’t accept easy answers or explanations. This is a time when careful vigilance is needed, and that applies to news and information, too.
• If you aren’t feeling well, even if it’s unrelated to Covid 19, call your doctor’s office.
• If you have a medical emergency, do not avoid the emergency room. You can have someone call ahead to find a separate entrance or timing, if you have that option, but do not risk not going if you need to.
• Dental emergencies happen, too. Call your dentist if you have a problem. Remember dentists are used to practicing very strong hygiene habits and are prepared for safe, effective treatment.
• You don’t need a haircut that badly. Wear a hat, try different styles, use product to contain it.
• Connect with friends and colleagues online through chats or video conferencing
• Find religious services online
• Seek out recovery support resources and online meetings.
• Find classes, new networking groups online, learn new skills, broaden your world

I keep hearing about not touching my face and eyes, but I wear co contact lenses ntact lenses. Should I stop?

No. There’s no reason to stop wearing contact lenses due to Covid 19. But given the concern lately, it’s a good time to remember and be extra careful, developing consistent habits, to always wash your hands for at least 20 seconds with soap and water before putting in your contact lenses. Also be sure to care for and disinfect your lenses and cases regularly.

Will covid-19 go away in the summer?

The Flu typically goes away in the Summer. Will Covid 19?

Unlikley. Countries all over the world are experiencing the effects of Covid 19, even warm sunny ones. Exposing yourself to the sun or heat won’t prevent you from getting the virus if you’re exposed. (Proper levels of Vitamin D, often gotten through healthy levels of sunlight exposure, is another factor in good health, and good health makes your body stronger and more able to fight any virus or disease, reducing the severity and the length of infection.)

The only known way to prevent Covid 19 is to avoid it, by making sure you wash your hands regularly and thoroughly, don’t touch your face, and maintain social distancing.

What can I do to cope with stress and anxiety?

It's normal to feel anxious or worried about Covid 19 . You can take care of yourself, and your family, by trying to:

• Take breaks from the news
• Get regular exercise and eat healthy foods
• Try to find activities that you enjoy and can do at home
• Stay in touch with your friends and family members

Keep in mind that most people don’t get severely sick from Covid 19. Even so, It helps to be prepared, and do what you can to lower your risk and help slow the spread of the virus. But try not to panic.

Why is social distancing so important?

Right now the only way Covid 19 is spreading is from person to person. Since there are many people who don’t have symptoms, or have symptoms that appear to be something else, like a cold or cough, we don’t know who has it and who doesn’t. So to reduce the spread of it, we need to reduce the close contact we have with other people.

In many places schools, businesses, and events with large gatherings have been cancelled. But there’s more to social distancing than just avoiding big crowds. Social distancing means avoiding close contact with anyone who is not part of your immediate household, and that includes even in small groups.

This is hard, but many are finding other ways to stay close, without being physically close, like over the phone or online through video calls and conferences.

Even when social distancing it’s important to get exercise and fresh air, so if you have any outdoor space, go take a walk, hike, or ride a bike, and get fresh air when you can. You can do this and still keep your distance from others, and wear a face mask when you might be around other people, like on a public trail.

This is a lot to ask, we know. It means changing your life, your habits, and it’s normal to want to get back to normal. But this virus has no known effective treatment or cure, so the only way to prevent it and to limit the spread is to keep social distancing. This virus is easily spread, and while it may not even be noticeable in some, it can kill others, and if people stop social distancing too soon, more people will get sick and more people will die.

Can Covid 19 be prevented?

While there isn’t yet a vaccine to prevent Covid 19, there are things you can do to reduce your chances of getting it. These steps are good for everyone, but are especially important for those at higher risk, such as older people or those with other health conditions that could make them more prone to get the disease if exposed.

Practice social distancing.

This is to avoid contact with people who are sick, whether they have symptoms or not, since you can have the disease without knowing it.

Social distancing means avoiding close contact with those who you don’t already live with. It’s also called physical distancing.

Social distancing means avoiding crowds, even small ones, as much as you can. The best way to do this is to stay at home, but if you need to go out, try your best to keep your physical distance from others. Stay at least 6 feet, or 2 meters, apart, and wear a face mask or covering if you can.

Wash your hands with soap and water often.

Washing your hands is especially important if you’ve been out in public or touching items that others have touched. This includes getting your mail or deliveries.

Use soap and water, rubbing your hands for at least 20 seconds, and be sure to wash your wrists, fingernails, and between your fingers. When you’ve done this for at least 20 seconds, rinse them and dry them with a paper towel that you can throw away.

If you aren’t near a sink you can use hand sanitizer to clean your hands. You’ll want a hand sanitizer with at least 60% alcohol in it to be effective, but whenever possible, soap and water works best.

 Avoid touching your face, especially your mouth, nose, and eyes.

Covid 19 and other viruses enter your body most easily through your mouth, nose, and eyes, so if you’ve been in contact with the virus, touching your face increases the chance that you can become infected.

Avoid traveling if you can.

Obviously you’ll want to avoid traveling to known hot spots, where there are large outbreaks of the virus, but any form of travel increases your risk of exposure, especially if you have to be in crowded places like airports. Traveling also spreads the virus around the country and the world. This makes it harder to contain.

Can I infect my pet?

There have been some cases where it appears that the Covid 19 virus spread from an infected person to an animal, like a pet, but this is uncommon and more studies need to be done to understand this. So far there’s no evidence that a person can get the virus from a pet.

Do bugs spread the virus?

There is currently no knowledge that bugs, such as flies, ticks, or mosquitoes transmit the virus.

Can I get Covid 19 from touching a delivery package or food container?

Covid 19 spreads from person to person, through respiratory droplets, either directly or indirectly through landing on surfaces. It is not known to spread through food.

Because it can last for a limited time on surfaces (possibly up to several hours) it’s important to continue being vigilant and practicing safe hygiene.

When you get a delivery or touch a take out food container, it’s unlikely that you will be exposed to the virus. The exposure time and amount from a single surface is limited, so the risk is minimal.

Still, to be safe, you can wipe down products and surfaces that you bring in from the outside, but the best approach is to make sure you wash your hands with soap and water, for at least 20 seconds, dry using a disposable towel, and don’t touch your face.

Can Someone Who Doesn't Have Symptoms Spread the Virus?

A person can be infected and spread the Covid 19 virus to others even without having any symptoms. That’s why keeping people apart is one of the best ways to slow the spread.

How is Covid 19 spread?

It is now thought that the spread of Coronavirus occurs mainly through close contact from person-to-person with proximity, length of exposure and the indoors each increasing probability of transmission.

The role of people who have COVID-19 but are without symptoms is not fully determined but it is believed that they may in some cases be able to spread the virus. What we do know is that the size of the exposure can be a determinant of the severity of the disease in individual patients in addition to other risk factors (such as number and severity of health problems)

In spreading from person to person the mechanism is:

Respiratory droplets produced when an infected person coughs, sneezes, or talks can enter the lungs of uninfected individuals and pass the disease as the droplets land in the mouths or noses of people nearby- additionally the droplets may be inhaled into the lungs.

The virus spreads easily

One of the things that has made COVID-19 the global pandemic it is - is the fact that the virus spreads relatively easily. It is very contagious and can also continue to spread “sustainably” to new people.

The virus that causes COVID-19 is spreading more very easily between people than influenza for example but less so than measles.

The probability of spread increases with the more closely and the longer a person interacts with others.

Can you get the virus from a surface.

While not by any means the main way the virus spreads it may be possible that a person can get COVID-19 through touching a surface that has the virus on it and then transmitting that to their mouth, nose and rarely it is believed, the eyes.

What is Covid 19?

Covid 19 stands for coronavirus disease 2019. It’s caused by a virus called Sars CO V 2. The virus first appeared in late 2019 and quickly spread around the world.

Because the infection affects the lungs and can lead to pneumonia, people with Covid 19 can have a fever, cough, trouble breathing, and other symptoms related to pneumonia.

Most people who get Covid 19 will not get severely ill, but some do. Because Covid 19 can be spread to others, to slow the spread of the virus many areas have asked us to stay home and stay away from other people.

I heard I can get sick from wearing a face mask because of Carbon Dioxide, is this true?

Generally, no. The myth that one can get carbon dioxide poisoning, or hypoxia, from wearing a face mask and breathing in your own expelled breath is unlikely. Non-medical face masks aren’t sealed to the face, therefore air and CO2 circulate in and out of the mask, and they’re typically not worn for a prolonged period of time.

There’s always an increased risk for anyone with a pre-existing underlying health condition, including anxiety, that may cause other symptoms, but in most cases these aren’t significant. If you have concerns about wearing a mask with your respiratory condition, check with your doctor.

For healthcare workers who do wear tighter fitting medical masks or respirators and wear them for a prolonged period of time, the risk may be higher, but they also receive additional training on this. If you’re wearing a medical mask or respirator, be sure to use it properly, to avoid any further health risks or concerns.

Patients with coronavirus have a number of coagulation (blot clots) abnormalities which can result in excessive tendency towards creating clots (thrombosis) and it is clear from the evidence that this may be a big risk factor for death in severely ill patients and needs to be carefully treated and studied further. The mechanisms are not currently well understood but involve:

• Endothelial injury
• Stasis
• Hypercoagulability.

Clinical feature can include, often despite prophylactic-dose anticoagulation:

• Venous thromboembolism including extensive deep vein thrombosis
• Pulmonary embolism which is seen in up to one-third of patients in the ICU even when  anticoagulation is given.

Autopsy studies also demonstrate that hypercoagulability is common in the most severely ill patients. In one study where a post-mortem was performed on 21 patients that died from coronavirus, a pulmonary embolism was found in four and in those who had the data available  and it was found that almost 50% of the deceased had mircrothombi in alveolar capillaries.

In another study of 12 post-mortem examinations 7 of 12 had bilateral deep vein thrombosis (clots) in the legs with all cases having been both bilateral and interestingly unsuspected in all patients. Of those 12 - the cause of death in at least 4 was determined to be a pulmonary embolism - clots in the lungs.

Studies also demonstrate that widespread clothing and micro clots were significantly more prominent in the lungs of the patients who died of coronavirus compared with the lungs of controls who died of for example the flu.

Risk factors for hypercoagulability

Studies indicate - due to the fact that most patients have risks such as obese males, other medical conditions with heart disease, high blood pressure and diabetes being common.

Other clinical presentations

The data regarding how the tendency for thrombosis can present includes:

• Arterial events such as an increased incidence of strokes,
• acute limb ischemia,
• potentially heart attacks and
• microvascular clotting and even bleeding.

I have diabetes and symptoms of Covid-19. What should I do?

If you feel like you are developing symptoms, call your doctor and have some additional information ready for him/her.

• Your last glucose reading and more if possible
• Have your ketone reading available
• Be aware of your fluid consumption
• List all your symptoms
• Ask any questions to help better manage your diabetes

What should I do if I have symptoms?

If you have a fever, cough, trouble breathing, or a combination of other Covid 19 symptoms, call your doctor or nurse. They’ll ask you about your symptoms, and about any recent travel, and if you’ve been in contact with others who have been diagnosed or have developed symptoms and might be sick. They’ll also ask you about your history, to rule out if your symptoms may be related to allergies, the flu, or other health conditions, and may have you get a test for the flu to rule it out.

If your symptoms aren’t severe, it’s best to call before you go in.

Many people with only mild symptoms should stay home and avoid other people until they get better. If your symptoms are severe or you’re very sick, you should go to the hospital or clinic. You should call ahead if you can to see if they have special precautions you should take and to let them be prepared for your arrival. Of course, if this is a medical emergency, you should call 9 1 1 for an ambulance.

Are Covid 19 Symptoms Different in Children?

While children can get Covid 19 , they are less likely to have severe symptoms. But this information and how it affects children is still largely unknown. More information about Covid 19 and children is still being developed as new types of cases and symptoms, while rare, are appearing around the world.

How Long do Symptoms Last?

For most people, symptoms fade within a few weeks. But in others, Covid 19 can lead to serious problems like pneumonia, not getting enough oxygen, heart problems, or even death. This is more common in older people or in those who have other health problems like heart disease, diabetes, lung disease, cancer, or obesity.

The symptoms of Covid 19 vary and typically show up about 4 or 5 days after a person is exposed and infected with the virus, but for others, it can take up to 2 weeks to show symptoms, if at all. Even a person who is infected but doesn’t have any symptoms can spread the virus to others.

When symptoms do happen, they can include:

• Fever
• Cough
• Trouble breathing
• Feeling tired
• Shaking chills
• Muscle aches
• Headache
• Sore throat
• Problems with sense of smell or taste
• Some people have digestive problems like nausea or diarrhea.

What does Self Isolating Mean?

Self-isolation or quarantine is when you have symptoms or you’ve been exposed to the virus and you are trying to avoid spreading it to others, including those in your household.

When you self-isolate you are minimizing any and all interaction with others, staying at least 6 feet (2 meters) away from others, and not touching surfaces or sharing items with them without cleaning and disinfecting them.

Here are some tips on how to self isolate (assuming you don’t need medical care)

• Have a large, well-ventilated area, ideally with a separate bathroom
• Don’t share a room with others. If that’s not possible, make sure the beds are at least 6 feet (2 meters) apart.
• Monitor your symptoms daily
• Remain in quarantine isolation for at least 14 days
• If you develop symptoms, especially any difficulty breathing, contact your doctor or medical professional immediately.
• Stay positive, stay connected via telephone or video chat as much as possible.
• Exercise, including breathing exercises.
• Talk during meal times, through doors or distance, to remain a part of the household.
• Use a mask whenever interacting with anyone else.
• Wash your hands frequently and don’t touch your face.
• Clean and disinfect your surroundings and all your dishes, utensils, after using them.
• Don’t panic, and don’t stress out about not being productive. By isolating you are doing something incredibly valuable and selfless.

What if I feel fine but think I was exposed?

If you think you were in close contact with someone with Covid 19 , but you don't have any symptoms, you should self-quarantine at home for at least 14 days. This means staying home as much as possible, and staying at least 6 feet, 2 meters, away from other people in your home. Self-quarantine is slightly different from self-isolation, which is when a person who is sick stays in a completely separate room from others.

You should also monitor and track any symptoms. If you do start to have symptoms, call your doctor or nurse right away.

What should I do if my child has symptoms?

If your child has a fever, cough, or other symptoms of Covid 19, call their doctor or nurse. They can tell you what to do and whether your child needs to be seen in person.

If you’re taking care of your child at home, the doctor or nurse will tell you what symptoms to watch for. Some children with Covid 19 suddenly get worse after being sick for about a week. Stay in regular contact with your child’s doctor’s office to document and discuss the symptoms, and they’ll keep you up to date on any concerns, and when to call for emergency help. For example, you should call right away if your child:

• Has trouble breathing
• Has pain or pressure in their chest
• Has a rash
• Has blue lips or face
• Acts confused or not like themselves

If you have a baby that’s having trouble feeding normally, you should also call the doctor or nurse for advice.

Are there other symptoms of Covid 19 that children may get, or can Covid 19 lead to other problems in children?

This isn’t common, but it can happen. There have been rare reports of children with Covid 19 developing inflammation throughout the body. This can lead to organ damage if it is not treated quickly. It’s been referred to as "pediatric multi-system inflammatory syndrome" or "multi-system inflammatory syndrome in children." The symptoms can be similar to other conditions like "toxic shock syndrome" or "Kawasaki disease." Doctors don’t yet know if the virus that causes Covid 19 also causes Kawasaki disease in some children.

If you notice a rash on your child, especially if they’ve got other symptoms, such fever, abdominal pain, vomiting, diarrhea, neck pain, rash, and feeling tired, you should contact your doctor right away.

Are Covid 19 symptoms different in children than adults?

In general, not really. Common symptoms include fever and cough. In more severe cases, people can develop pneumonia and have trouble breathing. Children with Covid 19 can have these symptoms too, but are less likely to get very sick.

Other symptoms both children and adults experience include: feeling very tired, shaking chills, headache, muscle aches, sore throat, a runny or stuffy nose, diarrhea, or vomiting. Like adults, some children don’t have any symptoms at all.

For children who do get Covid 19, babies seem to be at higher risk for more serious breathing symptoms. Serious symptoms are also more common in people, including children, who have certain health problems, like heart disease, diabetes, lung disease (such as asthma that is not well controlled or cystic fibrosis), severe obesity, or cancer.

What's your risk of Covid-19?

Are you wondering what your risk is when planning events or outings?

This site provides interactive context to assess the risk that one or more individuals infected with COVID-19 are present in an event of various sizes. The model is simple, intentionally so, and provided some context for the rationale to halt large gatherings in early-mid March and newly relevant context for considering when and how to re-open. Precisely because of under-testing and the risk of exposure and infection, these risk calculations provide furher support for the ongoing need for social distancing and protective measures. Such precautions are still needed even in small events, given the large number of circulating cases.

This map shows the risk level of attending an event, given the event size and location (assuming 10:1 ascertainment bias). Click the image to go to the page and find your event risk level.

resource developed by:

Patients with coronavirus have a number of coagulation (blot clots) abnormalities which can result in excessive tendency towards creating clots (thrombosis) and it is clear from the evidence that this may be a big risk factor for death in severely ill patients and needs to be carefully treated and studied further. The mechanisms are not currently well understood but involve:

• Endothelial injury
• Stasis
• Hypercoagulability.

Clinical feature can include, often despite prophylactic-dose anticoagulation:

• Venous thromboembolism including extensive deep vein thrombosis
• Pulmonary embolism which is seen in up to one-third of patients in the ICU even when  anticoagulation is given.

Autopsy studies also demonstrate that hypercoagulability is common in the most severely ill patients. In one study where a post-mortem was performed on 21 patients that died from coronavirus, a pulmonary embolism was found in four and in those who had the data available  and it was found that almost 50% of the deceased had mircrothombi in alveolar capillaries.

In another study of 12 post-mortem examinations 7 of 12 had bilateral deep vein thrombosis (clots) in the legs with all cases having been both bilateral and interestingly unsuspected in all patients. Of those 12 - the cause of death in at least 4 was determined to be a pulmonary embolism - clots in the lungs.

Studies also demonstrate that widespread clothing and micro clots were significantly more prominent in the lungs of the patients who died of coronavirus compared with the lungs of controls who died of for example the flu.

Risk factors for hypercoagulability

Studies indicate - due to the fact that most patients have risks such as obese males, other medical conditions with heart disease, high blood pressure and diabetes being common.

Other clinical presentations

The data regarding how the tendency for thrombosis can present includes:

• Arterial events such as an increased incidence of strokes,
• acute limb ischemia,
• potentially heart attacks and
• microvascular clotting and even bleeding.

Is Pregnancy a Risk Factor for Coronavirus?

A very important question in regards to pregnancy is whether pregnancy is a risk factor for COVID-19, in terms of being infection, severity of the disease and the death rate in mother and fetus.

The answers seems to be that yes it is a risk factor for at least severity of the disease in the mother and there is insufficient data regarding the fetus outcomes currently. A recent study from Sweden has found a five times greater risk of ICU admission and four times the risk of receiving mechanical ventilation than non pregnant women.

Now the CDC has released the results of its study lasting from January 22–June 7, as part of COVID-19 surveillance. Of the 91,412 women with laboratory-confirmed COVID-19 infections; nine percent were pregnant.

Among pregnant women with coronavirus, almost a third - 31.5% - reported having been hospitalised compared to almost a fifth of that amount  - 5.8% - in women who were not pregnant.  After adjustments for a variety of known risk factors such as age and other medical conditions, - the relative risk of being hospitalised for a pregnant woman was 1.5 times that of a non-pregnant woman and 1.7 times the risk for intubation and mechanical ventilation. Interestingly however the rate of death was similar suggesting that though the disease is more severe - it does not cause a higher mortality rate -

The CDC wrote that "To reduce occurrence of severe illness from COVID-19, pregnant women should be counseled about the potential risk for severe illness from COVID-19, and measures to prevent infection with COVID-19 should be emphasised for pregnant women and their families”. “We think it’s important to get the information out there that pregnant women need to take precautions,” Dana Meaney-Delman, CDC’s Covid-19 deputy incident manager, said.

The results also indicated that although data on race/ethnicity were missing for 20% of the pregnant women in the study, as with the general population, Black and Hispanic pregnant women were disproportionately impacted.

One issue with the study data needed to distinguish whether the hospitalisation was due to pregnancy related conditions or COVID-19 were not available. Also one can understand that hospitals may have a lower threshold for admitting pregnant women. However ICU admission and receipt of mechanical ventilation are distinct proxies for illness severity and the risks for both outcomes were significantly higher among pregnant women than among non-pregnant women.

The CDC further stated: "Although additional data are needed to further understand these observed elevated risks, pregnant women should be made aware of their potential risk for severe illness from COVID-19. Pregnant women and their families should take measures to ensure their health and prevent the spread of SARS-CoV-2 infection.”

Specific actions pregnant women can take include:

• not skipping prenatal care appointments,
• limiting interactions with other people as much as possible,
• taking precautions to prevent getting COVID-19 when interacting with others,
• having at least a 30-day supply of medicines,
• and talking to their health care provider about how to stay healthy during the COVID-19 pandemic.

While the agency wasn’t able to assess the effects of the virus on the fetuses or babies born to those women since the pandemic hasn’t gone on long enough, pregnant  women who get Covid 19 might have an increased risk of preterm labor and birth, when the baby is born before 37 weeks of pregnancy. This seems to be more of a risk in people who get very sick and have pneumonia. Preterm birth can be dangerous, because babies who are born too early can have serious health problems. So it is important to talk to your doctor, nurse or midwife about any symptoms or health concerns you have, even if they don’t appear to be related to Covid 19.

Related Posts:

• Can Covid 19 cause problems with pregnancy?
• Are pregnant people at high risk for severe symptoms?

The Flu Shot and Coronavirus

Should I get the flu shot this year? Will it help against coronavirus?

It is well documented now that there is a surge of COVID-19 across dozens of states while at the same time the incidence is decreasing in others.

However as we approach flu season when it is normally recommended to get the flu shot - it is highly likely than individuals who succumb to both viruses will suffer more severe illness and a higher number of deaths - particularly in those most susceptible to either.

Due to seasonality, a return to school and indoor activities the spread of flu will occur as it does every year this fall. We know that the flu vaccine works better some years than others and we know that it decreases sickness, hospitalisations severity and death. This year however the risks are higher as folks infected by both COVID-19 and the flu are highly likely to experience greater negative impacts.

While we know that in a typical year less than 50% of adults receive the flu vaccine vs a recommended 70% as set by the Department of Health and Human Services for 2020. Additionally we know that annually typically hundreds of thousands are hospitalised and tens of thousands die - the two together however could bring significantly more disastrous results. Given that flu shots are lower historically in black and Hispanic populations in the US - and that they have had a higher rate of coronavirus infection, sickness and death than the rest of the population - this can further exacerbate the demographic differences we will see.

In addition to masks, handwashing and social distancing reducing the spread of coronavirus fortunately these same factors reduce the spread of flu infections also. This can be further enhanced by a broader vaccination of the US population particularly susceptible sub-groups such as minorities and the elderly as well as health care workers who have a much higher chance of exposure to both viruses.

Does the flu vaccine work?

Yes. It works but not 100%. That is to say that the flu vaccine is imperfect and does not cover all strains of flu (which vary annually) it has a massive impact on reducing not only the severity of flu infections but also hospitalizations and death. Furthermore side-effects are generally mild with a fleeting headache and soreness around the injection site being relatively minor and infrequent side effects. Also as the vaccine is not a live virus - it cannot cause influenza itself though people may feel some mild flu symptoms due to the body’s response to the shot.

It is strongly recommended that vaccines should be especially considered in high risk environments such as classrooms and at work for those working in dense, high-contact environments in addition to those who normally are at high risk of sickness and death from the flu.

Who pays for the flu shot?

Federal law requires health insurers to pick up the cost of annual flu vaccination, as Medicare does. Medicaid vaccine coverage varies by state. Given the massive numbers of unemployed who have lost insurance - it is therefore more important than ever this year that states and the federal government to work together to make shots free or at least very inexpensive for the uninsured.

No association between asthma and increased risk of hospitalization in patients with COVID-19

Patients with asthma were not more likely to be hospitalized due to COVID-19 compared with patients without asthma, According to new data published in The Journal of Allergy and Clinical Immunology patients with asthma are not more likely to be hospitalized than patients without asthma. .This outcome is unexpected as asthmatic patients tend have worse outcomes in viral illness which often exacerbates the asthma.

Researchers in conducting a retrospective study across 10 U.S. hospitals in examining the prevalence of asthma and comorbidities in patients with COVID-19 found that there was no significant difference in risk for hospitalization between patients with asthma and those without, after adjusting for other risk factors such as age. Furthermore the risk of hospitalization was also not higher for patients with asthma when their risk factors such as smoking, heart disease, diabetes etc were taken into account.

Importantly, the researchers reported no difference in mortality for patients with coronavirus and with and without asthma.

More studies must be done to look at the underlying immune modulation caused by asthma or asthma treatment to see what impact it may have on COVID-19 outcomes, said Anju T. Peters, MD, MSCI, FAAAI, director of clinical research in the division of allergy/immunology and otolaryngology at Northwestern University Feinberg School of Medicine one of authors of the study.

Does Blood type Affect My Risk of Covid-19

Patients with COVID-19 infection have a dramatic variability in presentation, from being asymptomatic to presenting with rapidly declining respiratory discomfort and even sudden death.

While it is understood that older aged individuals and those with greater medical issues have a higher risk according to the U.S. Centers for Disease Control and Prevention. - there are unfortunately also too many cases of otherwise healthy younger adults with severe disease who also can suffer death. As such it is important to understand what other risk factors affect outcomes.

According to a European study from the genetic analysis of 1,900 patients with severe cases of coronavirus published in the New England Journal of Medicine, people with blood Type O, the most common blood type, are 35% less likely to get coronavirus while people who have blood Type A were “associated with” a 45% “higher risk of acquiring COVID-19”.

It is already understood that human blood group antigens can increase or decrease susceptibility to many infections by serving as receptors for bacteria, parasites, and viruses while several blood groups can modify the patients immune response to infection. For example in the case of populations living in endemic areas with malaria some genetic varieties of blood types show greater resistance to the disease.

Roy Silverstein, former president the American Society of Hematology and Chairman of the Department of Medicine at the Medical College of Wisconsin warns however that ‘Those who are not type A should not interpret this study to mean that they can let their guard down. Similarly, the data are not yet convincing enough to recommend that those with type A need to do even more than what is recommended.’

Other studies also suggest a statistical correlation between non-O blood type and a higher rate of infection or more severe disease.

While data is limited still - a Chinese preprint study that looked at over 2000 COVID-19 positive individuals reported that there was a higher infection and death rate in people with type A blood than the general population while conversely fewer individuals with Type O blood were infected than would have been expected statistically.
Additionally while it is still very early, preliminary data from 23andMe’s ongoing genetic study of COVID-19 in the 750,000 who participated in their study also points to differences in the susceptibility to the virus based on ABO blood type. Specifically the data suggests that O blood type appears to be protective against the virus by as much as 18% when compared to all other blood types.

Research is ongoing.

Who is at higher risk of more severe disease from COVID-19?

As you will read and hear over and over again those with the most severe health problems are at higher risk, as are the elderly, in terms of suffering more severe disease and higher mortality.

A list of the risk factors includes:

• People aged 65 and older.
• People who live in a nursing home or long-term care facility
• People who smoke
• People who are obese especially those with BMI of 40 or higher
• People with chronic lung disease
• People with moderate to severe asthma
• People who have serious heart conditions such as heart failure
• People who are immunocompromised whether it is due to:
  • Cancer treatment,
  • Organ or bone marrow transplantation,
  • HIV or AIDS if poorly controlled
  • Immunodeficiencies of various causes
• Prolonged history of corticosteroid use
• People with diabetes
• People with chronic kidney disease and those undergoing dialysis
• People with liver disease

As more clinicial information becomes available we will have more detailed information as to how each of these factors contributes to disease severity and outcomes

Are the risks different for people with type 1 and type 2 diabetes?

Less important than the type of diabetes are factors like the age of the patient, complications and other health issues and how well managed their diabetes is.

Those with a greater number and severity of diabetes-related health problems tend to have worse outcomes than otherwise healthy diabetics irrelevant of type.

I have diabetes and symptoms of Covid-19. What should I do?

If you feel like you are developing symptoms, call your doctor and have some additional information ready for him/her.

• Your last glucose reading and more if possible
• Have your ketone reading available
• Be aware of your fluid consumption
• List all your symptoms
• Ask any questions to help better manage your diabetes

Is COVID-19 different from the seasonal flu for Diabetics?

Yes - COVID-19 is a more serious illness with a higher rate of death and complications than the seasonal flu in - not only diabetics but everyone.

Recommended safety precautions for people with diabetes are no different than for the flu with frequent hand washing, covering coughs and sneezes.

Do I need to worry about DKA (diabetic ketoacidosis) and Coronavirus?

Experience with diabetes has shown that when sick with a viral infection, people with diabetes do face an increased risk of diabetic ketoacidosis. This is significantly more common in Type 1 diabetes.

Furthermore due to challenges associated with fluid intake and electrolyte levels - both important in sepsis management - the complications can be significantly worse in diabetics suffering from ketoacidosis.

Do people with diabetes experience a higher rate of serious complications from COVID-19?

Simply said: yes. People with diabetes do face a higher chance of experiencing serious complications from CV19 and it is understood that generally not only do diabetics in general suffer more severe symptoms but the risk increases the more severe and poorly controlled the diabetes. This is due to the fact that these risk factors increase the probability of the patient having other diabetes-related complications such as heart disease. Additionally the diabetes also reduces the bodies ability to as effectively fight infections.

Are people with diabetes more likely to get COVID-19?

While diabetics are not more likely to get Coronavirus than the general population the issue lies in the fact that they face worse clinical outcomes.

Data from China, Italy and elsewhere suggests that people with diabetes had significantly higher rates of serious complications and death than people without diabetes.

It is also evident now that the more number and severe the number of comorbidities a patient has - the worse the outcome in terms of need for hospitalisation, complications and death.

Can Someone Who Doesn't Have Symptoms Spread the Virus?

A person can be infected and spread the Covid 19 virus to others even without having any symptoms. That’s why keeping people apart is one of the best ways to slow the spread.

How is Covid 19 spread?

It is now thought that the spread of Coronavirus occurs mainly through close contact from person-to-person with proximity, length of exposure and the indoors each increasing probability of transmission.

The role of people who have COVID-19 but are without symptoms is not fully determined but it is believed that they may in some cases be able to spread the virus. What we do know is that the size of the exposure can be a determinant of the severity of the disease in individual patients in addition to other risk factors (such as number and severity of health problems)

In spreading from person to person the mechanism is:

Respiratory droplets produced when an infected person coughs, sneezes, or talks can enter the lungs of uninfected individuals and pass the disease as the droplets land in the mouths or noses of people nearby- additionally the droplets may be inhaled into the lungs.

The virus spreads easily

One of the things that has made COVID-19 the global pandemic it is - is the fact that the virus spreads relatively easily. It is very contagious and can also continue to spread “sustainably” to new people.

The virus that causes COVID-19 is spreading more very easily between people than influenza for example but less so than measles.

The probability of spread increases with the more closely and the longer a person interacts with others.

Can you get the virus from a surface.

While not by any means the main way the virus spreads it may be possible that a person can get COVID-19 through touching a surface that has the virus on it and then transmitting that to their mouth, nose and rarely it is believed, the eyes.

I heard I can get sick from wearing a face mask because of Carbon Dioxide, is this true?

Generally, no. The myth that one can get carbon dioxide poisoning, or hypoxia, from wearing a face mask and breathing in your own expelled breath is unlikely. Non-medical face masks aren’t sealed to the face, therefore air and CO2 circulate in and out of the mask, and they’re typically not worn for a prolonged period of time.

There’s always an increased risk for anyone with a pre-existing underlying health condition, including anxiety, that may cause other symptoms, but in most cases these aren’t significant. If you have concerns about wearing a mask with your respiratory condition, check with your doctor.

For healthcare workers who do wear tighter fitting medical masks or respirators and wear them for a prolonged period of time, the risk may be higher, but they also receive additional training on this. If you’re wearing a medical mask or respirator, be sure to use it properly, to avoid any further health risks or concerns.

Can Covid 19 cause problems with pregnancy?

From what experts know so far, most people who get Covid 19 during pregnancy will not have serious problems. But problems can happen if the mother becomes seriously ill.

Pregnant women who get Covid 19 might have an increased risk of preterm labor and birth, when the baby is born before 37 weeks of pregnancy. This seems to be more of a risk in people who get very sick and have pneumonia. Preterm birth can be dangerous, because babies who are born too early can have serious health problems. So it is important to talk to your doctor, nurse or midwife about any symptoms or health concerns you have, even if they don’t appear to be related to Covid 19.

Are pregnant people at high risk for severe symptoms?

Experts don’t yet know a lot about Covid 19 and pregnancy. But so far, pregnant people don’t seem more vulnerable to the infection than others, nor do they seem to have a higher risk of serious problems (like pneumonia) than other people of similar age. Most people who get Covid 19 during pregnancy recover before having their baby.

What If I'm Pregnant?

If you’re pregnant and you have questions about Covid 19 , talk to your doctor, nurse, or midwife.

Can I Be Immune to Covid-19?

Aside from durability, not all vaccines have complete protection, for example, the annual flu shot ranges in effectiveness and works better for children than for the rest of the population. In 2019, it was less than 50% effective in preventing the flu, but there were still major benefits.

While our hopes for a return to a ’ normal world" lie in a vaccine primarily and progress is being made in that regard with over 150 vaccines being investigated worldwide - we still have major questions that remain unanswered.

What is immunity?

When the general public uses the term immunity - it is thought of as an almost absolute protection. However in many cases immunity is anything but absolute. The flu vaccine, for example reduces the risk of more severe disease for example rather than infer absolute immunity.

How does immunity work?

In the case of COVID-19 the main mechanism is through the production of antibodies. But it should be noted that one study has found that as many as 8.5% of those infected had zero detectable antibodies. Additionally it is thought as survivors tend to be younger - there are also cell-mediated arms of the immune system that can neutralize the virus through white blood cells and cytokines.

As Charles Cairns, the dean of Drexel University College of Medicine has said: “those who have inflammation mount an immune response that’s more detectable and potentially more robust.” This further points to the potential importance of cell-mediated immune response in the case coronavirus.

How long does immunity last?

We do not know yet. However we do know of cases of patients who had a recurrent infection with COVID-19 and we also know that some other coronavirus infections confer only temporary immunity, in some cases as few as a few months. More data is required.

What factors affect immunity?

Essentially the level and duration of immunity from an infectious disease are highly correlated with the severity and duration of the immune response to the infection. As such infections with more severe symptoms tend to a stronger immune response thus inferring a higher level and duration of immunity. Conversely, mild or asymptomatic cases lead to generally lower antibody levels and thus potentially lower levels of, and duration of immunity. However we do not yet know if that is in fact valid for COVID-19.

What does immunity data imply re a potential vaccine?

Simply said - there is insufficient data to answer this with any degree of certainty.

"Obviously, a vaccine that works 100% of the time would be ideal, but that is not realistic," said Dr. John Mascola, director of the National Institutes of Health Vaccine Research Center.

The level of response to a vaccine may vary from a slight reduction in severity of the disease in some populations or people, to a very high level of protection in most individuals. With so many vaccines in development it is likely that the results will also vary.

Until we have the results of phase III trials which will measure the actual efficacy of the vaccine we won’t know for sure for any individual vaccine. We will thereafter have a better understanding of the relationship and degree thereof between antibody levels and immunity.

It should be noted however than in the case of the influenza vaccine which can have an effectiveness of only 50% in preventing the flu - still confers major benefits not only to those protected but the community as a whole by decreasing the number of infections, and deaths while also decreasing the number of those who become severely ill and require hospitalization, intubation and admission to intensive care.

How do the different vaccines being investigated work?

Different approaches are being used by various institutions to create a COVID-19 vaccine. The group from Oxford and its partner AstraZeneca for example are using the more traditional approach of an attenuated virus which is a virus that doesn’t make people sick but infers immunity. Yet others with Moderna and Pfizer being well known examples are using proteins that can "trick the immune system into mounting an effective response against future infection.”

Once there is a vaccine - who should get it?

Again we don’t know yet until results from the trials come in at the very least. However if as may be the case - previous infection with COVID-19 does not infer as strong or as long a level of immunity - then most people would likely be recommended to be vaccinated.

Additionally like in the case of the flu vaccine, a coronavirus vaccine might also work better for certain sub-groups.

What if the COVID-19 virus mutates?

The structure and biology of this virus is such that it is covered in tiny spikes called surface proteins. Most experts indicate that most vaccines being developed currently are likely to work into the future as sufficient mutation to incur lack of efficacy is unlikely - though a finite possibility does exist.

I was pretty sick a few months ago, and it wasn't the flu. Should I get an antibody test?

An antibody test detects the level of antibodies against Covid 19 in your blood. The antibody test is limited in that we don't know how long the antibodies last in a person's body. It also won't show the antibodies if you currently have the infection, even if you don't have any symptoms.

If you get a positive antibody test result it shows you likely had Covid 19. This doesn't necessarily mean you’re immune from getting reinfected, we simply don't know how long the antibodies last, or how much immunity they provide. Depending on the type of experience you had and your test results, you may be retested, and perhaps asked to take part in a blood plasma donation, to help others in developing treatments for the disease.

If you get a negative antibody test result it means you likely did not have the virus in the past, although it could just be too soon. The antibodies can take typically between 1 to 3 weeks to appear. A negative test also doesn't mean you don't have it now. The antibody test does not test for current infections, only past ones. Even if you don't have any symptoms, it could mean you were recently exposed and still able to transmit the virus to others.

If I get a test and I test negative that means I'm fine, right?

No, not necessarily. The Covid 19, like any other test, only tests for the current state, and means only active infections. You may have been exposed but not infected yet, which would result in a negative test, even though you could pass the infection to others. The CDC suggests that testing is best used to confirm suspected cases to help with exposure tracing and managing the disease in those who have more severe illness.

Is there a test to see if I had the virus before?

Yes, there is a blood test that can show if a person has had Covid 19 in the past. Over time, this could help experts understand how many people were infected without knowing it. Experts are also using blood tests to study whether a person who has had Covid 19 could get it again.

Should I get tested for Covid 19?

Testing for Covid 19 tells us if someone has a current infection. It doesn't tell us if a person has been recently exposed or has had the virus in the past. According to the CDC, not everyone needs to be tested, and there are criteria that doctors, states, and local officials use to determine if a test is needed. Decisions are made based on symptoms and criteria, that may be related to cost or limited tests or testing materials.

Since many people only get a mild illness and recover at home, they may not need to be tested. Testing helps identify and diagnose more complex cases, to rule out other diseases and conditions. If you believe you should have a test, contact your doctor to discuss the risk factors, symptoms, and concerns.

Is there a test for the virus that causes Covid 19?

Yes, there are tests to see if you have Covid 19. If your doctor or nurse suspects you have it , they might take a swab from inside your nose and have it tested. If you’re coughing up mucus, they might also test that sample. These tests can help your doctor figure out if you have Covid 19 or another illness.

In some areas, it might not be possible to test everyone who might have been exposed to the virus. If your doctor can’t test you, they might tell you to stay home, avoid other people, and call if your symptoms get worse.

Will my child need tests?

If a doctor or nurse suspects your child has Covid 19, they might take a swab from inside their nose for testing. These tests can help the doctor figure out if your child has Covid 19 or another illness.

In some areas, it might not be possible to test everyone who might have been exposed to the virus. If the doctor can’t test your child, they might tell you to keep them home and away from other people, and call if symptoms get worse.

Patients with coronavirus have a number of coagulation (blot clots) abnormalities which can result in excessive tendency towards creating clots (thrombosis) and it is clear from the evidence that this may be a big risk factor for death in severely ill patients and needs to be carefully treated and studied further. The mechanisms are not currently well understood but involve:

• Endothelial injury
• Stasis
• Hypercoagulability.

Clinical feature can include, often despite prophylactic-dose anticoagulation:

• Venous thromboembolism including extensive deep vein thrombosis
• Pulmonary embolism which is seen in up to one-third of patients in the ICU even when  anticoagulation is given.

Autopsy studies also demonstrate that hypercoagulability is common in the most severely ill patients. In one study where a post-mortem was performed on 21 patients that died from coronavirus, a pulmonary embolism was found in four and in those who had the data available  and it was found that almost 50% of the deceased had mircrothombi in alveolar capillaries.

In another study of 12 post-mortem examinations 7 of 12 had bilateral deep vein thrombosis (clots) in the legs with all cases having been both bilateral and interestingly unsuspected in all patients. Of those 12 - the cause of death in at least 4 was determined to be a pulmonary embolism - clots in the lungs.

Studies also demonstrate that widespread clothing and micro clots were significantly more prominent in the lungs of the patients who died of coronavirus compared with the lungs of controls who died of for example the flu.

Risk factors for hypercoagulability

Studies indicate - due to the fact that most patients have risks such as obese males, other medical conditions with heart disease, high blood pressure and diabetes being common.

Other clinical presentations

The data regarding how the tendency for thrombosis can present includes:

• Arterial events such as an increased incidence of strokes,
• acute limb ischemia,
• potentially heart attacks and
• microvascular clotting and even bleeding.

Dexamethasone - the first effective treatment

In a press release dated June 16th 2020 - researchers from the RECOVERY trial at Oxford, announced the results of a randomized control trial in which severely ill patients were given dexamethasone, an anti-inflammatory of the glucocorticoid family. The sickest of those patients who were on ventilators saw a decline in death of one third. In less such patients, those on oxygen therapy but not on ventilators mortality declined by 20%. Of note patients who were neither ventilated nor on oxygen showed no such decreases.

Richard Haynes from the University of Oxford, one of the leaders of the RECOVERY trial, wrote to the Scientist saying: "We tested it because we believed it could be effective, but I don't think anyone was expecting to see quite such large effects."

While there are those who say that it is too early to make a definitive conclusion many hospitals in US states are adding dexamethasone The benefits of the drug include the fact that it is a well known drug, cheap and widely available. Additionally the fact that it is generally safe, well-tolerated and has a long-half life - thus allowing once a day dosage - makes it a particularly good candidate. It also "makes sense" that it should work by decreasing the inflammatory and white blood cell response to the lungs.

In the UK, the chief medical officers of England, Wales, Scotland, and Northern Ireland wrote to all the doctors and hospitals to indicate that dexamethasone should become standard care for admitted patients with COVID-19 who require oxygen.

"It's a very safe, generally well-tolerated--at reasonable doses--steroid that works predominantly by its anti-inflammatory effects," said Dr. Matthew Cheng, a microbiologist and infectious disease expert at the McGill University Health Centre. "With regards to the press release, I was quite honestly elated. This is the first data that we have that suggests that a drug is able to improve the chances of survival in those that are critically ill, and so while I eagerly await the scientific publication I was absolutely thrilled to receive the news and to read about it yesterday," he added.

How does dexamethasone work?

Dexamethasone, a glucocorticoid and other similar drugs regulate the body's immune system and response by entering a cell's nucleus and suppressing expression of genes that encode inflammatory cytokines and increasing expression of other genes that have been shown to limit immune system overreactions.

ARDS is a syndrome with different causes, including pneumonia, sepsis, and inhalation injuries. Symptoms include shortness of breath, faster respiratory and heart rates, and dangerously low blood oxygen levels. According to Rochwerg, ARDS is inflammation-driven, so the problem is actually the intensity of the immune response, rather than the trigger itself. In ARDS, the body produces inflammatory cytokines, and white blood cells go into the alveoli of the lungs, potentially causing inflammation.

"COVID--in the extreme case--an cause ARDS, and that's why people die predominantly," Rochwerg says. People are sick for weeks upon weeks, by which time the virus might have cleared out of their systems, he explains, "but it's their own bodies' ramped-up inflammatory process that's now caused all the damage in the lungs. Based on that idea, it makes sense that steroids should work. They help dampen the host response. They help knock down those inflammatory cytokines and all those white blood cells going to the lungs."

While very promising in the sickest of patients the mortality rate still remained high and further trials and understanding is needed to improve outcome in both the sickest of patients as those who are less severely ill. More research is required with new drugs and strategies required to further decrease death and the severity of disease.

What should I do if I have symptoms?

If you have a fever, cough, trouble breathing, or a combination of other Covid 19 symptoms, call your doctor or nurse. They’ll ask you about your symptoms, and about any recent travel, and if you’ve been in contact with others who have been diagnosed or have developed symptoms and might be sick. They’ll also ask you about your history, to rule out if your symptoms may be related to allergies, the flu, or other health conditions, and may have you get a test for the flu to rule it out.

If your symptoms aren’t severe, it’s best to call before you go in.

Many people with only mild symptoms should stay home and avoid other people until they get better. If your symptoms are severe or you’re very sick, you should go to the hospital or clinic. You should call ahead if you can to see if they have special precautions you should take and to let them be prepared for your arrival. Of course, if this is a medical emergency, you should call 9 1 1 for an ambulance.

How Long do Symptoms Last?

For most people, symptoms fade within a few weeks. But in others, Covid 19 can lead to serious problems like pneumonia, not getting enough oxygen, heart problems, or even death. This is more common in older people or in those who have other health problems like heart disease, diabetes, lung disease, cancer, or obesity.

I've heard that bleach and disinfectant kill Covid 19. Can I use that for me if I get it?

No. Spraying your body with disinfectant will not be effective in curing or eliminating the virus in your body. In fact, it will only cause additional symptoms and can be harmful.

Also, do not use any disinfectants inside your body, either by drinking or injecting. This can be fatal.

Covid 19 is not killed in the body with disinfectants, alcohol, methanol, ethanol, bleach, or other such substances. Taking them internally will cause illness, organ damage, and could possibly kill you.

Are there drugs that are used to treat or prevent Covid 19?

While there is a great deal of research and testing going on, there isn't any drug or therapy that has shown to be effective in the treatment of Covid 19. There are studies currently being conducted with existing drugs, but there have been no conclusive outcomes for any, and there is a danger in taking them without the oversight of a doctor, because there are significant risks to those with pre-existing conditions, and in using improper dosages.

Do not take any prescription medications without the express advice of your doctor.

What's Being Done to Improve Treatment?

Because there’s no treatment for Covid 19 itself, only the symptoms, doctors are studying several different treatments to learn what might work for Covid 19 . There are a number of clinical trials, which are scientific studies to test treatments and medicines to see how well they work in patients with the disease. Depending on your symptoms and condition, your doctor may recommend you take part in one. It is important to only do this at the recommendation of your doctor. Do not try any new medicines or treatments without talking to a doctor.

How Do We Manage Severe Cases of Covid 19?

If you have more severe symptoms, especially those that include trouble breathing, you might need to stay in the hospital, possibly in the intensive care unit, or ICU. While there, you’ll probably be in a special isolation room where only medical staff will be allowed in the room, and they’ll have to wear special gowns, gloves, masks, and eye protection.

The doctors and nurses can monitor and support your breathing and other body functions and make you as comfortable as possible. You might need extra oxygen to help you breathe easily. If you’re having a very hard time breathing, you might need to be put on a ventilator, a machine that helps you breathe.

How Do We Manage Mild Cases of Covid 19?

Mild illness means you might have symptoms like fever and cough, but you don’t have trouble breathing. Most people with Covid 19 have mild symptoms and can rest at home until they get better. This usually takes about 2 weeks, but it's not the same for everyone.

If you’re recovering from Covid 19 , it's important to stay home and self-isolate until your doctor or nurse tells you it's safe to go back to your normal activities. This means staying apart from other people, even the people you live with. When you can stop self-isolation will depend on how long it has been since you had symptoms, and in some cases, whether you’ve had a negative test, which shows the virus is no longer in your body.

How is Covid-19 treated?

Right now there’s no specific treatment for Covid 19, and instead the only treatment is to treat the symptoms. People with mild cases may be able to stay home while they get better, but those with severe cases or other health problems might need to go to the hospital. Here is information on how mild and severe cases are treated.

What should I do if someone in my home has Covid 19?

If someone in your home has Covid 19 , there are certain steps you can take to protect yourself and others:

• Keep the sick person away from others. If possible, the sick person should stay in a separate room, and use a different bathroom. They should also eat in their own room. And to be extra safe, experts are recommending that the person stay away from the pets in the house until they’re better.
• Have them cover their face. The sick person should cover their nose and mouth with a cloth mask when they’re in the same room as other people. If they can't use a face cover, you can help protect yourself by covering your face when you’re in the room with them.
• Make sure everyone washes their hands with soap and water often, that includes both the sick person and everyone else in the house.
• Clean often. Here are some specific things that can help:
• Wear disposable gloves when you clean. It's also a good idea to wear gloves when you have to touch the sick person's laundry, dishes, utensils, or trash.
• Do the sick person’s laundry separately from everyone else’s in the house, and be careful to avoid contact. Wear gloves and cover your face when doing the laundry, and be sure to wash your hands before and after. Wash or wipe down the outside of the washing machine and dryer after putting in each load.
• Regularly clean things that are touched a lot. This includes counters, bedside tables, doorknobs, computers, phones, and bathroom surfaces.
• Use a disinfectant on surfaces. Soap and water are effective, but disinfectants on surfaces is best. Check your cleaning product labels to make sure they’re effective on viruses, since some products are only effective for bacteria. The EPA, the Environmental Protection Agency, has a list of products on their website that are effective disinfectants for covid 19.

What if someone I live with gets sick?

Most people who get Covid 19 can safely and fully recover at home. If someone in your home is sick, there things you can do to help them and to protect yourself from becoming infected. If a person is sick they should isolate from the rest of the house, but it’s also important to remember that they will need help, not only in staying isolated, but in meeting their basic needs. The symptoms of the disease can be rough, too, so remember, they’re sick, too. They’ll need your help.

• Help them with basic needs.
  • Remind them to follow their doctors instructions
  • Help them manage their symptoms with medications and care
  • Get them the supplies they need (medicine, toiletries, laundry, food and drink, etcetera)
  • Monitor their symptoms to track to see if they’re improving or worsening
  • Keep them engaged in the household, they’ll be lonely and feel like they’re a burden.
  • Take care of their pets
  • Remind them to exercise
  • Keep the doctor’s number handy, and call if symptoms worsen
  • Seek emergency help if the person has:

• • • Trouble breathing
    • Persistent pain or pressure in the chest
    • New confusion
    • Inability to wake or stay awake
    • Bluish lips or face

• Protect yourself
  • Stay at least 6 feet apart
  • Wear a mask, preferably a medical mask if you’re in close contact with the person
  • Wash your hands with soap and water for at least 20 seconds frequently, use hand sanitizer
  • Use a separate bedroom and bathroom, if possible
  • If you have to share a space maintain social distancing, wear a face mask, have them wear a face mask, and open a window to increase the air circulation
  • Eat in separate rooms and don’t share utensils or dishes
  • Wash the sick person’s dishes with soap in hot water, and wear gloves while washing them.
  • Wash your hands again after removing the gloves
  • Don’t share personal items with a person who is sick, including dishes, toiletries, brushes, sheets, blankets, towels, soap, shampoo
• Keeping it Clean
  • Clean and disinfect “high-touch” surfaces and every day items, like tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks, and electronics.
  • Use soap and water first, then follow up with a disinfectant cleaner.
  • Be careful using cleaning products, many can cause further breathing problems if used in closed spaces or combined. Read the instructions.
  • If you’re sharing a room with a sick person, don’t over clean. Only clean the person’s area if it’s dirty, to limit contact and possible infection.
  • The sick person can clean if they’re feeling healthy enough, but be careful if they are having trouble breathing. Don’t have them use strong cleaners if they’re having any respirator symptoms.
  • Make sure the sick person has their own cleaning supplies including tissues, paper towels, cleaners and sponges. Don’t share.
  • If you’re sharing a bathroom the sick person should clean up after themselves after each use, including disinfecting. If this isn’t possible, wear a mask and wait as long as possible after the sick person has used the bathroom before cleaning it.
  • Make sure to use liners or bags in all garbage cans.
• Laundry
  • Do the sick person’s laundry separately.
  • Don’t shake it out
  • Wear disposable gloves
  • Wear a face mask
  • Wipe down the machines after putting the dirty laundry in
  • Wash in hot water whenever possible
  • Remove gloves and wash hands right away
  • Dry on the hottest setting possible
  • Wash hands after putting the clothes in the dryer
  • Clean and disinfect the hampers before putting clean clothes back in
  • Wash your hands afterwards

What does Self Isolating Mean?

Self-isolation or quarantine is when you have symptoms or you’ve been exposed to the virus and you are trying to avoid spreading it to others, including those in your household.

When you self-isolate you are minimizing any and all interaction with others, staying at least 6 feet (2 meters) away from others, and not touching surfaces or sharing items with them without cleaning and disinfecting them.

Here are some tips on how to self isolate (assuming you don’t need medical care)

• Have a large, well-ventilated area, ideally with a separate bathroom
• Don’t share a room with others. If that’s not possible, make sure the beds are at least 6 feet (2 meters) apart.
• Monitor your symptoms daily
• Remain in quarantine isolation for at least 14 days
• If you develop symptoms, especially any difficulty breathing, contact your doctor or medical professional immediately.
• Stay positive, stay connected via telephone or video chat as much as possible.
• Exercise, including breathing exercises.
• Talk during meal times, through doors or distance, to remain a part of the household.
• Use a mask whenever interacting with anyone else.
• Wash your hands frequently and don’t touch your face.
• Clean and disinfect your surroundings and all your dishes, utensils, after using them.
• Don’t panic, and don’t stress out about not being productive. By isolating you are doing something incredibly valuable and selfless.

What if I feel fine but think I was exposed?

If you think you were in close contact with someone with Covid 19 , but you don't have any symptoms, you should self-quarantine at home for at least 14 days. This means staying home as much as possible, and staying at least 6 feet, 2 meters, away from other people in your home. Self-quarantine is slightly different from self-isolation, which is when a person who is sick stays in a completely separate room from others.

You should also monitor and track any symptoms. If you do start to have symptoms, call your doctor or nurse right away.

How is Covid 19 treated in pregnant women?

Doctors are studying several different treatments to learn whether they might work to treat Covid 19. In certain cases, doctors might recommend these treatments or taking part in a clinical trial, a scientific study that tests new medicines to see how well they work. But some medicines aren’t safe to take during pregnancy, so you should talk to your doctor about all the risks involved.

Fever is a common symptom of Covid 19. If get a fever while pregnant, ask your doctor, nurse, or midwife what to do. Acetaminophen (for example, Tylenol) can be used to treat a fever and is generally safe to take during pregnancy.

How is Covid 19 in children treated?

There is no known specific treatment for Covid 19. Most healthy children who get infected can recover at home, and usually get better within a week or 2.

It's important to keep your child home, and away from other people, until your doctor or nurse says it's safe for them to go back to their normal activities. This decision will depend on how long it’s been since the child had symptoms, and in some cases, whether they’ve had a negative test (showing that the virus is no longer in their body).

Doctors are studying several different treatments to learn whether they might work to treat Covid 19. In certain cases, for children being treated in the hospital, doctors might recommend trying these treatments.

What should I do if my child has symptoms?

If your child has a fever, cough, or other symptoms of Covid 19, call their doctor or nurse. They can tell you what to do and whether your child needs to be seen in person.

If you’re taking care of your child at home, the doctor or nurse will tell you what symptoms to watch for. Some children with Covid 19 suddenly get worse after being sick for about a week. Stay in regular contact with your child’s doctor’s office to document and discuss the symptoms, and they’ll keep you up to date on any concerns, and when to call for emergency help. For example, you should call right away if your child:

• Has trouble breathing
• Has pain or pressure in their chest
• Has a rash
• Has blue lips or face
• Acts confused or not like themselves

If you have a baby that’s having trouble feeding normally, you should also call the doctor or nurse for advice.

What's your risk of Covid-19?

Are you wondering what your risk is when planning events or outings?

This site provides interactive context to assess the risk that one or more individuals infected with COVID-19 are present in an event of various sizes. The model is simple, intentionally so, and provided some context for the rationale to halt large gatherings in early-mid March and newly relevant context for considering when and how to re-open. Precisely because of under-testing and the risk of exposure and infection, these risk calculations provide furher support for the ongoing need for social distancing and protective measures. Such precautions are still needed even in small events, given the large number of circulating cases.

This map shows the risk level of attending an event, given the event size and location (assuming 10:1 ascertainment bias). Click the image to go to the page and find your event risk level.

resource developed by:

I'm Sick with Covid-19. How Do I Prevent the Spread?

In order to care for yourself and to help protect other people in your home and community if you think you have COVID-19 or if it has been confirmed and you are sick there are many things you can do to help prevent the spread of the disease.

Stay home except as required for medical care

• Most people with COVID-19 have mild illness that does not require medical care and as such most can recover at home. In order to stop the spread of this very contagious disease it is recommended that you do not visit public areas or leave your home, except to get medical care.
• Self care is important and you need to get rest and stay hydrated. Smoking should be avoided. You can use over-the-counter medicines, such as acetaminophen or ibuprofen to control symptoms. Please follow the instructions carefully and do not use more than the recommended dosage.
• Symptoms that indicate a possible emergency include but are not limited to:
  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion
  • Inability to wake or stay awake
  • Bluish lips or face
• If have any other warning signs or if you think it is an emergency then contact your medical provider as soon as possible or 911 if severe.
• Public transportation, ride-sharing and taxis should be avoided.
• Separate yourself from others to avoid spread.

As the likelihood of spreading the disease increases dramatically with the length and proximity of exposure - it is vital that as much as possible you stay in a designated specific room and away from other people and even pets in your home. The use a separate bathroom is also recommended if that is feasible. In cases where you cannot avoid being around others or if you leave your home - a cloth face covering should be worn at all times.

I need to see a doctor. What should I do?

Firstly it is important that you call ahead prior to visiting your doctor as you may be able to have your care provided by phone or telemedicine. If you think you have COVID-19 but cannot postpone a visit to the physicians office then call and inform them so they can be better prepared for their and their patients protection.

Using masks

Wearing a mask which covers both nose and mouth is both critical and responsible for those with COVID-19

Even if you are at home in the presence of others it is recommended you wear masks. Even in front of pets. This is not necessary if you are alone.

However if you cannot tolerate masks due to e.g. lung disease - then coughs and sneezes still need covering and maintaining a distance of 6ft becomes even more important.

How to best cover coughs and sneezes

• Cover your mouth and nose with a tissue when you cough or sneeze.
• Throw away used tissues in a lined trash can.
• Immediately after it is important that you wash your hands with soap and water for at least 20 seconds. If soap and water are not available an alcohol-based hand sanitizer with at least 60% alcohol should be used.
• Soap and water are the best option, especially if hands are visibly dirty.

General tips:

• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Avoid sharing personal household items such as cups, glasses, utensils etc.
• Clean and disinfect areas that may have blood, stool, or body fluids on them.
• If you are sick you should try daily to disinfect the most high-touch surfaces in your room and bathroom.
• Gloves are suggested. High-touch surfaces include
  • phones,
  • remote controls,
  • counters, tabletops,
  • doorknobs,
  • bathroom fixtures,
  • toilets,
  • keyboards,
  • tablets, and
  • bedside tables

Using Disinfectants

• When using disinfectants be sure to follow the instructions on the label to ensure safe and effective use of the product. Several products recommend keeping the surface wet for several minutes to ensure germs are killed. Many also recommend precautions such as wearing gloves and making sure you have good ventilation during use of the product.
• Most EPA-registered household disinfectants should be effective.

General Tips

Clean Your Phone

This is important. Always wipe down your phone. You know not to touch your face and to wash your hands, but your phone is likely with you at every step of your day, exposed to an endless stream of germs and a high risk for transmission. And chances are while you’ve learned not to touch your face, you touch your phone and then your phone touches your face.

• • Wipe it down thoroughly, at least once a day
  • Take the case off and sanitize it with a wipe or a paper towel with hand sanitizer.
  • Avoid any ports so you don’t get liquids inside.
  • Take the case off and wipe that down separately, inside and out.
  • Let it air dry for a few minutes before putting it back on.
  • Use speakerphone whenever possible to avoid face contamination (but don’t be rude in public)
  • Use a head phone for private calls
  • Wipe down the surface regularly
  • Don’t take your phone into the bathroom

Public and Shared Bathrooms

• • Use toilet seat covers
  • Don’t touch anything with an uncovered hand, use a paper towel to open stall doors, flush.
  • Don’t place items on flat surfaces.
  • Use you’re the back of your hand to turn the faucet on or off whenever possible, more importantly turning it off, and use soap and water to wash your hands.
  • If there is an option, choose the paper towels to dry your hands, not the air blowers.
  • Never use reuseable towels in a public bathroom.
  • When opening the door to leave, use your foot or use a paper towel on the door handle.

Your Home & Car

You know to clean your house but pay particular attention to those areas where people are entering after being in the public, possibly exposed.

• • Wipe down outside and inside door handles
  • Wipe down counters after groceries or deliveries have been put away
  • Wash all new clothing that is delivered
  • Wipe down all surfaces in your car that you touched, inside and out, including door handles, gear shifts, steering wheel, radio knobs, trunk latches, etc
  • If you live in a building with public spaces, avoid touching shared spaces as much as possible, and if you have to, use a tissue or paper towel that you can dispose of between each touch point. Wash or sanitize your hands as soon as possible after using these. That includes:
    • Elevator buttons (use your knuckles if possible)
    • Stair railings
    • Door handles (when possible use your hip or leg to gently push doors open)
    • Mail boxes
  • Deliveries
    • If you’re ordering food or groceries, use no contact delivery options whenever possible
    • Wash your hands after receiving the deliveries
    • Always tip and tip well
    • If you’ve ordered take out food, use your own plates, don’t eat out of the containers the food came in.
    • Pay online by credit card whenever possible
    • If you have to pay by cash, put the money in an envelope so they aren’t touching it directly.
    • If you cannot do no contact delivery, wear a face mask and stay at least 6 feet apart.
  • Curbside Pick up
    • Pay online by credit card whenever possible
    • Wear a mask when picking up just in case they need to speak with you.
    • Have your trunk ready so they don’t have to wait and break social distancing
    • Tip, and tip well
    • Be patient and understanding
    • Show up at the scheduled time, on time.
    • If necessary, communicate through the open passenger-side window, not the driver’s side, to protect them from oncoming traffic, and to maintain social distance.
  • If you encounter resistance – Just walk away.
    Anyone resisting social distancing or flouting the recommendations isn’t likely someone who would be open to discussion or convincing. Engaging in discussions will only escalate the tension and risk exposure. If you are uncomfortable, notify management if possible, and get to safety.

General Health: Maintain your general health during this pandemic.

• Continue to take all medications
• Eat healthy
• Maintain healthy sleep habits
• Exercise regularly
• Relax
• Understand that this is a stressful time and we are all unsure and need reassurances. Don’t be too hard on yourself.
• Don’t accept easy answers or explanations. This is a time when careful vigilance is needed, and that applies to news and information, too.
• If you aren’t feeling well, even if it’s unrelated to Covid 19, call your doctor’s office.
• If you have a medical emergency, do not avoid the emergency room. You can have someone call ahead to find a separate entrance or timing, if you have that option, but do not risk not going if you need to.
• Dental emergencies happen, too. Call your dentist if you have a problem. Remember dentists are used to practicing very strong hygiene habits and are prepared for safe, effective treatment.
• You don’t need a haircut that badly. Wear a hat, try different styles, use product to contain it.
• Connect with friends and colleagues online through chats or video conferencing
• Find religious services online
• Seek out recovery support resources and online meetings.
• Find classes, new networking groups online, learn new skills, broaden your world

Can Covid 19 be prevented?

While there isn’t yet a vaccine to prevent Covid 19, there are things you can do to reduce your chances of getting it. These steps are good for everyone, but are especially important for those at higher risk, such as older people or those with other health conditions that could make them more prone to get the disease if exposed.

Practice social distancing.

This is to avoid contact with people who are sick, whether they have symptoms or not, since you can have the disease without knowing it.

Social distancing means avoiding close contact with those who you don’t already live with. It’s also called physical distancing.

Social distancing means avoiding crowds, even small ones, as much as you can. The best way to do this is to stay at home, but if you need to go out, try your best to keep your physical distance from others. Stay at least 6 feet, or 2 meters, apart, and wear a face mask or covering if you can.

Wash your hands with soap and water often.

Washing your hands is especially important if you’ve been out in public or touching items that others have touched. This includes getting your mail or deliveries.

Use soap and water, rubbing your hands for at least 20 seconds, and be sure to wash your wrists, fingernails, and between your fingers. When you’ve done this for at least 20 seconds, rinse them and dry them with a paper towel that you can throw away.

If you aren’t near a sink you can use hand sanitizer to clean your hands. You’ll want a hand sanitizer with at least 60% alcohol in it to be effective, but whenever possible, soap and water works best.

 Avoid touching your face, especially your mouth, nose, and eyes.

Covid 19 and other viruses enter your body most easily through your mouth, nose, and eyes, so if you’ve been in contact with the virus, touching your face increases the chance that you can become infected.

Avoid traveling if you can.

Obviously you’ll want to avoid traveling to known hot spots, where there are large outbreaks of the virus, but any form of travel increases your risk of exposure, especially if you have to be in crowded places like airports. Traveling also spreads the virus around the country and the world. This makes it harder to contain.

Can I get Covid 19 from touching a delivery package or food container?

Covid 19 spreads from person to person, through respiratory droplets, either directly or indirectly through landing on surfaces. It is not known to spread through food.

Because it can last for a limited time on surfaces (possibly up to several hours) it’s important to continue being vigilant and practicing safe hygiene.

When you get a delivery or touch a take out food container, it’s unlikely that you will be exposed to the virus. The exposure time and amount from a single surface is limited, so the risk is minimal.

Still, to be safe, you can wipe down products and surfaces that you bring in from the outside, but the best approach is to make sure you wash your hands with soap and water, for at least 20 seconds, dry using a disposable towel, and don’t touch your face.

Can Someone Who Doesn't Have Symptoms Spread the Virus?

A person can be infected and spread the Covid 19 virus to others even without having any symptoms. That’s why keeping people apart is one of the best ways to slow the spread.

How is Covid 19 spread?

It is now thought that the spread of Coronavirus occurs mainly through close contact from person-to-person with proximity, length of exposure and the indoors each increasing probability of transmission.

The role of people who have COVID-19 but are without symptoms is not fully determined but it is believed that they may in some cases be able to spread the virus. What we do know is that the size of the exposure can be a determinant of the severity of the disease in individual patients in addition to other risk factors (such as number and severity of health problems)

In spreading from person to person the mechanism is:

Respiratory droplets produced when an infected person coughs, sneezes, or talks can enter the lungs of uninfected individuals and pass the disease as the droplets land in the mouths or noses of people nearby- additionally the droplets may be inhaled into the lungs.

The virus spreads easily

One of the things that has made COVID-19 the global pandemic it is - is the fact that the virus spreads relatively easily. It is very contagious and can also continue to spread “sustainably” to new people.

The virus that causes COVID-19 is spreading more very easily between people than influenza for example but less so than measles.

The probability of spread increases with the more closely and the longer a person interacts with others.

Can you get the virus from a surface.

While not by any means the main way the virus spreads it may be possible that a person can get COVID-19 through touching a surface that has the virus on it and then transmitting that to their mouth, nose and rarely it is believed, the eyes.

I heard I can get sick from wearing a face mask because of Carbon Dioxide, is this true?

Generally, no. The myth that one can get carbon dioxide poisoning, or hypoxia, from wearing a face mask and breathing in your own expelled breath is unlikely. Non-medical face masks aren’t sealed to the face, therefore air and CO2 circulate in and out of the mask, and they’re typically not worn for a prolonged period of time.

There’s always an increased risk for anyone with a pre-existing underlying health condition, including anxiety, that may cause other symptoms, but in most cases these aren’t significant. If you have concerns about wearing a mask with your respiratory condition, check with your doctor.

For healthcare workers who do wear tighter fitting medical masks or respirators and wear them for a prolonged period of time, the risk may be higher, but they also receive additional training on this. If you’re wearing a medical mask or respirator, be sure to use it properly, to avoid any further health risks or concerns.

Who should wear Medical Masks?

Anyone working in health care settings or serving as a caregiver for patients with or suspected of having Covid 19 should wear medical masks, or respirators, such as the N95 or FFP2 masks. They should also use other personal protective equipment (PPE) and heightened hygiene, such as social and physical distancing when possible, and frequent hand washing.

The following people should choose medical masks over non-medical masks:

• Healthcare workers
  • Whenever possible, medical masks and respirators should be reserved for healthcare workers. They are the most exposed and are in regular, extended close contact with patients with or suspected of having Covid 19.
• People who are sick and exhibiting symptoms of COVID-19
  • People who are sick, even those who only have mild symptoms, should quarantine whenever possible, and wear a medical mask. This will help in keeping them from transmitting the virus to others and to surfaces. The virus is spread through coughing, sneezing, or even talking, and spread through droplets, which can come in contact with the faces and hands of others directly, or land on surfaces that are then touched by others.
• Anyone taking care of a person at home who is sick with COVID-19
  • If you are in close frequent contact with someone who is sick with Covid 19, either as a caregiver or provider, as you are facing repeated exposure to the virus, the medical masks can help protect, somewhat. Again, it’s important to continue to practice as much social distancing, avoiding unnecessary physical contact whenever possible, and frequent hand washing, cleaning, disinfecting, and sanitizing.

Should Children wear masks?

The CDC recommends that all children over the age of 2 wear a mask in public. You should select a mask that is the appropriate size, either a small bandana or a child size mask, so that it fits properly and doesn’t cover their whole face or restrict their breathing.

Anyone, including a child, with an existing respiratory illness should speak with their doctor first.

Are Non-Medical Masks effective in reducing the spread of Covid 19?

While there is a lot of information floating around about the effectiveness and dangers of using face masks, except for health care workers and caregivers, the use of non-medical face masks has shown to be effective in spreading the virus, especially for those people who are not sick, have mild symptoms, or are asymptomatic.

Healthcare workers and caregivers, and those regularly exposed to others with or suspected to have the virus, should not rely on a non-medical mask. This will offer a false sense of safety in a setting where prolonged exposure is likely. These individuals should instead where medical masks and personal protective gear for their own safety.

What is a Non-Medical Mask?

Non-medical masks are general face coverings that are often homemade using breathable fabrics. There are other masks that can be bought commercially. These masks cover the face and nose, secure with elastic over the ears or ties behind the head and neck and typically don’t have filters, like the N95 masks, although some designs include an option to add additional filter options in the mask. Non-medical masks can sometimes be washed and reused.

There are many patterns and designs for making masks at home, and now there are any number of stores and groups making masks for people. Scarves or bandanas can also be used as a face mask.

What if I’m sick, should I isolate or social distance from my pets?

There have been instances reported where it appears that animals have been infected with Covid 19, likely from infected humans. There are only a few cases, so we need to learn more before giving a definitive answer. But given the uncertainty, it’s best to be safe than sorry. So if you’re sick with Covid 19, treat your animals the same way you treat others in your household, and whenever possible, have someone else care for them while you’re sick.

When you’re sick you should limit interacting with your pet, just to be safe. This includes avoiding:

• Petting
• Snuggling
• Being kissed or licked
• Sharing food or bedding

If you are unable to have someone else care for your pet while you’re sick, follow the above guidelines, and be sure to wash your hands before and after interacting with them, and wear a face mask.

What should I do if someone in my home has Covid 19?

If someone in your home has Covid 19 , there are certain steps you can take to protect yourself and others:

• Keep the sick person away from others. If possible, the sick person should stay in a separate room, and use a different bathroom. They should also eat in their own room. And to be extra safe, experts are recommending that the person stay away from the pets in the house until they’re better.
• Have them cover their face. The sick person should cover their nose and mouth with a cloth mask when they’re in the same room as other people. If they can't use a face cover, you can help protect yourself by covering your face when you’re in the room with them.
• Make sure everyone washes their hands with soap and water often, that includes both the sick person and everyone else in the house.
• Clean often. Here are some specific things that can help:
• Wear disposable gloves when you clean. It's also a good idea to wear gloves when you have to touch the sick person's laundry, dishes, utensils, or trash.
• Do the sick person’s laundry separately from everyone else’s in the house, and be careful to avoid contact. Wear gloves and cover your face when doing the laundry, and be sure to wash your hands before and after. Wash or wipe down the outside of the washing machine and dryer after putting in each load.
• Regularly clean things that are touched a lot. This includes counters, bedside tables, doorknobs, computers, phones, and bathroom surfaces.
• Use a disinfectant on surfaces. Soap and water are effective, but disinfectants on surfaces is best. Check your cleaning product labels to make sure they’re effective on viruses, since some products are only effective for bacteria. The EPA, the Environmental Protection Agency, has a list of products on their website that are effective disinfectants for covid 19.

What if someone I live with gets sick?

Most people who get Covid 19 can safely and fully recover at home. If someone in your home is sick, there things you can do to help them and to protect yourself from becoming infected. If a person is sick they should isolate from the rest of the house, but it’s also important to remember that they will need help, not only in staying isolated, but in meeting their basic needs. The symptoms of the disease can be rough, too, so remember, they’re sick, too. They’ll need your help.

• Help them with basic needs.
  • Remind them to follow their doctors instructions
  • Help them manage their symptoms with medications and care
  • Get them the supplies they need (medicine, toiletries, laundry, food and drink, etcetera)
  • Monitor their symptoms to track to see if they’re improving or worsening
  • Keep them engaged in the household, they’ll be lonely and feel like they’re a burden.
  • Take care of their pets
  • Remind them to exercise
  • Keep the doctor’s number handy, and call if symptoms worsen
  • Seek emergency help if the person has:

• • • Trouble breathing
    • Persistent pain or pressure in the chest
    • New confusion
    • Inability to wake or stay awake
    • Bluish lips or face

• Protect yourself
  • Stay at least 6 feet apart
  • Wear a mask, preferably a medical mask if you’re in close contact with the person
  • Wash your hands with soap and water for at least 20 seconds frequently, use hand sanitizer
  • Use a separate bedroom and bathroom, if possible
  • If you have to share a space maintain social distancing, wear a face mask, have them wear a face mask, and open a window to increase the air circulation
  • Eat in separate rooms and don’t share utensils or dishes
  • Wash the sick person’s dishes with soap in hot water, and wear gloves while washing them.
  • Wash your hands again after removing the gloves
  • Don’t share personal items with a person who is sick, including dishes, toiletries, brushes, sheets, blankets, towels, soap, shampoo
• Keeping it Clean
  • Clean and disinfect “high-touch” surfaces and every day items, like tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks, and electronics.
  • Use soap and water first, then follow up with a disinfectant cleaner.
  • Be careful using cleaning products, many can cause further breathing problems if used in closed spaces or combined. Read the instructions.
  • If you’re sharing a room with a sick person, don’t over clean. Only clean the person’s area if it’s dirty, to limit contact and possible infection.
  • The sick person can clean if they’re feeling healthy enough, but be careful if they are having trouble breathing. Don’t have them use strong cleaners if they’re having any respirator symptoms.
  • Make sure the sick person has their own cleaning supplies including tissues, paper towels, cleaners and sponges. Don’t share.
  • If you’re sharing a bathroom the sick person should clean up after themselves after each use, including disinfecting. If this isn’t possible, wear a mask and wait as long as possible after the sick person has used the bathroom before cleaning it.
  • Make sure to use liners or bags in all garbage cans.
• Laundry
  • Do the sick person’s laundry separately.
  • Don’t shake it out
  • Wear disposable gloves
  • Wear a face mask
  • Wipe down the machines after putting the dirty laundry in
  • Wash in hot water whenever possible
  • Remove gloves and wash hands right away
  • Dry on the hottest setting possible
  • Wash hands after putting the clothes in the dryer
  • Clean and disinfect the hampers before putting clean clothes back in
  • Wash your hands afterwards

What does Self Isolating Mean?

Self-isolation or quarantine is when you have symptoms or you’ve been exposed to the virus and you are trying to avoid spreading it to others, including those in your household.

When you self-isolate you are minimizing any and all interaction with others, staying at least 6 feet (2 meters) away from others, and not touching surfaces or sharing items with them without cleaning and disinfecting them.

Here are some tips on how to self isolate (assuming you don’t need medical care)

• Have a large, well-ventilated area, ideally with a separate bathroom
• Don’t share a room with others. If that’s not possible, make sure the beds are at least 6 feet (2 meters) apart.
• Monitor your symptoms daily
• Remain in quarantine isolation for at least 14 days
• If you develop symptoms, especially any difficulty breathing, contact your doctor or medical professional immediately.
• Stay positive, stay connected via telephone or video chat as much as possible.
• Exercise, including breathing exercises.
• Talk during meal times, through doors or distance, to remain a part of the household.
• Use a mask whenever interacting with anyone else.
• Wash your hands frequently and don’t touch your face.
• Clean and disinfect your surroundings and all your dishes, utensils, after using them.
• Don’t panic, and don’t stress out about not being productive. By isolating you are doing something incredibly valuable and selfless.

What if I feel fine but think I was exposed?

If you think you were in close contact with someone with Covid 19 , but you don't have any symptoms, you should self-quarantine at home for at least 14 days. This means staying home as much as possible, and staying at least 6 feet, 2 meters, away from other people in your home. Self-quarantine is slightly different from self-isolation, which is when a person who is sick stays in a completely separate room from others.

You should also monitor and track any symptoms. If you do start to have symptoms, call your doctor or nurse right away.

How can I prevent my child from getting or spreading Covid 19?

While there’s currently no vaccine to prevent Covid 19, there are things you can do to reduce their chances of getting it and slow the spread of infection.

If your child is old enough, you can teach them to:

• Practice "social distancing." This means keeping people, even those who are healthy, away from each other. It’s also sometimes called "physical distancing." This is intended to slow the spread of the virus that causes Covid 19. Keeping your child home is the best way to protect them and others.
• Wear a Mask. The United States Centers for Disease Control and Prevention (the CDC) also recommends that people, including children 2 years and older, cover their face when they need to go out in public. This is mostly so that if your child is sick, even if they don't have any symptoms, they’re less likely to spread the infection to other people.
• Wash their hands with soap and water often. This is especially important after being out in public. Make sure to rub the hands with soap for at least 20 seconds, cleaning the wrists, fingernails, and in between the fingers. Then rinse the hands and dry them with a paper towel that can be thrown away. You can teach them how to do this properly and make it fun by singing songs, to make sure they wash long enough, and thoroughly enough.
• Use Hand Sanitizer. While washing with soap and water is best, if your child isn’t near a sink they can use a hand sanitizing gel to clean their hands. The gels with at least 60 percent alcohol work the best. It's important to keep sanitizer out of young children's reach, since the alcohol can be harmful if swallowed. If your child is younger than 6 years old, help them when they use sanitizer.
• Avoid touching their face with their hands, especially their mouth, nose, or eyes.

Younger children might need help or reminders to do these things.

Are Gas Stations Safe?

For the most part, yes. If you are pumping your own gas make sure you disinfect your hands before touching the pump, that includes not only pumping the gas but also selecting the type and amount. Use your knuckles rather than your fingers on the touch screens, and be sure to wipe down your credit card after using it. Wear a mask.

What about wearing gloves when out in public?

Wearing gloves in public is a personal decision, but it’s important to know the facts and proper uses of gloves. We currently don’t recommend using them as along with a false sense of safety, they can result in increased risk and spreading of the virus if not used correctly.

Just like with ungloved hands, touching contaminated surfaces and then other surfaces can lead to the inadvertent transmission and cross-contamination. Gloves won’t prevent or minimize that. For gloves to be effective they need to be treated as ungloved hands, with continued disinfecting and not touching multiple surfaces.

If you are sick, gloves can help a little in protecting others through direct contact, but if you are sick you should stay at home. If you cannot, it’s your choice to wear gloves to protect others. Remember that you need to practice social distancing and proper hygiene, even with the gloves on.

I heard I can get sick from wearing a face mask because of Carbon Dioxide, is this true?

Generally, no. The myth that one can get carbon dioxide poisoning, or hypoxia, from wearing a face mask and breathing in your own expelled breath is unlikely. Non-medical face masks aren’t sealed to the face, therefore air and CO2 circulate in and out of the mask, and they’re typically not worn for a prolonged period of time.

There’s always an increased risk for anyone with a pre-existing underlying health condition, including anxiety, that may cause other symptoms, but in most cases these aren’t significant. If you have concerns about wearing a mask with your respiratory condition, check with your doctor.

For healthcare workers who do wear tighter fitting medical masks or respirators and wear them for a prolonged period of time, the risk may be higher, but they also receive additional training on this. If you’re wearing a medical mask or respirator, be sure to use it properly, to avoid any further health risks or concerns.

Who should wear Medical Masks?

Anyone working in health care settings or serving as a caregiver for patients with or suspected of having Covid 19 should wear medical masks, or respirators, such as the N95 or FFP2 masks. They should also use other personal protective equipment (PPE) and heightened hygiene, such as social and physical distancing when possible, and frequent hand washing.

The following people should choose medical masks over non-medical masks:

• Healthcare workers
  • Whenever possible, medical masks and respirators should be reserved for healthcare workers. They are the most exposed and are in regular, extended close contact with patients with or suspected of having Covid 19.
• People who are sick and exhibiting symptoms of COVID-19
  • People who are sick, even those who only have mild symptoms, should quarantine whenever possible, and wear a medical mask. This will help in keeping them from transmitting the virus to others and to surfaces. The virus is spread through coughing, sneezing, or even talking, and spread through droplets, which can come in contact with the faces and hands of others directly, or land on surfaces that are then touched by others.
• Anyone taking care of a person at home who is sick with COVID-19
  • If you are in close frequent contact with someone who is sick with Covid 19, either as a caregiver or provider, as you are facing repeated exposure to the virus, the medical masks can help protect, somewhat. Again, it’s important to continue to practice as much social distancing, avoiding unnecessary physical contact whenever possible, and frequent hand washing, cleaning, disinfecting, and sanitizing.

Should Children wear masks?

The CDC recommends that all children over the age of 2 wear a mask in public. You should select a mask that is the appropriate size, either a small bandana or a child size mask, so that it fits properly and doesn’t cover their whole face or restrict their breathing.

Anyone, including a child, with an existing respiratory illness should speak with their doctor first.

Are Non-Medical Masks effective in reducing the spread of Covid 19?

While there is a lot of information floating around about the effectiveness and dangers of using face masks, except for health care workers and caregivers, the use of non-medical face masks has shown to be effective in spreading the virus, especially for those people who are not sick, have mild symptoms, or are asymptomatic.

Healthcare workers and caregivers, and those regularly exposed to others with or suspected to have the virus, should not rely on a non-medical mask. This will offer a false sense of safety in a setting where prolonged exposure is likely. These individuals should instead where medical masks and personal protective gear for their own safety.

What is a Non-Medical Mask?

Non-medical masks are general face coverings that are often homemade using breathable fabrics. There are other masks that can be bought commercially. These masks cover the face and nose, secure with elastic over the ears or ties behind the head and neck and typically don’t have filters, like the N95 masks, although some designs include an option to add additional filter options in the mask. Non-medical masks can sometimes be washed and reused.

There are many patterns and designs for making masks at home, and now there are any number of stores and groups making masks for people. Scarves or bandanas can also be used as a face mask.

What’s the right way to use a face mask?

• Before putting on the mask, wash your hands thoroughly with soap and water, for at least 20 seconds. If you’re not able to use soap and water, use hand sanitizer, preferably one with at least 60% alcohol.
• Put the mask on and secure it either over the ears or tie it behind your head, depending on the type of mask you have.
• Once you have the mask on, cover your mouth and nose with it, making sure there aren’t any gaps between your face and the mask.
• Do your best to avoid touching the mask while you’re using it. If you do, clean your hands with soap and water or hand sanitizer.
• If the mask gets damp or wet, replace it with a dry one.
• Don’t reuse single-use masks.
• To remove the mask, take it off from behind. Don’t touch the front of the mask. If it’s a single use mask, discard it properly. Don’t leave it on the ground or in a grocery cart. If it is a reusable mask, place it in a plastic bag or other container that isn’t touching other people or things.
• Once you’ve removed your mask, clean your hands with soap and water or hand sanitizer.
• Wash re-useable masks with soap and warm water, or in your regular laundry, after each use.

What about face masks?

While washing your hands often and practicing social distancing are still the best ways to protect yourself and others, the CDC, the Centers for Disease Control and Prevention, recommends covering your face when you need to leave your house. While most experts do not recommend those who aren’t health care workers from wearing medical masks, such as the N 95, they do suggest a cloth mask, a scarf, or bandana to protect others in case you’re sick to reduce the chance of spreading the disease, even if you don’t have symptoms.

There are many instructions online how to make your own masks using fabric and rubber bands. You should also be careful when taking your mask off, being sure to not touch your eyes, nose or mouth. Wash your hands or use hand sanitizer after removing it, and wash your mask regularly, with your normal laundry.

But even if you cover your face, it’s still safest to stay at home except when it’s necessary. And remember, when you’re in public, do your best to stay at least 6 feet, 2 meters, away from others.

Are Covid 19 Symptoms Different in Children?

While children can get Covid 19 , they are less likely to have severe symptoms. But this information and how it affects children is still largely unknown. More information about Covid 19 and children is still being developed as new types of cases and symptoms, while rare, are appearing around the world.

Should Children wear masks?

The CDC recommends that all children over the age of 2 wear a mask in public. You should select a mask that is the appropriate size, either a small bandana or a child size mask, so that it fits properly and doesn’t cover their whole face or restrict their breathing.

Anyone, including a child, with an existing respiratory illness should speak with their doctor first.

What if someone I live with gets sick?

Most people who get Covid 19 can safely and fully recover at home. If someone in your home is sick, there things you can do to help them and to protect yourself from becoming infected. If a person is sick they should isolate from the rest of the house, but it’s also important to remember that they will need help, not only in staying isolated, but in meeting their basic needs. The symptoms of the disease can be rough, too, so remember, they’re sick, too. They’ll need your help.

• Help them with basic needs.
  • Remind them to follow their doctors instructions
  • Help them manage their symptoms with medications and care
  • Get them the supplies they need (medicine, toiletries, laundry, food and drink, etcetera)
  • Monitor their symptoms to track to see if they’re improving or worsening
  • Keep them engaged in the household, they’ll be lonely and feel like they’re a burden.
  • Take care of their pets
  • Remind them to exercise
  • Keep the doctor’s number handy, and call if symptoms worsen
  • Seek emergency help if the person has:

• • • Trouble breathing
    • Persistent pain or pressure in the chest
    • New confusion
    • Inability to wake or stay awake
    • Bluish lips or face

• Protect yourself
  • Stay at least 6 feet apart
  • Wear a mask, preferably a medical mask if you’re in close contact with the person
  • Wash your hands with soap and water for at least 20 seconds frequently, use hand sanitizer
  • Use a separate bedroom and bathroom, if possible
  • If you have to share a space maintain social distancing, wear a face mask, have them wear a face mask, and open a window to increase the air circulation
  • Eat in separate rooms and don’t share utensils or dishes
  • Wash the sick person’s dishes with soap in hot water, and wear gloves while washing them.
  • Wash your hands again after removing the gloves
  • Don’t share personal items with a person who is sick, including dishes, toiletries, brushes, sheets, blankets, towels, soap, shampoo
• Keeping it Clean
  • Clean and disinfect “high-touch” surfaces and every day items, like tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks, and electronics.
  • Use soap and water first, then follow up with a disinfectant cleaner.
  • Be careful using cleaning products, many can cause further breathing problems if used in closed spaces or combined. Read the instructions.
  • If you’re sharing a room with a sick person, don’t over clean. Only clean the person’s area if it’s dirty, to limit contact and possible infection.
  • The sick person can clean if they’re feeling healthy enough, but be careful if they are having trouble breathing. Don’t have them use strong cleaners if they’re having any respirator symptoms.
  • Make sure the sick person has their own cleaning supplies including tissues, paper towels, cleaners and sponges. Don’t share.
  • If you’re sharing a bathroom the sick person should clean up after themselves after each use, including disinfecting. If this isn’t possible, wear a mask and wait as long as possible after the sick person has used the bathroom before cleaning it.
  • Make sure to use liners or bags in all garbage cans.
• Laundry
  • Do the sick person’s laundry separately.
  • Don’t shake it out
  • Wear disposable gloves
  • Wear a face mask
  • Wipe down the machines after putting the dirty laundry in
  • Wash in hot water whenever possible
  • Remove gloves and wash hands right away
  • Dry on the hottest setting possible
  • Wash hands after putting the clothes in the dryer
  • Clean and disinfect the hampers before putting clean clothes back in
  • Wash your hands afterwards

What if I feel fine but think I was exposed?

If you think you were in close contact with someone with Covid 19 , but you don't have any symptoms, you should self-quarantine at home for at least 14 days. This means staying home as much as possible, and staying at least 6 feet, 2 meters, away from other people in your home. Self-quarantine is slightly different from self-isolation, which is when a person who is sick stays in a completely separate room from others.

You should also monitor and track any symptoms. If you do start to have symptoms, call your doctor or nurse right away.

What if I want to breastfeed?

Breastfeeding has many benefits for both you and your baby, but at this time, it’s not known if the virus can be passed to a baby through breast milk.

If you’re sick but still want to have your baby breastfed, you might want to have another healthy adult feed your baby. If that’s not possible, it's important to be extra careful when feeding or holding your baby, whether or not you breastfeed. Even though experts don’t know if the virus can be spread through breast milk, you could pass it to your baby through close contact. You can protect your baby by washing your hands often and wearing a face mask while you feed them.

You might choose to pump breast milk for your baby. Whether you’re sick or not, be sure to wash your hands carefully before pumping, and if you are sick at all or have any symptoms, wear a mask while you pump. If you have the option, it’s a good idea to have someone who isn’t sick, or hasn’t been exposed, to clean your pump thoroughly between uses.

How can I help my child cope with stress and anxiety?

It‘s normal to feel anxious or worried about Covid 19. It's also normal to feel stressed or lonely when you can't do your normal activities or see friends and relatives. And it can be hard to manage jobs and school work when your family has to stay at home. This can all be particularly difficult on children who don’t fully understand what is happening and why.

You can help your child by:

• Talking to them simply about Covid 19 and why "social distancing" is important
• Limiting what they see on the news or internet
• Finding activities you can do together
• Staying in touch with friends and relatives through phone calls, video, or chats
• Taking care of yourself, including eating healthy foods and getting regular exercise

Your child's school might have resources to help your child learn from home. This can also be a good way to stay connected with teachers and classmates.

If your child is worried, you can remind them that most people don’t get severely ill or die from Covid 19. It might also help to remind them that by staying home, your family is helping to protect other people in your community.

What else should my family know about social distancing, especially with kids?

When you’re social distancing, you can still keep in direct contact with the people in your home, as long as everyone is healthy.

In many places, schools and day cares are closed temporarily. When experts recommend staying home and away from other people, it's important to take this seriously and follow instructions as best you can. Even if your child does not get very sick from Covid 19, they could still pass it along to others who could get very sick.

It is also important to avoid:

• Play dates, even in small numbers
• Group sports
• Playgrounds

Children can still play outside, but should be careful to stay at least 6 feet (2 meters) away from other people.

How can I prevent my child from getting or spreading Covid 19?

While there’s currently no vaccine to prevent Covid 19, there are things you can do to reduce their chances of getting it and slow the spread of infection.

If your child is old enough, you can teach them to:

• Practice "social distancing." This means keeping people, even those who are healthy, away from each other. It’s also sometimes called "physical distancing." This is intended to slow the spread of the virus that causes Covid 19. Keeping your child home is the best way to protect them and others.
• Wear a Mask. The United States Centers for Disease Control and Prevention (the CDC) also recommends that people, including children 2 years and older, cover their face when they need to go out in public. This is mostly so that if your child is sick, even if they don't have any symptoms, they’re less likely to spread the infection to other people.
• Wash their hands with soap and water often. This is especially important after being out in public. Make sure to rub the hands with soap for at least 20 seconds, cleaning the wrists, fingernails, and in between the fingers. Then rinse the hands and dry them with a paper towel that can be thrown away. You can teach them how to do this properly and make it fun by singing songs, to make sure they wash long enough, and thoroughly enough.
• Use Hand Sanitizer. While washing with soap and water is best, if your child isn’t near a sink they can use a hand sanitizing gel to clean their hands. The gels with at least 60 percent alcohol work the best. It's important to keep sanitizer out of young children's reach, since the alcohol can be harmful if swallowed. If your child is younger than 6 years old, help them when they use sanitizer.
• Avoid touching their face with their hands, especially their mouth, nose, or eyes.

Younger children might need help or reminders to do these things.

How is Covid 19 in children treated?

There is no known specific treatment for Covid 19. Most healthy children who get infected can recover at home, and usually get better within a week or 2.

It's important to keep your child home, and away from other people, until your doctor or nurse says it's safe for them to go back to their normal activities. This decision will depend on how long it’s been since the child had symptoms, and in some cases, whether they’ve had a negative test (showing that the virus is no longer in their body).

Doctors are studying several different treatments to learn whether they might work to treat Covid 19. In certain cases, for children being treated in the hospital, doctors might recommend trying these treatments.

Will my child need tests?

If a doctor or nurse suspects your child has Covid 19, they might take a swab from inside their nose for testing. These tests can help the doctor figure out if your child has Covid 19 or another illness.

In some areas, it might not be possible to test everyone who might have been exposed to the virus. If the doctor can’t test your child, they might tell you to keep them home and away from other people, and call if symptoms get worse.

What should I do if my child has symptoms?

If your child has a fever, cough, or other symptoms of Covid 19, call their doctor or nurse. They can tell you what to do and whether your child needs to be seen in person.

If you’re taking care of your child at home, the doctor or nurse will tell you what symptoms to watch for. Some children with Covid 19 suddenly get worse after being sick for about a week. Stay in regular contact with your child’s doctor’s office to document and discuss the symptoms, and they’ll keep you up to date on any concerns, and when to call for emergency help. For example, you should call right away if your child:

• Has trouble breathing
• Has pain or pressure in their chest
• Has a rash
• Has blue lips or face
• Acts confused or not like themselves

If you have a baby that’s having trouble feeding normally, you should also call the doctor or nurse for advice.

Are there other symptoms of Covid 19 that children may get, or can Covid 19 lead to other problems in children?

This isn’t common, but it can happen. There have been rare reports of children with Covid 19 developing inflammation throughout the body. This can lead to organ damage if it is not treated quickly. It’s been referred to as "pediatric multi-system inflammatory syndrome" or "multi-system inflammatory syndrome in children." The symptoms can be similar to other conditions like "toxic shock syndrome" or "Kawasaki disease." Doctors don’t yet know if the virus that causes Covid 19 also causes Kawasaki disease in some children.

If you notice a rash on your child, especially if they’ve got other symptoms, such fever, abdominal pain, vomiting, diarrhea, neck pain, rash, and feeling tired, you should contact your doctor right away.

Are Covid 19 symptoms different in children than adults?

In general, not really. Common symptoms include fever and cough. In more severe cases, people can develop pneumonia and have trouble breathing. Children with Covid 19 can have these symptoms too, but are less likely to get very sick.

Other symptoms both children and adults experience include: feeling very tired, shaking chills, headache, muscle aches, sore throat, a runny or stuffy nose, diarrhea, or vomiting. Like adults, some children don’t have any symptoms at all.

For children who do get Covid 19, babies seem to be at higher risk for more serious breathing symptoms. Serious symptoms are also more common in people, including children, who have certain health problems, like heart disease, diabetes, lung disease (such as asthma that is not well controlled or cystic fibrosis), severe obesity, or cancer.

Can children get Covid 19?

Yes. Children of any age can get Covid 19. While so far it appears children are less likely than adults to get seriously ill, there’ve been cases of serious illness in children.

Also, children can spread the virus to other people. This can be dangerous, especially for those who’re more vulnerable, such as those over 65 or who have other health problems.

Is Pregnancy a Risk Factor for Coronavirus?

A very important question in regards to pregnancy is whether pregnancy is a risk factor for COVID-19, in terms of being infection, severity of the disease and the death rate in mother and fetus.

The answers seems to be that yes it is a risk factor for at least severity of the disease in the mother and there is insufficient data regarding the fetus outcomes currently. A recent study from Sweden has found a five times greater risk of ICU admission and four times the risk of receiving mechanical ventilation than non pregnant women.

Now the CDC has released the results of its study lasting from January 22–June 7, as part of COVID-19 surveillance. Of the 91,412 women with laboratory-confirmed COVID-19 infections; nine percent were pregnant.

Among pregnant women with coronavirus, almost a third - 31.5% - reported having been hospitalised compared to almost a fifth of that amount  - 5.8% - in women who were not pregnant.  After adjustments for a variety of known risk factors such as age and other medical conditions, - the relative risk of being hospitalised for a pregnant woman was 1.5 times that of a non-pregnant woman and 1.7 times the risk for intubation and mechanical ventilation. Interestingly however the rate of death was similar suggesting that though the disease is more severe - it does not cause a higher mortality rate -

The CDC wrote that "To reduce occurrence of severe illness from COVID-19, pregnant women should be counseled about the potential risk for severe illness from COVID-19, and measures to prevent infection with COVID-19 should be emphasised for pregnant women and their families”. “We think it’s important to get the information out there that pregnant women need to take precautions,” Dana Meaney-Delman, CDC’s Covid-19 deputy incident manager, said.

The results also indicated that although data on race/ethnicity were missing for 20% of the pregnant women in the study, as with the general population, Black and Hispanic pregnant women were disproportionately impacted.

One issue with the study data needed to distinguish whether the hospitalisation was due to pregnancy related conditions or COVID-19 were not available. Also one can understand that hospitals may have a lower threshold for admitting pregnant women. However ICU admission and receipt of mechanical ventilation are distinct proxies for illness severity and the risks for both outcomes were significantly higher among pregnant women than among non-pregnant women.

The CDC further stated: "Although additional data are needed to further understand these observed elevated risks, pregnant women should be made aware of their potential risk for severe illness from COVID-19. Pregnant women and their families should take measures to ensure their health and prevent the spread of SARS-CoV-2 infection.”

Specific actions pregnant women can take include:

• not skipping prenatal care appointments,
• limiting interactions with other people as much as possible,
• taking precautions to prevent getting COVID-19 when interacting with others,
• having at least a 30-day supply of medicines,
• and talking to their health care provider about how to stay healthy during the COVID-19 pandemic.

While the agency wasn’t able to assess the effects of the virus on the fetuses or babies born to those women since the pandemic hasn’t gone on long enough, pregnant  women who get Covid 19 might have an increased risk of preterm labor and birth, when the baby is born before 37 weeks of pregnancy. This seems to be more of a risk in people who get very sick and have pneumonia. Preterm birth can be dangerous, because babies who are born too early can have serious health problems. So it is important to talk to your doctor, nurse or midwife about any symptoms or health concerns you have, even if they don’t appear to be related to Covid 19.

Related Posts:

• Can Covid 19 cause problems with pregnancy?
• Are pregnant people at high risk for severe symptoms?

What if I want to breastfeed?

Breastfeeding has many benefits for both you and your baby, but at this time, it’s not known if the virus can be passed to a baby through breast milk.

If you’re sick but still want to have your baby breastfed, you might want to have another healthy adult feed your baby. If that’s not possible, it's important to be extra careful when feeding or holding your baby, whether or not you breastfeed. Even though experts don’t know if the virus can be spread through breast milk, you could pass it to your baby through close contact. You can protect your baby by washing your hands often and wearing a face mask while you feed them.

You might choose to pump breast milk for your baby. Whether you’re sick or not, be sure to wash your hands carefully before pumping, and if you are sick at all or have any symptoms, wear a mask while you pump. If you have the option, it’s a good idea to have someone who isn’t sick, or hasn’t been exposed, to clean your pump thoroughly between uses.

If we are both healthy, can my partner be with me for the birth?

In areas where Covid 19 is spreading quickly, some hospitals have rules about who can be in the room during labor and delivery. Your doctor, nurse, or midwife will be able to tell you what to expect, knowing the situation may change based on the spread of the virus in the area. Your partner won’t be allowed to be with you if they have symptoms of Covid 19, have tested positive for the virus, or might have been exposed to someone who has it. If your partner can’t be with you, talk to your birth team about possibly having them available through phone or video during the birth.

Some people wonder if it would be safer to give birth at home instead of at the hospital. If you are curious about this, talk to your doctor, nurse, or midwife. Home birth has risks, too.

What will my delivery be like?

During your delivery you’ll be checked for fever and other symptoms of Covid 19 when you get to the hospital or birth center. Depending on where you live and if you have symptoms, you might also be tested for the virus. Even if you feel healthy, you should cover your nose and mouth with a cloth mask before going to the hospital. You can also expect to wear a mask during labor and delivery.

If you have Covid 19 when you go into labor, the doctors and nurses will take steps to protect others around you. For example, you will need to wear a medical mask if possible. You will probably still be able to have a vaginal birth, if that is what you planned. You don't need a c-section just because you are sick.

If you’ve tested positive or are suspected positive for Covid 19, you might not be able to hold your baby until you get better. If you do hold your baby, you will need to wear a face mask to lower the risk of spreading the infection. You might need to take other precautions too, and while they may be hard remember, these precaution are to protect your baby.

Will my regular prenatal appointments change?

Your doctor, nurse, or midwife will work with you to make a plan for your visits during pregnancy. If you live in an area where Covid 19 is spreading quickly, there will likely be some changes. For example:

• Your partner might not be able to join you for appointments
• If you have any symptoms of Covid 19, you’ll likely be asked to wear a medical mask during your appointments
• Your doctor, nurse, or midwife might group certain tests together so you don't need to go in as often
• You may be able to have some visits handled via telemedicine, meaning over a phone or video conference.

These changes can feel stressful. It helps to remember that the goal is to help protect you and others.

Can Covid 19 cause problems with pregnancy?

From what experts know so far, most people who get Covid 19 during pregnancy will not have serious problems. But problems can happen if the mother becomes seriously ill.

Pregnant women who get Covid 19 might have an increased risk of preterm labor and birth, when the baby is born before 37 weeks of pregnancy. This seems to be more of a risk in people who get very sick and have pneumonia. Preterm birth can be dangerous, because babies who are born too early can have serious health problems. So it is important to talk to your doctor, nurse or midwife about any symptoms or health concerns you have, even if they don’t appear to be related to Covid 19.

How is Covid 19 treated in pregnant women?

Doctors are studying several different treatments to learn whether they might work to treat Covid 19. In certain cases, doctors might recommend these treatments or taking part in a clinical trial, a scientific study that tests new medicines to see how well they work. But some medicines aren’t safe to take during pregnancy, so you should talk to your doctor about all the risks involved.

Fever is a common symptom of Covid 19. If get a fever while pregnant, ask your doctor, nurse, or midwife what to do. Acetaminophen (for example, Tylenol) can be used to treat a fever and is generally safe to take during pregnancy.

If I am pregnant and get sick, can I pass the virus to my baby?

Experts don’t yet know for sure. They think it’s not likely to happen while the baby is still in the uterus (womb), but mothers with the infection can pass the virus to the baby after it is born.

What should I do if I’m pregnant and have symptoms?

If you have a fever, cough, trouble breathing, or other symptoms of Covid 19, call your doctor, nurse, or midwife. They can tell you what to do and whether you need to be seen in person. They’ll also tell you if you should be tested for the virus.

Are pregnant people at high risk for severe symptoms?

Experts don’t yet know a lot about Covid 19 and pregnancy. But so far, pregnant people don’t seem more vulnerable to the infection than others, nor do they seem to have a higher risk of serious problems (like pneumonia) than other people of similar age. Most people who get Covid 19 during pregnancy recover before having their baby.

What If I'm Pregnant?

If you’re pregnant and you have questions about Covid 19 , talk to your doctor, nurse, or midwife.

Is Air Travel Safe?

Many people are considering their travel options both for work an leisure in a world dominated by the fear of catching (and transmitting) COVID-19

Does coronavirus spread on airplanes?

Yes. The data is still coming in but there is a known March 2 flight from the United Kingdom to Vietnam where it is believed that a single passenger transmitted the virus to as many as 15 others including a crew member. As would be expected 12 of the passengers were sitting close to the suspected infected individual.

An informal survey of 18 major airlines has thus far identified at least four more episodes of transmission in the first quarter of 2020

Do other similar viruses also spread on planes?

Yes. Viruses which spread through coughing, sneezing and breathing such as influenza and SARS are known to have spread on aircraft. SARS - itself a coronavirus - is believed to have been carried by passengers on at least 40 fights and caused transmission to other passengers. Studies find that the closer to the infected person - the greater the risk

Why is risk of transmission risky on flights?

COVID-19 is very contagious and when emitted from the noses and mouths of the infected, these droplets can then transmit the virus in particular through the mouth, nose or eyes. Additionally close proximity when sitting, waiting in lines, shopping in the food halls and using public bathrooms all add to the risks.

What about aerosols?

While transmission via smaller particles than droplets - known as aerosols can float in the air longer and can be thus inhaled the risk is believed to be lower. Additionally due to the modern aircraft ventilation systems in use - the risk is further mitigated by such things as HEPA filters which should mitigate the risk of this sort of spread. The air on a plane is generally a 50-50 mix of sterile outside air and recirculated cabin air that’s been filtered. According to Airbus SE and Boeing Co., all their aircraft are fitted with HEPA filters, which capture particles as small as the virus.

Most airlines have or are making the wearing of face masks mandatory and passengers have been taken off fights for non-compliance.

What can airlines do to lower risk of the spread of COVID-19?

There are many actions airlines can and are taking to mitigate risks from the more frequent cleaning of aircraft to reducing lines when possible and maintain social distancing. Contactless payments and interactions are being introduced in a variety of situations as is the availability of hand sanitisers. Some airlines have chosen to limit the number of passengers on flights including leaving middle seat empty. Additionally the mandated use of masks by crew and passengers is instrumental in reducing spread.

General Tips

Clean Your Phone

This is important. Always wipe down your phone. You know not to touch your face and to wash your hands, but your phone is likely with you at every step of your day, exposed to an endless stream of germs and a high risk for transmission. And chances are while you’ve learned not to touch your face, you touch your phone and then your phone touches your face.

• • Wipe it down thoroughly, at least once a day
  • Take the case off and sanitize it with a wipe or a paper towel with hand sanitizer.
  • Avoid any ports so you don’t get liquids inside.
  • Take the case off and wipe that down separately, inside and out.
  • Let it air dry for a few minutes before putting it back on.
  • Use speakerphone whenever possible to avoid face contamination (but don’t be rude in public)
  • Use a head phone for private calls
  • Wipe down the surface regularly
  • Don’t take your phone into the bathroom

Public and Shared Bathrooms

• • Use toilet seat covers
  • Don’t touch anything with an uncovered hand, use a paper towel to open stall doors, flush.
  • Don’t place items on flat surfaces.
  • Use you’re the back of your hand to turn the faucet on or off whenever possible, more importantly turning it off, and use soap and water to wash your hands.
  • If there is an option, choose the paper towels to dry your hands, not the air blowers.
  • Never use reuseable towels in a public bathroom.
  • When opening the door to leave, use your foot or use a paper towel on the door handle.

Your Home & Car

You know to clean your house but pay particular attention to those areas where people are entering after being in the public, possibly exposed.

• • Wipe down outside and inside door handles
  • Wipe down counters after groceries or deliveries have been put away
  • Wash all new clothing that is delivered
  • Wipe down all surfaces in your car that you touched, inside and out, including door handles, gear shifts, steering wheel, radio knobs, trunk latches, etc
  • If you live in a building with public spaces, avoid touching shared spaces as much as possible, and if you have to, use a tissue or paper towel that you can dispose of between each touch point. Wash or sanitize your hands as soon as possible after using these. That includes:
    • Elevator buttons (use your knuckles if possible)
    • Stair railings
    • Door handles (when possible use your hip or leg to gently push doors open)
    • Mail boxes
  • Deliveries
    • If you’re ordering food or groceries, use no contact delivery options whenever possible
    • Wash your hands after receiving the deliveries
    • Always tip and tip well
    • If you’ve ordered take out food, use your own plates, don’t eat out of the containers the food came in.
    • Pay online by credit card whenever possible
    • If you have to pay by cash, put the money in an envelope so they aren’t touching it directly.
    • If you cannot do no contact delivery, wear a face mask and stay at least 6 feet apart.
  • Curbside Pick up
    • Pay online by credit card whenever possible
    • Wear a mask when picking up just in case they need to speak with you.
    • Have your trunk ready so they don’t have to wait and break social distancing
    • Tip, and tip well
    • Be patient and understanding
    • Show up at the scheduled time, on time.
    • If necessary, communicate through the open passenger-side window, not the driver’s side, to protect them from oncoming traffic, and to maintain social distance.
  • If you encounter resistance – Just walk away.
    Anyone resisting social distancing or flouting the recommendations isn’t likely someone who would be open to discussion or convincing. Engaging in discussions will only escalate the tension and risk exposure. If you are uncomfortable, notify management if possible, and get to safety.

General Health: Maintain your general health during this pandemic.

• Continue to take all medications
• Eat healthy
• Maintain healthy sleep habits
• Exercise regularly
• Relax
• Understand that this is a stressful time and we are all unsure and need reassurances. Don’t be too hard on yourself.
• Don’t accept easy answers or explanations. This is a time when careful vigilance is needed, and that applies to news and information, too.
• If you aren’t feeling well, even if it’s unrelated to Covid 19, call your doctor’s office.
• If you have a medical emergency, do not avoid the emergency room. You can have someone call ahead to find a separate entrance or timing, if you have that option, but do not risk not going if you need to.
• Dental emergencies happen, too. Call your dentist if you have a problem. Remember dentists are used to practicing very strong hygiene habits and are prepared for safe, effective treatment.
• You don’t need a haircut that badly. Wear a hat, try different styles, use product to contain it.
• Connect with friends and colleagues online through chats or video conferencing
• Find religious services online
• Seek out recovery support resources and online meetings.
• Find classes, new networking groups online, learn new skills, broaden your world

Can Covid 19 be prevented?

While there isn’t yet a vaccine to prevent Covid 19, there are things you can do to reduce your chances of getting it. These steps are good for everyone, but are especially important for those at higher risk, such as older people or those with other health conditions that could make them more prone to get the disease if exposed.

Practice social distancing.

This is to avoid contact with people who are sick, whether they have symptoms or not, since you can have the disease without knowing it.

Social distancing means avoiding close contact with those who you don’t already live with. It’s also called physical distancing.

Social distancing means avoiding crowds, even small ones, as much as you can. The best way to do this is to stay at home, but if you need to go out, try your best to keep your physical distance from others. Stay at least 6 feet, or 2 meters, apart, and wear a face mask or covering if you can.

Wash your hands with soap and water often.

Washing your hands is especially important if you’ve been out in public or touching items that others have touched. This includes getting your mail or deliveries.

Use soap and water, rubbing your hands for at least 20 seconds, and be sure to wash your wrists, fingernails, and between your fingers. When you’ve done this for at least 20 seconds, rinse them and dry them with a paper towel that you can throw away.

If you aren’t near a sink you can use hand sanitizer to clean your hands. You’ll want a hand sanitizer with at least 60% alcohol in it to be effective, but whenever possible, soap and water works best.

 Avoid touching your face, especially your mouth, nose, and eyes.

Covid 19 and other viruses enter your body most easily through your mouth, nose, and eyes, so if you’ve been in contact with the virus, touching your face increases the chance that you can become infected.

Avoid traveling if you can.

Obviously you’ll want to avoid traveling to known hot spots, where there are large outbreaks of the virus, but any form of travel increases your risk of exposure, especially if you have to be in crowded places like airports. Traveling also spreads the virus around the country and the world. This makes it harder to contain.

Can Someone Who Doesn't Have Symptoms Spread the Virus?

A person can be infected and spread the Covid 19 virus to others even without having any symptoms. That’s why keeping people apart is one of the best ways to slow the spread.

How is Covid 19 spread?

It is now thought that the spread of Coronavirus occurs mainly through close contact from person-to-person with proximity, length of exposure and the indoors each increasing probability of transmission.

The role of people who have COVID-19 but are without symptoms is not fully determined but it is believed that they may in some cases be able to spread the virus. What we do know is that the size of the exposure can be a determinant of the severity of the disease in individual patients in addition to other risk factors (such as number and severity of health problems)

In spreading from person to person the mechanism is:

Respiratory droplets produced when an infected person coughs, sneezes, or talks can enter the lungs of uninfected individuals and pass the disease as the droplets land in the mouths or noses of people nearby- additionally the droplets may be inhaled into the lungs.

The virus spreads easily

One of the things that has made COVID-19 the global pandemic it is - is the fact that the virus spreads relatively easily. It is very contagious and can also continue to spread “sustainably” to new people.

The virus that causes COVID-19 is spreading more very easily between people than influenza for example but less so than measles.

The probability of spread increases with the more closely and the longer a person interacts with others.

Can you get the virus from a surface.

While not by any means the main way the virus spreads it may be possible that a person can get COVID-19 through touching a surface that has the virus on it and then transmitting that to their mouth, nose and rarely it is believed, the eyes.

I heard I can get sick from wearing a face mask because of Carbon Dioxide, is this true?

Generally, no. The myth that one can get carbon dioxide poisoning, or hypoxia, from wearing a face mask and breathing in your own expelled breath is unlikely. Non-medical face masks aren’t sealed to the face, therefore air and CO2 circulate in and out of the mask, and they’re typically not worn for a prolonged period of time.

There’s always an increased risk for anyone with a pre-existing underlying health condition, including anxiety, that may cause other symptoms, but in most cases these aren’t significant. If you have concerns about wearing a mask with your respiratory condition, check with your doctor.

For healthcare workers who do wear tighter fitting medical masks or respirators and wear them for a prolonged period of time, the risk may be higher, but they also receive additional training on this. If you’re wearing a medical mask or respirator, be sure to use it properly, to avoid any further health risks or concerns.

Who should wear Medical Masks?

Anyone working in health care settings or serving as a caregiver for patients with or suspected of having Covid 19 should wear medical masks, or respirators, such as the N95 or FFP2 masks. They should also use other personal protective equipment (PPE) and heightened hygiene, such as social and physical distancing when possible, and frequent hand washing.

The following people should choose medical masks over non-medical masks:

• Healthcare workers
  • Whenever possible, medical masks and respirators should be reserved for healthcare workers. They are the most exposed and are in regular, extended close contact with patients with or suspected of having Covid 19.
• People who are sick and exhibiting symptoms of COVID-19
  • People who are sick, even those who only have mild symptoms, should quarantine whenever possible, and wear a medical mask. This will help in keeping them from transmitting the virus to others and to surfaces. The virus is spread through coughing, sneezing, or even talking, and spread through droplets, which can come in contact with the faces and hands of others directly, or land on surfaces that are then touched by others.
• Anyone taking care of a person at home who is sick with COVID-19
  • If you are in close frequent contact with someone who is sick with Covid 19, either as a caregiver or provider, as you are facing repeated exposure to the virus, the medical masks can help protect, somewhat. Again, it’s important to continue to practice as much social distancing, avoiding unnecessary physical contact whenever possible, and frequent hand washing, cleaning, disinfecting, and sanitizing.

Should Children wear masks?

The CDC recommends that all children over the age of 2 wear a mask in public. You should select a mask that is the appropriate size, either a small bandana or a child size mask, so that it fits properly and doesn’t cover their whole face or restrict their breathing.

Anyone, including a child, with an existing respiratory illness should speak with their doctor first.

Are Non-Medical Masks effective in reducing the spread of Covid 19?

While there is a lot of information floating around about the effectiveness and dangers of using face masks, except for health care workers and caregivers, the use of non-medical face masks has shown to be effective in spreading the virus, especially for those people who are not sick, have mild symptoms, or are asymptomatic.

Healthcare workers and caregivers, and those regularly exposed to others with or suspected to have the virus, should not rely on a non-medical mask. This will offer a false sense of safety in a setting where prolonged exposure is likely. These individuals should instead where medical masks and personal protective gear for their own safety.

What is a Non-Medical Mask?

Non-medical masks are general face coverings that are often homemade using breathable fabrics. There are other masks that can be bought commercially. These masks cover the face and nose, secure with elastic over the ears or ties behind the head and neck and typically don’t have filters, like the N95 masks, although some designs include an option to add additional filter options in the mask. Non-medical masks can sometimes be washed and reused.

There are many patterns and designs for making masks at home, and now there are any number of stores and groups making masks for people. Scarves or bandanas can also be used as a face mask.

Are Gas Stations Safe?

For the most part, yes. If you are pumping your own gas make sure you disinfect your hands before touching the pump, that includes not only pumping the gas but also selecting the type and amount. Use your knuckles rather than your fingers on the touch screens, and be sure to wipe down your credit card after using it. Wear a mask.

Can I go to the park?

Yes. It’s important to exercise and stay active and exercise, not only to for physical fitness, but also for your mental and emotional wellbeing. Many parks are open and you can walk, ride, or run on the trails. It’s a great way to get out and safely connect with others but be careful and take precautions.

• Do’s
  • Visit parks that are nearby. There’s no reason to take additional risks required by traveling longer distances, including accessing public spaces, gas stations, and bathrooms
  • Prepare before you go: make sure the park is open and allowing visitors, and what facilities and restrictions are currently in place.
  • Continue to practice social distancing, staying at least 6 feet (2 meters) away from others not in your household, and avoid touching surfaces. Wash your hands or use hand sanitizer after touching anything and avoid using any public water fountains.
  • If you have your dog with you, keep the dog on leash and avoid risking contact with others, including other dogs or people.
• Don’ts
  • Don’t go to public parks or areas if you’re sick or have been recently exposed to Covid 19.
  • Don’t visit when the parks are crowded.
  • Don’t use the playgrounds or exercise equipment.
  • Don’t take part in organized sports, especially those that require close contact or sharing of equipment (such as tennis, where the ball is touched by all players)

Can I go to the beach?

As states begin to loosen stay at home orders, several are allowing visitors to beaches, with restrictions. Fresh air and exercise outside is always recommended, but when going, maintain the standard precautions of social distancing. Being at a beach is safer than being inside at a gathering, it’s still a risk to interact with large groups of people and share public spaces. That’s why many beaches are limiting activities that could force contact and proximity.

Also be aware that when you’re at the beach, you may need to use public changing rooms and bathrooms, which present more concerns about being in indoor close quarters with others. This makes it easier to spread the virus. Keep your distance and wash your hands thoroughly, frequently and wipe down any surfaces before touching them with a disinfectant wipe, including toilet seats, door knobs and handles.

How safe am I when I go to the grocery store?

Since the risk of infection depends on the level of exposure and the duration of exposure, running errands is a relatively safe experience. You won’t be in stores for a long period of time while shopping, and as long as you wear a mask, practice social distancing, and sanitize your hands before and after leaving, you’re risk of exposure is low.

But here are some tips to further reduce your risk:

• Shop infrequently. Plan your trips and needs so that you are only going shopping every one or two weeks.
• Have a list so you aren’t wandering around the store, but instead going in and out to get what you need.
• Go shopping at times when the stores are less crowded. Many stores are limiting the number of people allowed in at a time, so follow that guidance so you’re not left standing outside in line waiting to get in.
• Be aware of the times set aside for older and vulnerable people to shop, and don’t go during those times if you don’t have to.
• Pay by credit card if possible, reducing the exchange of cash increases the risk of exposing others.
• Know the stores rules around using your own bags before you go.
• Practice social distancing
• Only touch what you’re going to buy
• Wait your turn
• Be patient, everyone is getting used to this and doing their best
• If you aren’t comfortable or others aren’t practicing social distancing, leave and come back another time.
• Try to consolidate your trips to one store. Going to multiple stores increases your exposure and cross contamination.
• Use curbside pick up if possible.
• Don’t leave wipes, gloves, or other garbage in the cart of on the ground.

Is it safe to travel during the Covid-19 Outbreak?

The CDC recommends you stay at home whenever possible, practicing social distancing. Traveling increases your risk of exposure and the risk of exposing others, especially elderly and other vulnerable people, and carrying the virus to other locations. Only travel if you have to, and again, take precautions.

Different types of travel have different levels of risk. Traveling alone in a car, for example, carries little to no risk, except when you interact with others or use public facilities, such as stores, gas stations, or public restrooms. The same goes for the risks to traveling with others in your household.

Traveling on a train or airplane for longer distances dramatically increases your risk of exposure. On planes and trains people are close together for long periods of time. This raises the risk of transmission. They also have self-contained ventilation systems, so the air that flows through the cabins is circulated, spreading any droplets further throughout, and recirculates it.

When traveling, if you have to, wear a mask, wipe down any and all surfaces with a disinfectant wipe after every use or touch, and whenever possible wash or disinfect your hands frequently. And don’t touch your face.