COVID-19: What we know so far about the 2019 novel coronavirus
May 8, 2020
As an infectious disease specialist and hospital epidemiologist at the University of Chicago Medicine, my job is to prepare for outbreaks such as COVID-19 while caring for patients at our academic medical center on Chicago’s South Side.
The extent of this outbreak is rapidly evolving and risk assessment changes daily, but here’s what I can tell you about COVID-19 as of today:
When droplets land on surfaces, we can pick them up with our hands and transfer them to our eyes, mouth and nose when we touch our faces. This is why hand hygiene is so important. Good hand hygiene means washing our hands not just after we're using the restroom or before we're eating but regularly throughout the day. Respiratory secretions (like snot and sputum) may also be infectious, so cover your coughs and sneezes, use disposable tissues, throw them away when you're done and wash your hands afterward. Keep your work surfaces clean and wipe off your keyboard and your phone.
Aerosols are different. Think of hairspray after you use it in the bathroom. When you go back to the bathroom later, you may still be able to smell it because it’s lingering in the air. Obviously, we’re learning a lot about this virus, but most coronaviruses aren’t airborne that way.
Generally speaking, there may be moments when some of these droplets or particles are airborne, but it’s limited to times when we do special medical procedures that stir up the air that a patient is breathing. We call these things “aerosol generating procedures” and they include nebulizer treatments, high flow nasal cannula oxygen, placement of a breathing tube and a number of other things. These procedures increase the risk for healthcare workers caring for the patient and require them to wear more protective masks, like N95s. While these procedures make the respiratory droplets travel further than 6 feet, there isn’t any evidence that COVID-19 is carried far away on the air. Unless someone is coughing directly outside your window, it’s safe to have it open.
It’s important to know that people can also spread coronavirus in the days leading up to developing symptoms. In other words, if you start feeling sick on Wednesday, you were probably contagious on Monday and Tuesday. Since you didn’t feel sick yet, you — and the people you had contact with — couldn’t have known about the risk. This is one of the main reasons why we need things like stay-at-home orders. If you can’t tell who may have COVID-19, the only way to reduce your risk is to limit your contact with everyone.
Another important way to reduce that risk is to wear a cloth mask, which is now recommended by the CDC. While these masks are only partially protective if you have contact with someone who has COVID-19, they are really helpful in keeping you from spreading virus to others. Because the fabric masks trap your own respiratory droplets, they keep you from unknowingly spreading virus to shared surfaces (like boxes at the grocery store) or to other people (like the person next in line at the pharmacy). Because anyone could be spreading the virus even though they feel healthy, it’s important to wear a mask at all times. If everyone did that, it would really help reduce infection risk outside of our homes.
Still, it’s okay to take an abundance of caution if you are worried. Cleaning surfaces with disinfectant or soap and washing your clothes with regular detergent will disable the virus.
You are more likely to contract the virus through respiratory droplets from another person than off of a surface.
Protecting Yourself and Others From COVID-19
What can I do to help stop the spread of the coronavirus?
First and foremost, continue to take these preventive actions:
- Avoid close contact with people who are sick
- Don’t touch your eyes, nose and mouth
- Wash your hands thoroughly and frequently
- Clean and disinfect objects and surfaces you come in contact with regularly.
As COVID-19 spread rapidly here, our health and government officials across the country asked all of us to take additional steps to slow the spread of the disease, including:
Social distancing — Stay at least 6 feet away from other people and avoid large groups. Work from home if possible. Visit with loved ones via electronic devices. Learn more about the importance of social distancing.
Facemasks — Wear a facemask or other cloth face covering (e.g. bandana, scarf), especially in public areas where social distancing can be difficult (grocery stores, pharmacies). Surgical masks and N-95 respirators are in limited supply and need to be reserved for healthcare workers and medical first responders. If your doctor tells you to wear a medical mask, that’s okay too.
The Centers for Disease Control and Prevention (CDC) offers instructions for making and wearing a facemask. It’s important to know that fabric masks aren’t as protective as medical masks but if we all work together, they can really make a difference. Fabric masks trap your respiratory droplets (even the ones you can’t see from talking and breathing) and hold them in the mask so they don’t land on shared surfaces (like the railing on the train) or on other people (like the person next to you in line). Since anyone can be shedding virus, even if they don’t have any symptoms, it’s important for everyone to wear these masks all the time.
Stay-at-home orders — Some states, including Illinois, have enacted stay-at-home orders requiring people to remain in their homes unless they have an essential job, or are doing an essential task, such as grocery shopping or walking their dog. These orders have really changed things. Still, it can be very hard to understand why they are necessary, especially in places where there aren’t very many cases. It’s important to remember that every single one of us is susceptible to this infection and there are no vaccines or antivirals. And our hospitals and clinics are not able to handle all of us being sick at the same time.
The best and most effective way to implement a stay-at-home order is early on, when very few people are sick. In that setting, staying home will save the most lives and be able to be lifted more quickly. Once a city or town is experiencing lots and lots of cases, it can take a very long time for the infection rate to come back down to manageable levels. Even then, strict public health measures will be needed to keep the virus contained until there are vaccines or effective antivirals.
The more we work together and take proactive steps to prevent spread of COVID-19, the sooner we can get back to work and get our economy back on track.
Quarantine — If you or a family member have been exposed to the coronavirus or gets sick with COVID-19, you could find yourself in a mandatory 14-day (or longer) quarantine. You won’t be allowed to leave your home, even to run errands. Right now it feels like we are all in an extended quarantine but any re-opening of the economy will require us to return to strict containment measures including 14-day quarantines for those who are exposed.
Isolation — If someone in your home starts to feel sick they should isolate themselves inside the home, using a different bedroom or bathroom then others in your household, if possible. You can find good information on the CDC website to help you protect others in your house.
We shouldn't be staying at home or distancing because we’re scared. The individual risk to any one of us is low. We are taking these actions because we need to protect those of us who are at a higher risk. The speed at which this disease spreads throughout our community makes a big difference in terms of how many people are sick at the same time and whether or not we have enough beds for all the patients who need care. Even healthy people can get very sick with this virus and most of these patients can and will survive and heal if they have the right medical support. If we let the virus “run its course” we won’t have enough hospital beds or ventilators to help people survive.
Coronavirus Symptoms and Risk
Most people who become infected with the virus have mild symptoms and may not know they are sick. Others get flu-like symptoms. Some patients — particularly adults over 65 and those with underlying medical conditions — develop a severe form of pneumonia, which can lead to death.
Patients develop symptoms like fever, body aches, cough, shortness of breath and sore throat about 5-6 days after infection. We have recently learned that some people have the unusual symptom of losing their sense of smell, which affects taste as well. This seems to be temporary and eventually goes away. Most people will feel pretty miserable for a week and get better on their own. Some people won’t get as sick, but it’s still important not to be out and about, so as not to spread the disease. A minority of patients will get worse instead of better. This usually occurs after 5-7 days of illness and these patients will have more shortness of breath and worsening cough. If this happens, it’s time to contact your doctor again or go to an urgent care center or emergency room. Be sure to call first so they know you are coming.
The lack of previous experience with this virus is part of the reason public health officials are working so hard to contain and slow the spread of this particular coronavirus. When viruses are both new (which means the population is highly susceptible) and can easily pass from person to person (a high transmission rate), they can be very dangerous.
If your symptoms are not severe, but you are over 60 and have any chronic medical conditions, consider contacting your doctor to see if they recommend you come in for testing. Many doctors' offices now have phone triage and video visits, so be sure to reach out for help if you are concerned.
It looks like only about 20% of people who contract this novel coronavirus need to be hospitalized. The other 80% get what feels like a bad cold or flu and recover at home in about a week. A lot of this has to do with underlying medical conditions, but even healthy people can get pretty sick. People who are more vulnerable to any kind of infection, because of their age or chronic health conditions, are more at risk for getting really sick from COVID-19.
We don’t understand why some healthy people get better easily and others get so sick they need oxygen or even a ventilator to help them breathe, but we are learning more every day. If you have COVID-19 and you are getting sicker and sicker instead of better and better, you should contact your doctor or visit an emergency room. Be sure to call first so they know to expect you.
We strongly recommend that vulnerable individuals curtail all of their out-of-home activities in accordance with the recent U.S. Centers for Disease Control (CDC) guidelines. They should stay home as much as possible, not travel, and stay away from crowds.
We are seeing a higher number of COVID-19 cases among minorities and low-income families. This most likely reflects the ongoing racial and socioeconomic disparities in healthcare in these communities. Low-income workers are less likely to be able to work at home. Multiple families living in the same house and homelessness also contribute to the spread of the virus.
Additionally, African-Americans are more likely to have health conditions such as diabetes, heart disease and high blood pressure and these can be less well-controlled than in Caucasians. The causes for this are multifactorial but if people in underserved communities are less able to get care for their diabetes, they may also be less able to get care for COVID-19.
At UChicago Medicine, we are committed to caring for each and every person who comes our way, especially now during this crisis. We are providing the best care possible with world experts in critical care and infectious diseases for all of our patients with COVID-19.
One of the leading theories as to why some healthy people get sick enough from COVID-19 to need intensive care is because their immune systems are overly responsive and go too far in helping fight the virus. Researchers have described this complication — called a cytokine storm — in other serious infections and there are some early indications that it can happen with COVID-19. Basically, when some people get COVID-19, their immune systems get very revved up and send out chemical messengers, called cytokines, to mobilize other parts of the immune system to help fight the virus. These cytokines also affect other organs and this can be overwhelming, especially in the lungs.
It is safe to donate blood during the outbreak and there is a great need. Our national blood supply has been greatly reduced because blood drives across the country were cancelled due to social distancing guidelines.
If you had the virus, your blood is in especially high demand because your blood has developed antibodies to the virus. Donating your blood may help healthcare workers and COVID-19 patients. But you will need to wait about a month after your symptoms completely resolved to donate.
Learn about UChicago Medicine’s clinical trial on convalescent plasma transfusions for COVID-19 patients.
Coronavirus Screening and Testing
Testing for COVID-19 remains a sticky problem for many people and their doctors. While testing is becoming more available in many places, it can still be difficult to get a test for some people who really need one.
We’d like to be able to test anyone who wants to be checked, but we still need to reserve testing for those who are sick. People with symptoms of COVID-19 who are sick enough to need hospitalization must be tested. The same goes for those in nursing homes and other group settings, healthcare workers, first responder, and other essential workers. Many places, including UChicago Medicine, are now able to test symptomatic people who are high risk for complications of COVID-19. This includes older people, those with chronic medical conditions and those who are immunocompromised. Bottom line, talk to your doctor or check your local public health office for information on testing if you have symptoms.
Testing people who have been exposed but do not have symptoms is a tricky issue. First of all, the most common test available looks for actual pieces of the virus in a nasal or throat swab and it’s less reliable in people who don’t have symptoms. You may have heard stories about people who tested positive even though they felt completely fine. But there are also people who tested negative one day and then positive the next day. So a negative test doesn’t necessarily mean you are in the clear.
Lastly, there’s a new test that’s starting to be offered: serology. This blood test looks for antibodies that your body makes in response to infection. It isn’t as good at detecting illness when you are sick but it can tell if your body has seen, and conquered, COVID-19 in the recent past. This test is not yet approved by the FDA. Some experts are worried that the serological test may be falsely positive in some people who recently had the regular coronavirus (which causes the common cold) so follow your doctor’s advice about any results you might get.
At UChicago Medicine, we are considering anyone with respiratory symptoms, fever or any other symptom of COVID-19 as a potential case. That means we ask everyone about symptoms when they arrive at the medical center and take appropriate precautions.
Patients are put into isolation right away and staff wear personal protective equipment like gowns, gloves, masks and eye shields when they are in the patient’s room. Patients who need aerosol generating procedures (like nebulizer treatments or high-flow nasal cannula oxygen therapy) are placed in rooms that keep air flowing away from the hallway.
Many patients don’t need to stay in the hospital and are able to isolate at home.
If you think you may have COVID-19, reach out to your doctor right away. If you’re going to your doctor’s office or an emergency room, call ahead so someone can meet you outside to give you a facemask to help limit the spread of any germs. In the meantime, stay away from other people. If you live with others, choose a room or place in your home where you can be separated from the others. Don’t share utensils or cups. Have someone wipe down bathroom surfaces with disinfectant regularly, keep their hands clean, and try to keep the windows open for air circulation. Don’t forget to cover your coughs and sneezes.
At UChicago Medicine, you may be tested if you have any symptoms of COVID-19. These include: fever, cough, stuffy nose, difficulty breathing, body aches, new loss of sense of smell or taste, fatigue, headache, sore throat, nausea/vomiting or diarrhea. Additionally, we are testing asymptomatic patients for contact tracing or exposure to COVID-19.
Coronavirus Treatment and Recovery
About 20% of COVID-19 patients need to be hospitalized for their pneumonia-like illnesses. Some of them will require critical care and ventilators — special machines that help them breathe. And some need to stay on ventilators for weeks at a time. It’s this portion of patients who continue to be most concerning. Many of them will be able to recover with lots of time and support. Still, a high level of critically ill patients can overwhelm the healthcare systems across our nation pretty quickly. Some parts of the US have already been experiencing this. Without social distancing, it could be much worse. We need to make sure we slow the spread of COVID so there are enough hospital beds and ventilators for everyone who needs one.
For now, doctors can only treat the symptoms with supportive care, not the virus itself. There is no antibiotic (these are designed for bacterial infections, not viral ones) for COVID-19. Scientists are working on a vaccine, but we don’t expect to have a good vaccine until spring 2021.
However, ongoing trials at UChicago Medicine and other centers suggest that there are some existing antiviral drugs that may be helpful for the sickest patients. In fact, the University of Chicago is part of a multi-institutional team that has mapped a protein of SARS-CoV-2 and found drugs previously in development for SARS could be effective for COVID-19.
We are enrolling patients in trials of remdesivir, hydroxychloroquine and even using the antibodies in the blood serum of patients who have recovered to treat currently sick patients.
We still have a lot to learn about immunity to this infection but we do know that patients who recover make antibodies (also called immunoglobulins) to the virus. Antibodies are proteins made by the immune system to help fight off infections and they are specific to one type of invader. Once you have had an infection, your white blood cells make antibodies that can kill that infection right away if you are exposed again. For some infections, these antibodies are lifelong partners that will protect you forever. In other infections, like the common cold, the antibodies don’t stick around for more than a few months, so you can keep on getting the same cold viruses year after year.
We don’t know how long the antibodies to SARS-CoV2 (the virus that causes COVID-19) will last. But scientists are trying to find out if they can capture some of the antibodies in the blood of recently recovered patients and transfuse them into sick patients. We hope these antibodies will help people fight off the infection. These antibodies won’t last long and won’t help the recipient make their own antibodies any faster, but they might help hold COVID-19 in check while their own immune system gets to work.
We don’t know if these transfusions will help patients but there is some evidence that they worked for other infections in the past and we don’t have any reason to believe they will be dangerous. With any experimental treatment, it’s important to make sure patients understand the risks and benefits and anyone who is eligible to be part of a study gets to decide if he/she wants to participate.
Those with mild cases of COVID-19 appear to recover within one to two weeks. In severe cases, full recovery may take six weeks or more. When you no longer have a fever even without taking Tylenol or ibuprofen, your cough is gone, and you are eating a normal diet again, you can be considered well. That said, it’s normal to still feel more tired than usual and it will take some time for you to regain your strength. Everyone needs to stay isolated for at least a week. After that, most experts think it’s safe for you to return to work when you have been symptom free for at least 3 full days.
There is good evidence that most people make antibodies in response to infection and this will provide some protection. Limited reports of reinfection are still being investigated and we don’t know how good our immune response will be or how long it will last. So far, it doesn’t look like patients are going back to the hospital with another round of infection but even those who recovered early on in Wuhan, China have only been well for a few months. Experts from University of Chicago Medicine and around the world are working hard to answer this question.
The CDC recommends that you remain isolated until at least 7 days have passed since the start of your symptoms AND until you are symptom free for at least 3 days. If you are older or have a poor immune system, you may be contagious for longer and should stay isolated for at least 14 days. As you rejoin the "stay-at-home order" world, it’s wise to keep wearing a cloth mask when doing essential activities outside the house just like everyone else. If you aren’t sure, ask your doctor.
It’s too early to know if the coronavirus has long term effects on lung capacity or if it permanently damages other organs. Doctors will be monitoring patients who fully recovered from the virus to see if complications related to having the virus are permanent.
Daily Life During the COVID-19 Outbreak
Reach out to your doctor's office about telehealth options or pre-screenings so you can figure out whether or not you need make an appointment to see someone in person.
Traveling on public transportation or in other group settings is absolutely a risk because you're in a confined location with other people who may be sick. Many public transportation authorities have increased the frequency of cleaning buses and trains, but they can only do so much cleaning. Hand hygiene and not touching your face until after you've washed your hands are important ways you can prevent spread. It’s also a good idea to wear a fabric mask. These can help protect you if someone else is sick, they keep your hands off your face, and they can keep you from unknowingly spreading germs too. Lastly, keep your distance from others as best you can. While fewer people are riding buses and trains these days, it can still be worth it to wait for an even less crowded vehicle if you can.
Also, this is another reason why social distancing is so important. Some people have to take the bus and the train in order to get to work, including many healthcare providers. Those who don't need to take public transit should not use it, so that people who have to take the train or bus can spread out inside and reduce their risk. Our behavior can really affect what happens to everybody else in society, and it's a time for us to realize just how interconnected we really are. This is just one more way you can show your support and save the world a little bit by staying home.
We have not seen any evidence that COVID-19 can be transmitted through eating food. It may be possible to get the coronavirus by touching food or another surface that has the virus on it and then touching your mouth, nose or eyes or by eating food that someone sneezed or coughed on. However, SARS-CoV2 does not survive well in hot conditions so hot food (even takeout or delivery) should be pretty safe. In an abundance of caution, be sure to take the proper precautions — washing your hands with soap and water while unpacking and preparing food.
Grocery stores and pharmacies are still open so you can get what you need but, in case you suddenly get sick, it’s good to keep a few things on hand so you don’t need to go out. Continue to store some basic supplies such as non-perishable foods, prescription medications and comfort items to help keep you sane while you ride it out, just as you would during a natural disaster. However, COVID doesn’t threaten our water supply or electricity so hand-crank radios and pallets of water might be a bit overkill for this situation. Instead, maybe it’s time to choose a few puzzles and catch up on your favorite binge watching. Having a bunch of enjoyable things to do if you have to stay home for a while can go a long way toward making the entire situation more bearable.
It’s very important to practice self-care during a time when so many other things are uncertain out of your control. Eat healthy. Exercise at home or take socially distant walks with family or friends. Take a break from the news about the virus. Get plenty of rest – a good night’s sleep can boost your immune system, which puts you in a better position for fighting the virus.
We're regularly posting new coronavirus information, including tips on how to cope during the outbreak.
With all of the restrictions, event cancellations and school closures, it's important that we discuss what is happening with school-age children who will likely be disappointed or scared by what they are hearing. It's important to tell your children that they are going to be fine throughout this outbreak and that lots of grownups are working hard to keep everyone safe.
At the same time, we all need to keep others, including their parents and grandparents, safe. We need their help with social distancing, washing their hands and covering their coughs. There has never been a better time to teach your kids how to wash their hands properly and how to cover their coughs and sneezes. Then you can enlist them to assist in making sure your whole family is doing it right too. Kids can be excellent hand hygiene monitors.
That said, it’s certainly not unreasonable to think about carefully and thoughtfully expanding your “quarantine family,” provided everyone else is being safe, taking similar precautions and doesn’t have any other high-risk individuals at home. If you do choose to add to your group of regular contacts, know that it definitely comes with some risk. Think carefully about whether or not that’s okay with you. Then agree on some rules and disclosures ahead of time.
But that doesn’t mean we should all go do things just to do things. If we’re going outside our homes, we still need to take precautions and that’s going to be the situation for a while. The risk hasn’t changed from before – all that’s changed is that we know more about the virus and how transmissible it is and the need to reopen the economy has become more urgent.
Anyone could be spreading COVID-19, even if they feel completely fine (including you). If something is really important to you, or it’s something you really need to do, then you can and should feel comfortable going out. (Provided you’re still wearing a mask, social distancing and washing your hands.) But if don’t have to, please don’t.
It’s absolutely critical everyone involved is open and honest about their possible exposure and what they are and aren’t doing outside of their self-isolation. You’ll definitely want to keep wearing masks and washing your hands. Even then, it may not be the right decision for families with high-risk individuals at home, like older people or those with lots of medical problems.
I think a big misunderstanding is that people are always going to be safe around those they know well. That’s simply not true – especially since anyone can spread the virus, even if you feel completely well. You’re far more likely to pick up coronavirus from hanging out for an hour with a friend who seems healthy than you are by just passing someone on the street who may be coughing. And you have to keep in mind that you could be contagious as well.
How can I help UChicago Medicine fight COVID-19?
Visit our page on how you can help us during the COVID-19 crisis. Examples of ways to help include:
- Donate Food and Supplies
- Make a Financial Donation to UChicago Medicine or UChicago Medicine Ingalls Memorial Hospital
- Donate Blood
- Donate Plasma If You've Recovered from COVID-19
- Thank a Hospital Worker
Support UChicago Medicine's COVID-19 Response Fund
Help support our dedicated healthcare workers on the frontlines of the COVID-19 pandemic, as well as the adult and pediatric patients and families who are affected.