COVID-19 Frequently Asked Questions

What are Coronaviruses? Expand

Coronaviruses are a family of viruses whose genetic material are made up of positive-sense, single-stranded RNA. RNA is a nucleic acid that is used by the virus as a template to encode necessary proteins. Coronaviruses are characterized by surface proteins that form a solar crown-like shape around the virus, from where it gets its name. One of the other hallmarks of coronaviruses is their unique protein transcription activity, which allows for a high rate of mutation [1]. There are four classes of coronaviruses: alpha, beta, gamma, and delta; they differ in their surface proteins structures and in their hosts, and are abundant globally [1, 2]. They may adapt to infecting different organisms, although they do not typically cause severe symptoms. Human alpha- and beta-coronaviruses are known to infect a significant number of individuals annually, and make up almost 30% of respiratory tract infections, usually identified as the common cold [2]. The virus SARS-CoV-2, which causes COVID-19, has been identified as a beta-coronavirus, which typically infects bats [3].

How does the virus spread? Expand

The virus mainly spreads through close contact with an infected individual. Respiratory droplets, such as that produced by sneezing, coughing, and spitting, from an infected individual may enter an uninfected individual’s body through nasal, oral, or respiratory pathways [4].

Additionally, the virus is also cited to remain airborne for a few hours before settling onto any open surfaces [4]. A recent New England Journal of Medicine-published study found that in laboratory conditions, the virus remains suspended in aerosols in the air for three hours, before settling onto the open surfaces in the room [5]. While it is known that aerosols are produced during specific hospital procedures and during normal breathing and coughing, the relative role of aerosols in COVID-19 transmission is not yet confirmed. The study also concluded that the virus is viable, which means that it can survive, on each type of material for a characteristic set of time, with the virus living for up to 72 hours on plastics, 48 hours on stainless steel, 24 hours on cardboard, and four hours on copper [5]. Thus, the virus also spreads through contact with a contaminated surface if the individual then soon touches their own eyes, nose, or mouth without any proper hand-washing [4]. Infected individuals may also be asymptomatic (virus is present but no symptoms develop) or pre-symptomatic (virus is present but symptoms have not yet developed), but their role in transmission is not yet confirmed [6].

How does SARS-CoV-2 (COVID-19) cause infection? Expand

First, respiratory droplets containing the viral particles come into contact with an individual’s nose, mouth, or eyes. The viral particles travel through the airway and then attach to receptors on the surfaces of specific cells that produce a protein called ACE2 [7]. Once attached, the virus fuses its membrane with that of the cell, and releases viral genetic material into the cell. The virus’s genetic material “hijacks” the cell’s internal machinery to make more viral particles. The infected cell is also forced to make proteins that suppress the individual’s immune system. Once infected, a cell can release millions of copies of the virus, spreading to nearby cells and potentially being transmitted externally through droplets.

What is the significance of labelling the current COVID-19 outbreak as a “pandemic”? Expand

Until March 11, the World Health Organization (WHO) described the COVID-19 outbreak as an epidemic, an outbreak of disease that spreads quickly and affects many individuals at the same time [8]. By declaring the COVID-19 outbreak a pandemic — a disease occurring over a wide geographic area and affecting an exceptionally high proportion of the population — WHO has called international attention to the alarming spread and severity of the disease as well as the expectation that case numbers will continue climbing in the near future, thus alerting those communities who hadn’t already taken precautions to do so [9]. This does not mean that the dangers posed by this outbreak have changed in any manner, it is simply a warning and a plea to governments and other administrative institutions across the globe to take precautions and be prepared [10].

What does it mean to “flatten the curve”? Expand

The rapid spread of COVID-19 means that many thousands will get infected in the coming months — as has been accepted by health officials across the globe. However, the rate at which this infection spreads will make all the difference in whether or not those who need it are able to get adequate treatment [11]. The “curve” refers to the number of people who are projected to contract COVID-19 based on current distribution patterns. This curve, however, far exceeds the current capacity of healthcare institutions and resources. By taking precautions, such as maintaining social distance and washing hands frequently, this curve can be “flattened” — that is, the number of infected people at a given instance can be reduced such that the capacity of healthcare institutions is not exceeded and those infected can receive adequate care [12].

How does social distancing prevent the spread of infection? Expand

Under the circumstances, we are currently under order to practice social distancing, which includes maintaining a six foot distance between ourselves and others [13]. While this might sound like an inconvenience, the practice of social distancing has been found to be quite useful in preventing human-to-human transmission of the disease by reducing exposure rates. As a respiratory disease that is transmitted via direct contact with respiratory droplets and potentially via airborne aerosols, restricting interaction with others who potentially carry the virus reduces the basic reproduction number (R0) of the disease [14, 15]. R0 is the average number of people that will be introduced to a pathogen by a single person with the disease. In January 2020 in Wuhan, China, it is estimated that before travel restrictions were implemented, R0 was about 2.6, and was reduced by about half two weeks post implementation of travel restrictions. The effectiveness of travel restrictions in reducing exposure is directly comparable to that of implementing social distancing [16]. Even if you are wearing a face mask, it is still recommended that you maintain social distancing.

Should I wear a face mask? Expand

Yes, you should wear a face mask whenever you leave your home or when caring for an infected individual in your home. Due to the shortage of N95 and surgical masks in the US, the CDC recommends that all individuals wear cloth masks [17]. While cloth masks cannot completely block viral particles from passing through, they are recommended to reduce risk of infection. When removing your face mask, do so as if it has come into contact with viral particles: 1) do not touch your eyes, nose, or mouth; 2) wash hands immediately after removing. After removing a cloth mask, launder in a washing machine and dryer.

Why does vaccine development take so long? Expand

Vaccine development is a multistep process starting in the lab [18].

Preliminary research: Scientists in academic and governmental research labs around the world spend years finding better methods for vaccine development before it is considered for clinical use.
Preclinical trials: It is then tested in animal models before being approved for clinical trials.
Clinical trials:
- Phase I – small groups (up to 50) of low risk individuals get the vaccine and are monitored for a short period.
- Phase II – expand the number of subjects (up to 1000) and possibly to higher risk individuals.
- Phase III – expand the number of subjects and specifically test at risk individuals.

If the vaccine is deemed efficacious and safe, it is then reviewed and approved by the FDA [18]. In the case of the SARS-CoV-2 vaccine, as of 5/5/20, one candidate has made it to Phase II clinical development, and four more have begun combined Phase I-II trials that determine safety and efficacy at the same time [19]. [20] A chart on Wikipedia shows a list of most potential vaccine candidates and at what stage of development they are in. Please take this resource with a grain of salt.

Can you get COVID-19 more than once? Expand

The short answer is probably not, but we need to wait and see how things develop. There have been stories out of China and Japan where recovered COVID-19 patients have once again tested positive for the virus weeks after their symptoms have cleared. What is most likely in these cases are the tests showing false positives for infection. When our body mounts an immune response, the immune system begins producing pathogen specific antibodies, which provide longer term immunity after a disease has run its course. While the number of antibodies in the bloodstream decreases over time and can make people susceptible to diseases they have already had before, in the case of the COVID-19 virus, it has not been around for long enough for us to determine how long immunity lasts after symptoms clear.

Update: As of July 2020, there have been a few reports of re-infection by the SARS-CoV-2 virus that causes COVID-19, although these claims have many caveats and an individual will most likely not be re-infected by the virus. Firstly, antibody responses to viral infections are long lasting, many of which can protect an individual for life given that a pathogen can be recognized by the antibodies and does not drastically evolve [31]. This is utilized in the case of vaccines like MMR, which protects against measles, mumps, and rubella, and is shown in chickenpox infection where it is very unlikely for an individual to become infected again. In the case of SARS-CoV-2, some studies claim that the antibody response is only strong enough to prevent re-infection up to three months after recovery, yet this claim still cannot be completely substantiated due to other factors affecting the prevalence of the disease. The second aspect concerns this prevalence in the recent claims of new forms of SARS-CoV-2 due to the abundance of mutations [32]. While the virus mutates rapidly and exists as a quasispecies, forms that differ only due to miniscule mutations, in an individual, it is not very likely that a species would evolve to be more virulent or pathogenic than the original. These variants may still spread to other individuals, which may be a reason for “re-infection” due to antibodies not being optimized to recognize the pathogen, and can be mistaken for “new forms” of the virus. Since these mutations are parsimonious, most likely to change one aspect at a time, they can be used to trace and group infections to the point of mutation origin.

What are government plans and policies for the existing pandemic and future emergencies? Expand

After the 2003 SARs pandemic, many nations began to develop contingency plans for pandemics. Internationally, the World Health Assembly updated the International Health Regulations (IHR) to address problems uncovered during the SARS pandemic. However, progress towards the IHR has been uneven due to countries lacking resources to meet standards [21]. In the US, the White House Security Homeland Council outlined general strategies for an influenza pandemic, though strategies could be applied to different pandemics. The national strategy includes funding at both local and national levels, stockpiling of resources, new regulations, and more [22].

From the experiences of nations who have effectively addressed the current crisis, such as New Zealand, their approach can better improve other countries’ handling of the situation. Key aspects of New Zealand’s aggressive pandemic response were travel restrictions, the procuring of personal protective equipment, testing, tracing the spread of the virus from individuals, and a strict lockdown [23]. In total, New Zealand’s nationwide lockdown lasted 51 days total as case numbers eventually dropped to lower numbers. Other nations such as South Korea are currently addressing the pandemic using similar measures while slowly allowing businesses, schools, and other services to reopen.

What are the regulations for in-person classes at schools and universities? Expand

Schools are especially a complex situation because they are unique social environments that SARS-CoV-2 can spread easily in. The reopening of schools requires detailed planning on both the roles of administrators and students. Administrators have the responsibility to communicate, educate, and reinforce appropriate SARS-CoV-2 mitigation strategies, which includes the possibility of adjusting in co-curricular and extracurricular activities to limit spread of disease [24]. Canada, for example, announced fall plans that allow children to freely socialize in groups of six as long as groups are appropriately socially distanced from other groups [25]. Children wearing masks is already an accepted norm in nations such as China, Korea, Japan, and Vietnam especially during flu season. However, that is not true for all nations, as Canada, Denmark, and Norway, among others have made masks optional for both students and staff [25].

Whatever the US’s national policy prescribes, the CDC’s guidance is meant to supplement local rules laws, rules, and regulations already in place. In essence, schools and their communities will have the freedom to specifically determine how they will be reopened as long as they follow fundamental guidelines such as social distancing, hand hygiene, the creation of a contingency plan if a person is diagnosed.

What is the difference between “vaccines” and “disease treatments/therapies”? Expand

Vaccines are for those who have not been infected with a certain disease before and are typically composed of parts of a virus or bacteria that do not cause disease, but are recognizable by an individual immune system as harmful to the body. There are five types of vaccines that you can receive: live-attenuated, inactivated, subunit, conjugate, and toxoid. Live-attenuated vaccines are weak forms of the pathogen that are unable to cause major disease, while inactivated vaccines utilize a “dead” form of the pathogen [26]. These are commonly categorized as “whole-cell vaccines.” As the name suggests, subunit vaccines are fragments of a pathogen that have a pathogen recognizable feature, such as genetic material or proteins. Toxoid vaccines fall under a similar principle as subunit vaccines, but utilize a toxin or excreted substance from a pathogen instead. Lastly, conjugate vaccines manufactured and adapted pathogen fragments that are made to stimulate long term memory of the pathogen. In terms of SARS-CoV-2 in July of 2020, there are two promising vaccines that are approaching larger scale trials, as referenced aside [27, 28]. Conversely, treatments are for those who are currently in the throes of an infection for the alleviation of the disease, and include a number of different drugs that are currently being explored, and are regularly being re-evaluated for effectiveness [29]. Treatments can vary greatly depending on the disease, but can typically include chemicals that prevent the growth of a pathogen [30]. Both can take a long time to develop and ensure the safety of the drug, but due to the nature of the pandemic, these steps are being expedited at an unprecedented rate.

When are you “clear” of the virus? Expand

Symptoms of COVID-19 can occur anytime between 2 to 14 days post infection by the SARS-CoV-2 virus. Prior to the onset of symptoms, an individual is still able to transmit the disease to persons in close contact via touching infected surfaces and inhalation of infected air. Symptoms typically occur for one to two week and may not necessitate emergency medical treatment [33]. Individuals who believe they have contracted COVID-19 should still inform and follow precautions outlined by their health provider to ensure the safety of the individual and their loved ones. In more severe cases, symptoms can last six weeks or more, and may necessitate emergency medical treatment, specifically the need of a respirator. Post recovery data on possibility of transmission and the recurrence of symptoms is not definitive due to the course of the pandemic. In accordance, some studies have claimed the persistence of viral RNA in an individual’s body up to 33 days after symptom onset and into symptomatic recovery from the disease [34]. For the duration of the disease and the immediate time following symptomatic recovery, it is imperative that individuals follow precautions to prevent further transmission of the disease onto others.

Who can get the virus? Expand

In summary, everyone. Adults over 65 years old are more likely to develop serious symptoms leading to a major illness or even death. However, there have been many cases of healthy young adults requiring hospitalizations. Also, individuals with preexisting medical conditions such as hypertension or diabetes, must take avid preventative measures considering the higher risk of developing a serious case of COVID-19.

Why should you wear a mask despite being asymptomatic? Expand

Being asymptomatic, or lacking symptoms, does not mean an absence of infection; on the contrary, a person can host the virus yet be relatively well. Produced by breathing, respiratory droplets can expel the virus from inside the asymptomatic person to the environment, thereby spreading it to other people [35]. Even though the grids on a mask are too big to trap the virus itself, they are effective in catching these contaminated droplets [36].

References Expand

COVID-19 FAQ

COVID-19 Frequently Asked Questions