Category: Covid-19

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New rapid Covid-19 testing kit can return results in 15 minutes but not yet available in Australia – The Guardian

March 18, 2020

The federal health department says it sees merit in a newly developed rapid Covid-19 testing kit able to return results within 15 minutes, which experts say could help relieve significant pressure on pathology services.

Australias chief medical officer, Brendan Murphy, has warned the country faces extreme pressure supplying enough testing kits as the rate of infection continues to skyrocket, warning last week that the number of pathology testing kits, reagents and swabs was deteriorating rapidly with some regions now completely out of supplies.

The government has so far refused to say how many testing kits remain in the country, although the health minister, Greg Hunt, said on Tuesday the supply was sufficient for current requirements.

As the virus spread in Wuhan, Chinese researchers developed a more rapid point of care screening test, which detects antibodies that emerge some time after Covid-19 symptoms appear. A study in the peer-reviewed Journal of Medical Virology said the test could return results within 15 minutes, much faster than the current standard testing.

The test known as the COVID-19 IgG/IgM Rapid Test Kit is not currently in use in Australia, but the Guardian understands some companies are seeking to supply it onto the market.

A spokeswoman for the Department of Health said the rapid test had merit and that there were no compelling reasons not to use it based on the described science and methodology.

But she said the company behind it, the Nantong Egens Biotechnology Company Ltd, had not yet approached the regulator, the Therapeutic Goods Administration, for assessment and approval.

Such a device would need to be approved through the TGAs in-vitro diagnostics regulatory scheme before use, the department said.

The company has had the test validated by laboratories in Europe and China. But the spokeswoman said the same would need to occur in Australia.

Tests also require validation by testing laboratories in the Australian context before use, she said.

The Department of Health, in collaboration with the Public Health Laboratory Network, is monitoring the development of test kits and methodologies and their performance as they are used more widely around the world.

In Australia, a company called COVID-19 Rapid is representing three manufacturers seeking to get TGA approval for the rapid tests. A company spokesman said: Our TGA consultants have told us that unlike the US and Europe, securing approval will take too long and be very expensive.

Experts approached by the Guardian said the testing had potential benefits and drawbacks. The testing does not require a laboratory, which could help alleviate pressure on Australias pathology services and the rest of the health system.

Peter White, a virologist from the University of New South Wales, said if it were possible for rapid tests to be used by people at home it would help take the burden off an already strained health system.

These tests will be useful for sure, they could keep infected people out of the health system and they do also provide peace of mind, he said.

There are certainly some advantages. If someone thinks they have the virus and can do the test at home in 15 minutes thats someone who isnt presenting at a hospital, GP or pathology lab.

Even if you received a false positive, if you were able to take the precaution of having it backed up with [a traditional test] it would be good. If people received a negative result, they might be less inclined to visit the clinic which is going to free up hospital resources.

But, he stressed, the tests were not always as reliable as those currently being used in Australia. Because rapid test kits look for antibodies associated with the virus rather than the virus itself, they could record false-negatives if used at the wrong time.

The question is how significant those limitations are. It depends really on how many true cases you detect. Does it detect every positive, or does it miss 5%? he said

Because if you have to back up every test with a lab pathology test it might defeat the purpose a little bit.

Bill Bowtell, an infectious diseases expert from the Kirby Institute, said while there was no shortage of medical supply companies looking to profit off the Covid-19 crisis, the TGA would need to consider the kits closely.

In the end, anybody with anything to sell is in the market and their interest is to make the biggest claims, he said.

I think thats the case with a lot of the things that well see coming onto the market. Theres uncertainty because it didnt come to market after stringent testing, it came to the market because theres a feeling of my god we need it.

In normal circumstances you wouldnt touch it with a barge pole but this is what happens when theres a crisis.

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New rapid Covid-19 testing kit can return results in 15 minutes but not yet available in Australia - The Guardian

Retired and student medics may be called in to tackle Covid-19 in UK – The Guardian

March 18, 2020

Retired or not fully qualified nurses and other medical staff could be called in to help tackle the coronavirus pandemic, and given protection against any negligence claims, among a sweeping range of measures planned under emergency legislation.

Another possible power would allow police or immigration officers to detain a person for a limited but unspecified period if they might be infectious and to take them to a suitable place to enable screening and assessment.

The laws, expected to be introduced to the Commons on Thursday, will also give ministers the power to ban gatherings or events and temporarily close schools and colleges in the effort to curb the spread the virus.

An outline of the planned new laws, released on Tuesday evening, says the measures will be time-limited to two years and will not all come into force immediately, allowing the UK and devolved governments to switch on these new powers when they are needed.

It adds: The measures in the coronavirus bill are temporary, proportionate to the threat we face, will only be used when strictly necessary and be in place for as long as required to respond to the situation.

A key change would be to allow medical regulators to create emergency registrations for suitable people to become nurses, midwives or paramedics, such as those who have recently retired and students near the end of their training. The document does not mention doctors in relation to this.

They would be given indemnity for clinical negligence liabilities arising from NHS activities linked to the coronavirus outbreak, where none was in place.

Measures to encourage returnees would include suspending a rule that stops some NHS staff who return after retirement from working more than 16 hours per week, ensuring they do not lose out under pensions.

Other measures are intended to help ease pressures on NHS staff, such as changing mental health legislation so people seen as being a risk to themselves or others can be forced to have treatment on the opinion of just one doctor, not two.

Time limits as to when such people must be allowed to leave will also be extended or removed as needed.

Also, the obligation on some councils in England and Wales to provide certain statutory social care services could be eased to ensure the most urgent and serious care needs are met, even if this means not meeting everyones assessed needs in full or delaying some assessments.

While government guidance on avoiding pubs, bars and other crowded places is now voluntary, the new laws will allow the government to restrict or prohibit events and gatherings during the pandemic in any place, and to temporarily close educational establishments and childcare providers.

Another possible power would allow ministers to close ports or airports if too many Border Force staff are off sick. Others will expand the use of video and audio links in court proceedings.

A notably gloomy section is connected to the expectation of a rise in deaths, with one allowing a greater range of people, among them funeral directors, to register a death for the family.

A final part gives the power to extend statutory sick pay to all days off work, as promised by ministers.

Matt Hancock, the health secretary, said any new measures will only be used when it is absolutely necessary and must be timed to maximise their effectiveness, but crucially they give the government the powers it needs to protect lives.

He added: By planning for the worst and working for the best we will get through this, but this is a national effort and we must all work together from businesses prioritising the welfare of their employees, to people thoroughly washing their hands.

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Retired and student medics may be called in to tackle Covid-19 in UK - The Guardian

Hospital in Boston will be converted into Covid-19 treatment center – STAT

March 18, 2020

A Texas-based health care system announced Tuesday that it would convert one of its hospitals in Boston into a treatment center specifically for patients with Covid-19, taking special measures to clear the air of contamination and increasing its supply of ventilators and personal protective equipment.

The company, Steward Health Care, said Carney Hospital, located in Bostons Dorchester neighborhood, would become the nations first dedicated care center for treating patients with Covid-19, the disease caused by the novel coronavirus.

In a statement Tuesday, Steward Health Care said, among other measures, crews are adding negative pressure systems that clear the air of any contamination. The goal is to ensure that people who are hospitalized with severe Covid-19 infections can receive the dedicated care some require, as well as to allow regular operations at the companys other sites.

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We are prepared for an influx, the company said, though, as of now, the companys hospitals nationwide have treated just 10 patients with confirmed infections. The company, which is based in Dallas, has 35 community hospitals in nine states.

A significant amount of our resources remains centralized, ready to be deployed or redeployed across our different regions if and when they are needed, the company said.

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Hospitals around the country have already been allotting certain floors to treat Covid-19, canceling elective surgeries and other procedures that can be delayed, and postponing some appointments.

The concern is that a crush of Covid-19 patients could require all of a hospitals resources and equipment. Though its estimated that only a few percent of infections cause critical disease, a rapid spread of the virus throughout communities could still leave thousands of patients requiring intensive care and needing to be put on ventilators for long stretches of time.

Already, some hospitals have reported shortages of personal protective equipment like masks, gloves, and gowns, and some providers have said they have resorted to cleaning and reusing supplies they would have normally discarded. Though the availability of supplies varies around the country, some facilities have said theyre facing a lack of basic materials as well, including nasal swabs that are needed to conduct test for the virus.

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Hospital in Boston will be converted into Covid-19 treatment center - STAT

78 cases of COVID-19 confirmed in Tennessee – NewsChannel5.com

March 18, 2020

What is COVID-19 (a.k.a. the new coronavirus?)

According to the World Health Organization, coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases. Examples include the Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans. COVID-19 stands for "Coronavirus disease 2019," which is when this strain of the coronavirus was discovered.

What are the symptoms?

The CDC says patients confirmed to have the 2019-nCoV reportedly had mild to severe respiratory illness with:

Prevention

The CDC is recommending "common sense" measures such as:

Governor Bill Lee's guidance for mass gatherings, schools, state employees and the state capitol building to prevent the virus' spread:

Mass Gatherings

The CDC recommends gatherings of 10 people or more in the U.S. be canceled or postponed over the next eight weeks. The CDC added this advisory does not apply to placed of business and schools.

Schools

Tennessee schools are urged to close as soon as practically possible, with all schools expected to close by March 20. Schools should remain closed through March 31 to further mitigate the spread of the infectious disease.

State Employees, Business Travel

Effective immediately, state employees who have been trained and certified to work from home within the states Alternative Workplace Solutions (AWS) program will work from home through March 31, 2020. Approximately 11,000 state employees are certified AWS employees and can begin work from home with no disruption to state business.

Effective immediately, state employees have been instructed to cease all non-essential business travel through March 31, 2020.

Tennessee State Capitol Closed to Visitors

The Tennessee State Capitol is closed to tours and visitors through March 31, 2020. Members of the media will continue to have access to the State Capitol building.

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78 cases of COVID-19 confirmed in Tennessee - NewsChannel5.com

COVID-19: Mental health in the age of coronavirus – UN News

March 17, 2020

As WHO and health authorities across the planet act to contain the outbreak, advice on safeguarding your mental health, have been developed by the UN health agencys Department of Mental Health and Substance Use.

WHOs 31-point guidance specifically targets the general population; healthcare workers; health facility managers; childcare providers; older adults, care providers and people with underlying health conditions; and those who are living in isolation to try and contain the spread of the pandemic.

Be empathetic to all those who are affected, in and from any country, WHO highlights first, warning against stigmatizing anyone who has or had the virus.

It also recommended that you seek information updates from trusted sources only and at set times once or twice a day.

The sudden and near-constant stream of news reports about an outbreak can cause anyone to feel worried, said WHO. Get the facts; not the rumours and misinformation.

The website and local health authorities platforms can help to separate facts from speculation.

The UN Health agency also points to the benefits of helping others, such as by phoning neighbors or community members who may need some extra assistance.

Working together as one community can help to create solidarity in addressing COVID-19.

The UN health agency reminded everyone to honour caretakers and healthcare workers[for] the role they play to save lives and keep your loved ones safe, while assuring healthworkers that it is normal to feel under pressure and emphasizing that stress is by no means a reflection that you cannot do your job or that you are weak.

WHO urged them to rest sufficiently, eat healthy foods, get physical activity and stay in contact with family and friends.

This is a unique and unprecedent scenario for many workers, particularly if they have not been involved in similar responses, said WHO, with the reminder that this is not a sprint, its a marathon.

WHO advises that protecting staff from chronic stress and poor mental health will provide them with the capacities they need to perform their duties.

And focusing on the longer term rather than short-term crisis responses, team leaders or health facility managers are encouraged to deliver quality communication and accurate information updates to all staff.

WHO outlined the benefits in rotating workers from higher- to lower-stress functions and in partnering inexperienced workers with those who are more experienced, to provide reassurance.

Maintaining that the buddy system helps to provide support, monitor stress and reinforce safety procedures, WHO advocated for outreach personnel to work in pairs and to initiate, encourage and monitor work breaks.

When caring for children, WHO underscored the importance of helping them to find positive ways to express feelings, such as fear and sadness.

Children feel relieved if they can express and communicate their feelings in a safe and supportive environment, the UN health agency maintained, encouraging that if safe, they be kept close to their parents and family.

If not, regular contact with parents should be maintained, such as twice-daily scheduled phone or video calls.

As older adults and people with underlying health conditions who are vulnerable, may become more anxious, agitated and withdrawn during the outbreak, WHO stressed the importance of relaying clear instructions in a concise, respectful and patient way, noting that pictures may also be utilized.

Engage their family and other support networks to provide information and help them practice prevention measures, including handwashing, the UN health agency said. And when in isolation, stay connected and maintain daily routines, as much as possible.Keep things in perspectiveand avoid listening to or following rumours, concluded WHO.

Meanwhile, the UN Population Fund (UNFPA) has recommended that breastfeeding women who become ill should not be separated from their newborns.

While there is no evidence that the illness can be transmitted through breastmilk, UNFPA urged mothers who are infected to wear a mask when near their baby, wash their hands before and after feeding, and disinfect contaminated surfaces.

If a mother is too ill to breastfeed, she should be encouraged to express milk for the baby, while taking all necessary precautions, the UNs womens health agency said. Mental health and psychosocial support should be made available to affected individuals and their families.

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COVID-19: Mental health in the age of coronavirus - UN News

White House provides an update on COVID-19 testing in the U.S., says theres been a dramatic ramp – TechCrunch

March 17, 2020

During a White House press briefing on the state of the COVID-19 pandemic in the U.S., members of the White House coronavirus task force provided updates about the current state of coronavirus testing in the U.S. Given that the World Health Organization has said that testing is perhaps one of the most important parts of any effective method of combatting the outbreak, this is a crucial metric to track.

As we talked about earlier this week, the commercial system is rapidly advancing in the testing capabilities, explained task force member Admiral Brett Giroir. As of today our public health laboratories, meaning the CDC and the public health labs, have reported out 31,878 tests so almost 32,000 tests. The clinical laboratories, the Association of Clinical Laboratories, have reported out about 27,000 tests, and most importantly of those 27,000 during the cumulative period of time 8,200 of them were yesterday.

That brings the total number of tests conducted between these sources to just under 60,000, which Giroir said represents a dramatic ramp as the high-throughput [testing] comes in. He also noted that we dont yet have numbers reported from individual hospital labs that are also conducting testing, and that fellow task force member Ambassador Deborah Birxs forthcoming legislation will provide more clarity on the actual number, as it rolls all testing sources into a common reporting structure. This reporting arrangement should be in place by early next week, he said.

In terms of our drive to laboratories, again, these are blossoming all over the country, Giroir said. By individual states, the ones that we are heavily involved in, in really pushing equipment to, we expect over the next few days to be again setting up 47 of these in approximately 12 states. The material is already palletized and being shipped to the locations, most cities have the specific locations, some do not but its still gone to a central receiving, and we know that well be deploying at least 140 Commissioned Corps officers, and about half of the sites have reported their requirements, but 140 officers will be going and we expect that to go up.

Giroir added that they set up and ran a trial site of these mobile testing locations on Monday, with a full staff complement, and noted that while they had a lot of kinds in the system as you can expect, he added that this is the reason they do testing and people shouldnt expect them to be perfect when they first come online.

Ambassador Brix also said regarding testing that she believed we would see in the next few weeks that other tests that were used around the world were not of the same quality as the ones that are being deployed in the U.S., and that have been approved by the FDA for use by private labs. These provided more false positives and false results than the tests that will be in use in the U.S., she said, leading to potentially inaccurate data.

The U.S. reportedly refused use of WHO-prepared coronavirus testing kits early on in the COVID-19 outbreak, opting instead to develop its own via the CDC, though Admiral Giroir said that as far as he could discern, no one made an offer that the U.S. could refuse.

Testing should not be used as an assessment of your risk, Brix also added, noting that everyone should still follow the recommendations issued by the White House to maintain social distance and avoid groups of 10 or more individuals. She urged everyone, and young people especially who might think that because they dont feel sick or arent in as serous risk, to follow the guidance and stay home if possible.

Task force member Dr. Anthony Fauci addressed the interrelationship between testing and the social distancing and isolation guidelines. He clarified that even if we had no testing, we should be doing what were doing now, but stressed that testing was indeed important for providing healthcare workers and those working on strategy with an idea of what theyre dealing with, and the effect its having. He also noted that we shouldnt be looking at daily figures regarding confirmed cases as a good indicator of what impact distancing and other strategies are happening, since well only see how these efforts are playing out over a longer period of time.

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White House provides an update on COVID-19 testing in the U.S., says theres been a dramatic ramp - TechCrunch

Covid-19: How long does the coronavirus last on surfaces? – BBC News

March 17, 2020

As Covid-19 has spread, so has our fear of surfaces. There are now some familiar scenes in public places around the world people trying to open doors with their elbows, commuters studiously surfing their way through train journeys to avoid grabbing a handle, office workers rubbing down their desks each morning.

In the areas worst hit by the new coronavirus, teams of workers in protective clothing have been dispatched to spray a fog of disinfectant in plazas, parks and public streets. Cleaning regimes in offices, hospitals, shops and restaurants have been increased. In some cities, well-meaning volunteers even venture out at night to scrub the keypads of cash machines.

Like many respiratory viruses, including flu, Covid-19 can be spread in tiny droplets released from the nose and mouth of an infected person as they cough. A single cough can produce up to 3,000 droplets. These particles can land on other people, clothing and surfaces around them, but some of the smaller particles can remain in the air. There is also some evidence that the virus is also shed for longer in faecal matter, so anyone not washing their hands thoroughly after visiting the toilet could contaminate anything they touch.

It is worth noting that, according to the Centers for Disease Control and Prevention, touching a surface or object with the virus and then touching one's own face "is not thought to be the main way the virus spreads". Even so, the CDC, the World Health Organization and others health authorities, have emphasised that both washing one's hands and cleaning and disinfecting frequently touched surfaces daily are key in preventing Covid-19's spread. So although we still don't know exactly how many cases are being caused directly by contaminated surfaces, experts advise exercising caution.

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One aspect that has been unclear is exactly how long SARS-CoV-2, the name of the virus that causes the disease Covid-19, can survive outside the human body. Some studies on other coronaviruses, including Sars and Mers, found they can survive on metal, glass and plastic for as long as nine days, unless they are properly disinfected. Some can even hang around for up to 28 days in low temperatures.

Coronaviruses are well known to be particularly resilient in terms of where they can survive. And researchers are now beginning to understand more about how this affects the spread of the new coronavirus. (Read more about the global fight against Covid-19.)

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Covid-19: How long does the coronavirus last on surfaces? - BBC News

Coralville company to produce millions of kits to test for COVID-19 – KCRG

March 17, 2020

CORALVILLE, Iowa (KCRG) - The CDC has approved a company in eastern Iowa to start making large quantities of kits to test COVID-19.

Integrated DNA Technologies in Coralville announced Monday it got approval to make the test kits. They're called 'primer and probe' kits.

We are honored to be the first company in the nation to have our primer and probe kits approved by the CDC for use as a key component of the CDC EUA testing protocol for the diagnosis and detection of COVID-19, said IDT President Trey Martin.

Starting this week, the company is expected to make 5 million kits a week.

We continue to scale production to meet demand and we are in close communication with the CDC and U.S. Food and Drug Administration (FDA). IDT will also continue to supply its key component to laboratories, which may assist them in the development of a COVID-19 vaccine, Martin added.

IDTs recent history includes providing products to test for H1N1, Ebola virus, and Zika virus.

Click or tap here to see the full release from IDT.

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Coralville company to produce millions of kits to test for COVID-19 - KCRG

Number of COVID-19 cases in Erie County rises to 11, new case confirmed in Wyoming County – WIVB.com – News 4

March 17, 2020

BUFFALO, N.Y. (WIVB) The number of COVID-19 cases in Erie County has risen by four, now reaching a total of 11.

Two of the women who tested positive are in their 50s. One is currently isolated at home, while the other is hospitalized.

The other two new cases were contracted by men one in his 30s, and another in his 40s. Both recently traveled out of state.

Anyone who was at any of the following locations at the listed times should monitor themselves for symptoms of COVID-19 (fever, coughing, shortness of breath). Symptoms may appear 2-14 days after exposure.

Some recently traveled downstate, others outside of New York, and at least one recently came back from Italy. We know that at least some of them live in Buffalo, Clarence, Grand Island, Amherst, Elma and Orchard Park.

One of them works at Tops corporate headquarters in Williamsville. After last working on March 9, they are now quarantined at home. That employee had no contact with any supermarkets or warehouses.

A worker at the M&T Plaza in Buffalo is another one of the people confirmed to have coronavirus. M&T says the employee recently traveled out of state, and began experiencing flu-like symptoms before electing to self-quarantine. The worker was described as a non-customer facing colleague.

Outside of Erie County, two cases have been confirmed in Allegany County, and another has been confirmed in Wyoming County.

During a conference on Tuesday afternoon, Poloncarz said the county currently has less than five days worth of blood ready for those who need it.

Because of that, Poloncarz encouraged people to donate if possible.

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Number of COVID-19 cases in Erie County rises to 11, new case confirmed in Wyoming County - WIVB.com - News 4

Coronavirus tips and symptoms: What everyone should know about getting the new coronavirus – Vox.com

March 17, 2020

With the United States now facing its own serious coronavirus outbreak, its natural to wonder whether youll get the respiratory illness and what you can do about it. As of March 16, more than 3,900 cases and dozens of deaths have been reported in the US, according to the New York Timess tracker. But due to a lack of widespread testing, its likely the outbreak is much bigger.

One respected modeler, Trevor Bedford, a computational biologist at Fred Hutchinson Cancer Research Center in Seattle, says there may already be around 20,000 cases in the US. Marty Makary, a professor of medicine at Johns Hopkins University, told Yahoo Finance that the number of current infections could be between 50,000 and 500,000. Were about to experience the worst public health epidemic since polio, Makary said.

As further evidence of widespread unreported cases, Marc Lipsitch, director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health, pointed out on Twitter to the CDCs National Influenza Surveillance Report, which regularly tracks symptoms similar to those of Covid-19. He noted that symptoms such as fever, coughs, and sore throats are trending up, while confirmed flu cases are going down.

As the coronavirus spreads, its become a nationwide crisis that could severely strain our health care system. The elderly and chronically ill are particularly susceptible to severe Covid-19 illness, and tens or hundreds of thousands of them could require hospitalization in the coming weeks and months. So we need to take collective measures now to protect ourselves and others. Heres what you need to know:

There are a lot of acronyms floating around, so first, just know that the SARS-CoV-2 virus (the coronavirus) causes the disease Covid-19. The virus is most commonly spread by close contact with infected people who are within 6 feet of each other. When they cough or sneeze, they send droplets into the air, where they can land in the mouths or noses of people who are nearby, or possibly get inhaled into the lungs. Droplets containing the virus can also land on surfaces and objects where the virus can survive for some time.

According to a preprint paper (a study that hasnt yet been peer-reviewed) from researchers at the National Institutes of Health, Princeton, and UCLA who studied the novel coronavirus in a lab, it can survive for up to 24 hours on cardboard and for up to two or three days on plastic and stainless steel. (Another study suggests it can stay infectious for up to nine days.)

The danger of infection here is touching one of these surfaces and then touching your eyes, nose, or mouth. The CDC, however, says that this is not thought to be the main way the virus spreads.

Some diseases, like measles, can also be transmitted through aerosols, meaning that when someone coughs, tiny droplets filled with virus linger in the air, sometimes for hours, where others can breathe them in. Currently, theres limited evidence of the coronavirus being transmitted this way, but its worth noting. One preprint found the virus in aerosol form in hospitals in Wuhan, and others agree that there is a higher risk of doctors and nurses being infected through aerosols. Theres also growing evidence of fecal-oral transmission, meaning you can ingest the virus shed in feces through inadequate hand-washing or contaminated food and water.

The good news is that transmission can be prevented. Good personal hygiene and social distancing can be very effective. Im not one of those people who normally goes crazy about hand-washing, says Megan Murray, an infectious disease specialist and professor of global health at the Harvard School of Public Health. Now I really am, because that will help reduce [the] virus on your hands.

Washing your hands frequently and carefully for at least 20 seconds is better than using hand sanitizer because it actually destroys the chemical structure of the virus. Any old soap will break the viruss outer coating, and you dont need special antibacterial soap. If soap and water arent available, use hand sanitizer with 60 percent alcohol (no, this doesnt include Titos vodka).

New research suggests that people may be most infectious early in the disease (and even before symptoms start), meaning that as soon as you start to feel ill, its important to self-isolate. You dont need to be coughing to be contagious; the linked preprint suggests that somewhere between 48 and 66 percent of 91 people in a cluster in Singapore were infected by someone without symptoms.

This makes taking precautions now like canceling your travel plans and social gatherings even more important. The effectiveness of widespread travel bans, especially when community transmission is already occurring, is being hotly debated, but in general, minimizing social contact is the best method of prevention.

Avoid handshakes or hugs with people whove been out and about, and whenever possible, stay at least 6 feet away from others. This includes minimizing or avoiding play dates, sleepovers, shared meals, going out to eat, and visits friends and family members homes.

Also important to know is that according to one study from China, around 25 percent of all cases may originate in people who have no symptoms another reason social-distancing measures are so important.

The most common symptoms of Covid-19 are a fever, seen in almost 90 percent of patients, as well as a dry cough and shortness of breath. A study of 71 patients in China also suggests that a significant portion of coronavirus patients experience diarrhea, nausea, or vomiting, sometimes before respiratory symptoms begin. The World Health Organization (WHO) says these symptoms typically come on gradually.

Around 80 percent of Covid-19 cases are reportedly mild, but as James Hamblin of the Atlantic noted, that word can be misleading:

As the World Health Organization adviser Bruce Aylward clarified last week, a mild case of COVID-19 is not equivalent to a mild cold. Expect it to be much worse: fever and coughing, sometimes pneumoniaanything short of requiring oxygen. Severe cases require supplemental oxygen, sometimes via a breathing tube and a ventilator. Critical cases involve respiratory failure or multi-organ failure.

The incubation period before symptoms appear ranges from two to 14 days, but the median is 5.1 days. If youve been around someone who has a confirmed diagnosis of Covid-19 or displays its symptoms, the most responsible thing to do is to self-quarantine for two weeks.

Yes, you do.

The reason is that social distancing works best if everyone young and old, healthy and infirm practices it. No one has immunity, and everyone can get sick and spread the virus to others.

The more young and healthy people are sick at the same time, the more old people will be sick, and the more pressure there will be on the health care system, Emily Landon, an infectious disease specialist and hospital epidemiologist at the University of Chicago Medical Center, told Voxs Eliza Barclay and Dylan Scott.

Without protective measures, one person on average infects 2.5 others, and cases will spread exponentially. That means hospitals and medical staff will quickly become overwhelmed. At least 5 percent of Covid-19 patients may need intensive care, and many require hospitalization for weeks.

Even if youre not at a statistically higher risk of dying from Covid-19, its important to flatten the curve and adopt social-distancing measures immediately to prevent the most deaths.

Also, just being young and healthy is not a guarantee of mild illness. The epicenter of New Jerseys outbreak of Covid-19, Holy Name Medical Center, had 11 confirmed Covid-19 cases on March 14, six of which were in the ICU, with ages ranging from 28 to 48.

If you have one or more symptoms of the new coronavirus, call your doctor. If you are older or have underlying medical conditions, its even more important to call your doctor, even if you have only mild symptoms, according to the CDC. Before you go to your doctors office, Murray says you should call ahead so that medical staff can wear the appropriate protective gear and be ready to help take care of you without exposing others. Many health care facilities are requesting that you wear a mask if you have symptoms and are going in for testing.

Your doctor will determine whether you should be tested; if a test is ordered, you can expect a nasopharyngeal swab, where a tiny Q-tip is put up your nose a few inches not a fun procedure, but it doesnt hurt. Its then sent to a lab and put through a process called a polymerase chain reaction, which detects specific genetic material within the virus. How long it takes to get results back varies, but in the US, its currently taking a few days.

If youre concerned about the cost of getting tested which Rep. Katie Porter (D-CA) estimated at $1,331 the CDC recently committed to covering the cost of testing for all Americans regardless of insurance status, although when and how that will be implemented is yet to be announced. Currently, 1,000 insurers have waived treatment fees, and some cities and states like New York have said they will waive cost sharing for tests. This is important because if [insurers] dont cover treatment, you have to expect fewer people will go to get tested, says Jennifer Flynn, who runs health care campaigns for the Center for Popular Democracy.

Many people who know theyve been exposed are currently having difficulty actually getting tested. Flynn says her colleague developed similar symptoms after sharing a cab with CPAC participants, a conference in DC where multiple people fell sick from Covid-19.

Thats true even in Covid-19 hot spots. Helen Teixeria, a resident of Redmond, a suburb of Seattle, one of the nations outbreak epicenters, says she woke up last week with a tight chest, fever, and a dry cough.

First, she called the King County hotline and was told to call her primary care provider. Her doctor told her to go to the emergency room, where the hospital didnt follow standard isolation protocol and medical staff did not wear basic protective gear. Teixeria said she was unable to get a Covid-19 test because they were being tightly rationed for high-risk and hospitalized patients. Nor was she allowed to get a two-view chest X-ray so that I didnt contaminate the X-ray room, she says. A sympathetic nurse eventually slipped her off-the-record information on a private clinic where she might be able to get a Covid-19 test next week.

After you call your doctor, stay home, says Tom Frieden, former director of the CDC. It sounds like overly simple advice, but its the best thing you can do. Next, you should self-isolate, including staying away from anyone you live with.

If youre not in one of the CDCs high-risk categories, trying to see your doctor may actually expose you further. The single place youre most likely to encounter people with coronavirus is the hospital, so thats the last place you want to be if youre afraid of getting infected, Murray says. And if, in your quest to get tested, you go to multiple health care centers, youll be exposing health care workers in each location.

If you think you might have Covid-19 and frankly, even if you dont, so that you avoid possibly spreading it before you have symptoms avoid all public areas. This means dont go to school or work, and try to avoid taking public transportation, including ride-hailing services like Uber, Lyfts, and taxis. If you dont have adequate supplies at home, consider asking friends or family to make a delivery to your door rather than going out yourself. Dont let friends come visit while youre recuperating; instead, stay connected by phone or online.

If youre worried about quarantining in a home where you dont feel safe, 24/7 help is available from the National Domestic Violence Hotline. Call 1-800-799-7233 or text LOVEIS to 22522.

Self-care [for coronavirus] is very similar to other upper respiratory infections, says Elisa Choi, an infectious disease and internal medicine specialist in the Boston area. Over-the-counter medications, like cough suppressants, can help minimize coughing episodes, and expectorants can help you cough stuff up.

Pain relievers and fever reducers like acetaminophen (brand name Tylenol) and ibuprofen (Advil) can help treat muscle aches and reduce fevers.

Although Frances health minister warned that anti-inflammatories like ibuprofen and cortisone could aggravate the illness, other scientists are skeptical.

There are multiple assumptions that are made with that hypothesis that cant be made without being tested, Angela Rasmussen, a research scientist at Columbia Universitys Center for Infection and Immunity, told Vox. To my knowledge theres no evidence that ibuprofen makes [Covid-19] worse.

Choi also urges using common sense to manage symptoms. If youre feeling congestion, you can try taking a hot shower or steam, she says. Sleep and water are always good advice. The CDC says that drinking enough water every day is generally good for your overall health.

Choi and other medical professionals warn against circulating misinformation about home remedies, such as whats happening with an email erroneously claiming to be from Stanford. These remedies include holding your breath without coughing and keeping your mouth moist. Many of these treatments are unproven, and some can be dangerous. (For example, you can overdose on zinc.)

This is really a time to stick with the facts, Choi says. Stay away from things that are being promoted for sale without a known background. She recommends always checking with your doctor if you have questions about the veracity of a particular source. The CDC and WHO, as well as your local and state public health departments, are good sources of updated, verified information.

Choi says that suspected or confirmed Covid-19 patients should stay in their own room and (ideally) not share a bathroom.

They should try to stay as far away as possible from anyone else in the household, and at least 6 feet, she added. If you do share a bathroom, avoid being in the room at the same time as anyone else. The WHO found that most of the transmission in China was between family members.

If the sick person feels up to it, ideally they should be the one to disinfect the bathroom after they use it. If your living situation doesnt allow you to isolate yourself from others in your home, tell your doctor and/or health department.

The CDC has a complete guide to disinfecting commonly touched surfaces like counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables, and it recommends doing so every day. You can use one of the approved products or make your own, like adding four teaspoons of bleach to a quart of water. The CDC also recommends wearing gloves when touching possibly infected items, like used clothing or bedding, as well as when disinfecting commonly used surfaces. When youve finished, throw the gloves directly in the garbage and then wash your hands.

Choi suggests washing your hands frequently to protect others in your household, and covering your nose and mouth when you cough or sneeze with a tissue that you throw directly into the garbage. If youre feeling ill, dont share cups, utensils, dish or bath towels, toothpaste, bedding or anything else with anyone. The coronavirus can stick around on surfaces for several days.

Choi recommends closely monitoring your symptoms. Its less about a number and more about the progression, she says. Generally, a low-grade fever is considered less than 100.4, but older people are generally less likely to mount a fever response. The main thing to watch for is symptoms getting worse. For example, if you initially have a mild cough but start to have prolonged bouts, or if coughing becomes painful, she recommends calling your doctor again.

The CDC says that you should seek medical attention immediately if you have difficulty breathing or shortness of breath, persistent pain or chest pressure, an onset of confusion or the inability to stay awake, and bluish lips or face. If you do decide to go to the hospital, make sure to call ahead so the hospital can prepare to admit you without exposing others. If you already have a mask at home, this would be a good time to wear it; if you dont, please dont go buy one. There is a severe shortage, and medical staff need them.

Know that if you do go to the hospital, there is currently no treatment for Covid-19. Remdesivir, an antiviral drug, is in clinical trials, but right now, doctors are limited to providing supportive care such as supplemental oxygen.

While theres still a lot we dont know, Murray says that you should self-isolate for at least 14 days after your initial symptoms. (There have been a few reports of patients shedding viruses for up to 28 days, but those appear to be outliers.) This means avoiding contact with everyone. (Read Voxs guide to self-isolation here.)

For her part, Choi recommends minimizing all contact until your doctor or a public health department tells you that you are no longer contagious.

Measures for pandemic control can be stressful, Choi says, especially for people who may have challenges with being isolated. This feeling may get worse over the next few weeks, as current social-distancing measures are likely to be extended. Such measures can also cause financial hardship and stress for people who cant work from home or wont get paid if they dont go to work.

Many people are experiencing cognitive dissonance about the ongoing normality of their daily lives, or, conversely, experiencing very rapid change. Be kind to yourself and others if you are struggling. Whether youre afraid of getting sick or reacting to uncertainty, financial hardship, or a lack of information, anxiety is a natural response and you are not alone.

If you have preexisting mental health conditions, be aware that this may trigger new or worsening symptoms. (The Substance Abuse and Mental Health Service Administration has a 24/7 Disaster Distress Helpline, reachable at 1-800-985-5990. It also has an app with additional resources.)

No matter how stressed you feel, its crucial not to scapegoat others. This virus is not transmitted by or infecting any particular group. Ive experienced anti-Asian racism myself, says Choi, and its disrespectful, hateful, and not grounded in facts.

Know that the situation is not hopeless; collectively changing behavior can go a long way toward controlling the spread of this disease. China has now closed all of its temporary hospitals as its case numbers continue to decline. But the social and economic repercussions of this pandemic may continue for months, so prepare yourself mentally for a long haul.

Do the small things that are in your control, like giving yourself a break from the news put down Twitter and maintaining normal routines as much as possible. If youre at home with family or roommates, find ways to give each other space. Be creative about finding ways to exercise; YouTube videos are a great resource, if you cant get outside. Talk to your loved ones about what you and they need to stay happy and healthy.

Japan and China have both reported multiple cases of people testing positive after initially recovering. Its unclear if these were relapses or new infections. In four medical professionals in Wuhan, a test detected the viruss genetic material up to 13 days after they stopped having symptoms, but finding genetic material doesnt necessarily mean you can still infect others.

Once youve gotten sick, you might have some immunity, says Peter Hotez, dean for the National School of Tropical Medicine of the Baylor College of Medicine, but really the jurys still out. We dont know, it depends on your antibody response, he says. (A new, encouraging preprint showed that in some monkeys, reinfection of Covid-19 does not occur.)

Hotez suggests that recovered patients do seem to produce antibodies. He pointed to a new paper on the possibility of using blood from recovered patients as a treatment, or even a preventive measure for first responders.

Still, recovered patients may also experience lasting effects; doctors in Hong Kong said that some recovered patients had a 20 to 30 percent drop in lung capacity. Another alarming preprint suggests some patients may have permanent kidney damage.

What about building herd immunity?

The UK government on Friday announced a strategy of allowing the virus to spread to build herd immunity, although it since walked it back and is recommending self-isolation. For herd immunity to control Covid-19, more than 60 percent of the population will need to get the disease. The logic is that extreme lockdowns now wont stop the virus from returning in the future, when those measures are loosened.

The problem is that many people may succumb to the disease in the meantime, and that by not attempting to control the spread, hospitals and medical systems will be overwhelmed. Achieving herd immunity in the UK would require more than 47 million Britons to be infected, which could mean around hundreds of thousands would die. Immunity might also not last long enough to help, as with the flu, where new strains emerge each year. Relying on herd immunity also conflicts with WHO policy. Anthony Costello, a pediatrician and former WHO director, tweeted, Is it ethical to adopt a policy that threatens immediate casualties on the basis of an uncertain future benefit?

There are two likely ways this pandemic will end now that the virus is so widespread: 1) So many people will get it that well develop a natural herd immunity, a term that is used to describe people getting a disease and becoming immune as a result, or 2) well make and widely produce an affordable vaccine. It is very unlikely that well see a big decline in Covid-19 cases solely due to the weather getting warmer. Plenty of places where there is currently warm weather, like Singapore and Australia, have Covid-19 cases.

There are no easy answers. We have to recognize that were gonna start seeing a fair number of hospital admissions, especially ICU admissions, Hotez says, and we have to ask the hard questions about what treatment we can do now. Developing a vaccine will take many months at best, which is why in the meantime, changing your behavior is so important.

Ultimately, this is a new disease, so while were trying to make new predictions about risk, all bets are off, says Choi. Were learning as everything is evolving actively in real time.

Lois Parshley is a freelance investigative journalist and the 2019-2020 Snedden chair of journalism at the University of Alaska Fairbanks. Find her on Twitter @loisparshley.

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Coronavirus tips and symptoms: What everyone should know about getting the new coronavirus - Vox.com

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