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Health Desk articles

What do we know about controlling the spread of COVID-19 through hyper-local measures?

Imposing restrictions at a hyper-local level, such as by postal code or zip code, can work to contain COVID-19, but is not without challenges and comes with a set of both pros and cons. The pros come into effect if individuals who are residents of that zip code or neighborhood a) follow the restrictions imposed and do not travel outside their neighborhood, especially at a mass level. The cons come into effect if individuals who are residents of that zip code or neighborhood either do not follow restrictions imposed, or travel outside their neighborhood, especially at a mass level. As a result, it’s crucial to communicate with residents so that they understand the expectations and what is at risk if local measures aren’t followed. To help ensure that they are followed, local public health officials and leaders must share information with residents on how to access the resources that they need hyper-locally, both for healthcare and otherwise, so that individuals are not pushed to seek resources outside of their affected area, and in turn potentially increasing positive rates in other neighborhoods, worsening the problem overall.  Of note is that hyperlocal surveillance of COVID-19 is also useful for tracking and ultimately controlling the spread of the virus, as the more local the data is, the more granular it is likely to be and the less gaps it is likely to have.

Is the flu vaccine more important during the COVID-19 pandemic?

As the Northern Hemisphere enters influenza (flu) season during the COVID-19 pandemic, it is more important than ever to get vaccinated against the flu. Reasons include: - Reducing strains on health systems providing testing and care - Preventing patients from becoming infected with the flu and COVID-19 at the same time - Protecting the lives of people who are the most vulnerable to getting sick, such as very young children, people with certain health conditions, and older adults Flu cases occur year-round, but tend to peak during the fall and winter seasons in the Northern Hemisphere. Seasonal flu vaccines, also called flu shots when given via injection, help the body to develop antibodies about two weeks after vaccination. These antibodies help the immune system fight against infection from certain strains of influenza viruses. Each year, research indicates what the most common influenza viruses may be during the upcoming season, and flu vaccines are developed to tackle those strains. Flu vaccines do not protect against every strain of influenza because there are many, and mutations are frequent. Flu vaccines are widely considered safe and effective for preventing illness and death from the flu. Flu vaccines can have added benefits for people with certain chronic medical conditions, such as reducing illness flare-ups in people with chronic obstructive pulmonary disease (COPD) and reducing the risk of heart attacks, strokes, and death among people with heart disease. There are many types of flu vaccines available, including for children as young as 6 months of age and for older adults above 65 years of age. Most flu vaccines are considered safe for the general population between 6 months and 65 years of age, including pregnant women and people with certain health conditions. There are limited exceptions to who should get a flu vaccine, based on factors such as age, health status, and allergies. Anyone with concerns about getting a flu vaccine can consult a doctor. The U.S. Centers for Disease Control and Prevention (CDC) recommends getting a flu vaccine every year, and emphasizes the importance of getting vaccinated against the flu in 2020 due to the ongoing COVID-19 pandemic. It is better to get a flu vaccine early in the season, before the flu season peaks, rather than waiting until influenza viruses are spreading in your community. When going to get a flu vaccine during the COVID-19 pandemic, plan to take recommended precautions such as wearing a face covering (preferably a cloth mask over a surgical mask) and practicing good hygiene.

Can nose swab testing for COVID-19 be harmful?

Nasal or nose swab testing for COVID-19 is a completely standard and safe procedure to detect COVID-19. It does not pose any significant risks to the patient, beyond some discomfort. The procedure can trigger tears when performed correctly, because it activates a reflex in your body. The procedure does not last for more than five seconds per nostril, and there are no lasting effects from the test. The nose swab needs to be inserted quite far into the nose in order to get a sample of secretions that can be sent to a lab for analysis. Since most people do not typically experience an object being inserted into the nose on a regular basis, they can experience minor discomfort, but there are no other short or long-term harms that result from the procedure. It is virtually impossible for swab testing to access or have any impact on the blood-brain barrier. The blood-brain barrier is a packed layer of cells that creates a barrier, protecting molecules in the blood from the brain's blood vessels. Rupturing the blood-brain barrier would require breaking through multiple layers of tissue, drilling through bone, and going through blood vessels, which is not possible with a nasal swab. The nasal swab technique is standard practice across the world, and it cannot rupture the blood-brain barrier or the endocrine glands, nor can it infect the brain, as some have falsely claimed.

How might wildfires and other natural disasters impact COVID-19 transmission?

Wildfires and natural disasters may impact COVID-19 transmission by increasing the spread of the virus among people exposed to wildfires, smoke, and other disasters. The U.S. Centers for Disease Control and Prevention (U.S. CDC) noted that "Wildfire smoke can irritate your lungs, cause inflammation, affect your immune system, and make you more prone to lung infections, including SARS-CoV-2, the virus that cause COVID-19." The more people cough and struggle to breathe this way, the more likely they are to spread viral particles in the process. This can spread those particles in the air and around the area so more people are likely to be exposed to the virus in addition to the wildfire smoke. People most at risk from wildfire smoke overlap with some of those most at risk for COVID-19 including adults age 65 and older, pregnant people, people with chronic health conditions, and people with limited access to medical care. For these reasons, the U.S. CDC has outlined steps for preventing further spread of the virus through several safety and prevention tips. Some of these tups include reducing wildfire smoke exposure by seeking cleaner air shelters and air spaces (while still maintaining social distancing and wearing masks) and creating a cleaner air space at home by taking actions like using a portable air cleaners with doors and windows closed, using do-it-yourself box fan filtration units, use air conditions, heat pumps, fans, and windows shades, work with an HVAC professional for help with different filters and settings, and avoid activities that create more indoor and outdoor air pollution like frying foods, sweeping, vacuuming, and using gas-powered appliances. In addition to limiting outdoor exposure when it is smoky outside and chooser lower intensity activities to reduce smoke exposure, the U.S. CDC recommends cloth face coverings or more intense respirators, and getting prepared for the wildfire smoke season by planning evacuation routes and stocking up on medicine. Finally, the U.S. CDC suggests monitoring and planning for the weather including paying attention to the air quality index and knowing the difference between COVID-19 and wildfire smoke exposure symptoms.

Does wearing a face mask put you at higher risk of cancer?

Wearing a face mask does not put you at a higher risk of cancer. There is no current evidence linking the use of face masks to cancer, and science shows that any risks associated with wearing masks are low overall, while the benefits are high.  Because of how tiny oxygen and carbon dioxide molecules are, face masks neither decrease the amount of oxygen that enters a mask nor increase the amount of carbon dioxide that stays in a mask. As a result, face masks do not disrupt the body’s pH levels, affect the bloodstream, or alter one’s body in any way that would put someone at higher risk of cancer. The claim that wearing face masks causes cancer has been circulating on Facebook and other social media platforms, citing a January 2021 study that did not study face masks or mask wearing in general. An article from Blacklisted News falsely suggested that mask wearing can lead to reproduction of bacteria, which then leads to cancer. The articled stated that harmful microbes can grow in a moist environment, like the ones created around the mouth and face because of constant mask wearing. The article suggests that microbes can grow and replicate before traveling through the trachea into blood vessels in the lungs. From there, they allege the the microbes cause an inflammatory response. It's true that oral bacteria can contribute to oral infections, dental plaque, and cancer. However, bacteria is also a normal part of our skin and other organs. It can contribute to health in positive and negative ways. The study that linked mask wearing to the development of advanced lung cancer did not involve long-term mask wearing as part of the study. The article that wrote about it falsely assumed that masks could be the cause of this bacteria, rather than its normal presence in the human body and microbiome. There is no evidence that mask wearing can pose a danger to health, including altered carbon dioxide and oxygen levels. Bacteria can build up over time in a mask, so they should be cleaned and dried properly. This build up does not cause cancer.  The American Lung Association verified that masks cannot cause lung cancer and the United States Centers for Disease Control and Prevention noted that any carbon dioxide build up in masks should not impact people who wear face masks in order to prevent COVID-19 infections and transmission.

If you can get COVID-19 through your nose and mouth, why not your ears?

Getting infected with COVID-19 through the ear is not as likely as getting infected through the nose, mouth, and eyes. Experts believe this is because the surface of the outer ear canal is more like the skin on the rest of our bodies, which acts as a protective barrier that makes it more difficult for the SARS-CoV-2 virus, causing COVID-19, to enter. In contrast, the tissues lining the surface of the nose, mouth, and eyes are mucous membranes (or a thin lining of cells that secrete mucus), which are an easier way for SARS-CoV-2, the virus causing COVID-19, to enter. Like the nose, mouth, and eyes, ears are connected to the upper part of the throat and respiratory tract. Doctors and researchers are currently looking into the risks of COVID-19 transmission when patients have open ear injuries or are getting invasive ear procedures (ex. surgery), as both the patients and the healthcare providers should be adequately protected from exposure. For the average person, ears remain a less likely pathway for getting COVID-19. There are currently not specific recommendations for preventing transmission through ears. Preventative public health recommendations remain focused on face coverings over the nose and mouth, eye protection for people who may be at higher risk of exposure (ex. frontline workers), hand hygiene (ex. avoid touching the face, clean hands with soap and water or alcohol-based sanitizers), and physical distancing.

What do we know so far about COVID-19 and immunity?

The evidence around COVID-19 and immunity is rapidly evolving. Based on what we know so far, COVID-19 patients become immune (protected from reinfection) for at least 3 months, if not longer, after they recover from the illness. However the virus is still new and there are no long-term studies published about it yet, so it's hard to accurately assess how long immunity persists in the population. A study in Nature found that men's immune systems, particularly older men over the age of 60, may make them twice as likely to get severely sick or die in comparison to women from the same age group. These results are not entirely surprising. Scientists already know that women's immune systems typically are stronger at fighting other illnesses, compared to men. Public health experts believe this may mean that men need to rely more on vaccination, rather than natural infection, to safely protect against recurring infections. Levels of antibodies, which are particles an infected person produces to fight off an illness, typically shrink after recovery. In August 2020, the New York Times reported the first documented case of re-infection with COVID-19. A 33-year-old man, who was first diagnosed with COVID-19 on March 26, 2020, had no detectable antibodies after his first infection. On August 15, 2020, he tested positive again and researchers confirmed that the test result was due to a new infection, rather than a prolonged previous infection. Antibodies are only one component of the body's complex immune system and its response to COVID-19. Antibodies prevent a future infections, but other mechanisms, like cytotoxic (also known as killer) T-cells, can find and kill an infection. Memory B-cells also help bodies produce antibodies to prepare for possible future infections. Based on the current evidence so far on COVID-19, we know that if the initial infection is more severe, immunity will typically last longer: re-infection might still be possible, but it will be far less likely to result in another severe infection.

Why do self-isolation or quarantine timelines sometimes change?

The U.S. Centers for Disease Control and Prevention (U.S. CDC) recently changed quarantine guidelines. They now recommend that most people who test positive for COVID-19 isolate themselves for 10 days after their symptoms begin. The CDC previously recommended isolation for 14 days for the general population. They changed it because the latest data shows that people with mild to moderate COVID-19 (the majority of patients) are not likely to be infectious for longer than 10 days after first experiencing symptoms. In some cases, people who are experiencing more severe or critical symptoms from COVID-19 may need to quarantine for a longer period of time (up to 20 days after symptoms have started). Asymptomatic patients (individuals who never experience any symptoms, but still test positive for COVID-19) can discontinue quarantine or self-isolation precautions 10 days after their first positive test for COVID-19. Sometimes detectable levels of the virus can still be found in recovered patients, but there is no evidence to indicate that those patients are actually able to transmit the virus to other people. As a result, the U.S. CDC recommends ending quarantine or isolation measures after symptoms have ended. In general, given the limited testing availability in the United States and many other countries, the U.S. CDC does not recommend re-testing patients repeatedly if they have completed a 10-day quarantine if they have no symptoms or if symptoms have gone away, as long as the patient does not have other health conditions that leave them immunocompromised. It is important to note that isolation should only end at 10 days if the person hasn’t had a fever for at least 24 hours or any other symptoms have not improved. Patients with severe immune deficiencies may require additional tests in consultation with public health and infection control experts before to ending their quarantine. The World Health Organization (WHO) still recommends a 13-day period of self-isolation for any person who has tested positive for COVID-19. For asymptomatic patients who test positive for COVID-10, WHO recommends isolating for 10 days after testing positive. If countries decide to implement testing as part of their isolation strategy, the WHO recommends allowing people to stop isolating after two negative rapid tests at least 24 hours apart. Overall, most public health experts recommend a 10-day quarantine after a positive COVID-19 test, or after the start of symptoms.

What are virus shut-out masks?

There is no scientific evidence that products marketed as “virus shut-out” (i.e. masks, cards, tags) prevent, treat or cure COVID-19 infection. In a search of medical and scientific literature, there were no search results or studies that mentioned “virus shut-out” masks.  Based on the Virus Shut-Out Tag Facebook page and a search of "virus shut-out" website information, the primary product being promoted is the “virus shut-out” tag for wearing around one's neck. that will reportedly “reduce the 90% risk of being infected by continuously sending out the lowest concentration of chlorine dioxide.” The Virus Shut-Out Tag Facebook page states that the cards “are not specifically made for COVID-19 and there’s no approved therapeutic claims.” The U.S. Environmental Protection Agency (EPA) states that the product is not registered with the EPA and “its safety and efficacy against viruses have not been evaluated.” The U.S. Centers for Disease Control and Prevention (US CDC) website states that the alleged active property, chlorine dioxide, is toxic and can be dangerous with long term or frequent exposure. On the Virus Shut-Out Tag Facebook page, the “virus shut-out” tag is promoted to be used “with masks for better and stronger protection.” It is not clear if the masks on the company website are medical grade or provide protection above and beyond what cloth face masks provide.

What does it mean for COVID-19 to impact the brain?

Physicians and scientists are learning more about how COVID-19 impacts organs outside of the respiratory system, such as the brain. The emerging evidence has revealed that some COVID-19 patients experience neurological symptoms in the brain, spinal cord, nerves, and ganglia (cell bodies that relay nerve signals). In early March 2020, observational data from 58 patients in France indicated the presence of neurological symptoms such as agitation, confusion, disorientation, and encephalopathy (brain damage). In April 2020, a study was published on 214 COVID-19 patients in China with "severe infection," where over a third were reported to experience neurological symptoms, including acute cerebrovascular diseases and impaired consciousness. In July 2020, another study on over 40 British patients provided additional evidence about neurological symptoms, ranging from brain inflammation and delirium to nerve damage and stroke. Some of these patients reported severe symptoms, such as strokes and paralysis resulting from nerve damage, while others experienced more minor symptoms like breathlessness and fatigue. Most of the cases with brain inflammation were diagnosed with acute disseminated encephalomyelitis (ADEM), which is a rare illness involving inflammation of the brain and spinal cord that results from viral infections. Data from London indicated an increase in ADEM cases for this study period during the pandemic, as the number of reported cases would typically have been expected over a 5-month period rather than a 5-week period in the city. SARS-CoV-2, the virus that causes COVID-19, was not detected in the cerebrospinal brain fluid of any of the British patients tested, which may suggest that the virus did not directly attack the brain and that the symptoms could have occurred post-infection. Vanderbilt University Medical Center launched a study in July 2020 that will study delirium, post-traumatic stress disorder (PTSD), and depression in patients who have been hospitalized with COVID-19. These disabling impacts are also known as post-intensive care syndrome (PICS), and previous studies of intensive care patients similar to COVID-19 patients suggest that 33-50% experience dementia, 10-20% experience PTSD, and 33% experience major depression. Researchers are also studying whether COVID-19 patients with brain inflammation are at higher risk of autoimmune disorders like demyelination, where the protective coating of nerve cells is attacked by the immune system and may lead to weakness, numbness and difficulty with daily activities. With the increasing evidence of neurological symptoms, which have not been found to occur as commonly as respiratory symptoms, researchers and health care practitioners are continuing to observe patients around the world to learn more about how COVID-19 impacts on the brain. The long-term implications are still unclear, since COVID-19 is a new disease and there has not been enough time to observe the development of symptoms in patients over long periods of time.

Are teachers more likely to be infected in the general community, or in schools?

This question can only truly be evaluated on a case-by-case basis, as there are many different points that have to be considered. Variables include: - Where schools are located (major cities, rural areas, small towns, etc.) - How many children are in each classroom - How many students and teachers are wearing masks all day - How much distance is between desks - How many other people live with teachers in their homes - If the school is located in a place with a virus outbreak - Individual behaviors like taking public transportation, social distancing and mask wearing In addition to the individual risks each teacher faces, schools pose additional risks due to the high number of students who are in close contact with one another in closed, tight rooms. This can make prevention tools like social distancing and frequent hand washing difficult. It is also why it is important for school systems that are reopening, or have already reopened, to create safe, healthy spaces for students and teachers with policies like mandatory mask wearing, allowing for six feet/two meters of distance between desks, routine testing (if possible), using proper ventilation, consistent and frequent cleaning and decontamination of surfaces, installing physical barriers, and avoiding group transportation. Keeping both students and teachers safe in schools and communities depends on the behaviors, environments, underlying risk factors, and choices made by school systems and individuals. This is why it is not possible to accurately estimate where teachers are more likely to get infected with COVID-19, but shows why it is so critical to prevent the spread of the virus in all environments.

Is there any relationship between eating sugar in foods and COVID-19?

While a varied and balanced diet including fruits and vegetables does help to support the immune system in general, there is no evidence to suggest that special diets, consumption of particular foods, or taking vitamin, mineral, or herbal supplements will prevent, treat or cure COVID-19. For patients with type 2 diabetes, using medications, diet controls (intentionally eating for your condition, like controlling carbohydrate intake and limiting sugar), and exercise to keep blood sugar levels within a normal range has been associated with better outcomes in patients with COVID-19. While diets high in sugar have been shown to impact health, it is not well understood how much added sugar is needed to cause health problems. Studies show that people who consume diets that are high in sugar are more likely to be overweight or obese and have other health problems like insulin resistance (where their bodies are not able to use sugar correctly), type 2 diabetes, high cholesterol, kidney disease, or fatty liver disease than people who consume little added sugar. In addition, sugar has been linked with inflammation and poor immune function in the body, especially when a person has insulin resistance or excess body fat. Researchers do not know how much, what type, or under which conditions sugar may cause problems in the short or long term.  

How many days after exposure should one be tested to yield the most accurate results, and with which test?

Research suggests that diagnostic testing is more accurate a few days after symptoms start, or around a week after exposure to a person who is infected with COVID-19. Testing more than once can confirm negative results, when appropriate, and when tests are available. During the wait for test results, it is essential for people who suspect they have COVID-19 or have been exposed to COVID-19, to take precautions and self-isolate when possible. It is also important to consider what type of test is being used to check for a COVID-19 infection, as this will likely impact how accurate the test is and how long it will take to get results. Molecular tests are among the most accurate diagnostic tests currently available for detecting whether someone has an active COVID-19 infection. Molecular tests use methods such as RT-PCR (reverse transcription polymerase chain reaction) to detect genetic material from SARS-CoV-2, the virus that causes COVID-19, in respiratory samples such as nose and throat swabs. Molecular tests have a higher risk of false negatives in the earliest days after exposure and symptom onset, according to an August 2020 publication in the Annals of Internal Medicine by researchers at John Hopkins University who reviewed 7 published studies on the performance of RT-PCR molecular tests. The researchers found that on average, the false negative rate was lowest around day 8 of an infection or 3 days after symptom onset (symptom onset is typically several days after an infection starts), with the false negative rate rising again as the infection continues. False negative test results in the early stages of infection are concerning, because other research (including studies published in Nature and the American Journal of Pathology) have found that COVID-19 patients can be most infectious to others in the early days of infection, when test results may be more likely to come back as false negatives. Some testing policies recommend that people get tested twice to confirm a negative result. Repeat testing to confirm negative results can be particularly important for people who may interact with high-risk populations (ex. healthcare workers, caretakers), people who may interact with many others outside of their household (ex. an employee going back to the office, a student returning to in-person classes), and people who may need medical care for COVID-19 (e.g. elderly patients with underlying conditions). Molecular tests are a relatively accurate type of diagnostic testing, and they have a lower chance of false negatives when conducted a few days after symptoms start, or approximately a week after exposure. A lower chance of false negatives does not mean there is no chance of inaccurate test results, so repeat testing may be recommended to confirm test results in certain situations. With all the ongoing research and development work on COVID-19 tests, pandemic testing guidelines may continue to evolve.

Should disinfection tunnels be used?

The World Health Organization (WHO) and other international health agencies do not recommend using disinfection tunnels to prevent transmission of COVID-19. This is due to concerns about their safety and effectiveness. Disinfection tunnels are spaces (such as a tunnel, room, cubicle, or cabinet) in which people are sprayed with chemical disinfectants or exposed to other disinfection methods, such as ultraviolet (UV) light. These disinfection methods are often applied to the surfaces of objects. Their use directly on people can be dangerous to human health and may not stop the transmission of COVID-19. If a person is infected with COVID-19 and passes through a disinfection tunnel, any disinfection would only be external and the infected person could still exhale droplets (by breathing, speaking, coughing, sneezing, etc.) that could transmit COVID-19 to others. People passing through disinfection tunnels can experience physical as well as psychological harm. Chemical disinfectants sometimes used in these tunnels can be toxic to the human body, leading to irritation or damage of the eyes, skin, lungs, and gastrointestinal system (for example nausea or vomiting). Some chemical disinfectants are flammable and explosive, generate toxic gases, and are harmful to the environment. UV light exposure, which is also sometimes used in disinfection tunnels, can lead to skin burns, skin cancer, and eye damage. The International Ultraviolet Association (IUVA) states: "there are no protocols to advise or to permit the safe use of UV light directly on the human body at the wavelengths and exposures proven to efficiently kill viruses such as SARS-CoV-2." Psychologically, the pain and stress of passing through a disinfection tunnel can be traumatic. Preventative measures (such as physical distancing, hand washing, wearing masks, and ensuring good ventilation) are recommended to help reduce the transmission of COVID-19, but disinfection tunnels are not recommended as a COVID-19 preventative measure.

What do we know about antihistamines, including cetirizine, as a treatment for COVID-19?

Antihistamines are medications people can purchase over the counter without a prescription to help improve their allergy symptoms. They are among the many medications being researched as potential treatment options for COVID-19. Few studies about the efficacy of antihistamines as a treatment for COVID-19 are complete, and there is no evidence that supports the theory that antihistamines are an effective treatment for the virus. Current research is investigating whether some antihistamine medications like cloperastine, clemastine, and Azelastine can help improve symptoms or shorten the duration of COVID-19 infections, but early research has only identified these potential medications in laboratories. That means that they have not completed testing these medications in humans, so we don't know if they have any impact. Cetirizine (an antihistamine medication also known as Zyrtec) is currently being studied with famotidine (an antihistamine and antacid medication) to see whether it can be effective in treating COVID-19, particularly in patients with very aggressive immune system responses. An early study in a pre-print journal that has not been reviewed by experts or published yet, found promising results for helping ease symptoms in hospitalized patients. The study did not have a control group to compare these patients to (which is generally part of published studies on medication) and had a small population size. Overall, there has yet to be evidence that antihistamines —including certirizine—can treat COVID-19.

What do we know about Bro-Zedex as a treatment for COVID-19?

Bro-Zedex is a cough syrup that is used to treat symptoms of a cough. There are Bro-Zedex formulas for both wet and dry coughs, and the ingredients in each type are different. For wet coughs, the key ingredient in the orange-colored Bro-Zedex is bromhexine, which is a medication that treats respiratory issues that cause excessive mucus and phlegm in the throat and mouth. Bromhexine does this by making the mucus in the throat thinner and easier to remove through coughing. This formula's other ingredients - menthol, guaifenesin, and terbutaline - can make the phlegm in your chest and throat thinner so it's easier to cough up, cool and soothe sore throats, and relax the muscles in your airways. For dry coughs, Bro-Zedex comes in a green liquid and its main ingredients are ambroxol, levosalbutamol, and guaifenesin. This formula loosens congestion in your chest and throat by breaking up phlegm and also relaxing the muscles in your airway so you can breathe easier. Though these formulas work in similar ways, their ingredients are meant to relieve specific symptoms that come with wet and dry coughs. Bro-Zedex is not used as a treatment for COVID-19 on its own, but may help relieve some of the uncomfortable symptoms that occur in mild to moderate cases of the infection, like coughing and phlegm build-up. Current research is looking at whether bromhexine can be taken for prevention - before a COVID-19 infection to prevent someone from getting sick, or as part of a treatment plan in more severe cases to help improve some symptoms. Bro-Zedex is also part of clinical trials where researchers are looking to see if it can shorten the amount of time a person has COVID-19 symptoms or help prevent hospitalized patients infected with COVID-19 from becoming infected with other respiratory illnesses while they are still in the hospital. _This entry was updated with new information on August 11, 2020._

When do we consider someone with COVID-19 to have recovered?

Different institutions (including hospitals, clinics, public health agencies, and government agencies) have used different criteria to define when someone with COVID-19 is considered recovered. These criteria are often used to decide when someone can be allowed to leave the hospital or can stop isolation. A review of COVID-19 recovery guidelines being used around the world show most doctors agree on the following criteria: 1) Clinical: The patient no longer has symptoms, and 2) Laboratory: The patient has negative test results (testing through swabs taken from the nose and throat) showing the virus is no longer present in the upper respiratory system. Both of these criteria should be considered in combination to determine recovery. Negative test results are important because people can still spread the virus even if they have no symptoms or their symptoms have stopped. In addition, the European Centre for Disease Control and Prevention (ECDC) suggests also considering the following criteria to determine if a patient has recovered: 3) Positive serological or antibody test results from blood samples. Antibody tests can show if your immune system has produced antibodies to fight off COVID-19 which would signal that you had been infected with the virus. Antibody tests are typically done at least 1-3 weeks after a patient first experiences symptoms. However, antibody test results should not be used on their own to determine recovery - they should be used in combination with the other two criteria. It is not always possible to use these recommended criteria to determine recovery. For example, some people with COVID-19 experience only mild symptoms (fatigue, shortness of breath, etc.) yet are not hospitalized because these symptoms are not severe enough. These mild symptoms can however persist over long periods of time (weeks to months) which further complicates how to decide if someone has recovered or not from COVID-19.

What are the different types of vaccines?

Historically, there are four main types of vaccines:  - Live-attenuated vaccines - Inactivated vaccines - Subunit, recombinant, polysaccharide, and conjugate vaccines - Toxoid vaccines Vaccine designs are based on how our immune systems respond to germs, who in the population (children, adults) needs to be vaccinated against the germ, and the best approach and technology available to create the vaccine. This is why there are different vaccine types to respond to different germs. Live-attenuated vaccines use a weaker - also called 'attenuated' - form of a living germ, which would normally cause a disease in stronger forms but is almost completely harmless in a vaccine because the virus has been weakened. Some of these live-attenuated vaccines are used to protect against diseases like measles, mumps, rubella; rotavirus; smallpox; chicken pox; and yellow fever. Inactivated vaccines use the killed or inactive version of the germ, so they are not as capable at helping humans develop some immunity to a germ** **as live-attenuated vaccines and can't provide immunity for as long. These vaccines protect against diseases like hepatitis A, influenza, polio, and rabies. Subunit, recombinant, polysaccharide, and conjugate vaccines use particular pieces of the germ, like its protein or sugars, to create a strong immunity to specific parts of the germ. Some illnesses these vaccines focus on are hepatitis B, HPV, whooping cough, shingles, and meningococcal disease. Toxoid vaccines use a harmful product called a 'toxin' that is made by the germ. A toxin is a living organism that can normally cause harm to parts of the body like tissues when they come into contact with them. However, toxins in vaccines are harmless because they have been very weakened in laboratories as their only job is to teach the immune system how to fight the germ. They create immunity by focusing on the specific parts of the germ that cause illness instead of the entire germ. These vaccines target illnesses like diptheria and tetanus. Researchers trying to develop COVID-19 vaccines are using many of these types of approaches to vaccine design. Two new types of vaccines are gaining attention in the scientific world. One of these vaccine types use the genes of the COVID-19 vaccine called 'DNA' and 'RNA' to create a strong immune system response. The other new type of approach to vaccine development uses a platform base called 'recombinant vector vaccines' which act like how infections would impact your body normally. As we learn more about the virus and how to create immunity in people through vaccines, we will learn if any of these vaccine types can successfully prevent COVID-19 infection in people.

What do we know about monoclonal antibodies as part of a treatment or vaccine for COVID-19?

Antibodies are tiny proteins created by the immune system to attach to any foreign invaders in the immune system (antigens) and also tell the immune system to begin defending itself from this threat. Monoclonal antibodies (which means 'one type of antibody') are antibodies created in a lab that can act as a replacement for the antibodies the body normally creates. The difference between these lab-made antibodies and those created by the immune system is that the monoclonal types are uniquely designed to target a specific antigen, in this case the virus that causes COVID-19, so it can send it messages, try to destroy it, and even make it easier for the immune system to find the antigen and attack it. Once the antigen is mapped out in the lab and scientists are able to produce monoclonal antibodies to attach to them, the lab then makes a large amount of these antibodies so they can help the immune system in its fight against a threat. COVID-19 is unique because it is characterized by its spikes, which you can see under a microscope. Monoclonal antibodies created in the lab work by targeting and breaking these spikes on the virus, which are critical for the virus to enter our cells and infect us. There is growing interest in their potential for use in both vaccine development, but also treatment for infection. The hope is that these antibodies can work as both a vaccine to prevent infection, and/or as a therapeutic treatment to help reduce severity of illness in patients with COVID-19. It is likely that after rigorous testing for safety and effectiveness, these antibodies would be produced in labs, manufactured in large quantities, and they would be injected into people to prevent infection from the virus. As of now, no monoclonal antibody treatments have been approved for this use and are still being heavily researched. _This entry was updated with new information on August 11, 2020._

How effective is spraying disinfectants in public places in curbing the spread of infection?

Transmission of COVID-19 from surfaces contaminated with the virus has not been documented, but it is possible that the reason for this is due to gaps in research and contact tracing._ _There is limited research about the effectiveness of disinfecting public spaces, but researchers are working to determine whether or not spraying disinfectant will impact the amount of virus transmissions that occurs from people coming into contact with objects like water fountains, playground equipment, and hand rails. The United States Centers for Disease Control and Prevention still states that thoroughly cleaning and disinfecting indoor surfaces in public places is a best practice for preventing the spread of COVID-19. As it is possible to spread the virus through contaminated surfaces, thoroughly cleaning and disinfecting all surfaces - not just spraying disinfectant - that humans touch in both public and private settings. However, it should be noted that spraying disinfectants in public places may be harmful to humans as exposure to disinfectant sprays can cause dangerous respiratory effects when inhaled. Other potential impacts are skin and eye irritation, potential corrosion, and some disinfectants might have a chemical (formaldehyde) that is known to cause cancer. Lastly, some chemical disinfectants are flammable, explosive, can generate toxic gases, and can potentially be harmful to the environment, so serious caution should be taken when spraying any of these disinfectants to large surface areas or for a prolonged period of time.

Are children less susceptible to contracting the novel coronavirus?

According to the Mayo Clinic in the U.S., children of all ages can catch the virus that causes COVID-19, but they do not become physically sick as often as adults. They are also less susceptible to experiencing severe side effects from the virus in comparison to older adults. However, some children do develop complications from COVID-19, such as multisystem inflammatory syndrome (MIS-C), which is characterized by inflammation in different body parts, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. While MIS-C is rare, it can be deadly and remains poorly understood based on current research. Some evidence suggests that children may be less likely to contract the novel coronavirus, but it is still unclear whether this effect is due to limited interactions between children and hence fewer opportunities for transmission, or whether they are truly less susceptible to contracting the virus. The World Health Organization (WHO) does not see a clear trend in the data yet, but large scale serological studies (studies that look at antibody presence in the blood) are currently underway and are likely to provide more clarity. Previous studies from Wuhan, China indicated that the virus was milder in children and transmission was fairly limited: a study of more than 72,000 cases by the Chinese Center for Disease Control and Prevention indicated that children under the age of 10 represented less than 1% of all cases. However, studies are ongoing to assess the level of susceptibility among children, and the evidence is still evolving.

What is the best measure (cases, hospitalizations or deaths) for measuring the level of infection in a community?

Ultimately, no single statistic or measurement can accurately indicate the state of a disease within a population. To best understand the level of infection in a community, all these numbers need to be looked at together. Until there is more routine testing to identify all infected patients (with or without symptoms), the risk of infection is likely to remain unclear. In order to attempt to measure the level of infection in a community, we can look at the number of hospitalizations, the proportion of the population who has the disease at any given moment (period prevalence), or the number of new cases of disease over a given time interval (incidence rate). The number of COVID-19 deaths during a given period can provide an important snapshot to understand the impact of the virus, but it is not a very good measure of a population's risk of contracting the virus. Tracking incidence rate is a more useful measure, because it helps us understand what proportion of an initially disease-free population develops the disease over a specified time period. This is a far more accurate measure of how likely a person in a population is to get infected compared to the number of deaths within a population. Additionally, in trying to understand how the number of deaths vary between populations, it's best to compare the mortality rate (number of deaths in relation to the overall population), because simply looking at the number of deaths does not account for differences in the size of populations.

Are there any side effects of using hand sanitizer?

Side-effects of hand sanitizer are short-term and often mild. The side effects are usually related to skin irritation, like cracking and bleeding, due to either irritation from the product or overuse and drying of the skin. It is important to always check the label to ensure safe use. Ingestion or use around the eyes and nose can cause irritation. Alcohol-based hand sanitizer should contain at least 60% alcohol to be effective. Hand sanitizer is a good way to clean hands when soap and water isn't available and is effective against the virus that causes COVID-19. The U.S. Food and Drug Administration (FDA) has recently issued a warning on the increase in hand sanitizer products containing methanol, instead of ethanol. Methanol, or wood alcohol, is a toxic substance when absorbed through the skin or when ingested that can lead to blindness, hospitalizations, or death. On August 5, 2020, the U.S. Centers for Disease Control and Prevention (CDC) reported 4 deaths and 3 patients with visual impairments from drinking hand sanitizer. The FDA has recalled over 135 hand sanitizer products for safety reasons, and also warns against false labels claiming a hand sanitizer product is "FDA-approved" (because the FDA has not and does not approve any hand sanitizer products). Hand sanitizer products should be stored out of the reach of children to help prevent accidental ingestion. If you become exposed to hand sanitizer containing methanol and are experiencing symptoms, seek immediate treatment for potential reversal of methanol poisoning.  _This entry was updated with new information on August 10, 2020._

What is the difference between exposure and infection to a virus?

When it comes to infectious diseases, "exposure" means coming into contact with a virus or bacteria. Infection happens when someone is exposed and actually becomes sick from the exposure. Exposure does not always lead to an infection. If the time a person is exposed to the virus is very short, if the amount of virus that enters the body is not in a large enough quantity, or if the body's immune system is able to quickly fight it off, then exposure will be less likely to lead to infection. Many things have to happen for an exposure to result in an infection, especially the ways in which a person was exposed to the virus. In the case of the virus that causes COVID-19, exposure takes place usually by breathing in the virus through the nose or the mouth, and sometimes the virus enters our bodies through the eyes. People can be "exposed" to different viruses in different ways, such as by eating food with a virus on it, or getting bit by a mosquito or other animal that carries a virus. Again, in the case of COVID-19, exposure typically happens by breathing in the virus through the nose or the mouth. Other factors that can impact whether an exposure leads to an infection include whether the germ is a virus, a bacteria or a parasite; how strong or "infectious" it is; and the strength of our body defense system (immune system). For example, you could be exposed to whooping cough (pertussis) by someone in the same room as you, but whether or not you end up being infected depends on several factors. These factors include how close to the person you were, how long you were exposed for, and if you are vaccinated against whooping cough.

How does the immune system work to fight COVID-19?

When our bodies are exposed to pathogens - tiny, foreign organisms such as viruses, bacteria, fungi, worms and other invaders - our natural defense called the 'immune system' tries to protect us and keep us healthy. When the body senses that the pathogen, in this case, COVID-19, is trying to get into the body through the nose, mouth, or eyes, it launches into the first part of this defense called the 'innate immune system.' A. Innate Immune System This part of the immune system tries to prevent the virus from spreading and reproducing in our bodies, and from moving around in our bodies. The innate immune system is made up of several types of defenses, including the skin and body openings (like the mouth and nose); different white blood cells to defend our bodies from pathogens; and different substances in bodily fluids and the blood to try and stop the virus from reproducing. This system tries to prevent the virus from entering the body through the mouth, nose, and eyes, but if the virus does get inside a person, then white blood cells will move toward the virus' location and cause an increase in blood circulation there so it becomes hot and swollen while the body might also produce a fever (as high temperatures can sometimes kill pathogens). At this point, other cells in the blood and tissue try to enclose the virus and eat the viral particles. But if after four to seven days, the innate immune system is not able to kill all of the virus and the virus causes an infection, the adaptive immune system will begin to defend the body. B. Adaptive Immune System The adaptive immune response, also called the acquired immune system, is a much more focused effort to target and destroy the foreign threat: the virus. Two important parts of the adaptive immune system are white blood cells called B cells and T cells. B cells create antibodies - small proteins that attach** **to unique parts of each pathogen called 'antigens'. When your body senses a particular antigen attached to the virus in the body, B cells then creates antibodies that can connect to those antigens using a specific shape that was created to match it. Meanwhile, T cells try to kill the antigen like an army fighting off an invader. Some T cells also help B cells make antibodies while others are busy working to stop the virus from reproducing in your body and spreading to different parts of your body. This part of the adaptive immune response also creates longer term memory of the virus that will help it fight off the virus if it is exposed to it again in the future, and to launch its defenses more quickly. Researchers are now studying how long-term this memory-based immunity lasts and how strong it is in defending against COVID-19 infection in the future. C. Conclusion Hopefully at this point, the innate and adaptive immune systems are able to kill the virus and create some immunity to it. If not, the immune system continues working to fight off the virus, but symptoms might worsen as the body weakens after spending so much energy to fight off the virus. In some cases, COVID-19 might impact organs so severely that it can result in death.

What do we know so far about face masks and their ability to prevent COVID-19?

According to the World Health Organization (WHO), wearing masks is part of an overall strategy to suppress the transmission of COVID-19, along with maintaining at least 2 meters (6 feet) distance and frequently washing your hands. A recent study conducted by the U.S. Centers for Disease Control and Prevention found that by wearing two masks, people's protection against the virus in the air dramatically increased. The study demonstrated that wearing any kind of mask provides significantly more protection against infectious COVID-19 aerosols than not wearing a mask. When dummies wearing two masks - like cloth face masks over surgical masks - were exposed to infectious aerosols, their level of protection was roughly 92%. The CDC now recommends fitting a cloth mask over a medical procedure mask, and knotting the ear loops of a medical procedure mask and then tucking in and flattening the extra material close to the face. However, the U.S. CDC does not recommend wearing two disposable masks at one time or another mask on top of a KN95 or N95 mask. There are generally two kinds of face masks that are available: medical masks and non-medical (or fabric) masks. Medical masks can protect people from getting infected as well as prevent people who are infected from spreading disease to others. Therefore, WHO recommends medical masks to be worn by health workers, care givers of patients infected with COVID-19, anyone who has mild symptoms of COVID-19, people with other health conditions which make them more susceptible to COVID-19, as well as people who are 60 years or older because they have a higher risk of getting infected with COVID-19. The WHO advises that non-medical masks should be worn in areas where there is high transmission of COVID-19, crowded places where at least 2 meters (6 feet) physical distancing is not possible, on public transport, in shops and other closed areas. COVID-19 can spread from people without symptoms, as they may not know that they are infected but are equally capable of spreading the virus. Hence, masks should be worn in public settings. The U.S. CDC warns that masks with exhalation valves or vents may not help prevent the spread of COVID-19 from the person wearing such a mask to others, therefore these masks should not be used for that purpose. The U.S. CDC also does not recommend face shields as substitutes for masks because of the large gaps below and alongside the face. Ideally, face shields should be used in combination with face masks. Wearing a face mask protects others from you when you cough, sneeze, talk, or just breathe, particularly indoors or when standing close to someone. Face masks also protect the wearer by preventing people from touching their mouth and nose, as well as reducing the amount of virus inhaled from other people nearby and reducing the risks of severe illness. In addition to social distancing measures (maintaining 6 feet or 2 meters between people), face masks are recommended to prevent the spread of COVID-19, even in hot climates. There is no evidence that surgical masks or cloth masks lower oxygen levels at all. It is important to use a mask that allows you to breathe comfortably while talking and walking and that fits well on your face. For safety, there are exceptions to wearing masks for children under the age of 2, for people with certain medical conditions or who have trouble breathing, and for anyone who is unconscious or unable to remove the mask without assistance. Mask wearing is a fundamental element of pandemic response for respiratory illnesses because masks act as a physical barrier from the release of infectious respiratory droplets that may come from your mouth or nose when you speak, sing, sneeze or cough.

What are COVID-19 risks for cancer survivors (5+ years)?

The majority of cancer survivors, who have been cancer-free for at least five years, are likely to have normal immune system functions and are not at an increased risk for COVID-19. However, every body is different so every cancer survivor should speak with a doctor who knows their full medical history and can discuss their personal risks with them. For some cancer survivors, their previous treatments might impact their risk of getting COVID-19 or having a severe form of the disease, as these treatments can have long term effects on the immune system and cause the survivor to have preexisting conditions that may put them at a higher risk for viral infection. For example, patients who have undergone a bone marrow transplant (also known as a 'stem cell transplant') might not regain a completely functional immune system as the transplant depletes their white blood cell system (which the body then replaces). Some patients who have undergone bone marrow transplants are no longer immune to illnesses they had become immune to before the procedure. These patients can be at risk for a number of infections, including COVID-19, but the longer it has been since treatment, the more time your body's immune system has had to improve. Despite not having a higher risk of becoming infected with the virus than the general population, it should be noted that cancer survivors do have a higher risk of complications if they become infected with COVID-19. This group is also more likely to be hospitalized if they are infected, compared to people who have never had cancer before. To protect themselves from the virus, just like the general population, cancer survivors should use protective measures like wearing cloth masks over surgical masks, maintaining at least six feet of distance, staying home when they can, and washing hands thoroughly and often.

What do we know so far about COVID-19 and nursing homes?

The risk of exposure to the novel coronavirus that causes COVID-19 is particularly high in nursing homes, which cater to vulnerable older adults who often have chronic illnesses or underlying conditions. A nursing home in Kirkland, Washington was one of the first hotspots for the COVID-19 pandemic in the United States: the facility accounted for 30 out of the 46 deaths in Washington due to COVID-19 at the time. Since then, there have been several outbreaks in nursing homes across the United States, including in Montana and Utah, as of July 2020. The U.S. Centers for Disease Control also found that long-term nursing care facilities were vulnerable to outbreaks long before the COVID-19 pandemic: 80% of the 2,590 non-foodborne outbreaks of norovirus in the US from 2009 to 2012 were attributed to long-term care facilities. Nursing home residents are vulnerable to severe complications and mortality from COVID-19, and residents often live close to one another, which makes it challenging to implement quarantine and social distancing measures. Close proximity to caregivers who assist multiple residents across different rooms in the facility can also contribute to transmission of the virus, especially if infection prevention control measures are inadequate. Many staff lack access to paid sick leave, which may incentivize them to work even while experiencing symptoms of COVID-19. The Occupational Safety and Health Administration (OSHA) recommends encouraging long-term care facility or nursing home workers to stay home if they are sick, screen workers and residents regularly for symptoms of COVID-19, adhere to U.S. CDC visitation guidelines, maintain at least 6 feet / 2m between workers, visitors, and residents, stagger breaks to prevent overcrowding, and provide hand washing facilities and alcohol-based hand sanitizer throughout the nursing home, among other measures. The U.S. CDC further recommends improvements in reporting COVID-19 cases from nursing home facilities, assigning at least one individual trained in infection and prevention control (IPC) to manage IPC on-site, screen visitors upon entry, and limit visitors (especially if they are experiencing symptoms), and create a robust testing plan for all employees and residents of the nursing home. There should also be guidelines in place to dedicate a separate unit of the nursing home to care for known or suspected COVID-19 patients to prevent further transmission. Visitation requirements can be tightened or relaxed depending on the number of cases in the community: the U.S. CDC recommends use of alternative methods such as video conferencing in lieu of in-person visits. Preventive measures include restricting all visitors except for compassionate care reasons, such as end-of-life care.

Is the Russian vaccine a successful cure for COVID-19?

COVID-19 vaccines are being developed to prevent people from getting the disease, not to treat or cure patients who already have the disease. Many experts continue to caution that a vaccine may not be widely available until 2021, which would already be record-breaking timing for vaccine development, manufacturing and distribution. In the summer of 2020, Russia's Sechenov First Moscow State Medical University announced human clinical trials of a COVID-19 vaccine, with 18 people vaccinated on June 18 and 20 people vaccinated on June 23. Russia's initial announcements of their human clinical trials were accompanied by projections that the vaccine could be distributed in August and mass produced by private corporations in September 2020. Health experts responded with cautions about how there are many challenges in scaling up from a vaccine that has been tested on just a few dozen people in one country to a commercially available vaccine that is available and suitable for millions of diverse people around the world. In August 2020, President Vladimir V. Putin announced that Russia approved its first COVID-19 vaccine, although global health authorities warned that the vaccine has not yet completed important late-stage clinical trials with larger numbers of people to determine the vaccine's safety and effectiveness. The first approved Russian vaccine, called Gam-COVID-Vac Lyo, was registered by the Gamaleya Research Institute of Epidemiology and Microbiology at the Health Ministry of the Russian Federation for a combined phase 1 and 2 trial. Public health experts have been concerned that skipping phase 3 clinical trials and rushing vaccine approval can potentially endanger people. Russia's first approved vaccine is now being offered outside of trials in small quantities to people at higher risk of infection, such as healthcare workers. In September 2020, the head of Rospotrebnadzor, a Russian agency regulating health care, announced that Russian researchers have completed early clinical trials of a second vaccine, which uses proteins that mimic those in the coronavirus that causes COVID-19. This differs from the first approved vaccine in Russia, which uses common cold viruses. Beyond the Russian vaccine trials, there are several human clinical trials for COVID-19 vaccine candidates happening around the world, with some trials involving hundreds or thousands of people over observation periods of many months. Rigorous clinical trials are important to understand whether vaccine candidates are safe and without major negative side effects, as well as whether vaccine candidates are effective and can actually provide immunity for long periods of time.

What do we know about pregnancy and COVID-19?

If a pregnant person becomes infected with COVID-19 there is a higher chance they will require hospitalization and suffer more serious symptoms of the disease. In early November 2020, the U.S. Centers for Disease Control and Prevention (U.S. CDC) released a report on 400,000 women between the ages of 15 and 44 with symptomatic COVID-19 which found that admission to the intensive care unit (ICU), invasive ventilation, extracorporeal membrane oxygenation, and death were more likely in pregnant women than in non-pregnant women. The report includes that increased risk for admission to the ICU was "particularly notable" among Asian and Native Hawaiian/Pacific Islander pregnant women, and that both disproportionate risk for SARS-CoV-2 infection and higher risk for death was observed for pregnant Hispanic women. Highlighting the racial/ethic disparities, the report states that "regardless of pregnancy status, non-Hispanic Black women experienced a disproportionate number of deaths." This report adds to the current knowledge around increased risks related to COVID-19 for pregnant women, particularly pregnant women of color, and suggests that pregnant women should be counseled about increased risks of severe illness or death related to COVID-19 as well as measures to prevent infection in their families. Preterm birth has also been associated with COVID-19, according to another report released by the U.S. CDC in early November 2020. The U.S. CDC encourages people to take preventive measures while pregnant and to seek prenatal care throughout pregnancy. If a person is infectious during labor, it is possible for them to spread the virus to the baby. Outside of the U.S., the World Health Organization (WHO) has reported that emerging international research suggests pregnant women with COVID-19 are more likely to need intensive care if severely ill, and more likely to give birth prematurely. The latest findings also suggest that pregnant women with COVID-19 who have pre-existing medical conditions, who are older, or who are overweight are more likely to suffer severe health complications due to COVID-19.

What do we know about the inflammatory syndrome impacting children with COVID-19?

The majority of young people infected have had relatively mild cases of COVID-19. However, the U.S. Centers for Disease Control (U.S. CDC) recently identified the more severe multisystem inflammatory syndrome in children (MIS-C) as a new syndrome associated with the virus that causes COVID-19. This inflammatory syndrome was first identified in April 2020 and is characterized by inflammation in different body parts, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. While MIS-C is rare, it can be deadly. Symptoms in children include fever, abdominal (gut) pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, or fatigue. This is a newly identified condition that requires more research, but doctors have observed that symptoms can develop within four weeks of exposure to the novel coronavirus. The inflammation can be managed with medicines that can prevent damage to vital organs. MIS-C occurs in young people under 21, according to its case definition, although it is thought to mostly affect children between the ages of 2 to 15 and is not commonly reported in babies. The U.S. CDC recommends immediately contacting a doctor if your child exhibits any of the symptoms of the inflammatory syndrome. We still do not know why some children experience symptoms, while others do not, and it is unclear if children with particular health conditions are more likely to get MIS-C. At this point, the best prevention measures include taking all precautions to avoid contracting the novel coronavirus, including hand washing, social distancing, avoiding public gatherings, and wearing masks.

What do we know so far about dexamethasone as a potential treatment for COVID-19?

Dexamethasone is a low-cost, anti-inflammatory medication that is part of the corticosteroid family. Corticosteroids function similarly to the cortisol produced in the body's adrenal glands yet they are synthetically made. Corticosteroids are commonly prescribed to suppress the immune system and reduce swelling and itching common to allergic reactions. Dexamethasone has been widely used since the 1960s, but it has recently been part of several studies exploring potential therapies for COVID-19. In the RECOVERY (Randomised Evaluation of Covid-19 Therapy) Trial at Oxford University (UK), the largest COVID-19 drug trial to date, researchers studied the impact of dexamethasone by comparing the roughly 2,000 patients who received the medication with the 4,000 patients who did not receive the medication. They found that the mortality risk was lowered for patients with severe cases of COVID-19 who were on ventilators or receiving oxygen. For patients with mild cases of COVID-19, beneficial effects were not observed. Dexamethasone has not been approved as an official treatment for COVID-19 outside the United Kingdom thus far, and the World Health Organization (WHO) has urged caution since these results are preliminary, have yet to be evaluated through the peer-review process, and represent findings from only one trial. Despite this, the medication is currently being used in several countries as a part of various treatment strategies for COVID-19. The WHO has also recently added dexamethasone and other steroids into its treatment guidelines for COVID-19. In two other recent studies using corticosteroidal medications (including dexamethasone) as potential treatments for COVID-19, one found a reduction in the number of days patients required ventilator support, and the other found that the corticosteroid medications were associated with an increased duration of illness (among other adverse impacts). Corticosteroids, including dexamethasone, are still an unproven treatment for COVID-19.

How can we tell if an increase in cases is the result of an increase in testing or something else?

A lot can be learned and based off of the percent-positive rate (e.g. how many tests result positive out of all the tests taken) and the number of cases in total. We cannot assume that an increase in cases or a growing percent-positive rate is purely a result of an increase in testing instead of a growing outbreak. Instead, we need to look at all of them together. A rise in the number of reported cases of COVID-19 could be related to an expansion of testing if the percentage of positive tests decreases or stays the same at the same time that the number of cases increases. Should percentage of positive tests increase while case counts also go up, this indicates that we cannot entirely blame the increase on expanded testing. The biggest indicator of a growing outbreak is if the percentage of positive tests increases along with the number of cases despite testing data staying the same or decreasing. When testing is not always widely available and reserved just for symptomatic people, the percent positivity will increase as with the number of cases. If testing is expanded and made more available, we will gain a better understanding of the true number of cases and percent-positive rate. If this percent positivity continues to grow along with the number of cases, this would be an indicator that the outbreak is worsening.

Is it true that India's Bharat Biotech is not too far away from finding a vaccine for COVID-19 as they have now been approved for human trials?

At this time, it is unlikely that a vaccine for COVID-19 will be produced before 2021. The Indian Council of Medical Research, the primary body overseeing clinical research for COVID-19 in India, has pushed to fast-track clinical trials for the Bharat Biotech-developed drug COVAXIN, which is currently in Phase II trials. ICMR had initially announced an ambitious deadline of August 15th 2020 to launch the vaccine, which had been criticized by doctors and researchers as a rushed and impractical timeline that carries substantial risks. ICMR has clarified that the intention is to complete the trials as fast as possible and speed up recruitment of participants, but everything will depend on the results of the clinical trials. The timeline to develop a safe and effective vaccine is lengthy and requires several stages of clinical trials, as well as plenty of regulatory oversight. This process usually takes several months and can continue for more than a year. Even if pre-clinical data is promising, human clinical trials that are necessary to deploy a vaccine take place in stages that take a very long time, in order to assess efficacy and safety. The process typically takes well over 12 months to complete. Lots of testing happens in animals before a vaccine begins phased testing in humans. During the first stage of vaccine testing on humans (Phase I), a new vaccine is provided to small groups of people—which is the first time the vaccine is tested in humans. The second stage (Phase II) involves testing the vaccine on people who have similar characteristics (such as age and physical health) to the target population, which means the group for which the vaccine is intended. The goal of this stage is to identify the most effective dosages and schedule for Phase III trials. The final stage (Phase III) provides the vaccine to hundreds of people across several different healthcare settings from the target population to see how safe and effective it is. Once the vaccine clears this last stage, the manufacturer can apply for a license from regulatory authorities to market for human use.

Why are smell tests being proposed over temperature checks at workplaces?

While many businesses and public spaces have begun using temperature checks as a way to try to identify people who might be infected with COVID-19, several studies have proposed that using a smell test in addition to a thermometer check may be a more accurate way of detecting potential cases. The reasons for this are numerous, and are mostly due to concerns about the effectiveness of temperature checks. Some of these issues include: - The fact that many people with COVID-19 never develop any symptoms such as fevers; - People with fevers might not have the virus at all and could have any number of other illnesses; - Infrared/non-contact thermometers are often inaccurate and operating errors may occur; and - People who take over-the-counter medication for fevers might be ill but will not present with a fever. Using a temperature check alone is not an effective strategy to detect COVID-19 infections at public sites. On the other hand, the potential benefits of a smell test are numerous, as the loss of smell— also called 'anosmia'—is relatively unique to COVID-19, whereas fevers are common symptoms in many illnesses. For instance, a recent preprint study (awaiting peer-review) showed that COVID-19 patients were 27 times more likely to have lost their sense of smell than people without the virus, but only 2.6 times more likely to have fever or chills than those without the virus. Another study demonstrated that people with a loss of smell are "more than 10 times more likely to have COVID-19 than other causes of infection," according to Dr. Carol Yan, making it a more accurate marker for COVID-19 than a fever would likely be, as they have many other causes and are associated with many other illnesses. Reasons like this are why many health experts believe that a combination of a smell test in addition to temperature checks could more accurately test and identify people for COVID-19.

How easily does COVID-19 spread from contaminated surfaces or animals?

According to the U.S. Centers for Disease Control and Prevention, COVID-19 doesn't easily spread from contaminated surfaces to humans. While it is not likely, it is still possible for the virus to spread through contaminated surfaces. Recent studies suggest that the more humid a region may be, the longer the virus may survive on surfaces. Another study found that the virus can remain on surfaces like plastic and steel for 48-72 hours, and for up to 24 hours on cardboard. If a person touches a contaminated surface with traces of the virus and then proceeds to touch their eyes, nose, or mouth, they could still become infected if the surface contains large amounts of the virus. Washing your hands for 20 seconds, avoiding touching your face, and cleaning surfaces often is an important step in stopping the potential spread of the virus. The virus that causes COVID-19 primarily spreads through close, person-to-person contact, not through surface contamination, so continuing to maintain six feet (two meters) of distance, wearing a cloth mask over a surgical mask, and staying home as much as possible are the key steps in combatting the virus. The risk of contracting the virus from the surfaces of animals and pets is also considered to be low. The U.S. CDC noted in June 2020 that there is currently no evidence that animals have a significant role in spreading COVID-19 and the risk of animals spreading it to humans is low. However, more studies are needed to determine if and how a variety of animals might be impacted by the virus.

If COVID-19 is transmitted via airborne particles, how might testing change?

Though the potential for airborne transmission likely wouldn't change testing methods outside of a push for more extensive testing in general, it might influence policy regarding mandating mask wearing, air purification and ventilation systems, and other methods of prevention related to airborne viral spread. SARS-CoV-2 (the virus that causes COVID-19) is not airborne in the traditional sense. COVID-19 spreads primarily through relatively large respiratory droplets that fall to the ground and into faces and bodies of others. These larger droplets, 'respiratory droplets,’ are wet from saliva and mucus and fall quickly to the ground. Scientists think this type of infectious droplet is how the majority of COVID-19 infections spread.  On the other hand, examples of airborne diseases are tuberculosis and measles, and the way these diseases spread is primarily through the air in smaller particles called 'microdroplets' or 'droplet nuclei.' Smaller droplets can stay in the air for longer periods of time because they are so small and light. Exhalation, talking, coughing, and singing can cause these small droplets to linger in the air for hours after a person leaves a room. SARS-CoV-2 viral particles may be part of these tiny droplets, and can travel beyond 6 feet (2m) in certain situations, but the disease is still not understood to be transmitted primarily through lingering infectious particles in the air.  The aerosol or airborne transmission of COVID-19 occurs more indoors in close contact. This might mean that people who don't fall into the U.S. Centers for Disease Control and Prevention-defined category of "exposed" to the virus (within 6 feet or 2m of an infected person for more than 15 minutes), but were in the same room as an infected person for an extended period of time, may now be considered ‘exposed’ and require testing. There is currently some controversy around this topic, as 239 scientists recently sent a letter to the World Health Organization (WHO) urging them to recognize the potential of people catching the virus from droplet nuclei via airborne transmission. These scientists believe that the evidence supporting the concept of airborne transmission mean current procedures like social distancing and vigorous hand-washing do not provide enough protection from virus-carrying microdroplets that can stay suspended in the air for hours. Thus, the potential for people inhaling these droplet nuclei into their noses and mouths means additional prevention steps are needed. The WHO previously maintained that the novel coronavirus is mainly spread by respiratory droplet transmission, but has since acknowledged the emerging evidence for airborne transmission in "crowded, closed, poorly ventilated settings," while cautioning that the evidence is preliminary and should be assessed further.

Is paracetamol effective in treating or curing COVID-19?

Paracetamol (also known as acetaminophen, Tylenol, Dolo 650) can help relieve symptoms associated with COVID-19, but it cannot cure the viral infection. Paracetamol, also known as acetaminophen, is a medication commonly used for mild to moderate pain and aches relief, and fever reduction. Since some people infected with COVID-19 experience fever, body aches and headaches, this drug has been prescribed to relieve those symptoms. Paracetamol can provide some relief for patients with these symptoms, but it is not a cure against COVID-19. Paracetamol made news headlines early in the pandemic because some governments, including the United Kingdom and France, and the World Health Organization encouraged people with COVID-19 to take paracetamol rather than ibuprofen – another drug used to help manage symptoms like fever, headache, or body aches. At the time, there were concerns about a link between ibuprofen and other drugs that could be prescribed to COVID-19 patients (such as non-steroidal anti-inflammatory (NSAID) drugs) that could lead to an increased risk for illness or for worsening of COVID-19 symptoms. As the pandemic evolved, the WHO changed their stance on March 19 2020 to say that they do not recommend avoiding ibuprofen to treat COVID-19 symptoms. While paracetamol is routinely used to relieve COVID-19 symptoms, it is important to strictly respect the dosage prescribed as stated on the medication bottle. The dosage of paracetamol for adults is 1-2 500 milligram tablets up to four times in 24 hours, with at least four hours in between doses. Any higher amount can be dangerous and is not advised. _This entry was updated with new information on August 4th, 2020_

What is pool testing and why is it being used?

Pool testing, distinct from individual testing, tests a pool (or group) of people at the same time and is a form of testing that has been used for diseases like HIV/AIDS before the current COVID-19 pandemic. Normally, when a COVID-19 test is done using a nasal swab on a patient, that sample is then tested individually to determine if the virus is present, and this can take anywhere from 15 minutes to several days, depending on the abilities of the lab running the test. With pool testing, anywhere from roughly 3 - 50 samples are combined and all of the swabs are tested at once. If the test result from that pool test is negative, then all patients in that pool do not have the virus. If the result is positive, then each swab must then be tested one-by-one. Pool testing, also called "batch testing," is currently being used in order to test many more people for COVID-19 than individual tests alone. This is because instead of testing patients and then analyzing their samples individually to determine whether or not one patient has been infected with COVID-19, pool testing combines many samples and tests them at the same time. Pool testing has gained popularity in recent months due to surging numbers of COVID-19 infections around the world. This method gives laboratories the ability to save time, test greater numbers of people, and use their resources most efficiently. These tests are most useful in places with large populations but a lower number of COVID-19 cases within that population, including group settings like schools or workplaces. In places with with a high rate of infections, this testing strategy would not be as beneficial since most patients would be tested individually either way. Another potential hurdle is that pool testing might lead to more false-negative tests. This is because if a patient does have the virus and it is present in their individual test sample, that sample will be diluted when it is combined with the rest of the samples from the larger group, possibly to the point where the viral load is undetectable.

Can traditional Chinese medicine like rhodiola or forsythia help treat COVID-19?

While there are historical uses for these herbal treatments, peer-reviewed studies to support the use of rhodiola, forsythia, or other tradtional Chinese medicines (TCM) for COVID-19 are limited. However, the limited evidence that does exist suggests that TCM used as a supplement with other treatments, such as antiviral medications and antibiotics is promising. One systematic review found that TCM could potentially help eliminate pathogens in the early stage of the virus; control inflammation and strengthens body resistance to the virus in the intermediary stage; and relieve depletion during the late stage of COVID‐19. However, more research is needed to confirm these results. Rhodiola is often used for stress, but has not been proven effective in treating COVID-19. Following the announcement from a Chinese official regarding approval of three herbal supplements for treatment, there was widespread concern regarding the lack of rigorous studies to support their use. More empirical research is needed to understand the role of TCM as a supplementary treatment for COVID-19. While there have now been a number of approvals of treatments for emergency use for COVID-19 approved in the U.S. and elsewhere, it is crucial to note that no COVID-19 treatment has been formally recommended by the World Health Organization (WHO), and more research is needed on larger samples and long-term to understand the impacts of TCM and other potential COVID-19 treatments.

What are the many benefits of testing?

Testing provides several benefits during a pandemic, including early diagnosis, contact tracing, prevention, and surveillance. Viral testing identifies if an individual is currently infected with the virus that causes COVID-19. At the individual level, it allows infected individuals who were potentially experiencing symptoms to be diagnosed and access the care they need. At the community level, viral testing prevents further infections since an infected individual can take all necessary precautions to not infect other people. It also allows public health experts to identify new cases and track the spread of the virus through contact tracing by following the chain of transmission. Viral testing is commonly used to test people who have symptoms of COVID-19 as well as caregivers, essential workers, travelers, and others who may not show active symptoms. Serology tests - also called antibody tests - are useful to find out if an individual has been previously infected with the virus that causes COVID-19. These kinds of tests look for antibodies in the blood, which determine if there was a previous infection. It allows public health experts to find out how many COVID-19 infections have occurred in the past, and to track what percentage of the population has been infected over time, which has important implications for surveillance. At a policy level, serology testing can guide social distancing or quarantine guidelines. The U.S. Centers for Disease Control use a serology surveillance strategy to better understand the spread of the virus by testing in different locations, at different points of time, and within different populations (ex. across age, ethnic and socioeconomic groups) in the United States. However, it's important to note that the evidence surrounding serology testing and its link to immunity (protection) is still evolving. We do not understand fully if prior infection is evidence of immunity, know how long antibodies can protect the body, or whether patients can get infected again after a previous infection.

What do we know so far about COVID-19 and alkalinity?

Eating more acidic or alkaline foods is not related to an increased or decreased risk of COVID-19 infection. Widely circulated social media posts falsely suggest that the pH of COVID-19 ranges from 5.5 to 8.5. Often these posts advise readers to eat alkaline foods (specifically fruits and vegetables) with a pH of more than 8.5 to prevent COVID-19.  Viruses themselves do not have pH levels, because they are not water-based solutions.In chemistry, pH (power of hydrogen, or potential for hydrogen) is a scale used for water-based solutions to indicate if they are acidic (pH below 7, with a lower pH indicating a stronger acid), neutral (pH around 7), or basic (pH above 7, with a higher indicating a stronger base). Since viruses are not water-based, the pH scale does not apply to the novel coronavirus SARS-CoV-2, the disease that causes COVID-19.While some illnesses or medications may cause blood pH levels to increase or decrease in our bodies, foods eaten as part of a regular diet do not have a significant impact on blood pH. Saliva and urine pH may change in response to diet, but these changes are variable from person to person and **will not prevent or cure COVID-19**. Many claims about alkaline foods preventing COVID-19 refer to a 1991 paper in which another type of coronavirus, the coronavirus mouse hepatitis type 4 (MHV4), was studied in mouse or rat cells in a solution with a pH of 5.5 to 8.5. Mice and rats are not the same as humans, and this study was not conducted in humans or on human cells. In addition, MHV4 is not the same as the SARS-Cov-2 virus that causes COVID-19, and this study was performed well before the SARS-Cov-2 was discovered in 2019. Eating a well-balanced diet including a variety of fruits and vegetables can help support immune function which may help to prevent illness in general, but there is not enough evidence to suggest that a well-balanced diet would be effective in preventing or treating COVID-19. 

Is favipiravir effective in treating COVID-19?

There is currently not enough evidence to know whether or not favipiravir, also known as Avigan, can effectively treat COVID-19; however, the preliminary evidence is promising. Favipiravir is a drug that is used as an influenza medication in Japan and China, and is currently in studies to treat other viral infections, including COVID-19, in many other countries. Early studies involving favipiravir has showed promising results in reducing the duration of symptoms of COVID-19 and aiding in the recovery of patients. However, there were shortcomings to these early studies, such as only having a small number of patients involved and the presence of age differences between study groups. Additionally, not all studies randomly assigned to their groups (called randomization) and not all studies "blinded" their study subjects and their doctors (meaning they both knew which treatments they received and didn't receive). This helps explain why there is a lack of consensus as to whether or not favipiravir is an effect treatment for COVID-19 at this time. Main advantages of favipiravir are that it is administered orally and that it can be given in patients who are symptomatic but not ill enough to be hospitalized. As of November 2020, the International Journal of Infectious Diseases published a set of case studies of COVID-19 treated with favipiravir among patients in critical or severe condition, and found that all patients showed a clinical and chest imaging improvement, and all patients recovered without subsequent hypoxemia. Once again, while these results are promising, they are case studies and not formal research studies and therefore have signifiant limitations.

How reliable are temperature checks for re-opening businesses?

Checking people for fever before they interact with others has been proposed as a means to help reduce transmission of disease. Some countries such as China and South Korea have widespread checks of body temperature to help identify individuals with fevers in offices, restaurants, airports, or other popularly-frequented locations. As a standalone measure, checking for fever is insufficient to prevent disease transmission because of how asymptomatic and pre-symptomatic people can get others sick. Diagnostic testing for COVID-19 - not temperature checks - is a much more accurate, effective means of determining whether or not employees might be infected with the virus. Additionally, temperature testing may be difficult to implement in some locations due to limited resources, privacy concerns, and other reasons. Some experts have cited concerns about workplace surveillance and privacy while using infrared temperature checks. There are also questions about the effectiveness and accuracy of these workplace thermometers, especially considering how many pre-symptomatic and asymptomatic patients might not have any symptoms during the duration of their illness. Lastly, fevers might be indicative of other factors or illnesses unrelated to COVID-19; for example, elevated body temperature is commonly observed in people who are physically exerting energy or under great stress.

Is it safe to wear a mask?

Wearing a face mask is both safe and recommended to slow the spread of COVID-19. The United States Centers for Disease Control recommends widespread use of cloth face coverings over surgical masks to prevent spread from people who might have the virus that causes COVID-19 without realizing it. While N95 masks are in short supply and should be reserved for healthcare workers, cloth face coverings should always be worn when interacting with other people in close proximity (including but not limited to grocery shopping, ordering food at a restaurant, interacting with people within 6 feet in outdoor spaces). You should clean your hands before touching the mask, make sure the mask covers your nose and mouth, and ensure the mask fits tightly on your face without leaving exposed spaces. Additionally, you should avoid touching the front of the mask, avoid taking the mask off when talking to other people; only remove the mask by touching the straps; wash your hands after removing the mask; wash the mask in soap and detergent with hot water at least once a day; and avoid sharing masks with others or leaving used masks around other people. While mask wearing is recognized as safe and is advised by the World Health Organization and other leading health advisory groups, there are cases where masks should not be used. For instance, masks are not safe for children under 2 years of age, people who have trouble breathing in general, or individuals who are unconscious or who would be unable to remove the mask without help.  Several cities and states, such as New Orleans and Washington, have mandated the use of face masks to slow the spread of the virus. However, masks alone are not enough. In addition to wearing a mask to help stop the spread of the virus, public health experts encourage social distancing (staying at least 6 feet (2 meters) away from others) as well as frequent and thorough hand washing.

Why are Brazil's cases surging right now?

Brazil has reported over 1.2 million cases and 54,000 deaths as of June 26, 2020. The recent surge in cases is mainly stemming from the country's densely populated regions, such as Sao Paolo and Rio de Janeiro. Studies estimate that 25% of the Brazilian population in Sao Paolo did not adequately adhere to quarantine guidelines, and the presence of densely packed low-income neighborhoods known as favelas has exacerbated the spread of the virus. In a new study, researchers conducted over 3,000 rapid tests in six of the city's most densely populated neighborhoods and found that infection rates were far higher than the official estimates: some studies had previously estimated that 9.5% of people in Sao Paolo were infected, but the most recent estimates from the largest favela in Sao Paola indicated almost 25% of people who were tested were positive. Medical experts attribute the surge in cases in major cities to relaxed quarantine and isolation measures. Major cities in the country have lifted lockdown measures, and reopened restaurants, shops and businesses. Another research study found that more than 75% of the confirmed cases are from the relatively densely populated southern and southeastern regions of Brazil, and the exponential growth in COVID-19 cases has stemmed from difficulties in effective social distancing. The study reports that many informal workers are continuing to work and information regarding minimum infection prevention and control measures, including hand washing and social distancing, has not been effectively communicated and followed.

How soon can we have a COVID-19 vaccine?

The timeline for COVID-19 vaccine availability is rapidly evolving, with differences between multiple vaccine candidates and rollout plans in different countries. While the vaccine development and testing processes normally take many years, these processes have been accelerated during the COVID-19 pandemic. Several COVID-19 vaccines have reported promising results from clinical trials so far. As of December 2, 2020, Pfizer's vaccine candidate received approval from the U.K. government to begin mass distribution, with at-risk populations and healthcare workers being the first priorities. Both Pfizer's and Moderna's vaccine candidates have applied for Emergency Use Authorization (EUA) from the U.S. government, and have the potential to begin distribution outside of trials before the end of 2020. In a departure from the rigorous review processes typically used for vaccines, China and Russia approved and started distributing experimental vaccine candidates earlier in 2020, based on preliminary data, rather than waiting for results from large-scale trails. There are currently more than 200 potential vaccines for COVID-19 under development around the world. Each potential vaccine must be thoroughly tested to determine whether it has any harmful side effects, whether it can prevent disease in other mammals, and whether it successfully produces antibodies, which are the biological tools or instructions our immune systems need to defend against the virus. Scientists also need to assess how the immune system responds to the vaccine in general, which takes time. Even with an expedited timeline and regulatory approval process, researchers must ensure adequate clinical testing and adherence to regulatory standards, manufacturing, and quality control processes. Additionally, several COVID-19 vaccine candidates require multiple doses to be effective and cold storage during transport. There are concerns about the cost and infrastructure requirements for vaccines to be distributed equitably in certain regions of the word. Public health experts hope that multiple vaccine candidates can be widely approved and distributed in 2021, to help end the global COVID-19 pandemic.

How effective are Remdesivir and Favipiravir, and can they be taken without medical supervision?

On November 19, 2020, the World Health Organization (WHO) recommended against the use of the antiviral Remdesivir (also known as Veklury) due to lacking evidence, following months of controversy regarding the utility of the drug. This decision was made based on four trials, including one conducted by the WHO, called the Solidarity trial, which is the largest so far and includes over 5,000 patients being used to study Remdesivir. The pre-print study found that Remdesivir (along with Hydroxychloroquine, Lopinavir and Interferon) regimens appeared to have little or no effect on hospitalized COVID-19, measured by by rates of overall mortality, initiation of ventilation, and the duration of stay in the hospital. The study also found that that Remdesivir does not reduce COVID-19 deaths. The trial studied data from 405 hospitals in 30 countries, and randomly assigned more than 11,000 people hospitalized with COVID-19 to assess Remdesivir and three other drugs. 301 of 2,743 people hospitalized with COVID-19 taking Remdesivir died, compared with 303 of 2,708 who were not taking Remdesivir, demonstrating that Remdesivir does not have a statistically significant mortality benefit.  Despite this recommendation by the WHO, Remdesivir continues to be recognized as a credible treatment for COVID-19 among hospitalized individuals, including in the U.S., Japan, and Germany. On October 22, 2020, the U.S. Food and Drug Administration (FDA) approved Remdesivir based off of the evidence of three randomized controlled trials. Remdesivir was the first officially approved treatment of COVID-19 within the U.S. The approval followed the FDA’s Emergency Use Authorization (EUA) for Remdesivir on May 1. Remdesivir was developed by pharmaceutical company Gilead. The other three studies the WHO panel reviewed evidence for to make their decision found more positive evidence regarding Remdesivir, but were smaller in size. One clinical trial, conducted by the National Institute of Allergy and Infectious Diseases, assessed COVID-19 recovery time within 29 days of being treated. The trial looked at 1,062 hospitalized subjects with mild, moderate, and severe COVID-19 who received Remdesivir versus those who did not. The median time to recovery from COVID-19 for those who received Remdesivir was 10 days compared to 15 days for those who did not, a statistically significant difference. The odds of clinical improvement were also higher for those who took Remdesivir at Day 15 compared to those who did not. This difference, however, was not statistically significant. A second study found that the odds of a subject’s COVID-19 symptoms improving were higher if they had taken Remdesivir compared to if they had received the standard of care. If the drug was taken for 10 days rather than 5 days, the chances increased more, but not to a statistically significant extent. The third, separate study found that a patient’s odds of their COVID-19 symptoms improving were similar for those taking Remdesivir for 5 days as those for 10 days, and that there were no statistically significant differences in recovery or mortality rates between the two groups. Once again, these studies are smaller in size than the WHO Solidarity trial.   Favipiravir is also considered to be a possible treatment for COVID-19. A small study showed the virus being reduced faster with the drug in comparison to other medications. Without further study, there is not enough evidence suggesting effectiveness and safety. Many studies for COVID-19 treatments remain underway, and it is too early to determine which additional ones may be effective therapeutic options for COVID-19 patients. When Favipiravir or any medication not officially approved is prescribed, it is important that medical providers monitor the patient's clinical condition noting effectiveness and possible negative side effects. 

How does COVID-19 differ from malaria?

COVID-19 and malaria are two different diseases with different ways of being spread and caught. Malaria is spread by mosquitoes, and humans become infected by mosquito bites. COVID-19 is spread by respiratory droplets that we inhale through our nose or our mouth. COVID-19 and malaria have been incorrectly linked for several reasons. Firstly, around the world, hydroxychloroquine, a drug used to treat malaria, received extensive news coverage because there were claims that the drug was effective against COVID-19. A few clinical trials and studies investigated hydroxychloroquine and found no evidence that the drug was effective against COVID-19. In some unfortunate cases, adverse events occurred in people taking this medication. Secondly, malaria and COVID-19 share some symptoms, although the list of COVID-19 symptoms currently grows and changes every day. Malaria symptoms usually appear 10-15 days after the infective mosquito bite and the first symptoms a patient feels are fever, headache, and chills. On the other hand, people infected with COVID-19 usually develop symptoms within 5 days and, in some cases, infected people never develop symptoms at all. Finally, there is a difference between fevers caused by malaria and those caused by COVID-19. Often malarial fevers are cyclical, reoccurring at predictable times based on which strain of malaria was contracted. In comparison, fevers caused by COVID-19 do not appear to occur in cycles. The most common COVID-19 symptoms are: fever, dry cough and tiredness. Less common symptoms include: aches and pains, sore throat, diarrhea, conjunctivitis, headache, loss of taste or smell, a rash on skin, or discoloration of fingers or toes.

What are dual treatments and are there any available for COVID-19 right now?

"Combination treatments" are the use of two or more drugs to treat a single disease. Currently, there are no combination treatments (also known as dual treatments) that are officially approved for use to treat COVID-19. However, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, announced on June 23, 2020 while testifying before a House committee on the U.S. response to the COVID-19 pandemic that Remdesivir is being used in combination with anti-inflammatory drug baricitinib. An NIH clinical trial has been underway since May to test the efficacy of the combined treatment, with results not yet released. Only three standalone drugs have officially received emergency use authorization (EUA) from the Federal Drug Administration (FDA) in the US; these include the anti-viral remdesivir (which the WHO has issued a warning for but which still has an EUA in the US), anti-malaria drugs chloroquine and hydroxychloroquine (which the FDA later issued a warning for), and a drug used to sedate patients that are on a ventilator. (These EUAs do not constitute a formal approval of the drug, but rather a possibility given to American doctors to use chloroquine and hydroxychloroquine in the treatment of COVID-19 if the doctor has no other options and after discussing with the patients the risks involved.) In terms of approval of combination treatments, on November 19, 2020, the FDA issued an EUA for the drug baricitinib, in combination with remdesivir, for the treatment of suspected or laboratory confirmed COVID-19 in hospitalized adults and pediatric patients two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). One example of a combination therapy being tested is the dual use of drugs lopinavir and ritonavir, which are in use to treat (not cure) HIV. The combination of these two drugs is known under the brand name Kaletra. Studies are still relatively inconclusive, but most have shown Kaletra to be ineffective for improving COVID-19 outcomes. One study, however, found that when taken with two other drugs — ribavirin and interferon beta-1b — the virus took less time to clear from the patient's body. There are a number of limitations from this trial that warrant further testing. Other studies testing combination therapy have focused on pairs with remdesivir. One study, which led to the combination treatment approved through an EUA by the FDA mentioned above, tested the impacts of remdesivir and anti-inflammatory drug known as baricitinib on time to recovery in hospitalized patients and found a significant reduction. Another tested the combination of remdesivir with the drug leronlimab, an antiviral that has also has shown to have some anti-inflammatory benefits. Studies are also exploring more holistic and less pharmacological approaches as complementary COVID-19 treatment — that is, a potential additional treatment used in combination with other COVID-19 treatments. For instance, some researchers are exploring Traditional Chinese Medicine as a complementary therapy to combat COVID‐19 in conjunction with other therapies being used such as antiviral medications and antibiotics. Virgin coconut oil (VCO) is also being studied in the Philippines and other countries as a potential supplementary treatment for COVID-19 such as antiviral medications and antibiotics. These studies assessing combination treatments will get us closer to understanding if certain combination therapies might be effective for treating COVID-19.

Could the oral polio vaccine be a solution for Covid-19?

It's too early to know. Successful discovery and safe delivery of a vaccine are very challenging. In the pandemic context we are in, many scientists are turning to existing drugs and vaccines to try and see if they can repurpose them to tackle COVID-19, especially since their safety profiles, side effects, and effectiveness are already known. Similarly, the safety track record of the oral polio vaccine is also known, and scientists are now studying its efficacy against COVID-19. The hypothesis these scientists have suggested is that the oral polio vaccine – a weakened version of the live polio virus – is assumed to trigger a general immune response in the body - production of antibodies against a foreign organism to be protected in the future if infected again with the same organism. When the body's immune system engages this response to fight off the unknown virus, scientists believe the body will develop antibodies specific to the novel coronavirus, the virus that causes COVID-19. However these are early studies occurring in animal models only at this stage and with no results yet. Moreover, there is no consensus yet among scientists as to whether choosing the oral polio vaccine as a candidate was a good idea in the first place. Some note that there are risks in introducing the oral polio vaccine in some populations which is why in most of the world, doctors have phased out the oral formulation in favor of the inactivated polio vaccine, which is more widely used today.

Does COVID-19 impact men worse than women?

Data from around the world has demonstrated the fact that men are impacted more greatly than women by COVID-19. For example, men are more likely to be hospitalized with severe symptoms of the virus and have higher mortality rates than women; and this finding is consistent across age groups and geographies. Researchers have been trying to understand the causes of this and are developing hypotheses to explain the differences between the immune systems' response to COVID-19 in men and women. At this stage, they are exploring these disparities using biological, social, and behavioral lenses. Based on previous studies with similar viruses, data has illustrated that sex differences in immunity are caused by both genetic as well as hormonal differences between women and men. For example, in females, hormones such as estrogen and progesterone may be protective against the virus, yet it is possible testosterone does the opposite for men. In terms of underlying illnesses, the data also illustrates that men are more likely to suffer from hypertension, heart disease, and diabetes than women. Since the beginning of the pandemic, we have learned that these types of underlying conditions have been associated with a higher risk of complications from COVID-19. Behavioral factors may also explain this difference. For instance, females may be more likely to be frontline workers than men, which could create more risks for exposure. In terms of lifestyle, men tend to be more likely to be smokers, which is a risk factor for COVID-19 since it is a respiratory illness. From past studies, we also know that men are less likely to seek out medical care when there's a problem in comparison to women, which means they may interact with the health system at a later stage in the disease when symptoms are more severe. Similarly, in the case of COVID-19, men are less likely to engage in behaviors like mask-wearing and hand-washing, which may increase their risk of contracting the disease. Source: Dr. Sabra Klein (Johns Hopkins University)

Are there ayurveda cures for COVID-19?

Ayurveda is ancient Indian medical system that focuses on natural, holistic approaches to physical and mental health. Currently, there is no evidence to indicate that Ayurvedic medicine cures or prevents COVID-19. Similar claims for Ayurvedic cures have been made in the past for other infectious diseases with no known cure, such as HIV/AIDS, without any reliable evidence. Such bold claims should always be treated with caution. In this particular case, the CEO of a major manufacturer of herbal products has claimed to have produced an Ayurvedic cure without providing any independent data to support these claims. While the company claims to have tested hundreds of patients in a "clinical case study" which showed a 100% recovery rate, it is unclear whether any control group was included or whether the design of the study was strong enough to substantiate such claims. In addition, the company stated that all patients tested negative for the virus within 5-14 days after receiving the Ayurvedic medicine, but it is unclear how long each patient had the virus or were symptomatic. The study also falsely claimed that Ayurvedic medicine is a cure for COVID-19 without disclosing how many patients were included in their research and how they can be sure that patients would not have tested negative naturally once the immune system fought off the infection over time. Ayurvedic medicine may be a helpful complement to Western medicine, and may not actively cause harm in some cases, but it should not be consumed as a cure for COVID-19. Instead, traditional prevention measures such as wearing masks and social distancing, should be followed to prevent infections.

What do we know about the use of the drug avifavir to treat COVID-19?

Avifavir is an antiviral medication primarily used to treat severe cases of influenza. This medication is currently being studied in several countries as a potential experimental treatment for COVID-19, but we do not yet have enough evidence to determine whether or not Avifavir is an effective treatment for the virus. Recently in Russia, the health ministry approved the medication's use as a COVID-19 treatment by using an accelerated, short-term form of a clinical trial with fewer people involved than traditional studies would normally require. However, this study has not been published in a peer-reviewed journal so the data, methods, and other study characteristics have yet to be critiqued or evaluated by other scientists. Though this research is still occurring in the country, Russia's preliminary results suggested Avifavir might help reduce the number of days people are infected with the virus and shorten the duration of time people experience high-grade fevers while sick. In September 2020, a publication from India reviewed clinical trials in China and Japan, along with the on-going trials in Russia and other on-going studies in Saudi Arabia, the United States, and India. The researchers acknowledged that Avifavir does not have as much supportive data to back its use compared to other drugs, but that it may be emerging as a medication that is worth considering in mild to moderate cases. The preliminary results from a study in India suggest that Avifavir may help reduce the time it takes for COVID-19 patients to recover, and lead to a two-day shorter viral shedding period when patients are infectious. Until more studies are completed and a greater amount of data can demonstrate Avifavir's efficacy and safety, we do not have enough information to determine whether or not this medication can help treat COVID-19.

Why are we repurposing old drugs to fight new diseases, and what might be the implications for COVID-19?

There is a whole branch of medical research and pharmaceutical companies dedicated to drug repurposing. In practice, it has led to some therapeutic breakthroughs. For example, aspirin which is historically known for treatment of pain, fever or inflammation, has then be found to be effective against some cardiovascular diseases and is now being studied for potential anti-tumor growth in some cancers. Developing new treatments against new diseases often takes several years, if not decades. With the COVID-19 pandemic death toll increasing by the day, scientists are racing to find drugs that could prevent, treat or simply decrease the severity of COVID-19. Scientists have therefore turned their attention to studying drugs that have been studied for other viruses like the MERS coronavirus, HIV (the virus that causes AIDS), hepatitis C, ebola, influenza, etc. to see whether these drugs would also be effective against this new threat, COVID-19. Since these studies build on existing knowledge, the drug development timeline is substantially shortened, as is the required financial investment. Beyond the time-intensive process of developing new drugs, the advantages of repurposing drugs are numerous. First, existing drugs already have an existing safety track record, and have obtained regulatory approval or are in the later stages of clinical trials. Moreover, they have already been produced and may already be on the market, so plans to increase manufacturing can rapidly occur since the infrastructure already exists and does not need to be re-created. Because of this, scientists can focus on studying whether these drugs are effective against COVID-19, and if so, they can be brought to clinical use at the bedside of patients rapidly. Drug repurposing is very common in medical research as science rarely happens in a vacuum, but rather builds on previous iterations and experience.

How are migrant laborers in India being impacted by the COVID-19 pandemic?

India enacted one of the toughest nationwide lockdown policies in response to the COVID-19 pandemic, and shut down all travel and movement with barely four hours notice on March 24, 2020. The lockdown disproportionately impacted the informal sector of India (the part of any economy that is not regulated by the government), and left thousands of migrant laborers and daily wage earners stranded. With buses and trains shuttered, migrant laborers had to walk hundreds of kilometers back to their villages, and many died along the way. India's COVID-19 response has been criticized for inadequately accounting for the needs of the most marginalized and vulnerable residents who lacked resources to cope with the abrupt lockdown. Now that the lockdown has ended, the Supreme Court of India has ordered states to identify stranded migrant laborers and facilitate their return to their hometowns. Several states, including West Bengal, Odisha, Bihar, and Jharkhand, have reported spikes in infections as more than 10 million migrant workers return to their homes following the easing of lockdown measures. The actual impact of migration on COVID-19 cases is difficult to ascertain, since testing has also improved, but the sudden influx of migrant laborers has made it even more difficult for the state healthcare institutions to treat and care for COVID-19 cases.

What do we know about the association between blood type and severe reaction to COVID-19

As of now, there is not enough evidence to indicate whether or not there may be some connection between blood type and COVID-19 risk, though the link is likely to be minimal if it does exist. Studies previously cited in the news suggested that Type A blood could be associated with higher risks of severe cases of COVID-19, and reporting included studies that had not yet been assessed by scientific experts (referred to in science as the peer-review process). One of these recent studies had been peer-reviewed and published in the New England Journal of Medicine (NEJM); however it used genes to determine the blood type, which is a method that is not very accurate. The gene testing company, 23andMe, recently released the preprint of a study (awaiting peer-review and using a similar gene association method) that identifies a strong association between blood type and COVID-19 diagnosis. The study suggests that people with blood group O tested positive less often compared to people with other blood groups, under similar circumstances. Two more recent studies from Columbia University and Massachusetts General Hospital in the U.S. found that blood type is not associated with risks of intubation or death from COVID-19, after adjusting for other factors. While scientists continue to learn more, age and underlying health conditions remain more significant risk factors for severe COVID-19 symptoms, and Type A blood is not thought to be a major risk factor at this time. While some studies have suggested a potential risk reduction for people with Type O blood, not all the studies have been peer-reviewed and the use of blood donors as study participants can give the appearance of Type O being more protective than it is (Type O blood is over-represented in blood donors, compared to the general population). Type O blood does not mean immunity to COVID-19.

Can we use sewage water to detect COVID-19 in a community?

SARS-CoV-2 is the virus that causes COVID-19. It leaves the human body through our waste, so flushing the toilet with that waste means traces of the virus can be found in sewage water. This is why COVID-19 has been recently detected in sewage water in regions that have tested for it. By collecting water from sewers, scientists in the U.S. and Europe are now testing sewage for the virus, using it as a collective sample to measure infection levels among thousands of people. Recent studies have shown that sewage water can be used as an early diagnostic tool for determining where potential COVID-19 cases might be occurring in a city. A recent study showed that measuring virus levels in municipal sewage helped researchers predict where forthcoming COVID-19 cases would be coming from a week before people began testing positive for the virus in that area. They did this by comparing the amount of virus found in the sewage water with the amount of confirmed cases in an area's hospitals. We have observed that estimating the true number of COVID-19 cases is extremely challenging; these estimates often lead to underestimating the true scope of the pandemic in a community because many people are never tested for the virus even if they are ill. Moreover, asymptomatic patients or those with mild symptoms may never seek out testing and therefore won't be counted; but they can still transmit the virus. In this context, measuring overall virus levels in sewage over time could indicate the scope of the pandemic; indicate whether an outbreak is growing or shrinking; and can act as a surveillance system that would allow to detect new waves of an outbreak before patients develop symptoms and go to hospitals. (Source: [Biobot Analytics](https://www.biobot.io/))

Why does COVID-19 make some people sick for months?

Because the COVID-19 virus is new, we still don't know why some people might become sick longer than others—but we do know that people infected with COVID-19 who have severe symptoms tend to have symptoms for longer than those with mild cases. Differences in immune responses, including lower levels of antibody production, can impact how long patients remain sick with COVID-19. COVID-19 can impact many organs, which might help explain why the virus can cause symptoms that continue over a longer period of time in some patients. Akiko Iwasaki, a Yale immunology doctor, believes some potential reasons the virus lasts longer in some patients is because the virus might remain in one of the organs that is not tested by nasal swabs; that non-living parts of the virus can still cause your immune system to overreact like the virus is still alive and reproducing in your body when it isn't really doing that; and the virus might not be present in your body any longer, but your immune system is stuck in the state of fighting it off. Additionally, after becoming infected with different viruses, your body can take a while to heal. So even if you don't have the virus anymore, you may continue coughing and not be able to breathe as well as you normally do, since your throat and lungs have yet to fully heal and recover. Currently, the majority of patients infected with COVID-19 have symptoms for several days - 6 weeks.

Can we trust antibody tests to tell who has been infected and who hasn't?

Antibody tests are now available in many parts of the world, and they can play an important role in understanding COVID-19 trends and identifying groups at higher risk for infection.  Diagnostic tests are never 100% accurate. Sometimes, a test will produce false positives (when you test positive for the virus, but don't have it) and false negatives (when you test negative for the virus, but you really have been infected). The antibody tests for COVID-19 are similar. To be able to trust the results of an antibody test, we must look at its ability to detect the presence of COVID-19 antibodies when they are present, and its ability to confirm the absence COVID-19 antibodies when they are truly absent.  In the context of the current pandemic, it is important for us to reduce the amount of false positive test results that can occur by choosing a test that is highly specific. This means we must choose a test whose ability to correctly identify those without the disease is as accurate as possible, so that a negative test result truly means that person has not been infected with COVID-19. This is because an individual with a false positive test result may be mistakenly reassured that they are safe, and may pay less attention to basic prevention (e.g., social distancing). In this context, the U.S. CDC recommends choosing a test with very high specificity, perhaps 99.5% or greater. Irrespective of where people reside, they should choose the test available on the market with the highest specificity. However, it is important to note that at this stage of the pandemic, we don't know yet exactly what a positive antibody test means in practice. We are not sure yet if a positive antibody test means that the antibodies will give the person immunity (i.e. prevent them from getting sick again with COVID-19); and if they do, how long this protection can last (weeks? months?). Several studies are currently underway.

What do people mean when they refer to COVID-19 as being a blood vessel disease?

Patients who have been infected with COVID-19 can sometimes develop severe symptoms. Some of these symptoms include things like blood clots, heart problems, and "COVID toes." One thing all of these issues have in common is their link to blood vessels, which are the tubes that deliver blood and oxygen throughout the body. When these tubes, and the cells that line the insides of the tubes (endothelial cells), have challenges carrying and spreading blood to organs and tissues, issues like blood clots, kidney damage, inflammation of the heart and swelling of the brain (encephalitis) can occur in patients. This is why some doctors are calling the virus a "vasculotropic" virus (virus that affects blood vessels). More research is needed to present such findings conclusively. Though COVID-19 was originally thought to be a respiratory illness, some researchers believe that the virus may be able to move from the lungs into the blood vessels (pulmonary system), often causing additional symptoms such as the ones mentioned above. While some patients have been impacted by blood vessel-related symptoms, more research is still needed to determine its exact impacts on the body and its organs. At this point in time, blood clots due appear to be a major cause of negative health outcomes in patients with severe cases of COVID-19, bringing heightened awareness to the potential involvement of blood vessels and blood flow as an effect of the virus.
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