When someone has been infected with COVID-19, their body's immune system produces antibodies (special proteins) that work to destroy the virus. These antibodies can usually be found in someone's blood after they recover from the virus, specifically in a portion of the blood called 'plasma.' Antibodies in plasma help an infected person fight off the virus, so researchers are studying whether transferring plasma from patients who have recovered from COVID-19 (also called 'convalescent plasma') can help strengthen people's immune systems to fight off the infection. This experimental use of convalescent plasma for COVID-19 is not currently an approved treatment by the World Health Organization, and there is a lack of scientific evidence to allow convalescent plasma to be routinely prescribed to patients with COVID-19. However, there are potential benefits to convalescent plasma use that have been demonstrated with other diseases. These benefits are believed to outweigh the potential risks. Given the current lack of scientific evidence, the use of convalescent plasma has not been formally approved by the US Food and Drug Administration (FDA). On August 23, 2020, however, the administration did issue an emergency use authorization (EUA) for investigational convalescent plasma use for the treatment of COVID-19 in hospitalized patients. This means that convalescent plasma is now regulated as an investigational treatment for COVID-19, but it not yet fully approved for use. More than 70,000 patients have received convalescent plasma in the US. Recent studies are inconclusive and have not shown significant benefits for patients who receive convalescent plasma, but more research needs to be conducted before scientists reach a consensus about the benefits vs possible negative impacts plasma may have in patients with COVID-19.

The United States Food and Drug Administration (U.S. FDA) recently issued two Emergency Use Authorization (EUAs) for American pharmaceutical company Eli Lilly's most recent COVID-19 treatments. The first emergency use authorization was issued on November 19, 2020, for bamlanivimab, an antibody treatment. Bamlanivimab has been shown to reduce emergency room visits and hospitalizations in patients who receive the medication quickly after their diagnosis, according to early studies. No benefit has been shown in hospitalized patients with the virus. The treatment was developed with collaborators including Vancouver-based AbCellera and the U.S. National Institutes of Health. Bamlanivimab is a monoclonal antibody drug that mimics the immune system’s own antibodies that fight off harmful antigens such as viruses (like COVID-19). In this way, the medication might be able to help block the virus from entering and infecting healthy human cells. This drug should be dispensed as soon as possible after a person tests positive for the virus and within 10 days of developing systems. Bamlanivimab is authorized for people 12 years of age and older who weigh at least 40 kilograms (88 pounds) and who may be at risk for developing a severe case of COVID-19 infection or be hospitalized due to its impacts. Bamlanivimab was developed from the blood of a recovered patient who had developed antibodies to the virus. The data used to support this emergency use authorization was based on a phase two randomized clinical trial in 465 non-hospitalized adults with mild to moderate COVID-19 symptoms. Patients treated with bamlanivimab showed reduced viral load and rates of symptoms and hospitalization in comparison with those who did not receive the treatment. On November 19, 2020, (U.S. FDA) issued an EUA for the emergency use of Eli Lilly's drug baricitinib to be used in combination with another COVID-19 U.S. FDA-approved treatment, remdesivir, in adult patients who have been hospitalized with COVID-19. This treatment, which also goes by the brand name Olumiant, is normally used to treat rheumatoid arthritis and was developed in partnership with Incyte. In comparison to treating patients with remdesivir alone, baricitinib was shown to reduce time to recovery, when combined with the remdesivir. The safety of this investigational therapy is still being studied, but this medication combination was authorized for patients two years of age or older with suspected or confirmed cases of the virus who require supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). The combination of drugs improved patients' median time to recovery from eight to seven days compared to remdesivir alone, a 12.5% improvement in the  1,000 patient study that began on May 8,2020, to assess the efficacy and safety of baricitinib plus remdesivir versus remdesivir in hospitalized patients with COVID-19. The proportion of patients who progressed to ventilation, or died by day 29, was 23% lower when given both drugs in comparison to remdesivir alone. By day 29, deaths among patients were also reduced by 35% for the combination treatment when compared to remdesivir by itself. The recommended dose for baricitinib in COVID-19 patients is 4 milligrams once daily for 14 days or until hospital discharge.

**Approval status:** On December 2, 2020, the U.K. Medicines and Healthcare products Regulatory Agency (MHRA) granted an emergency-use authorization to a 2-dose mRNA vaccine developed by Pfizer and BioNTech, roughly seven months after the clinical trials started. Other vaccine candidates are currently under review by the regulator. **Approval processes:** In the United Kingdom, vaccines are approved by the regulator (the MHRA) based on criteria including safety, quality, and efficacy. The MHRA has been using a "rolling review" process since June 2020 to assess COVID-19 vaccines in an accelerated timeframe, with teams of scientists often requesting and reviewing data on various topics in parallel. The European Union (EU) requires vaccines to be authorized by the European Medicines Agency (EMA), but allows individual countries to use an emergency procedure to distribute a vaccine for temporary use in their domestic market. The MHRA chief executive stated that they used this existing EU provision to fast-track approval in the U.K. before the rest of the EU, since the U.K. is still subject to EU rules until their transition period for leaving is completed on December 31, 2020. **Distribution status:** The U.K. announced that 357 million doses of seven different vaccines have been purchased, which includes 40 million doses of the Pfizer and BioNTech vaccine. An initial delivery of 800,000 doses of the Pfizer and BioNTech vaccine (which can provide two doses to 400,000 people) was received from a manufacturing site in Belgium, and was divided between the four countries of the U.K. on the basis of population (with most going to England and Wales, 65,500 doses going to Scotland, and 25,000 doses going to Northern Ireland). The first vaccinations outside of trials in the U.K. began on December 8, 2020, prioritizing residents and caretakers in care homes for older adults (also known as aged-care). A 90-year-old woman was the first person outside of trials to receive a vaccine dose in her country. **Distribution priorities:** The U.K. Joint Committee on Vaccination and Immunisation (JCVI) identified that the first phase of vaccinations should focus on directly preventing mortality and supporting the National Health Service (NHS) as well as the social care system. This first phase includes nine priority groups, which taken together are estimated to represent 99% of preventable mortality: 1. Residents in a care home for older adults and their carers 2. All those 80 years of age and over and frontline health and social care workers 3. All those 75 years of age and over 4. All those 70 years of age and over and clinically extremely vulnerable individuals 5. All those 65 years of age and over 6. All individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality 7. All those 60 years of age and over 8. All those 55 years of age and over 9. All those 50 years of age and over The next phase of vaccinations will focus on further reducing hospitalization and targeting those at high risk of exposure and/or those delivering key public services. This next phase is likely to include people at increased risk of exposure to COVID-19 due to their occupation, such as first responders, the military, those involved in the justice system, teachers, transport workers, and public servants essential to the pandemic response. **Distribution processes:** The Pfizer and BioNTech vaccine requires storage in ultra-cold temperatures of -70 degrees Celsius. A shipping box has been developed that is packed with dry ice to maintain the necessary temperature for 5,000 doses, which can be transported by airplane. Once the doses arrive in the target country, the country can store the dry ice packs in a freezer farm for up to 6 months. If unopened, the dry ice packs can keep the doses cold for up to 10 days during transport. After the vaccine is thawed, it can be stored for up to 5 days at between 2 and 8 degrees Celsius. The U.K. Security Service (MI5) and National Cyber Security Centre (NCSC) are working to provide security for the vaccine supply chain and distribution, which could be disrupted by hacking and other attacks. The U.K. Ministry of Defence has announced that it is providing 60 military planners to work with the government's vaccine task force and 56 personnel to help construct vaccination centers. The U.K. Armed Forces Minister announced that more than 2,000 military personnel have been deployed so far to help with testing and other COVID-19 response, and that 13,500 military personnel remain on "high readiness" to provide support. In England, 50 NHS hospitals are serving as initial hubs for administering the vaccine.

By using a test-trace-isolate strategy of containing infectious diseases early in the pandemic, Iceland was viewed as a model for quickly addressing and managing the spread of COVID-19. In September and October of 2020, however, the number of daily COVID-19 cases rose, peaking higher than in the first wave of the pandemic. The number of daily COVID-19 cases has been dropping back down in November and early December of 2020. According to the World Health Organization, as of December 8, 2020, there have been 5,496 confirmed COVID-19 cases with 27 deaths in Iceland. Iceland is a small nation and, as an island, its borders are well controlled. Frequent testing, including testing for all who enter the country, in combination with contact tracing, isolation, and quarantine measures, has helped ensure that hospitals are not overwhelmed by patients. Doctors have reported that, while hospitalizations are greater in the second wave of the pandemic, intensive care admissions for COVID-19 are lower. The lower need for intensive care may be because younger, otherwise healthy people are being infected at higher rates than older individuals. In addition to earlier monitoring and supportive treatments, the lower number of deaths may also be related to the fact that most residents of Iceland (95.3%) have access to Universal Health Coverage and the incidence of pre-existing conditions (like obesity and diabetes) is lower than in many countries, including in U.S.

Many people infected with COVID-19 have mild or no symptoms, but some of the short-term impacts reported by people with mild symptoms include shortness of breath, fever, cough, fatigue (tiredness), and body aches. For more severe cases, short-term impacts may include respiratory (breathing) failure, confusion or other neurological problems, and kidney or heart damage due to a lack of oxygen or blood clots that can sometimes cause long-term problems. The worse the symptoms of COVID-19 are, the more likely major organs are to be negatively impacted. COVID-19 may impact organ systems directly (in the case of the virus causing inflammation in the lungs and airways) or indirectly (where organ damage is caused by illness that is a result of COVID-19 infection, but the organ damage is not caused by the virus infecting the organ directly). Recent studies document long-term impacts of COVID-19 on different organs in the body, including lung scarring, limited lung capacity, neurocognitive impacts, heart damage, renal failure, and more. Lungs: Though it can impact other organs, COVID-19 is primarily thought of as a lung (or respiratory) illness. Patients with lung problems like asthma, chronic obstructive pulmonary disease (COPD), and other chronic (long-term) lung diseases may be at higher risk of having complications from COVID-19. In any infected patient, COVID-19 may cause pneumonia (where the lungs fill with fluid), acute respiratory distress syndrome (ARDS), and sepsis (a bloodstream infection). Lung problems may be short or long term, and experts have suggested that it can take months, possibly even more than a year, for lung function to return to normal after a COVID-19 infection. Early rehabilitation has been shown to improve respiratory (breathing) problems in patients who have had severe COVID-19. Heart: Studies have shown that heart problems are also common. One German study reported that 78 out of 100 patients recovering from a COVID-19 infection had heart-related problems, such as inflammation and scarring, that could have serious consequences. In addition, heart problems have been reported in 40% of COVID-19 deaths. In September, US CDC reported that heart conditions like myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the covering of the heart), are associated with COVID-19. Such heart damage might also explain long-term symptoms like shortness of breath, chest pain, and heart palpitations. Although rare, severe heart damage has also been seen in young, healthy people. Kidneys: The American Society of Nephrology reported that approximately 50% of patients with severe cases of COVID-19 in intensive care experience kidney failure. During July 2020, the impacts of COVID-19 on the kidneys made the news, following updated recommendations from the American Society of Nephrology. On this topic, Mount Sinai Health System Associate Professor of Nephrology and RenalytixAI Co-Founder, Dr. Steven Coca warns about the rise in “chronic kidney disease in the U.S. among those who recovered from the coronavirus...Since the start of the coronavirus pandemic we have seen the highest rate of kidney failure in our lifetimes. It’s a long-term health burden for patients, the medical community — and the U.S. economy.” New research and media reports are continuing to be released. Brain: 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). Researchers believe that these effects are an indirect impact of COVID-19 (meaning these effects occur because of illness related to COVID-19, but not as a direct result of the virus entering the tissue). Studies from around the world have reported neurological symptoms in COVID-19 patients ranging from brain inflammation and delirium to nerve damage, stroke, and impaired consciousness in as much as 30% of patients. Researchers have long been concerned about the risks of post-traumatic stress, dementia, and delirium in patients who require intensive care (even without COVID-19). The long-term implications of COVID-19 on the brain and nervous system are still unclear, since COVID-19 is a new disease and there has not been enough time to observe patients over long periods of time. Neurological complications have, however, been reported during previous epidemics, such as the Severe Acute Respiratory Syndrome (SARS) epidemic in 2003 and the Middle East Respiratory Syndrome (MERS) outbreak more recently in 2012. Since this is a new illness, the real long-term impacts remain unknown. The longer-term effects of COVID-19 are still being studied. Exhaustion, anxiety, dizziness, headaches, muscle aches, loss of taste and smell, and difficulty breathing are often reported in patients who experience symptoms for weeks following their infection with COVID-19. For some people infected with the virus, symptoms have lasted longer than 100 days.

Some vaccines can be very successful at preventing illnesses or reducing the severity of it, but no vaccine is 100% effective on an entire population. This is because immune responses vary from person to person. The measles vaccine is one of the most successful vaccines, which is 99 per cent effective at preventing the disease. The effectiveness of the flu vaccine administered in the US varies widely from year to year (anywhere from 20% to 60%), depending on how well the annual vaccine attacks that year's mutation of the virus. The duration of how long a vaccine protection lasts, and how many doses might be needed for it to be effective also varies from disease to disease. For the COVID-19 vaccine, the U.S. FDA has set an effectiveness threshold of 50% to be approved or grants the emergency use authorization. A vaccine might not be 100% effective, but if most people get vaccinated then vaccination not only protects individuals, but also prevents the virus from circulating widely in a community.

In silico methods are computational predictions that have been used for decades to help reduce the required time and expenses during drug development, including for drugs that fight cancer and tuberculosis. During the COVID-19 pandemic, in silico methods have been used in various ways to find effective interventions for preventing and treating COVID-19. For example, in silico methods have been used to quickly screen a large number of compounds, helping to identify which have more potential to inhibit the virus SARS-CoV-2 that causes COVID-19 for application in therapeutic drugs. Another example is the use of in silico methods to model how COVID-19 can spread in a population, and to simulate the impact of different preventative measures such as wearing masks. In silico methods can also be used to speed up the design and evaluation of medical devices and other supplies. Additionally, in silico methods have been used to model, and sometimes attempt to predict, COVID-19 symptoms or complications by comparing simulations to actual clinical data. Researchers are continuing to apply in silico methods in different ways to figure out how to best prevent and treat COVID-19.

Antigen tests for COVID-19 have many advantages, including rapid results, cheap production costs, and a high rate of accurate test results for people who are actively infected with COVID-19. However, one of the major downsides of these tests is their high rate of false negative results (having a negative test result even if you are actively infected with the virus). Comparatively, false positive test results, which incorrectly show that a healthy person is infected by the virus when they are not, are very rare in tests that have been approved by regulatory agencies like the U.S. Food and Drug Administration (FDA). Despite having low rates of false positives, these types or errors in antigen tests still exist due to technical issues like handling, contamination, or test errors. These considerations have a large impact as their effects can directly result in health impacts for people who test positive (but are not) and are quarantined with people with active infections or receive treatments like medication when it may be harmful. While most newer antigen tests aim to accurately identify people with active COVID-19 infections at least 80% and 90% of the time (true positive rate), some antigen tests have been reported to have false positive or false negative rates as high as 50%. Several experts recommend using a second test to confirm a patient is truly negative or positive, particularly when patients may have no symptoms or have not been exposed to people who tested positive for the virus. While antigen tests can usually diagnose active COVID-19 infections, they are more likely to miss an active infection in comparison to molecular tests like polymerase chain reaction (PCR) tests. Several countries have begun authorizing the use of newer antigen tests that report lower rates of false positives and false negatives. For example, as of early December 2020, the U.S. FDA has granted Emergency Use Authorizations (EUAs) for a handful of the more accurate antigen tests that are available. As more of these tests are produced and used on a wide scale, we hope to learn more about their accuracy and achieve as sensitive (correctly identifying those who are are actively infected with the virus) and specific (correctly identifying those who do not have an active infection) as possible.

Some vaccines, including the Oxford Astra-Zeneca vaccine, are developed using something called a viral vector. A viral vector involves using a weakened and modified version of a virus, in order to teach the body how to activate an immune response against the actual virus. The University of Oxford-AstraZeneca vaccine, AZD122, uses an adenovirus vector as its technology. A spike glycoprotein (S) is found on the surface of the SARS-Cov-2 coronavirus virus through which the virus binds to receptors on human cells (ACE2 receptor) and gains access to insert itself and cause infection. Genetic material of this spike protein is added to ChAdOx1 virus vector so that the adenovirus can stimulate a response from a person's immune system when their body detects it in cells. When the vaccine is injected, it penetrates into the body and gives a blueprint (DNA) for how to defend itself against COVID-19. In this case, that means the cells start to produce club-shaped spike proteins found in coronaviruses, including COVID-19. These three-dimensional spike proteins are so similar to a normal COVID-19 infection that it causes inflammation and the creation of antibodies and T cells. Then, when a vaccinated person is eventually exposed to COVID-19, their body attacks the virus because it already recognizes how to respond to those spike proteins, and can fight against them to prevent infection. Essentially, the vaccine helps train human bodies to detect and eliminate a real COVID-19 infection by showing it mock spike proteins, before COVID-19 can cause any severe symptoms or a severe infection. Similar to all vaccination, it could cause side effects. Completed Phase 3 study results of this vaccine trial are yet to be published, but some early trial data showed that 60% of trial participants reported side effects from the injections. These symptoms included pain, feeling feverish, chills, muscle ache, headache, and malaise and many were treated with paracetamol. Injection-site pain and tenderness were the most common local adverse reactions within 48 hours of the injection and a significant number of side effect symptoms were reported in each age group over temporary symptoms of fever, sore throat, headaches or diarrhea. 

COVID-19 can be spread in all climates and seasons. According to an August publication in the journal Nature, 'No human-settled area in the world is protected from COVID-19 transmission by virtue of weather, at any point in the year.' Studies that have explored the impact of temperature or weather on COVID-19 have shown mixed results. Some have been positive, some negative, and others neutral. Researchers have concluded that there are many factors that likely play a much larger role in the spread of the virus than the weather, including population density, human mobility, social distancing policies and practices, testing, public health facilities, and more. While more studies are needed, warmer weather does not appear reduce the spread of COVID-19, and it does not impact how the virus spreads from person to person. Routine hand-washing, social distancing practices, avoidance of crowds, wearing face masks, and surface cleaning should be used to prevent the spread of COVID-19 between people and via indirect (non-contact) transmission.

Hydroxychloroquine is not a recognized prevention, treatment or cure for COVID-19. Earlier in the pandemic, hydroxychloqoruine was proposed as a treatment for COVID-19, on the basis of some preliminary results from small, uncontrolled clinical trials. Since then, more robust randomized controlled trials have been conducted to study hydroxycholoquine as a treatment for hospitalized coronavirus patients. Study results published in November 2020 show that hydroxychloroquine does not benefit adults hospitalized with the coronavirus disease. Another study published in 'The Lancet' in November 2020 reported that hydroxycholoquine does not prevent mortality from COVID-19 even among those who were using it before they got infected with SARS-CoV-2. Around the world, some countries have authorized chloroquine or hydroxychloroquine for the treatment of COVID-19 despite limited clinical evidence supporting its efficacy. This decision follows some preliminary results coming out of China and France in March 2020, where a few small clinical trials showed limited success of the medication. On June 15th 2020, the U.S. FDA revoked the special permission to use chloroquine and hydroxychloroquine in emergency situations for COVID-19, citing that these drugs are unlikely to be effective in treating COVID-19 and highlighting serious cardiac adverse events and other serious side effects reported in studies.

In early September of 2020, the World Health Organization (WHO) issued guidance that a class of steroids called corticosteroids - specifically dexamethasone, hydrocortisone, and methylprednisolone - should be considered treatments for severe cases of COVID-19, but should not be used in milder cases. These steroids are given systemically, meaning through the veins or in an oral pill form. Inhaled steroids have not be recommended or approved for use in COVID-19 cases by the WHO or U.S. FDA. Inhaled corticosteroids (ICSs) are used to treat asthma and other lung diseases, such as chronic obstructive lung disease (COPD). Due to lack of sufficient scientific evidence, whether ICSs protect or contribute to worse outcomes in COVID-19 patients is still debated. According to NIH Clinical Trials website, a randomized clinical study by Oxford University is underway to understand if ICSs can prevent or treat COVID-19. The Lancet Respiratory Medicine Journal published more information in September 2020 on the relation of COVID-19 mortality and inhaled corticosteroids. The publication states that using ICS might reduce immunity to fight viruses and increase pneumonia in patients with COPD. ICS use has also shown protection against COVID-19 by reducing the frequency of exacerbations and replication of SARS-CoV-2. However, there were significant differences in age and underlying illnesses about the groups studied. Common devices used as inhalers include a metered-dose inhaler (MDI), nebulizer and dry-powder or rotary inhaler. There have been rumors circulating about using "nebulizers" to inhale steroids, such as the anti-inflammatory drug budesonide (brand name Pulmicort), to potentially treat COVID-19. "Nebulizers" are a type of inhaler that change liquid medications, like budesonide, into a mist that can be more easily inhaled into the lungs. Nebulizers can be more expensive than the most common type of inhaler used by people with asthma, and patients usually use nebulizers for specific reasons, such as if a child or someone with severe asthma is having difficulties inhaling medicine. Inhaled steroids like budesonide can have side effects, and are also crucial for patients with health conditions who do not have COVID-19, so these should only be used when recommended by your doctor. Budesonide can be inhaled or taken orally, and when inhaled is part of a family of anti-inflammatory medications called inhaled steroids that are primarily used to help manage symptoms for conditions like asthma and chronic obstructive pulmonary disease (COPD). Budesonide is a prescription-only drug that is not approved by the U.S. Food and Drug Administration (FDA) for treatment of COVID-19.

Obesity is a key risk factor for severe cases and death from COVID-19. Hospitalization, intensive care needs and death from COVID-19 is more common among obese individuals. However, as per the recent pre-print of a study that looked at the association between obesity and SARS-CoV-2 infection rates, COVID-19 symptoms, and change in immune response among non-severe cases, obesity, was not linked with increased risks of getting infected with SARS-COV-2. Obese individuals showed more pronounced symptoms, including fever as compared to non-obese people. In the non-severe cases studied, the immune response of obese individuals to the infection was not significantly different from the immune response of non-obese individuals.

Long-term care (LTC) facilities, often called nursing homes or assisted living facilities, are uniquely vulnerable to COVID-19 transmission. This is partially because COVID-19, like many other respiratory viruses, can easily be spread between people in enclosed spaces. In addition, since many residents at nursing homes are over the age of 65 and have preexisting conditions (i.e. heart disease, diabetes, or breathing problems) that my affect their immune systems and organ function, they are at a greater risk for severe disease if they do get COVID-19. This is why LTC facilities are considered to be high risk for COVID-19 spread. Though the number of COVID-19 cases in LTC facilities are strongly associated with the number of COVID-19 cases in their surrounding communities, research continues to show that COVID-19 infections spread quickly in LTC facilities among residents and staff. In addition to resident-specific risk factors, other factors that impact how COVID-19 has spread in LTC facilities include staffing shortages, low pay, and poor staffing ratios as well as a lack of resources dedicated to infection prevention, including guidelines to follow, dedicated staff members, and protective equipment. Shared living spaces like cafeterias and group rooms make social distancing difficult and can make it hard to isolate patients who are ill. Though additional funding was allocated to LTC facilities from the US government in May 2020 and new testing requirements for staff and residents were put into place in August 2020, LTC staff and residents have continued to be significantly impacted by the virus. As of early November 2020, the impact of COVID-19 on US LTC facilities, residents, and staff has continued to grow to record highs. According to data from the Kaiser Family Foundation (dated November 6th, 2020), 26,515 LTC facilities had known cases of COVID-19. There have been a total of 728,750 cases with 100,033 deaths associated with LTC facilities, and LTC facility deaths account for 40% of total COVID-19 deaths nationally.

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.

Thrombosis occurs when a clump of blood changes from a liquid form to a semi-solid form (called a 'blood clot' or 'thrombus'), and then becomes big enough to partially or fully block the regular flow of blood in veins or arteries. In some severe cases of COVID-19, thrombosis can happen, which prevents blood from flowing normally in patients (despite many of taking blood thinners meant to prevent blood clots from occurring). In some COVID-19 patients, thrombosis may contribute to causing respiratory (breathing) failure, kidney failure, heart attacks, strokes or other dangerous medical issues that can lead to death. Research studies have shown that thrombosis is a known complication of COVID-19 and is associated with an increased risk of death. More research is needed in this area to determine exactly **why** thrombosis may be occurring. Recent analyses show that many hospitalized patients with COVID-19 who developed thrombosis also developed pneumonia and other lung and respiratory problems. Some patients also developed damage to their blood vessels, while a significant number also developed pulmonary embolisms (blood clots in the lung). These other impacts must also be considered when studying and determining the cause of death related to COVID-19.

Maternal COVID-19 infection during pregnancy may be a risk factor for premature birth. In November 2020, the US Centers for Disease Control and Prevention (CDC) released outcomes data for infants born to birth givers who had been diagnosed with COVID-19 during pregnancy. The data was collected between March and October of 2020 and included a total of 3,912 infants. Incidence of prematurity in study participants was higher than average, which suggests that maternal COVID-19 infection acquired pregnancy (not in general) may be a risk factor for prematurity. This report found that 12.9% of infants born to individuals who had been diagnosed with COVID-19 during pregnancy were born prematurely (<37 weeks gestation), which is greater than the national estimate of 10.2%. In the U.S., COVID-19 has not impacted all communities equally; non-Hispanic Black and Hispanic communities have been unduly impacted by the virus. Racial and ethnic disparities also exist in overall health outcomes and impact maternal morbidity, mortality, and adverse birth outcomes. In this study, non-Hispanic Black and Hispanic women were disproportionately represented, and the authors note that further observation and analysis of outcomes by race and ethnicity is needed. Another study published in the Lancet in October 2020 found that the incidence of preterm births went down in the Netherlands after the implementation of COVID-19 pandemic mitigation policies. The authors suggest that some of the observed decrease in preterm births could be related to reductions in maternal exposure to air pollution and reductions in pregnant women seeking obstetric care that induces preterm birth. While the impact of COVID-19 on pregnancy outcomes remains under investigation, the CDC continues to encourage pregnant people to attend prenatal care appointments; practice handwashing, social distancing, and mask wearing (preferably a cloth mask over a surgical mask); and avoid crowds especially in indoor areas to prevent COVID-19 infection. They also suggest that providers counsel pregnant individuals on steps to prevent COVID-19 infection.

Standard vaccine development is a long process. Multiple studies on safety often take place over multiple years. Manufacturers use phased testing to determine an effective vaccine dose and to evaluate if the vaccine works, if it’s safe, if it has significant or serious side effects, and if immune systems respond well to the vaccine. To pursue regulatory authorization, a vaccine’s benefits must be shown to be greater than its risks, and vaccine safety and effectiveness are considered to be top priorities by regulatory agencies. Regulators around the world oversee vaccine development and testing at both national and international levels. In the European Union (EU), the European Medicines Agency (EMA) has a COVID-19 Task Force (COVID-ETF) that takes “quick and coordinated regulatory action on the development, authorization, and safety monitoring” for medicines and vaccines to treat and prevent COVID-19. In the US, the Food and Drug Administration (FDA) Center for Biologics Evaluation and Research (CBER) ensures that “rigorous scientific and regulatory processes are followed by those who pursue the development of vaccines.” Similar to the COVID-ETF in Europe, the FDA has also recruited experts from government agencies, academia, nonprofit organizations, pharmaceutical companies, and international partners to “develop a coordinated strategy for prioritizing and speeding development of the most promising treatments and vaccines.” To facilitate timely vaccine development during health crises, the US FDA sets clinical trial standards for scientific data on safety and efficacy, which manufacturers need to achieve in order to bring a vaccine to the US population. Once manufacturers meet those criteria, companies can pursue Emergency Use Authorization (EUA) approval, through which the manufacturer’s EUA submission is reviewed by FDA career scientists and physicians. So far, Moderna and Pfizer have both submitted data on their vaccines for FDA EUA approval.  While some COVID-19 vaccine manufacturers have requested emergency authorization with regulatory agencies around the world, it is important to note that if emergency authorization is approved, it is generally considered to be an emergency exception, with temporary permissions designed to accommodate the current COVID-19 public health crisis. Emergency authorization is not the same as formal licensing, which can take months. Unlicensed vaccines may be authorized by regulatory agencies and their lack of licensing does not mean that the vaccine has not been rigorously tested. Because of the nature of pandemic circumstances, for emergency authorizations, governmental agencies rather than manufacturers often assume responsibility for vaccine safety. In the US, for example, the Public Readiness and Emergency Preparedness Act (PREP Act) provides manufacturers, distributors, and others with liability immunity, as long as they have not participated in “willful misconduct.”  Regulatory oversight and monitoring will continue even once vaccines are approved for emergency use. In addition to testing by the vaccine manufacturers, government regulators regularly test vaccines for quality, and tweak manufacturing once they are released onto the market. Post-authorization, US vaccine safety monitoring is performed by the federal government (US FDA and the US Centers for Disease Control and Prevention [CDC]) and other agencies and organizations who are involved in healthcare delivery. Vaccine safety and monitoring systems are in place to quickly identify rare side effects that were not identified in clinical trials, and to detect possible vaccine safety problems.  Though no major safety concerns have been identified in the current vaccine trials, even when the current clinical trials are completed pharmaceutical companies, regulatory agencies, public health experts, researchers, and others will continue to evaluate safety, efficacy, effectiveness, and side effects in the years to come. The US FDA has stated that “efforts to speed vaccine development to address the ongoing COVID-19 pandemic have not sacrificed scientific standards, integrity of the vaccine review process, or safety.”

Once vaccine doses are distributed in the millions to a population, we can expect to see cases of COVID-19 dropping in those populations within a few months. Following a decrease in case numbers, we can expect decreases in hospitalization rates (the number of hospitalizations per 100,000 individuals), and then decreases in mortality rates (the number of deaths due to COVID-19 in a population). Importantly, we do not yet know how much we'll see these case numbers drop following the first vaccinations, because we don't yet know how effective the vaccines are outside clinical trials. The decrease could be minuscule or massive — and there's no way of knowing until the vaccines are distributed. The data we have on the most promising vaccines reflect vaccine efficacy, which is different than effectiveness and shows us how well a vaccine works to prevent a particular disease in a controlled, research environment. The data currently shows 95% efficacy for the Pfizer vaccine and 94.5% efficacy for the Moderna vaccine, with efficacy to be announced soon by AstraZeneca. We will not have data on vaccine effectiveness until a vaccine is made available to large populations outside of clinical trials. Given that U.K. Medicines & Healthcare products Regulatory Agency (MHRA) authorized the supply of Pfizer and BioNTech’s COVID-19 mRNA vaccine on December 2, we will likely have data on the Pfizer vaccine's effectiveness first. Once we have information on effectiveness, we’ll have a better sense of how the vaccines will impact metrics such as case numbers, test-positive rates, hospitalization rates, mortality rates, and level of disease severity. If vaccine distribution begins in early-mid-December (the Pfizer vaccine is set to begin being distributed in the U.K. on December 8), by mid-March to the highest risk individuals a population may begin to see declining case numbers. Depending on the rate at which a population is vaccinated, and particularly when distribution of the vaccine moves from highest risk individuals to the broader public, a December distribution start date to high-risk individuals followed quickly (within one month or so) by the general public could potentially vaccinate approximately 70% of that population by mid-late summer (within 6-8 months). This level of vaccination in a population would mean the population reaches herd immunity, triggering significant decreases in COVID-19 metrics such as case numbers, hospitalization rates, and mortality rates. However, if the general public in a population does not have access to vaccinations until later than this timeline (for example, April - June), herd immunity may not be reached until the fall or end of 2021 (6-8 months following). It is important to note that these types of timelines are estimates and based on an assumption that mass vaccination production and delivery is efficient. It also typically takes a few weeks for the body to build immunity after vaccination, so as a result, it is still possible for someone to contract COVID-19 just after they receive a vaccine, influencing case numbers. Case numbers, hospitalization rates, and mortality rates following vaccination in a country will depend on a variety of factors. First, different populations within countries suffer from COVID-19 morbidity and mortality differently. Black Americans, for example, have 2.6x higher case numbers, 4.7x higher hospitalization rates, and 2.1x higher mortality rates than white Americans. This will impact how much case numbers, hospitalizations and deaths fall in those populations after the first doses of vaccines get distributed to Americans. The distribution of vaccines is also not guaranteed to be equitable and there are varying degrees of willingness to even take a vaccine in some populations. Finally, some communities within a country may continue to practice recommended preventative guidelines (i.e. masks, social distancing) after the first rounds of vaccination, while others may not. Current projected distribution plans across the two most promising vaccines is for the vaccine to first go to emergency department clinicians, outpatient clinicians, testers at symptomatic sites, other high-risk health care workers, immunocompromised individuals, EMTs, and potentially essential federal employees, followed by the rest of the general population. However, in the case of Pfizer, they are permitting the regions, countries, and states, distributing the vaccines to determine the distribution plans. For instance, in the U.S., distribution plans are by state. In the United States, vaccines are currently intended to be allocated to all 50 states and eight territories, in addition to six major metropolitan areas. Pfizer, which has filed for emergency use authorization (EUA) in the U.S. and is the closest to potential approval, is prioritizing this approach over a plan that would prioritize the hardest-hit areas of the country, which they’ve said was decided due to the rapid wide spread of the virus. This plan will have impacts for the case rates and other metrics, as equal distribution will lead to different outcomes than targeted distribution. Other barriers to vaccine access include, among others, continual access to health care, particularly given that both the Pfizer and Moderna vaccine require two doses; cost (the vaccines are free but vaccination providers will be able to charge an administration fee); and potential supply chain challenges.

Calprotectin is a type of protein that is released into the body by neutrophils (a type of white blood cell). Neutrophils help heal damaged tissues and stop infections from spreading. When there is any type of swelling in a person, the amount of neutrophils produced by the immune system increases naturally, in order to help protect and defend the body. When there is inflammation in the gastrointestinal (GI) tract (the digestive system in humans and animals that help them digest, absorb, and discard food and liquids), neutrophils move to that area and release the calprotectin protein to help protect and defend the body. Because of this, studies have shown that increased levels of calprotectin in the body are linked to higher levels of inflammation in the GI tract, so calprotectin levels are often tested in people with gastrointestinal issues to determine whether or not they have illnesses like inflammatory bowel disease or other infections. Despite calprotectin normally being used as a marker for inflammation in the intestines, new research claims that measuring levels of this protein might help determine whether or not people who have tested positive for the coronavirus may develop more severe symptoms. Recent research in a pre-print study and a Letter to the Editor (in the Journal of Infection) shows a potential link between the levels of calprotectin in people infected with COVID-19 and more severe cases of the virus. In another pre-print study (which should not be used to guide medical treatments or practices) researchers found a potential link between higher levels of calprotectin in the body of COVID-19 patients with a higher number of patients who require breathing support with a ventilator (a machine that makes sure your body gets enough oxygen by moving air in and out a patient's lungs).  Both of the studies suggest that testing levels of calprotectin in people with the virus might help doctors predict how severe each patient's symptoms and outcomes might be. Studies are ongoing, but there is not enough evidence at this time to support this finding and no scientific consensus whether or not calprotectin can serve as a prediction of how serious the virus will be in some patients. Researchers will continue studying calprotectin in COVID-19 patients, but for now, calprotectin is still used primarily as a way for doctors to see if patients have inflammation in their intestines.

Recent research has shown that a person infected with COVID-19 may be able to spread the virus up to 72 hours before they begin to have any symptoms and up to 10 days after symptoms disappear. New studies have suggested that people are the most infectious in the 48 hours before they start to experience any symptoms. People who test positive for COVID-19 but do not develop symptoms in the 10 days following the test result are considered to be likely no longer contagious after those 10 days. There may be exceptions to these timings, so experts recommend 10 days of isolation after either testing positive for the virus, being exposed to a person who has been infected with COVID-19, or developing any symptoms. The best way to ensure you are no long contagious is by having two negative COVID-19 tests more than 24 hours apart. However, as per the U.S. CDC, individuals who were severely ill from COVID-19 or are severely immunocompromised might need to remain isolated for longer than 10 days and up to 20 days because they may still be producing viral particles.

Immunological memory is the ability of your body's immune system to recognize a foreign virus or bacteria that the body has encountered before and start an immune response. A pre-print study was released on November 16, 2020 that assesses immunological memory to the virus SARS-CoV-2 for more than six months. This study analyzed 185 COVID-19 cases in the United States, including 41 cases after 6 months post-infection. Study authors found it promising that they could measure at least three components of immune memory in 96% of cases over 5 months after symptom onset. The authors believe this implies that durable immunity to help protect against reinfection of COVID-19 could be possible in most people. No significant difference was detected between males and females, and the authors reiterated that "the magnitude of the antibody response against SARS-CoV-2 is highly heterogenous between individuals." The authors acknowledge several study limitations, such as the relatively low number of severe COVID-19 cases in their study. Additionally, there is limited data on protective immunity against the virus SARS-CoV-2 and the disease COVID-19, so the authors cannot make direct conclusions about protective immunity from their study results at the time of publication because "mechanisms of protective immunity against SARS-CoV-2 or COVID-19 are not defined in humans." More research is underway to better understand long-term immunity against COVID-19.

There is no evidence that flu shots (influenza vaccines) increase someone's chances of getting COVID-19. Flu shots are widely considered a safe way to help prevent someone from getting sick with the flu. A September 2020 publication in the Journal of Clinical and Translational Science by researchers from the Cleveland Clinic analyzed data from 13,000+ COVID-19 tests, comparing people who received flu shots with people who did not receive flu shots. The researchers found that people who received flu shots were not at higher risk of being hospitalized, being admitted to the intensive care unit (ICU), or dying from COVID-19. Doctors and public health experts recommend flu shots for the general public as a safe way to protect against severe illness and death from the flu, which is important during the COVID-19 pandemic to reduce strains on health systems and healthcare workers.

Though vaccine efficacy and vaccine effectiveness are similar terms and are often used interchangeably, the differences between the two are important. In this entry, we rely on the United States Centers for Disease Control and Prevention's (U.S. CDC) definitions of effectiveness and efficacy. When a new vaccine is being developed and studied in clinical trials, scientists report on vaccine efficacy. Efficacy is a term used to describe how well the vaccine protects clinical trial participants from getting sick or getting very sick. The term does not describe how well a vaccine works on the general public. The efficacy of a vaccine reflects ideal circumstances, like a research trial, which are different than real-world conditions. Once a vaccine is made available for large population groups, vaccine effectiveness can be measured. Effectiveness is the amount of protection given by a vaccine in a certain population when its used under field conditions (somewhat normal practices, less than perfectly controlled like in a research study). It considers other factors like population-level differences in health status, weight, age, and other factors across communities. Effectiveness is a more reliable and accurate term for how helpful a vaccine is at preventing disease in daily life when people are doing regular community-based activities like socializing, going to work or school, and grocery shopping.

On November 18th, 2020, Pfizer announced that its experimental COVID-19 vaccine (BNT162b2) prevented infection in 95% of overall participants who received the drug company’s late-stage clinical trial dose. In adults over 65 years of age, the vaccine was effective in over 94% of volunteers. These early results exceeded the minimum United States Food and Drug Administration (U.S. FDA) target of 50% efficacy—but it is important to reiterate that no vaccine is ever 100% effective. It is impossible to know how well a vaccine actually works until it is deployed  in the real world and given to large populations, not just volunteer participants in a trial.  While the current data is promising, it has yet to be evaluated by the U.S. FDA, and more information is needed before Pfizer can pursue approval for the vaccine. The company has concluded its phase III trial but will continue to monitor patients for any adverse reactions or events. Additionally, to ensure that there are not major safety concerns, the U.S. FDA is requiring manufacturers to provide at least two months of follow-up data for at least half of the volunteer participants. Most serious side effects from vaccines occur within about six weeks after the vaccine is given. In vaccine clinical trials, any observed impacts of the vaccine on volunteer participants are eventually considered side effects with more serious side effects causing the trials to pause or stop completely. No safety concerns about these potential side effects have been reported so far. Pfizer recently stated that the only side effects that occurred in more than 2% of participants was fatigue at 3.8% and headache at 2.0%. Because the news about this vaccine is still early, there is still a lot we don't know. Remaining questions include when the vaccine might be available for everyone, if it will work in children younger than 12 (as they have been excluded from the early trials), if it will stop the virus from spreading in people who are infected but don't have any symptoms (asymptomatic), if it will prevent people from developing severe cases, and how long the vaccine might offer protection from the the virus. This vaccine requires an initial injection followed by a secondary shot called a “booster” to achieve its full level of protection. The vaccine was found to be effective against COVID-19 beginning 28 days after the first dose. The clinical trial included more than 43,000 volunteer participants, many of whom already received two doses of the vaccine. In the interim analysis, there were 94 cases of COVID-19 in trial participants, and the study continued until there have been 164 cases of COVID-19 among study volunteers. It is important to note that these study results may not play out the same under “real life” circumstances because of differences in health status, weight, age, and other factors across communities. While Pfizer has reported that 42% of participants are from “diverse backgrounds,” the study population may not reflect the diversity of our global populations and communities despite the vaccine being effective across age, gender, race and ethnicity demographics in the trials.

COVID-19 has not been linked directly to air-pollution, and there has not been research conducted to show that reducing air pollution leads to fewer COVID-19 deaths. However, urban air-pollution (that commonly contains fine particulate matter from things like cars or trucks, fires, coal-based power) is associated with an increase risk of breathing problems and respiratory (breathing) illnesses. Exposure to high levels of bad air pollution damages the throat and lungs and causes chronic inflammation that could limit how well the lungs are able to protect themselves from infections. It has been reported that individuals with existing breathing problems (i.e. asthma, emphysema) are may be at higher risk of COVID-19. Studies conducted in China, Italy, and the United States have shown that in areas with higher amounts of air pollution there is an increase in the number of COVID-19 cases. However, the United States study notes that the findings are for county-level populations and cannot be used to link individual cases to air pollution. More studies will need to be conducted to better understand how air quality may affect individual people and their risk of COVID-19

The Oxford-AstraZeneca COVID-19 vaccine (AZD1222) does not contain human cells or tissues. The AZD122 (ChAdOx1 nCov-19) is a weakened version of an adenovirus—a harmless virus that usually causes the common cold in chimpanzees— and is used as a way to transport the vaccine's ingredients into the human body. This type of vaccine is called a "vector vaccine," because the adenovirus serves as the vector (or vehicle) for getting the drug into human cells. The adenovirus can stimulate a response from a person's immune system when their body detects it in cells. Essentially, the vaccine helps train human bodies to detect and eliminate a real COVID-19 infection through showing it mock spike proteins, before COVID-19 can cause any severe symptoms or a severe infection. During preclinical research, MRC-5 cells were used to determine how effective the vaccine may be in human clinical trials, but the MRC-5 cells are not used in the manufacturing process for this vaccine. There are different processes used to make vaccines. Often, when vaccines are being made, viruses are propagated (grown in the lab) in special laboratory cells, and the viruses are then collected to make the vaccine. To make this COVID-19 vaccine, the virus is propagated using another type of cells, the HEK 293 cell line. However, there is no evidence that these cells are present in the vaccine itself. The cells are removed through a filtering and purification process that breaks down the cellular pieces and remaining DNA before a vaccine is deployed to humans. The HEK 293 cells and MRC-5 cells (mentioned above), as well as many other research cell lines, were collected from fetal tissue in the 1960s and 1970s. Since then, labs have reproduced those cell lines for some medical purposes, including research and vaccine development. These cells are not part of the vaccine. It is also important to distinguish between fetal cells and cultured (lab grown) cells. Fetal cells are not used in vaccine production.

Wearing a mask with polytetrafluoroethylene (PTFE) does not increase your risk of getting cancer or any other negative health outcome. PTFE is the polymer that also makes Teflon, the brand name of a non-stick chemical coating commonly used on kitchen appliances such as pots and pans. While some masks are sprayed with PTFE or have a PTFE filter, as PTFE has widely been used in the field of air filtration, it would take a mask with PTFE to 1) be heated to an extremely high temperature — 300 to 400 degrees celsius or 572 to 752 degrees Fahrenheit, 2) for fumes to be released, and 3) for those fumes to be breathed in, for any ailment to be caused. The specific condition the highly unlikely hypothetical scenario would cause is not a cancer, but rather is a flu-like ailment known as “[polymer fume fever](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544973/),” informally known as Teflon flu. Most surgical face masks do not contain PTFE, and are made out of a different type of plastic called polypropylene. If you do have a mask that contains PTFE, there is no evidence that wearing the mask would cause any flue-like symptoms or other negative outcomes when worn properly and normally. 

While the current data is promising, the study is ongoing, and more information is needed before Pfizer can pursue U.S. FDA approval. To ensure that there are not major safety concerns, the U.S. FDA is requiring manufacturers to provide at least two months of follow-up data for at least half of the volunteer participants. Most serious side effects from vaccines occur within about six weeks after the vaccine is given. In vaccine clinical trials, any observed impacts of the vaccine on volunteer participants are eventually considered side effects with more serious side effects causing the trials to pause or stop completely. No safety concerns about these potential side effects have been reported so far.

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. 

Virgin coconut oil (VCO) is being studied in the Philippines and other countries as a potential supplementary treatment for COVID-19 — that is, a potential additional treatment used in combination with other COVID-19 treatments. These community-based trials are being carried out by the Filipino Department of Science and Technology (DOST) at the Sta. Rosa Community Hospital in Laguna, and involved both probable cases of COVID-19 (i.e. highly suspected cases) and mild cases of COVID-19. There are also two trials being carried out at the Philippine General Hospital (PGH) looking into the effects of VCO on moderate cases of COVID-19 or those who are hospitalized. These two sets of studies aim to understand if VCO can shorten the COVID-19 recovery time, prevent further complications, and prevent hospitalization time. These studies follow 6 months of laboratory experiments that found VCO to decrease the coronavirus count by 60 to 90% for mild to moderate cases of COVID-19. If proven to be effective with sufficient evidence in the community-based trials, VCO could be a safe and affordable supplementary treatment for COVID-19. It is important to note that these studies are still in development and that The World Health Organization (WHO) does not support the use of any specific medication to treat, cure, or prevent COVID-19. While coconut oil is safe in certain doses, more evidence is needed to understand its effect on COVID-19 and it should not be used as a COVID-19 treatment or prevention medication. 

High levels of false negatives from RT-PCR testing and long waits to receive test results have led many medical institutions to use chest CT (computed tomography) scans to diagnose COVID-19. Several studies, mostly conducted in China, have shown higher sensitivity of CT scans in detecting coronavirus when a PCR test showed a negative result. However, this does not mean that CT scans alone should be used for disease identification. CT scans can also miss detecting the virus and be misidentified with other pulmonary infectious/ viral pneumonias. Some experts believe that CT scans do not add any diagnostic value, while others believe that from a population health perspective during a pandemic, CT scans should be used to isolate suspicious cases for COVID-19, because of its high sensitivity and rapid identification. Some studies support a dual approach of CT scans and RT-PCR, or the use of chest CT scan to screen for coronavirus when RT-PCR tests are negative. CT scans are relatively expensive compared to swab tests and also expose patients to a small dose of radiation. Some experts argue that because CT scans are resource intensive, they cannot be used as a population-wide testing tool. The American College of Radiology (ACR) and US CDC recommend against using Chest CT scanning for screening or diagnosis of coronavirus disease 2019. On the other hand, the National Health Commission of China has encouraged the use of Chest CT scans for diagnosis. Local resource constrains and expert physician advise on individual patient conditions are important factors in deciding on the use of CT scans or not.

Positivity rates of COVID-19 are not an indication of herd immunity. The rate of positivity in a community is defined as the percentage of total COVID-19 tests that come back positive out of all the people who have been tested in that community or population, within a given time period. Positivity rates can indicate an increasing outbreak, if the rate of positive tests increases while the amount of testing stays the same. A positivity rate can also indicate that not enough tests are being conducted, if more tests come back with positive results but tests were conducted on a smaller percentage of the population than the week before. Neither of these have anything to do with herd immunity. "Herd immunity" refers to a given percentage of people that need to become immunized to a virus, through vaccines or through becoming infected in a natural setting, against a virus in order to provide safety for an entire population—i.e. the herd. It's the idea that if most people are immune, then the rate of transmission will be low or non-existent. COVID-19 is not vaccine-preventable at this time and we know very little about how we become immune to the virus. Herd immunity would require a large majority of the population to become infected with the virus and obtain long-term immunity to COVID-19 — but since we know so little about long-term immunity right now, we can't say anything about herd immunity in relation to COVID-19. Percent positive rates of COVID-19 are not being used to determine herd immunity in a community because we know so little about immunity in general, and because positive rates can mean a wide variety of things. If there is a higher percentage of positive test results in a region, this is not indicative of any potential for herd immunity, because evidence to support long-term immunity is lacking.

Without a distinct, explicit, and obvious uptick in travel pattern volumes, and access to data about those travel pattern volumes, it is not possible to predict how the number of cases in one state or geographical region, such as the U.S. Midwest, will impact COVID-19 infection rates in another state or region, such as Florida. Known mass migration from one region to another could help epidemiologists predict how COVID-19 may spread, but U.S. travel tends to be spontaneous and multidirectional, with individuals traveling across and between different regions, rather than traveling as a large group from one specific region to another. Though widespread travel and transmission patterns are difficult to predict, we can reasonably conclude that a high volume of COVID-19 cases throughout the United States means that the likelihood of transmission of COVID-19 in the country is high, compared to other parts of the world. To prevent the spread of COVID-19, public health experts continue to recommend that people wash their hands, wear masks (the U.S. Centers for Disease Control and Prevention recommends wearing a cloth mask over a surgical mask for increased protection), avoid crowds (especially indoors), practice social distancing, and stay home when possible. Out of the top five states that have seen COVID-19 cases rise the fastest during the first couple weeks of October 2020, four states (Idaho, Nebraska, South Dakota, North Dakota) are in the Midwest. Some health care workers and public health researchers have referred to the rising cases in the Midwest during the fall of 2020 as a "third wave," after the summer wave and the initial wave of COVID-19 cases. Dr. Anthony Fauci and other infectious disease experts have warned that states across the U.S. could see another wave of COVID-19 cases, particularly with current case numbers remaining high in several places, colder weather setting in and coinciding with what is typically the annual influenza (flu) season, and people starting to become fatigued with maintaining pandemic prevention measures. Simultaneously in Florida, 5,558 new COVID-19 cases were reported on October 22, 2020, which is one of the highest single-day increases that the state has seen since mid-August 2020 (the only days with higher numbers in the fall of 2020 are thought to be due to irregularities in reporting). The reported increase brings Florida's statewide total to 768,091 COVID-19 cases and over 16,470 deaths related to COVID-19 as of October 22, 2020. Following the Florida Governor's decision on September 25, 2020 to move to Phase 3 of their reopening plans, including fully open bars and restaurants, public health experts have been warning that Florida could see a rise in COVID-19 cases and that this could also coincide with the anticipated flu season.

Using an at-home ultraviolet (UV) light is ineffective at treating, curing or preventing COVID-19, and can be highly dangerous. There is one type of UV ray (UVC rays) that can kill the COVID-19 virus, but it is highly dangerous to use UVC ray treatment unless you’re properly trained. It is not intended for use outside of hospital settings, such as in public non-hospital spaces or at home.  Exposing yourself or your belongings to at-home non-UVC UV rays through lamps or lights for any period of time does not prevent someone from spreading COVID-19 to another person or catching COVID-19 from another person, and does not disinfect items.  Long-term exposure to sunlight or UV radiation can be very damaging and increase your risk of skin cancer. As of now, there is no clear benefit of using any at-home UV products for preventing or treating COVID-19. 

Mental state and emotion cannot prevent COVID-19 from spreading. The use of face coverings, physical distancing and hand washing are recommended guidelines by WHO and US CDC health officials to reduce the spread of the SAR-CoV-2 virus. A recent study by researchers at Aarhus University found that people who are empathetic towards those who may be more vulnerable to the infection tend to wear face masks and maintain physical distancing more often. The study demonstrates that evoking empathy may be effective for promoting and encouraging the use of face masks and physical distancing, compared with using factual information alone. The findings do not imply that if one is empathetic or in a particular mental state, they will not spread the virus.

There are 3 main types of COVID-19 tests. Two are diagnostic (molecular and antigen tests), which means they show active infections. One test type looks for antibodies that occur in the body following a previous infection (also known as antibody tests). 1) Molecular tests (polymerase chain reaction (PCR) tests, viral RNA tests, and nucleic acid tests) are completed using nasal swabs, throat swabs, and through testing bodily fluids like saliva. These tests look for evidence of genetic material from the virus. They have a low rate of false-positive results (when a test says you have the virus, but you do not). Using a deep nasal swab PCR test that collects viral material at the back of nose, near your throat, is the most trusted option of the molecular tests. That's because it is the most accurate, and there is a higher amount of virus in that area of the body than anywhere else. These tests are highly sensitive, which means they are able to accurately determine when a person actually has an infection. However, the method is uncomfortable, the results can take hours to days, they are the most expensive to do, and can be overly sensitive and pick up inactive virus fragments when a person no longer has an active infection. 2) Antigen tests are completed using nasal or throat swabs and they look for proteins (antigens) from the virus. Most people are familiar with this technology because it is commonly seen in pregnancy tests. These results are available in as little as 10 minutes, the test is less expensive than other forms, and uses simpler technology than PCR tests. These tests are usually mostly accurate for positive results, but might require a molecular test to confirm if a person really is negative because they can often have a high rate of false-negative results. 3) Antibody tests are different than diagnostic tests because they are blood tests that look for a former COVID-19 infection through the presence of antibodies,  a protein that latches on to foreign invaders in the body - in this case, COVID-19 - neutralizes them, and then remains in a person's system after infection. A person produces COVID-19 antibodies when they are exposed to the virus, so an antibody test can show whether or not someone has been infected in the past. Antibody test results are usually available within a few days. However, these tests produce some false-negatives and we don't know enough about how long antibodies last after exposure or infections, how long any immunity might last, and how many antibodies are needed in a person who has recovered from the virus to show a positive test result. There are many different elements involved in how accurate or reliable tests may be at the time they are taken and at the stage of exposure and infection each person is presently in, and every testing type has different strengths or weaknesses. It is important to remember that the best test for each person should be chosen with their doctor on an individual basis.

Pausing or suspending clinical trials occurs frequently in the development of new medications and vaccines. This is because every clinical trial is overseen by a data and safety monitoring board that routinely looks at data from the different trial phases to see if there are any harmful or adverse issues happening in trial participants. The board also monitors to see if there is any evidence of the vaccine being effective. If the board has any concerns at any point during a clinical trial, they will suggest stopping a trial until they can determine a) what caused the patient(s) to develop a harmful medical issue, b) if people receiving the vaccine in the clinical trials are doing much better than those who didn't, or c) if people who received the vaccine are doing much worse than the people who didn't. These prescheduled checks by the boards may sound alarming, but they occur frequently in all phases of clinical trials. As vaccines move into the third phases of clinical trials, in which they are given to tens of thousands of people, it is not surprising that one or more people develop a medical issue which may or may not be related to the vaccine itself. Lists of side effects that you see on medications stem from these clinical trial phases. Studies also have pre-set protocols and criteria that determine what events will cause them to pause or stop their research phases. They cannot ethically continue with the trial if they have reasons for concern about the health of clinical trial participants who have received their vaccines.

The virus that causes COVID-19 primarily spreads through close, person-to-person contact, not through surface contamination. However, the virus can live on surfaces and the amount of time that SARS-CoV-2 can survive on a surface depends on the material of the surface. According to a recent study published in the Virology Journal, depending on the temperature, COVID-19 survived on different surfaces from a few hours to several days, with a half-life (time taken for 50% of the virus to no longer be infectious) of up to 2.7 days. The virus remained infectious on stainless steel, polymer and paper notes, glass, cotton and vinyl for much longer at 20°C as compared to 40°C. In practice, the amount of the virus on a surface usually drops dramatically in the first few hours. It is also important to note that even though some of the living virus might still be detected on a surface after several hours or days, it might not be present in a large enough quantity to make someone sick. The recent findings, however, suggest that the virus can remain infectious for longer periods of time than considered earlier, especially at lower temperatures. If a person touches a contaminated surface with traces of the virus and then touches their eyes, nose, or mouth, they could become infected if the surface contains large amounts of the virus. This is why it is important to clean and disinfect any surfaces that people might come into contact with, especially those like doorknobs, cell phones, light switches, handles, countertops, sinks, toilets, and more. If possible, people should try to avoid touching high-contact surfaces in public. Washing your hands for 20 seconds, avoiding touching your face, maintaining six feet (two meters) of distance and wearing a mask (the U.S. Centers for Disease Control and Prevention recommends wearing a cloth mask over a surgical mask for increased protection) are key steps in combatting the spread of the virus.

There is no single definition of a “wave” of a disease in public health. Defining a disease wave varies across scientific literature and even by the scientist you ask. This lack of continuity has to do with the complexity of disease outbreaks, and in particular 1) the ways in which diseases affect different populations at different times, 2) the difficulty in accessing accurate data, and 3) most importantly, the lack of a standardized definition of a disease wave. We do, however, know a disease wave when we see one in public health, and agree on indicators of second, third, and fourth waves, and beyond. A disease wave can be thought of as a sustained surge (or spike) in cases, following and relative to a period of sustained low cases. Think of a line on a graph that curves high (first wave), dips low (end of the first wave), then curves high again (second wave).  In defining the end of a first wave for the U.S., on June 18 2020, Dr. Anthony Fauci, U.S. White House advisor and director of the National Institute of Allergy and Infectious Diseases, told the Washington Post that in order to consider the first wave in the U.S. technically "over", we would need to see a specific region, state, or city have a sustained decrease of positive infection rates until they were in the low single digits.  This is just one expert's definition, however, and just because a region may not have reached single digits of positive test rates does not mean they might not be considered by some to be in a second wave now, and by others in a third wave, if they’re seeing a significant and sustained surge in positive rates compared to what that area’s positive test rate number was previously. 

Conjunctivitis, also known as pink eye because it can cause the white of the eye to appear red or pink, is an inflammation or infection of the conjunctiva (a transparent membrane that lines the eyelid and covers the white part of the eye). Conjunctivitis can have different causes, including bacterial infections and viral infections (including adenoviruses, which cause the common cold, and the novel coronavirus that causes COVID-19). The appearance of reddish eyes can also be due to allergies, dryness, fatigue, or other factors and does not necessarily mean a person has conjunctivitis. Some research studies have identified conjunctivitis as a possible symptom of COVID-19, including a study of 38 patients with COVID-19 in China, which found that 12 of the patients had ocular or eye-related symptoms such as conjunctivitis. Patients with more severe COVID-19 were more likely to have ocular symptoms, and 1 patient in the study presented with conjunctivitis as their first symptom. In Canada, a case study was published on a female patient with COVID-19 who had severe conjunctivitis and minimal respiratory symptoms. In the U.K., another case study of a male patient with COVID-19 found that conjunctivitis was a symptom in the middle phase of COVID-19 illness. A review of ocular symptoms in COVID-19 patients that was published in August 2020 found no reports of COVID-19 becoming sight-threatening. The American Academy of Ophthalmology has stated that conjunctivitis can be an infrequent symptom of COVID-19, estimated to occur in 1% to 3% of patients who test positive for COVID-19. A meta-analysis of 1167 patients in 3 studies found that the overall rate of conjunctivitis was 1.1%, with the rate being 3% in patients with severe COVID-19 and 0.7% in patients with non-severe COVID‐19. Conjunctivitis may be more common as a COVID-19 symptom in children. A study of 216 children with COVID-19 in China found that 22.7% showed an ocular symptom, including conjunctivitis. Since conjunctivitis is not among the most common COVID-19 symptoms and can have underlying causes that are unrelated to COVID-19, many public health and medical experts are advising that adults and children with suspected conjunctivitis seek care for their eyes. If someone with conjunctivitis has been at risk of exposure to COVID-19, a healthcare provider can help with determining whether a person with conjunctivitis should also get tested 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.

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.

Public health agencies have been updating their recommendations for isolation during the COVID-19 pandemic, as the scientific understanding of how long someone can be sick and infectious to others evolves. For example, the U.K. Chief Medical Officers extended their isolation period for people who test positive from 7 days to 10 days in July 2020, the Indian Ministry of Health and Family Welfare reduced their isolation period for international travelers from 14 days to 7 days in August 2020, and the French Prime Minister reduced their self-isolation period for people who test positive from 14 days to 7 days in September 2020. The World Health Organization (WHO) criteria for releasing COVID-19 patients from isolation was updated in late May 2020 to recommend that people who are asymptomatic remain in isolation for 10 days, and that people with symptoms remain in isolation for at least 10 days after symptom onset and at least another 3 days without symptoms (or a minimum of 2 weeks). One large contact tracing study found that people were less likely to become infected with COVID-19 when exposed to a positive case after 6 days or more of the infected person's symptom onset, which is in alignment with how certain countries are now using 7 days as their recommended isolation period. Other studies suggest people with mild to moderate cases of COVID-19 may be infectious up to 10 days after the symptom onset, with a documented case report of a person with mild COVID-19 who was shedding "replication-competent" virus specimens (an indicator for being able to infect others) for up to 18 days after symptom onset. Furthermore, some research suggests that people with more severe cases of COVID-19 or who are severely immunocompromised may remain infectious for up to 20 days after symptom onset. In terms of COVID-19 patients having evidence of the virus in their bodies for long periods of time, there have been studies suggesting that people with COVID-19 can continue to shed detectable virus specimens from their upper respiratory system for up to 3 months (or about 90 days) after symptom onset, but it is important to recognize that this may not be at a concentration that's high enough for the virus to replicate and infect others. People who continue to shed virus specimens for many weeks or even months after symptom onset are sometimes called "persistently positive," but according to a review of studies by the U.S. Centers for Disease Control and Prevention (CDC), there is currently little evidence of transmission by "persistently positive" people who have clinically recovered from COVID-19. Most of the data on how long people with COVID-19 remain infectious comes from adults, so more research is needed to understand how long children and infants may remain infectious. Additionally, research is ongoing on how the virus is shed in certain situations, such as in people who are immunocompromised. As more research findings emerge, public health guidelines will likely be updated around the recommended isolation periods for people with COVID-19 or who have been in contact with someone confirmed to have COVID-19.

COVID-19 transmission on airplanes is still being researched. There have been documented cases of COVID-19 transmission on airplanes, with the majority being to people seated within 1-2 rows of an infected person or through contact with airline crew. While traveling on an airplane is not risk-free for COVID-19 transmission, it is generally considered a lower-risk activity due to how air is circulated through a HEPA (high efficiency particulate air) filter and mixed with fresh air from outside, and especially when other public health guidelines are followed such as passengers wearing masks or face coverings, passengers maintaining physical distance as much as possible, and disinfecting surfaces between passengers. On crowded flights, the risk of COVID-19 transmission is higher when it may not be possible to avoid sitting within 6 feet of other people, sometimes for several hours. Other COVID-19 transmission risks related to airplane travel include being in proximity to other people when at airport terminals and security lines, being in contact with frequently touched surfaces in places such as public restrooms, and being in proximity to other people during some forms of transport to and from the airport like ridesharing services and public transportation.

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.

Given that the the period between exposure to COVID-19 and symptom onset can be between 2-14 days, U.S. President Donald Trump could have been infected as early as two weeks ago. He could have been contagious as early as approximately 12 days before his positive test result. Since other prominent individuals in Donald Trump’s circles have also tested positive in days following Trump’s positive result — such as Melania Trump, presidential adviser Hope Hicks, and Trump campaign manager Bill Stepien — all infected members of the White House may have overlapping chains of transmission and as a result, contact tracing efforts will be complex. As a result, the optimal, comprehensive contact tracing approach in this situation would look as follows:  1. Donald Trump and all individuals who tested positive in his close circles would provide detailed information on where they were and who they had close contact with in the 14 days prior each of their positive test results. Close contact includes anyone who has been within 6 feet (2 m) of any of them for at least 15 minutes, or indoors with any of them without a mask on within two days of any of the three diagnoses 2. A team of contact tracers would then quickly alert the identified individuals, to let them know that they may have been exposed to COVID-19 3. The individuals from the close contact group would then be assessed for symptoms and tested for COVID-19 4. The people from the close contact group who test negative for COVID-19 would then be instructed to self-quarantine for 14 days after they were exposed, keep social distance from others, self-monitor for COVID-19 symptoms, and send doctors and the state health department daily health updates 5. The people from the close contact group who don’t have symptoms, but have also not been tested, would be instructed to follow guidelines as if they tested negative 6. The people from the close contact group who test positive would be instructed to self-isolated and recover at home for minimum 10 days and then self-quarantine for 14 days after being exposed, seek medical care if they experience emergency warning signs, and monitor symptoms and avoid spreading the virus 7. The people from the list who have symptoms of COVID-19 but can’t be tested would be asked to follow the guidelines as if they tested positive 8. Each close contact would get tested again one week after initial testing 9. Contact tracing steps 1-8 would repeat for the close contacts of each individual who tests positive Though the incubation period of the virus that causes COVID-19 is 2-14 days, the incubation period of infection is most often 3-5 days, so it's most likely that Trump was infected between Saturday, 9/26/2020, and Monday, 9/28/2020. That makes him mostly likely infectious as of Tuesday, 9/29/2020. This entry was updated with new information on October 4, 2020.

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.

Thymosin alpha-1 has not been shown to be safe or effective in preventing, treating, or curing COVID-19. The drug has been sold under the brand name Zadaxin, and was created to act as a lab-made version of a natural substance in the body that can stimulate some immune functions and responses in humans. However, despite many inaccurate claims by several wellness groups, thymosin alpha-1 has never been approved by the U.S. Food and Drug Administration (FDA) for COVID-19, or any other condition. It has been granted "orphan drug designation" in order to research the drug as a potential treatment for some rare illnesses (though has yet to be approved for any). Thymosin alpha-1 has been approved in 30 countries outside the United States for treatment of chronic viral infections, including HIV and chronic hepatitis C, and it has some promising research occurring in other types of disease responses, but has not been designated as a COVID-19 treatment by the World Health Organization. Though there are currently some studies being conducted that research the impact of thymosin alpha-1 on COVID-19 patients, including clinical trials, there is not enough evidence to support using this drug as a treatment or prevention tool for the virus.

There is no evidence to suggest that the use of face masks increases the risk of developing pneumonia, or any other bacterial, fungal or viral infection in the lungs. In fact, according to a study published in the Preventive Medicine journal, wearing face masks is shown to protect people against bacterial infections in hospital settings, where health care workers are most prone to antibiotic-resistant bacteria. The American Lung Association also endorses the U.S. CDC recommendation of wearing masks in public. WHO and CDC both recommend that general sanitation guidelines should be followed to ensure one is wearing clean masks. Wet or visibly dirty masks should not be worn, as they can be contaminated with micro organisms.

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.

COVID-19 is far more lethal than the virus that causes the common cold, even though the vast majority of COVID-19 patients only experience mild or no symptoms. The best available current evidence indicates that the novel coronavirus is easily transmissible in the absence of social distancing and mask wearing, and is responsible for more than 900,000 deaths globally. The common cold is generally not lethal, with some rare exceptions. The flu, which is deadlier than the common cold, killed 0.1% of the people who contracted it in 2019. It is still too early to discern accurate global death estimates for people who have contracted COVID-19, but estimates have ranged from 1% to 25% of all cases, depending on the country. Even conservative COVID-19 death rates (around 1% ) would mean that the novel coronavirus is at least 10 times as deadly as the flu, and significantly more lethal than the common cold. Compared to the common cold, COVID-19 kills more people in every age group, and is especially more lethal in the oldest age groups. However, it is important to note that actual case numbers and the ability to accurately attribute cause of deaths to COVID-19 is still evolving. As the pandemic progresses and scientists receive a complete picture of all known infections, the risk of death will become more clear.

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.

Pleurisy, also known as pleuritis, is the inflammation of the pleura tissues that separate the lungs from the chest wall. It can be caused by respiratory infections, inherited genetic conditions, or certain medications. Public health and medical experts have not found pleurisy to occur as a result of wearing a mask or face covering to prevent COVID-19 transmission. Mask-induced pleurisy has not been validated in scientific or medical literature. The Chief Medical Officer of the American Lung Association stated that there is not a "medically plausible mechanism for mask-wearing to cause pleurisy." Regarding concerns about wearing masks for 3 hours or longer leading to pleurisy or other health issues, healthcare workers have been wearing tighter masks for much longer than 8 hours a day without negative side effects. Wearing masks is generally considered safe for children and adults. There are a few exceptions, for very young children (under 2 years of age in the U.S.) and people with health conditions that make it difficult to wear a mask (ex. certain pre-existing pulmonary or cardiac issues, mental health conditions, developmental disabilities). For the vast majority of people, wearing masks are an effective way to help reduce COVID-19 transmission without causing any major side effects, as long as masks are kept clean and used correctly.

Levotop 500 is an antibiotic that is used to treat infections caused by bacteria. COVID-19 is an infection caused by a virus, not a bacteria. Therefore, Levotop 500 is not a medication that is effective in preventing, treating or curing COVID-19. Levotop is used to treat bacterial infections like pneumonia, bacterial sinusitis, gastroenteritis and chronic bronchitis.  Some antibiotics are being used in patients who are initially hospitalized because of COVID-19 to treat "co-infections" or "superinfections." Co-infections can occur when a COVID-19 patient also has a second infection, or catches one while hospitalized, and needs antibiotics to treat the second infection. Superinfections can happen on top or after an existing infection. It is possible that a hospitalized COVID-19 patient's immune system is weaker than normal, making it more vulnerable for all kinds of infections from germs, including bacteria.

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.

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.

Mini, portable air purifier necklaces (such as the type available for purchase on consumer websites) have not been shown to prevent COVID-19 infection and there have been no studies about their effectiveness to date. Indoor air purifier units can help reduce tiny parts of virus in the air (airborne contaminants) in a home or confined space if they are used correctly, but they are not enough to protect people from COVID-19.

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.

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.  

COVID-19 can impact people in different ways, but most people who are infected with the virus will only have mild to moderate symptoms and won't need to be hospitalized. Most cases of the virus are not dangerous, but should be taken seriously. The World Health Organization says the most common symptoms are: - fever - dry cough - tiredness Symptoms fewer people have include: - aches and pains - sore throat - diarrhea - conjunctivitis - headache - loss of taste or smell - a rash on skin, or discoloration of fingers or toes Symptoms that are serious and which mean people should contact a medical professional as soon as possible include: - difficulty breathing or shortness of breath - chest pain or pressure - loss of speech or movement A person may have mild symptoms for a week or so, and then their condition might worsen rapidly. There maybe others who show no symptom at all. Children, generally speaking, have similar symptoms to adults but with milder illness. People who are older have been shown to have more severe forms of illness. Some people with COVID-19 have also been experiencing neurological symptoms, gastrointestinal (GI) symptoms (relating to the stomach and intestines), or both. Because we are learning more about this virus every day, including new symptoms, it is important to pay attention to what your body is feeling and contact a medical professional if you begin to experience any of the above symptoms or notice any other changes in how you normally feel. Additionally, the United States Centers for Disease Control People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. This list does not include all possible symptoms, but these may appear **2-14 days after exposure** **to the virus**: - Fever or chills - Cough - Shortness of breath or difficulty breathing - Fatigue - Muscle or body aches - Headache - New loss of taste or smell - Sore throat - Congestion or runny nose - Nausea or vomiting - Diarrhea Additionally, the United States Centers for Disease Control urges people to seek emergency medical care if they are experiencing any of these symptoms: - Trouble breathing - Persistent pain or pressure in the chest - New confusion - Inability to wake or stay awake - Bluish lips or face

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.

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.

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.

It is very rare for a person wearing a mask to develop a staph infection as a result of the mask. Staphylococcus aureus, also known as a 'staph infection,' is a germ that can be found on people's skin, and can potentially cause serious infections if it enters the bloodstream. Usually staph infections are minor and can be treated with antibiotics, but more severe infections can be worrisome. In order to develop a staph infection, the person wearing the mask would have to have an open lesion or untreated wound on their face, but even then, it very rarely happens. Some of the same prevention tips health organizations recommend for preventing COVID-19 infections can help prevent staph infections, like washing your hands rigorously, cleaning and bandaging wounds on your skin, and regularly cleaning your mask. Wearing moisturizers like lotion can also help protect your skin from irritation which could lead to an open wound, if the skin becomes raw. Though cases of staph infections related to mask wearing are very rare, it is important to take prevention measures seriously to avoid a potential infection.

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.

COVID-19 delirium occurs in patients who have a sudden onset of mental disturbances that results in confusion and a lack of accurate perceptions regarding their environment and current state. Delirium itself is a change in mental abilities that results in the inability to think clearly, reduced awareness, and often emotional shifts. Delirium often occurs rapidly in patients and is frequently attributed to severe or chronic illness, changes in metabolism (the reactions and processes in your body that convert food into energy), infections, and other factors. Researchers and doctors have been drawing attention to the fact that regardless of age, potentially 1/3 of COVID-19 patients can develop symptoms of delirium. More recent studies have seen delirium in 20-30% of hospitalized patients with higher rates occurring in critically ill patients (upwards of 60-70%). For example, Vanderbilt University Medical Center launched a study in July 2020 that will study delirium, among other impacts on the brain, in patients who have been hospitalized with COVID-19. The researchers share that in previous studies of intensive care patients similar to COVID-19 patients, 33-50% experience dementia. Delirium can lead to longer hospital stays, which increases the risk for complications. _This entry was updated with new information on August 20, 2020._

Assurance testing, also called 'universal testing,' is a process in which an entire population gets tested for a virus several times over a specific period. So far during the pandemic, testing has mostly been saved for people who are experiencing symptoms, people who were in contact with individuals who tested positive for COVID-19, or people who are at high-risk of infection. Assurance testing would remove those limitations and allow everyone to get tested. Assurance testing tests large regions so that if an outbreak happens, it can be caught early and controlled through isolation measures. This type of testing could help different regions as they begin to reopen economies, schools, and other large gatherings after the lifting of lockdown and shelter in place orders. Assurance testing can help people interact with one another safely without leading to an increase in cases and uncontrollable outbreaks. Social distancing and mask wearing are still recommended in most regions for the near future, but assurance testing could help to maintain lower levels of the virus in populations that have been able to reopen.

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.

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.

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.

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._

While scientists have hypothesized that COVID-19 came from snakes, pangolins, bats, and other creatures, we still don't know exactly which animal passed the virus to humans, or how many species it might have impacted along the way. Scientists have determined that the virus did come from animals, not humans, and was first traced to a wet market in Wuhan, China. Many countries are hoping an independent investigation will take place to determine when and how COVID-19 first entered the human population, and at exactly what location. Many experts believe that the virus is a "wild" one, meaning that one animal species transmitted the virus to another species before it was spread to humans. The only way to determine exactly which animal the virus came from is to find the original animal species in the wild.

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._

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._

There is no reliable evidence so far to suggest that cannabis can prevent, treat or cure COVID-19. One pre-print (a type of study that is yet to be peer-reviewed) from Canada suggests possible anti-inflammatory properties in cannabis may be effective in future treatments of the disease. The study also suggests that cannabis could be used to prevent infection from the SARS-CoV-2 virus that causes COVID-19. SARS-CoV-2 gains entry into cells in the human body by interacting with the ACE2 receptor protein, which is found on the surface of many cells. This study suggests that cannabidiol (CBD), one of the active ingredients in cannabis, may affect the virus' ability to bind to the ACE2 receptor protein and enter cells. However, none of the claims in the pre-print study have been validated in large-scale studies, and pre-print data should always be treated with caution. Another lab, in Israel, is studying the effects of cannabis on the immune system's response to COVID-19 and analyzing the potential for molecules in cannabis to prevent the virus from entering cells and spreading. This research, however, has been undertaken by a cannabis research and development company based in Israel, and not independently verified by other scientific studies that are not linked to the cannabis industry. At this point, there is insufficient independent research to make any claims about the use of cannabis in preventing, treating, or curing COVID-19.

There is no proof that wearing a mask can reduce oxygen levels, also known as hypoxia. The United States Centers for Disease Control and Prevention (U.S. CDC) recommend wearing cloth masks over a surgical mask in public, which are not too tight on our faces and allow for easy breathing. Even doctors and healthcare professionals wearing N95 masks (which fit very tightly around the face and are made to create a seal around the edge of the mask) are not at risk of hypoxia. However, for any person with preexisting lung or breathing problems in general, they should speak with their doctors about their concerns regarding masks.

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.

No. Gasoline and/or diesel should not be used as a disinfectant, does not work as a disinfectant, has not been shown to kill the virus that causes COVID-19, and may be very harmful to human health. According to the U.S. National Institute for Occupational Safety and Health, gasoline exposure through the skin or eyes, drinking, or breathing can cause many health problems including the following: ·      Irritation or burns of the eyes, skin, or mucous membranes (i.e. the tissues in the nose, eyes, mouth, throat) ·      Headache, weakness, blurred vision, dizziness, slurred speech, confusion, convulsions ·      Chemical pneumonitis (when liquid gasoline is inhaled into the lungs and causes damage) ·      Possible liver or kidney damage ·      Long-term exposure may cause cancer ·      Gasoline is flammable and improper storage / use can lead to fires and burn injuries Gasoline exposure should be avoided and, if accidental exposure does happen, washing the exposed area is important. When exposed to gas fumes, it is important to leave the area where the fumes are to an area with fresh air or ventilation. Seek medical help for breathing problems as well as slurred speech, dizziness, confusion, or other symptoms of neurological (brain and nervous system) problems. 

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_

No, it is not safe to say in scientific terms that bald men are more likely to have COVID-19. In May 2020, a research study was widely reported in news headlines, which suggested male pattern baldness (androgenetic alopecia) could mean higher risks for severe COVID-19 symptoms. However, this is not exactly what the researchers found. The authors of this publication also acknowledged there were research limitations meaning their results cannot be generalized to a larger population and further studies are needed. Published in the Journal of the American Academy of Dermatology (JAAD), the researchers wrote that out of 122 men and 53 women admitted with COVID-19 to hospitals in Madrid, Spain, they found 79% of the male patients had some hair loss or baldness (alopecia) while estimating the prevalence of baldness in the general population is only 31%-53%. However, the researchers acknowledged limitations of their findings, including how only 175 people were studied (in research terminology, this is considered a** **small sample size that limits how findings can be generalized to a larger population). They also acknowledged that patients in the study were all admitted to a hospital with COVID-19, meaning there was no comparison group (control group) of participants without COVID-19 to compare the findings against the general population. Additionally, the research did not include information about patient outcomes (such as how the patients fared after they were admitted to the hospital), so it was not possible for researchers to compare outcomes for patients with and without baldness. In general, many researchers and doctors have cautioned that older people and men are more likely to have severe cases of COVID-19 requiring hospitalization, and older men are also more likely to be bald. For these reasons, "bald men are more likely to have COVID-19" is an incorrect interpretation of the published research.

Chloroquine is a medication that is taken to prevent or treat malaria, which is transmitted by mosquitoes bites. It's also used to treat some intestinal infections. On the other hand, hydroxychloroquine is a medication that is also taken to prevent and treat malaria, but it can also treat other diseases such as rheumatoid arthritis or lupus. Both of these medications are antimalarials, but hydroxychloroquine is a newer, slightly altered version of chloroquine that has fewer side effects and dissolves more easily in the body, so it is often considered a safer medication for patients to take. Despite recent media coverage of the COVID-19 pandemic, neither chloroquine nor hydroxychloroquine are approved treatments against COVID-19. Several research studies conducted around the world have demonstrated that hydroxychloroquine is likely not effective against 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.

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.

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.

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.

There is no evidence that food or the packaging it comes in plays a role in COVID-19 transmission. The public health community is continually learning about how the novel coronavirus spreads, and what transmission routes are most likely to make it spread. Because of this continual learning in the public health community, there has been confusion around how easily COVID-19 spreads, through which routes, and what precautions are really necessary—such as wiping down grocery packaging. According to recent studies, the risk of becoming infected by surfaces like food and packaging is quite low, but the same prevention measures experts have been suggesting for months should still be followed. Health experts recommend hand washing after handling produce and putting away groceries, but not that people wipe down or disinfect the packaging or belongings before coming inside. They should instead use hand washing after bringing items inside and putting them away.

There is no known cure for COVID-19 right now, but there are ways to manage the symptoms of the disease. A cure is a substance or act that ends and relieves the symptoms of a medical condition so patients can have their health restored. One for COVID-19 is currently being researched in many clinical trials around the world, but no treatment or practice has been shown to effectively meet these standards. Healthcare professionals around the world are researching various treatments for COVID-19, including drugs that already exist to treat other conditions to see if they may be effective against COVID-19 as well. No treatments are currently approved by the U.S. Food and Drug Administration (FDA) for COVID-19, but because COVID-19 is a public health crisis, doctors can treat patients using some drugs that are not technically approved for COVID-19. Emergency use authorization enables unapproved medical products or unapproved uses of approved medical products to be used for diagnosis, treatment or prevention in an emergency setting, even if the treatments may still be under further study. Remdesivir, an antiviral drug manufactured by Gilead Sciences that stops the virus from replicating, received emergency use authorization by the U.S. FDA. It reportedly reduced the recovery time for hospitalized patients from 15 days to 11 days, and early results indicate that it may reduce mortality among patients who are very sick from COVID-19. In terms of clinical management of symptoms, the U.S. National Institutes of Health (NIH) COVID-19 treatment guidelines indicate that Remdesivir supplies are limited and should be prioritized for patients who need it most (hospitalized patients who require supplemental oxygen). The guidelines also recommend the use of dexamethasone, a steroid that can reduce inflammation, for patients who require ventilators or supplemental oxygen (and potentially other corticosteroids). Healthcare professionals may use ventilators and supplemental oxygen to ensure that hospitalized patients have a healthy supply of oxygen in the body, and monitor patients accordingly. Prone positioning (flipping COVID-19 patients onto their bellies in order to open up their lungs ) is also widely used to help patients recover from the virus. At present, there is no cure for COVID-19.

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.

Alum (also called potassium alum or aluminum potassium sulfate) has been widely used in cosmetics, pharmaceuticals, food, and even textiles, but it has not been tested against viruses. While alum has some antimicrobial and anti fungal properties, it has not been shown to be an effective alternative for sanitizer or disinfectants. It is possible that there might be research, in the future, regarding the use of alum as an anti-viral disinfectant and cleaner, but the current literature does not support its use as an alternative to those on the EPA List N disinfectants with claims against Emerging Viral Pathogens.

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.

Attending protests or mass gatherings can increase the risk of catching COVID-19 or spreading the disease. This is especially so given the large amount of people who are infected with COVID-19 but do not have any symptoms (pre-symptomatic and asymptomatic), and may feel well enough to attend a mass gathering like a protest or march. In this context, there are a few steps you can take to reduce the risk of COVID-19 transmission. These include first of all wearing a mask and trying to maintain a certain distance from other people at the protest - 6 feet (or 2 m) where possible. Additionally, wearing heat resistant gloves and eye protection (ex: sunglasses) is also recommended. Since yelling - even through a mask - can increase the spread of respiratory droplets due to the force that pushes them out, it is recommended to choose signs or drums (or similar noise makers) if you want to express a message. To prevent further spread of the virus, it is recommended to stick to a 'buddy group' when participating in protests to keep the number of close contacts low. In the event one person in the group is found to be infected with COVID-19, it will be easier to contact all the people who came into close contact with that person and take the recommended public health measures. Similarly, it is recommended for protesters to get tested if possible after taking part in protests. In the US, some states are offering free testing for protesters. Finally, make sure to carry hand sanitizer to disinfect your hands as much as needed and carry water to keep hydrated.

According to the U.S. Department of Justice (DOJ), which enforces the Americans with Disabilities Act (ADA), there is no "blanket exemption to people with disabilities from complying with legitimate safety requirements necessary for safe operations,” including mask policies set by businesses and local governments. The ADA does require that people with disabilities are “reasonably accommodated,” such as by finding alternative public health measures for people who cannot safely wear and breathe through a mask. Wearing masks or other face coverings can help slow the spread of COVID-19. The U.S. Centers for Disease Control and Prevention (U.S. CDC) recommends wearing surgical masks over cloth masks, except for children under 2 years old, and anyone who has trouble breathing, anyone who is unconscious or incapacitated, and anyone who is unable to remove a mask without help.

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.

"COVID toes" typically refers to purple or pink discoloration, often with small, raised bumps on the skin on the tips of the toes and, in some instances, on the hands. Current research on the symptom is still evolving, and the exact cause of the symptom remains unclear. It is also important to note that multiple of the reports published about "COVID toes" are not based on patients having positive laboratory test results for COVID-19. The association with COVID-19 in these reports is based on the patients self-reporting COVID-19 symptoms or reporting having been in close proximity with someone diagnosed with COVID-19. The appearance of "COVID toes" and other symptoms can vary from patient to patient, and a dermatologist or clinician should be consulted for better clarity and safety in diagnosis. As of now, it is not clear what makes some people infected with COVID-19 have this reaction to the virus. It is not clear when in the course of illness the discoloration and rashes are most likely to be observed, and some reports suggest that these symptoms may occur more commonly in people without other typical symptoms of COVID-19.

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.

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.

People with severe COVID-19 illness often require medical care due to the symptoms they experience, like trouble breathing, chest pressure, fatigue, etc. While there is no specific treatment or cure for COVID-19, as it is a new viral infection, people are receiving supportive treatment to help them recover, though some people eventually die as a result of the virus. Supportive treatment is treatment that helps to alleviate the symptoms caused by an illness but can't actually cure the illness itself. Supportive care gives symptoms relief while the infection naturally subsides over time, at which point the symptoms diminish greatly and patients can go back home. Examples of this include giving oxygen to a patient, injecting steroids to reduce inflammation, giving ventilation to help them breathe, and other necessary medical interventions that do not stop the virus but do treat the more severe symptoms.

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.

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.