The Osmosis COVID-19 FAQ
Published on Mar 12, 2020. Updated on Sep 15, 2020.
Last week, Osmosis hosted a series of Q&A events on Facebook Live, Instagram Live, and YouTube focused on the topic of COVID-19, the novel coronavirus that has been making headlines in 2020.
During the AMA events, our Chief Medical Officer, Rishi Desai, MD, MPH, an Infectious Disease Specialist and former Outbreak Investigator at the CDC, answered as many of your questions as possible, addressing common misconceptions, rumors, and concerns.
Since the event, we’ve had a number of individuals and organizations write in with questions, which we’ve included in this FAQ. Here’s a rundown of the topics Osmosis has been asked to address so far:
General questions about COVID-19
Healthcare professionals & COVID-19
How to prepare for COVID-19
Travel & COVID-19
Older adults, chronic conditions, & COVID-19
Children & COVID-19
Pregnancy & COVID-19
List of psychological health resources
General Questions About COVID-19
What are the early signs/symptoms of the COVID-19 coronavirus?
Fever, cough, and shortness of breath are the early symptoms—it’s very similar to the flu in that regard.
How is COVID-19 different from the flu?
The most concerning difference between COVID-19 and the flu are how quickly COVID-19 spreads and its mortality rate. COVID-19’s R-naught is around 2.2, which means that for every one person that gets sick, 2.2 people will be infected. COVID-19’s mortality rate is thought to be around 3.4%, but this is a crude estimate that will likely change as testing expands and we identify more people with few or no symptoms. For comparison, during a bad flu season, influenza has an R-naught of 1.3 and a mortality rate of 0.1%.
Influenza also has a vaccine every year which has 50–60% vaccine efficacy, and can be treated with medications like Oseltamivir. COVID-19 has no vaccine, currently, and one isn’t likely to be available for quite some time. There are no FDA approved treatments for COVID-19, but Remdesivir is in clinical trials and has been used in some patients successfully.
How is COVID-19 transmitted?
The main way that COVID-19 spreads is when the virus is flung from one person to another when a person carrying the virus coughs or sneezes.
How do I know if I should get tested for COVID-19? Where can I get tested?
Right now, people who are ill should self-quarantine. If your illness worsens (elevated fever or breathing becomes more difficult), you should call your clinic to see if you should get tested for COVID-19 or other conditions, like the flu. Each hospital or clinic may have slightly different testing protocols. Some states haven’t begun widespread testing, so call your hospital or clinic to find out what you should do.
What can I do to prevent catching or spreading coronavirus?
Follow these four steps to do your part and curb the spread of coronavirus:
Wash your hands regularly for about 20 seconds with soap and water.
Don’t touch your T-zone (eyes, nose, and mouth).
Stay away from anyone who’s symptomatic.
If someone at home has symptoms, make sure they wear a face mask to catch any sneezes or coughs.
How can I boost my immune system?
Getting the flu shot and the streptococcal vaccine can prevent against other causes of pneumonia, and that can make folks even more susceptible to serious illness with COVID-19.
What’s is the incubation period of COVID-19?
Generally, COVID-19 incubates for a median of five days, with reports of up to 24 days. A 14-day quarantine period is being implemented as a standard precaution to catch anyone who may develop symptoms.
How deadly is COVID-19?
As of now (March 10), official data shows that the global mortality rate is 3.4% (flu is around 0.1%). That’s 34 times more deadly than the flu. The vast majority of those deaths are among people over age 60. This number will fluctuate based on location and number of people tested. For example, in the US, using the same time range as the statistic above, the CDC has reported more than 500 cases and 19 deaths in the US spread across 34 states, for a 3.8% mortality rate.
Could COVID-19 mutate into something more deadly?
COVID-19 is caused by the SARS-CoV-2 virus, but on close inspection, it’s not a single virus, but rather a group of closely-related viruses that have slightly different RNA. That’s because the virus is actively mutating, which means that there is a possibility that the virus could cause more disease and death over time.
However, this is not cause for panic. We have a growing awareness of the number of asymptomatic people who have COVID-19, which will lower the overall mortality rate. In addition, there are large-scale clinical trials testing out Remdisiver as a treatment for COVID-19. There’s also a growing sense of urgency around the world which means more resources are being pooled to help curb the spread of this disease. What this hopefully means is that we will be able to identify cases more quickly and reduce the spread.
Will the spread of COVID-19 slow down or stop during summer?
COVID-19 may or may not slow down in the summer months. If COVID-19 does transmit less in the community during warmer weather (a big if), there's still a risk that it will raise its head again at the end of the year. In other words, once the disease becomes endemic, it can settle down for a while and then resurge later.
It’s also important to note that the seasons in the northern and southern hemispheres are opposite, so that may allow for ongoing transmission.
What are the available treatments for COVID-19?
Currently, people who are hospitalized with COVID-19 are generally being offered supportive care—oxygens, fluids, and so on. In very rare cases, Remdesivir has been used, and it’s the subject of several large-scale clinical trials.
Who’s most at risk for contracting COVID-19?
Older adults (age >60) and people with pulmonary conditions are at greatest risk for contracting COVID-19. That said, there have been a number of serious cases in young and previously healthy individuals, too.
Once you’ve recovered from COVID-19, can you still be infectious?
Generally, the thought is that once you have recovered you are not infectious anymore. There are two reasons for this: low lingering levels of virus in bodily secretions, and nothing to force that virus out (like a cough or sneeze).
How might COVID-19 affect my daily life?
As long as COVID-19 is deemed dangerous, anyone with an upper respiratory tract infection will be expected to wear a mask and to self-quarantine as much as possible. Going to work with a cold or sending a mildly-ill child to daycare will likely no longer be acceptable. Remote work options and daycare arrangements will be increasingly important issues.
COVID-19 & Healthcare Providers
What precautions can healthcare providers take against COVID-19?
This answer to this question can be broken down into a list of do’s and don'ts:
Do: know the number of the state and local department of public health.
Do: understand isolation protocols as well as basics around negative and positive pressure rooms (e.g. you don’t want to send a COVID-19 patient with abdominal pain to a positive pressure OR).
Do: know if your laboratory has the capacity to do RT-PCR.
Do: learn the classic chest CT findings because they are over 95% sensitive in detecting early COVID-19 disease (compared to RT-PCR which is only 30–70% sensitive).
If you see a patient with symptoms:
Do: wear an N95 mask and ensure that there’s a good seal (remove facial hair), along with personal protective equipment (PPE) including eye protection.
Don’t: work extra hours or allow yourself to get overly fatigued (this was a risk factor for healthcare workers contracting the illness in China).
Are there any updates about the vaccine for COVID-19?
A vaccine is still a ways off. One possible treatment from Moderna Therapeutics is in FDA phase 1 clinical trials. It’s an mRNA vaccine that gets antigen presenting cells to replicate the protein found on the surface of the SARS-CoV-2 virus, allowing people to build up antibodies to it.
What are the clinical or laboratory criteria that may lead you to suspect COVID-19?
When diagnosing a patient who may have COVID-19, health professionals can look at a combination of:
Vital signs (severe or not); especially the respiration rate, and the presence of fever (>38 ºC or 100.4 ºF)
Chest imaging: chest X-ray and chest CT
CBC and blood culture.
Rapid testing for flu and a respiratory viral panel (where available)
Respiratory or blood PCR for COVID-19
What are the various types of masks? What is the correct way of wearing the mask?
There are two types of masks: surgical masks, which don’t protect you from COVID-19, and N95 masks, which are for healthcare providers and need to be properly sealed. Learn more in our video on this topic.
Why aren’t antibodies from recovered patients being segregated and amplified to be used as treatment?
They are. Antibodies recovered from patients are actively being researched as a potential treatment for COVID-19.
What percent of people getting this virus will develop serious disease?
Roughly 20% of people develop serious disease, and it’s mostly among older adults (age >60). That figure may go down as testing expands and more asymptomatic and mild cases are identified.
What's the difference between COVID-19 and recent previous outbreaks like SARS and MERS?
With both the SARS outbreak in 2002 and MERS outbreak in 2012, far fewer people were affected, but the mortality rates were far higher: SARS had a 9.6% mortality rate, and MERS had a mortality rate of around 34%.
How long can COVID-19 survive without a host?
Coronaviruses have been found to survive for hours to over a day on non-porous fomites. There are special cleaners that should be used for disinfection that you can check out on the CDC website.
What can I do as an intern in the hospital to protect myself?
As an intern, you can:
Wear personal protective equipment, including a properly-fitted N95 mask.
Remain in negative pressure environments when you’re with a COVID-19 patient.
Wash your hands.
Take frequent breaks.
At the first sign of illness, prioritize your own wellbeing.
If it becomes a pandemic, what do we need to do to prevent getting the disease while staying at home?
In the case of a pandemic that leads to high levels of disease in your community, you can:
Stock up on your medications and other basic supplies.
Figure out remote work options.
Figure out how to take care of your children or dependents (e.g. if daycares close).
Avoid ill people on the street and unnecessary exposure to large groups of people.
What are healthcare professionals in the US currently doing to get ready for COVID-19?
Hospitals and clinics are working around the clock to get personal protective equipment for the healthcare workers to protect them from the disease. Nearly 15% of healthcare workers in China became severely ill or died, and there have already been healthcare worker strikes due to inadequate protection. Understaffed clinics and hospitals will make this outbreak much more difficult to control, so protecting healthcare professionals is a major priority.
Also, healthcare professionals are learning more about the disease and how to manage it. CDC protocols are actively changing in terms of who needs to get tested and how that testing should be carried out, and there’s new data coming out every day. For example, there’s new data showing that detection of early disease with RT-PCR is only 30–70% sensitive, as compared to chest CT, which is more than 95% sensitive. Therefore, learning the classic findings of COVID-19 disease on chest CT scans is very important.
What should healthcare professionals be doing to prepare for a COVID-19 outbreak in the US?
Hospitals and clinics are at the frontlines of this outbreak, and they need to ensure the safety of the healthcare professionals in terms of having enough personal protective equipment (PPE) on hand and teaching staff how and when it should be used. Healthcare professionals should learn the local protocols around patients with COVID-19, including who to notify. That includes who to test, how to do the testing, who to isolate, as well as how and when to treat patients with COVID-19.
What do healthcare professionals need to know about COVID-19?
Healthcare professionals need to work closely with state and local health departments to make sure that they are aligned on protocols. They need to know that data is coming out quickly and that guidelines might change day to day as new testing protocols and testing methods become available. The same applies to quarantine and treatment guidelines.
What do healthcare professionals need to ensure their patients and the general public know about the virus?
Patients and the general public should know that people are working hard to keep them safe. In the near term, there are efforts to expand testing and to study treatment options like Remdisivir. In the long-term, there are researchers looking to get vaccine candidates through the FDA process—but that’s not likely to happen until 2021. In return, healthcare professionals need the general public to stay informed and to stay calm. That means doing things like washing their hands to prevent transmission of the disease, and not wearing N95 masks in low-risk situations. These masks are in limited supply and that depletes the resource, which can lead to shortages where they are really needed—in hospitals and clinics.
How can I prepare for COVID-19?
What can I do to prepare for upcoming changes?
COVID-19 doesn’t represent a public health crisis: it’s a public health education crisis. The most important thing to do is to stay calm and take some concrete steps.
If you are well and want to prepare:
Do: keep the phone number for your nurse or doctor advice line handy.
Do: carry a working thermometer.
Do: wash your hands with soap and water for at least 20 seconds (the amount of time it takes to sing “Happy Birthday” twice) or use an alcohol-based sanitizer.
Do: figure out remote work options, if possible.
Do: figure out childcare plans, if you have children.
Don’t: touch your eyes, nose, or mouth.
Don’t: wear a surgical mask, as it won’t prevent you from breathing in the virus.
Don’t: wear an N95 mask, because community risk is low, supplies are limited, and they’re needed for high-risk groups, like healthcare workers.
Don’t: interact with people who have symptoms, including family members (unless it’s unavoidable, such as caring for a child).
If you have symptoms:
Do: Wear a mask so you don’t get family members or roommates sick.
Do: Self-quarantine and wear a surgical mask if you absolutely need to leave the house.
Remember, you may have another illness like the flu, so you only want to go to the healthcare center if your illness is worsening so that you don’t inadvertently expose yourself to other people who may have COVID-19.
If you have a child, that means making sure that you have back-up options for childcare or can work from home if needed.
Do: continue hand-washing (especially after you sneeze/cough or touch your face).
Do: keep very close track of your illness:
Check your temperature (Fever is 100.4 ºF / 38 ºC or higher) .
Keep track of how difficult it is to breathe on a scale of 1–10 (lower on the scale is better).
Keep track of how many coughing fits you have per an hour.
Keep track of how many cups of water did you drink (higher is better).
Keep track of how often you’re urinating (the more often, the better).
Don’t: immediately go to the clinic or hospital.
Don’t: unnecessarily expose others (travel and socialize only when necessary).
If your symptoms are getting worse:
Do: Call your nurse or doctor advice line.
Do: Put on a surgical mask if you’re told to go to the hospital/clinic.
If COVID-19 only causes flu-like symptoms in most cases, why are global health officials so concerned?
COVID-19 causes mild symptoms like a slight cough or a low fever, but it can progress to more serious symptoms like a severe cough, high fever, and shortness of breath. The disease can also progress into ARDS (acute respiratory distress syndrome and shock), both of which cause death in roughly 3% of cases.
Travel & COVID-19
I’m a frequent business traveler. What can I do to stay safe when travel is unavoidable?In general, you should ask yourself if travel really is unavoidable. If you have to travel, keep the following tips in mind:
Follow the general instructions in the above section (How do I prepare for COVID-19?)
If you’re on a flight with a person that is ill next to you, ask to switch seats.
Don’t share meals or drinks with travel companions.
Should I cancel my vacation plans because of COVID-19?
COVID-19 can cause mild as well as severe disease in young, healthy people—although the highest risk is among elderly individuals with pre-existing lung diseases like chronic obstructive pulmonary disease (COPD) and asthma. There are also many large events that are being canceled internationally as well as smaller events in the US. There’s also the concern that national borders are being more carefully monitored and in some cases closing down to other countries. Travel during this time is a highly personal decision, and the ultimate justification has to be made by the person traveling.
Older adults (age >60), chronic conditions, & COVID-19
How can older adults and people with chronic conditions protect themselves against COVID-19?
In addition to following general guidelines around hand-washing, not touching the face, and practicing social distancing, older adults and people living with chronic conditions should come up with a COVID-19 action plan.
This plan could involve ordering extra medication, buying extra groceries with non-perishables, and scheduling frequent check-ins by phone or video call. You might also consider setting up a food delivery service to minimize the need for the at-risk person to venture into areas or interact with people that might get them sick.
Older adults and people living with chronic conditions are advised to be vigilant about the state of their own health, and to call a doctor or health hotline if they notice any symptoms of COVID-19 (fever, coughing, shortness of breath). If you suspect an at-risk family member may have COVID-19, call your non-emergency hotline first and ask for advice before proceeding to the hospital.
Finally, older adults and people living with chronic conditions should make an effort to keep the home free of harmful bacteria. Thoroughly clean any frequently-touched surfaces like door and cupboard handles, countertops, taps, remotes, cell phones, and other electronic devices. As we mentioned above, the EPA has a list of approved disinfectants that will kill the vast majority of harmful bacteria.
As someone in an at-risk health group, should I avoid my scheduled medical check-ups for now?
Before venturing out to the clinic, call your doctor first and check in with them over the phone to see what sorts of arrangements might be made. If you live in an area with cases of COVID-19, you should try to avoid visits to clinics and hospitals unless it’s an emergency.
Should I consider taking my older relative out of long-term care?
Before making a decision like this, check in with the administration of the care home to see what precautions they’re taking against COVID-19. Many care homes are implementing policies that require visitors to be screened based on where they live, where they’ve traveled, and how their recent health has been, in an effort to identify COVID-19 risk factors.
If you do decide to bring an older adult into your home, be sure to consider if you can offer them an adequate quality of life. Ultimately, it’s your decision—one that should be made carefully.
Children & COVID-19
How should I talk to my children about COVID-19?
Teaching children about COVID-19 is like teaching them about anything else—you have to relate it to the context of their world. Your approach will differ depending on the age of the child.
For elementary school children, you should reinforce what they need to do to stay safe, and to keep their friends safe, too. Emphasize the need to wash your hands with soap and water while singing happy birthday twice. Tell them to avoid touching their face, and to protect others by coughing and sneezing into the crook of the elbow.
For middle and high school-aged children, emphasize the fact that COVID-19 causes many of the same symptoms as the flu, but that in some people (mainly the elderly) it can get much more severe. Communicate that the key thing is to practice good hygiene (using the tips above) and that they should stay home from school and sports if they’re not feeling well.
I’m a parent who’s worried my child is being fed misinformation about COVID-19 at school. What should I do?
Situations like this need to be addressed as quickly as possible. Communicate your concerns promptly to teachers and school administrators. Share educational resources from credible sources like the CDC, WHO, and Osmosis to ensure that children are being exposed to the most reliable sources of information.
Pregnancy & COVID-19
What should pregnant people know about COVID-19? Is there evidence that the virus can be transmitted in vitro?
COVID-19 is caused by SARS-CoV-2, a type of coronavirus. We have limited data on this coronavirus, but there was a recent case series of infants born to mothers with COVID-19, where none of the infants tested positive for the virus. Additionally, samples of amniotic fluid or breast milk did not contain the virus.
There are also media reports of a 30-hour-old infant with COVID-19. This suggests that there may be transmission occurring through the placenta. We also have data from prior coronavirus outbreaks like SARS and MERS, both of which were associated with infants being delivered preterm and small for gestational age. These coronaviruses were also associated with pregnancy loss, including miscarriage and stillbirth.
All of this suggests a possibility that coronaviruses as a group may be able to pass across the placenta from the parent fetus. Currently, though, there is no evidence that that has happened with SARS-CoV-2.
How can I keep my newborn safe from COVID-19?
Newborns are primarily around the caretakers in the home, so the best way to protect them is to keep everyone in the home COVID-19-free. Encourage everyone in the household to wash their hands like it matters, not to touch their face, and to avoid people who are ill. Also, avoid taking newborns to places that might put their health at risk, especially communities and regions with endemic disease.
Can COVID-19 be transmitted via breast milk?
One recent case series looked at mothers with COVID-19 and didn’t find evidence of the SARS-CoV-2 virus in breastmilk, but there were antibodies against SARS-CoV-2 in one sample. That suggests that the breast milk from someone who has had COVID-19 may offer some degree of protection to the newborn.
The CDC has no clear recommendation at the moment with regard to breastfeeding. That said, the main risk here is that the infected parent can transmit the virus through respiratory droplets while they’re breastfeeding.
Any breastfeeding patient with a confirmed diagnosis of COVID-19 should wash their hands for at least 20 seconds before touching the infant, and wear a face mask while breastfeeding. When expressing breast milk with a breast pump, the parent should wash their hands before touching any equipment and clean it thoroughly after use. If it’s an option, the parent may look to another person without COVID-19 to breastfeed the child instead.
Are there any scenarios where parents and newborns should be separated in light of a COVID-19 diagnosis?
Currently, there are no explicit guidelines around this, but either person diagnosed with COVID-19 poses a health risk to the other. For example, a parent who is recovering from COVID-19 may need to be temporarily separated from a baby with an impaired immune system.