Inside Covid-19

Covid-19: Answers to the burning questions you may have

The Wall Street Journal has been taking questions from readers about the novel coronavirus. Here, we compile the answers based on interviews with experts.
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As people get used to the idea that they will have little social contact from Thursday for three weeks; many questions have arisen on how it should be managed and what is and isn't allowed. South Africa is known to be a nation that is not that law abiding and where we like to rebel against authority – it started way back with the Voortrekkers not liking the government in the Cape and packing up their goods and was elevated to something noble during the anti-apartheid movement. The knock-on effect is that South Africans are rule breakers and we see this manifesting right now as the nation prepares to lockdown where some business owners have been told by their workers that they can't see the point of a lockdown as it is meant for rich people who travel and the Chinese. For other questions that our readers may have, the Wall Street Journal has provided answers, which we adapted for SA readers where needed. It contains plenty of helpful information about the coronavirus and the course of the disease, whether pets are safe, precautions for pregnant women and possible remedies for people who contract the disease. – Linda van Tilburg

Coronavirus: You ask, we answer

By WSJ Staff, with adds from BizNews

The Wall Street Journal has been taking questions from readers about the novel coronavirus. Here, we compile answers to your questions based on interviews with experts.

Q: Is there any information on the number of people who have had Covid-19 and are no longer contagious?

A: There are nearly 355,000 confirmed cases world-wide as of March 23, according to data from Johns Hopkins University. Of those confirmed cases, more than 100,000 people have recovered. The vast majority of recoveries are in China. Deaths from the novel coronavirus have topped 15,000 globally. The US currently has more than 41,000 confirmed cases and has reported nearly 500 deaths. South Africa has just over 550 confirmed cases as of 24 March with no deaths.

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Q: I am 70 years old, live alone and have no nearby family or friends. How will I know the difference between a severe cold/flu and Covid-19 before it is too late to drive myself to the doctor?

A: If you feel ill, first call your doctor before going in. If you don't have your own doctor, consider calling a telehealth provider. Locally in South Africa you can use Discovery Health's  DrConnect or Profmed's Medici apps, which put you in contact with a doctor virtually.

The primary symptoms of Covid-19 are fever, cough and shortness of breath. The CDC has set up a "self checker" questionnaire that can help you better understand symptoms you may be experiencing.

If you are feeling anxiety around the coronavirus or about getting sick, visit the NICD's website or call +27-11 386 6400

Q: Is it safe to eat food taken out from restaurants?

A: The main risk from ordering food and groceries is that you could catch the virus from an infected delivery person, if he sneezes or coughs on you. That is because the virus spreads mostly by person-to-person contact. It is less likely, although still possible, to get the virus from touching contaminated packaging. There may also be a small risk from touching raw food that has the virus on it and then touching your face. But there appears to be no risk of contracting the virus by eating it in cooked food, experts say.

Doctors say ordering food is generally safer than going to a grocery store or a restaurant, because you come into contact with fewer people.

Q: I'm a college student going home for spring break. My friends and I want to hang out with each other. What can we do to hang out in a group, but prevent spreading coronavirus?

A: Young people are being advised to follow the same guidelines as older folks: Avoid nonessential travel, restaurants and gatherings of more than 10 people. From midnight on Thursday South Africans will be in lockdown accept for essential services personnel.

Epidemiologists are growing concerned that pushback by younger generations against these social-distancing measures could undo all efforts to slow the spread of the virus. Children and young adults are no less likely than older people to get infected and transmit the virus.

Q: How long will this virus last and remain a potential threat? Will it always be a part of our environment, or will it run its course and completely disappear?

A: Most forecasters are reluctant to predict – at least publicly – how this will play out. Amesh Adalja, a senior scholar at Johns Hopkins Centre for Health Security, said the outbreak is still in the first inning. It isn't yet clear how many people have the disease, how quickly it is spreading or even how deadly it is.

Coronaviruses in general aren't as seasonal as the flu. So although they are less prevalent in the spring and summer, they have more of a presence than influenza. A different coronavirus strain called SARS (severe acute respiratory syndrome) started in November 2002 and was gone by the summer of 2003, notes Gregory Poland, director of the Mayo Clinic's Vaccine Research Group in Rochester, Minn. But that didn't happen with the MERS (Middle East respiratory syndrome) strain.

Covid-19 — the illness caused by the new coronavirus — has circulated in some areas with warmer climates, such as Hong Kong and Singapore. But in general there have been relatively few cases in warmer climates.

Q: I would like to know what to have on hand – food, water, etc. – in case we need to be under quarantine, and how long that could be. Weeks? Months?

A: If you are told to self-isolate, you will need to stay at home and avoid contact with others for 14 days. Stock up on some supplies in case you have to remain home, infectious-disease experts say. To avoid cleaning out store shelves, just buy a few extras on your regular orders or trips to the store. Items to consider include shelf-stable foods like cans of beans, packages of rice and pasta, and beverages; pain relievers and other common medications; extra prescription medications; and hygiene and cleaning products.

Q: Is Covid-19 more or less contagious than the flu or other viral respiratory diseases?

A: Covid-19 appears to be more contagious. The measure used by health professionals is R0 — pronounced "R naught." R0 is an estimate of how many healthy people one contagious person will infect. The R0 for Covid-19 is estimated to be 2.6. "That's a lot," says William Schaffner, a professor in the division of infectious diseases at Vanderbilt University Medical Center in Tennessee.

In comparison, for influenza the figure is somewhere around 1.2 to 1.8, says Dr. Poland.

Q: How long do antibacterials such as Purell last when applied, and are they effective?

A: Experts say alcohol-based sanitisers last only a minute or two and must be reapplied when recontamination occurs. In addition, hand sanitisers aren't as effective as soap and water at removing certain kinds of germs, says the Centres for Disease Control and Prevention.

The CDC recommends washing your hands with soap and water when it is available and using a hand sanitizer only when soap and water isn't an option. Although alcohol-based hand sanitizers can deactivate many types of microbes very effectively when used correctly, people might not use a large enough quantity of the sanitizer or might wipe it off before it has dried. When using hand sanitizer, apply the product to the palm of one hand (read the label to learn the correct amount) and rub it all over the surfaces of your hands until they are dry.

Q: How safe are swimming pools and hot tubs?

A: Currently, there is no evidence the virus can be transmitted to humans through pools or hot tubs, according to the CDC. Proper maintenance and disinfection (through the use of chlorine and bromine) should eliminate the virus that causes Covid-19.

Q: Does having a pneumonia shot prevent or help mitigate the impact of the coronavirus?

A: The pneumonia vaccine doesn't protect you from the coronavirus but will lower your risk of bacterial pneumonia, or lung infection, according to the University of Virginia Medical Center. The centre advises people to get the pneumonia vaccine if they are eligible. This vaccine is recommended for adults older than 65, those between the age of 2 to 64 with certain medical conditions, and adults 19 to 64 years old who smoke cigarettes.

Q: Can my pet get sick if I had this virus? Can I get the virus from my pet?

A: Currently, there is no evidence that pets can be infected with the novel coronavirus, according to the World Health Organisation. A report from Hong Kong emerged in late February that a dog belonging to an infected patient had returned a "weak positive" test for the virus. However, authorities at the Agriculture Fisheries and Conversation Department couldn't determine how the dog contracted it. Experts have urged pet owners to maintain good hygiene, such as washing hands, and to refrain from kissing their pets.

Q: How do I know if I have coronavirus?

A: The telltale sign is difficulty breathing or shortness of breath combined with a high fever, says Wilbur Chen, an associate professor of medicine at the University of Maryland School of Medicine. A high fever would be 38,333°C or higher.

The virus infects the lower respiratory tract. Patients initially develop a fever, cough and aches, and can progress to shortness of breath and complications from pneumonia, according to case reports. They might develop nausea, with vomiting and diarrhea. Some become only mildly ill or are infected but don't get sick. Others are mildly ill for a few days, then rapidly develop more severe symptoms of pneumonia.

Q: How does the mortality rate of coronavirus compare with the flu?

A: Mortality rate estimates for the new coronavirus are often cited as about 2%, though estimates have ranged from 1.4% to 3.4%. In comparison, the mortality rate for severe seasonal influenza is much lower, at 0.1%.

Once the number of asymptomatic or minimally symptomatic cases is known, the real fatality rate for new coronavirus might be less than 1%, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, wrote in a New England Journal of Medicine article.

The statistics fluctuate depending on the numbers of confirmed cases and deaths, which change daily. So the exact rate won't be known until experts know the true denominator, which is the total number of people infected, including those who are asymptomatic or never got tested.

Q: What, if any, precautions should be taken by pregnant women?

A: Experts say pregnant women fall into the vulnerable category of people more likely to get seriously ill with the new virus. Although the precautions are the same, pregnant women need to be especially vigilant. Avoid large public gatherings if you're in an area with new coronavirus cases, says Dr. Poland of the Mayo Clinic. "The precautions should be heightened," he says.

Cameron Wolfe, associate professor of medicine at Duke University Health System's division of infectious diseases, recommends making sure you have an influenza shot if you are pregnant and asking whether your doctor has contingency plans if new coronavirus cases escalate, such as conducting a virtual visit through telemedicine when possible.

Q: How should I treat packages? Is it possible to transmit the virus through the mail?

A: The CDC has stated there is likely very low risk that the virus can be spread from imported products or packaging, because of poor survivability of coronaviruses on surfaces.

Q: How can I best protect myself?

A: David Eisenman, director of the UCLA Center for Public Health and Disasters, says that the most important thing you can do is wash your hands frequently, for at least 20 seconds each time. Wash them regularly when you are at the office, when you come home, before you eat and other times that you are touching surfaces. You can also use an alcohol-based hand sanitizer.

Don't touch your eyes, nose or mouth—viruses can enter your body that way. Wipe down objects and surfaces frequently with household cleaner, which will kill the virus. Maintain a distance from people who are sick.

And get a flu shot if you haven't already. "It prevents you from getting an illness that you think is coronavirus, because they can act very similarly," Dr. Eisenman said.

Q: What are the "underlying health conditions" that can put a person at greater risk of death from the coronavirus?

A: Adults of all ages have been infected by the coronavirus, but the risk is highest for older people and those with underlying health conditions. People with diabetes, heart disease and lung disease, including respiratory illnesses, as well as smokers, are at increased risk of severe illness. Most of the 1,023 people whose deaths were included in a study by the Chinese Center for Disease Control and Prevention were age 60 or older, and/or had other illnesses.

Public-health experts advise staying calm and following the same precautions recommended for preventing flu or any other respiratory virus. Stick with the basics: Wash your hands, cover your coughs and sneezes, and stay at home from work or school when you're sick.

Q: Is taking common cold remedies a good practice?

A: Experts say this is helpful for controlling symptoms, which is the mainstay of treating the new coronavirus. But it isn't a cure and won't prevent you from infecting others.

Q: If you touch a hard surface that has the virus on it, and then touch food and eat it, can you expose yourself to it?

A: The virus transmits through "respiratory droplets" when an infected person speaks, coughs or sneezes, according to the WHO. The droplets can settle on nearby surfaces, where they can survive for a period, though it isn't known for how long. A person can become infected by touching a contaminated surface, then touching their mouth, nose or eyes.

Dr. Poland says if it is a surface exposed to sunlight outside, the virus likely lives for only a few minutes or up to an hour. But if it is indoors and a dry environment, germs can live up to a day or two.

If someone at home is sick, the CDC recommends cleaning surfaces that are touched frequently — such as doorknobs and countertops — every day. Regular household disinfectant wipes and cleaners should suffice. Anything with alcohol or bleach works.

Q: What precautions would you recommend taking on an airplane?

A: The WHO advises that travellers exercise the same precautions they would follow to avoid catching any bug: Keep hands clean and use antiseptic wipes on any surfaces, such as tray tables and armrests, where germs can linger. Contrary to popular belief, cabin air is less of a concern; virtually all international jetliners are equipped with high-efficiency particulate air filters, similar to those used in hospital operating rooms. Cabin air is refreshed every two to three minutes.

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