What is the 2019 novel coronavirus, or COVID-19?
Coronavirus is the name of a large family of viruses. Some cause infection specifically in humans while others cause infection in animals. There are many types of human coronaviruses, including some that cause the common cold. Rarely, animal coronaviruses may develop the ability to also infect humans.
COVID-19 is a disease caused by a new (novel) coronavirus that has not previously been seen in humans and is thought to have originated from an animal coronavirus in Wuhan, China. The name of this disease was chosen by the World Health Organization and stands for Coronavirus Disease 2019. Currently, COVID-19 is the cause of a contagious respiratory infection in humans that has been spreading across the world. It is NOT the same thing as MERS or SARS-CoV, two other coronavirus diseases that originated from animals and then spread to people.
More information on the origin of COVID-19 can be found here.
What are the symptoms of COVID-19 infection?
Reported illness in confirmed COVID-19 cases around the world range from mild symptoms for the majority of those affected, to severe respiratory illness and death. The following symptoms may be found 2-14 days after exposure and appear flu-like: Fever, cough, sore throat, shortness of breath, chills, body aches, headache, and new loss of taste or smell. Nasal congestion, nausea/vomiting, and diarrhea occur in a minority of patients along with other symptoms of the virus.
More information on symptoms of COVID-19 can be found here.
How is COVID-19 spread?
COVID-19 is spread person to person and can be transmitted through respiratory droplets containing virus that travel 3 to 6 feet before landing. Infection can be spread if respiratory droplets produced when an infected person coughs or sneezes land in the eyes, nose, or mouth of people nearby, or if they are inhaled into the lungs. Respiratory droplet transmission is also how influenza (flu) and many other respiratory viruses spread. COVID-19 can also be spread by contact with a contaminated surface or other objects, and touching your eyes, nose, or mouth.
More information on how COVID-19 is spread can be found here.
Who is at higher risk of serious illness with COVID-19?
Based on numerous published studies in the past several months, children continue to show that they are the least likely age group to experience severe illness. However, certain groups are considered at higher risk of serious disease, including older adults and those with chronic medical conditions like diabetes, immunocompromised status, heart disease, chronic lung disease, and kidney disease.
How can I prevent from getting COVID-19 disease?
There is currently no vaccine or antiviral therapy proven to be effective against COVID-19, although vaccine development and clinical drug trials are in their earliest stages. The best way to prevent illness is to avoid being exposed to the virus. COVID-19 can be spread by those with asymptomatic infections as well as by those who are in the early period of infection before symptoms develop. While most healthy children and adults will be able to manage their illness at home, this is not true for everybody. For everyone’s safety at this time, we encourage staying home as much as possible and limiting in-person social activities and exposures, including playdates with those outside your household. Avoid unnecessary international travel as well as busy public places. Practice “social distancing,” which means limiting close contact with others outside of your household and maintaining a physical distance of at least 6 feet from other people when outside the home.
In addition, these everyday preventive practices are recommended to help prevent the spread of respiratory diseases:
- Wear a cloth face cover when it’s necessary to go out in public, to protect other people in case you are unknowingly infected. Continue to keep at least 6 feet between yourself and others. The cloth face cover is not a substitute for social distancing.
- Avoid close contact with people who are sick.
- Avoid touching your eyes, nose, and mouth.
- Stay home when you are sick.
- If you’re in a private setting and do not have on your cloth face covering, cover your cough or sneeze with a tissue, then discard in the trash and wash hands. Or, cover your cough or sneeze with your elbow or shoulder instead of hand.
- Disinfect high-touch surfaces (e.g. phones, doorknobs, countertops, light switches, bathroom fixtures, etc.) using an EPA-certified cleaning product effective against COVID-19. More information on effective household disinfection recommendations can be found here.
- Wash hands frequently, and especially before touching your eyes, nose, or mouth. A 20-30 second soap and warm water scrub of all hand surfaces is recommended if you have surface grime or residue on hands. Otherwise, a hand sanitizer made with at least 60% alcohol is adequate. Apply enough product to allow a 20 second rub of all hand surfaces. Store all hand sanitizers out of reach of young children. More information on proper hand hygiene use can be found here.
Why does the CDC now recommend the use of cloth face masks?
In a change from previous guidance, the CDC now recommends the use of cloth face masks when leaving the house as part of a bundle of behavior-based practices to prevent the spread of COVID-19. What’s the reason behind this change?
- The incubation period (time between exposure to the virus and when symptoms first appear) for COVID-19 is reported to be between 2-12 days for the majority of cases.
- New data suggest infected persons may be contagious 1-3 days before symptoms develop.
- The CDC estimates that at least 25% of persons infected with COVID-19 have no symptoms.
- Patients with less serious symptoms or no symptoms at all likely play an important role in how COVID-19 is spread.
- Wearing a cloth face mask when outside of the home may prevent those with no symptoms or mild symptoms from unknowingly spreading the virus to others, slowing down the spread of COVID-19 in our communities.
- Cloth face masks may also provide some protection from exposure to the virus during times when social distancing isn’t possible, although not as effectively as surgical masks or N95 respirators which are currently in short supply and being prioritized as critical for healthcare workers.
What is the most effective way to use a cloth face mask?
- A cloth face mask should ideally be made out of multiple layers of a pre-washed tight-weave non-stretch cotton material.
- The mask should cover both nose and mouth and fit snugly but comfortably. It should be breathable.
- Cloth face masks should be laundered or washed routinely depending on frequency of use. Laundry detergent/soap and water are adequate to kill the virus, due to their ability to break apart the fat layer (lipid envelope) protecting the virus.
- Avoid touching the eyes, nose, or mouth when removing the face mask and wash hands immediately after removing.
- Cloth masks should not be worn by children under 2 years, have severe intellectual or respiratory impairment, or by those who are unable to remove the mask without assistance. Supervise children under 4 years of age when wearing a face mask. Masks should not be worn around the neck.
My child is unable to wear a face mask. What should I do when we are in public?
- First, remember that those who are in the home setting with their usual household members don’t need to wear a mask (children included) provided that no individuals have been recently exposed to a person with COVID-19. Face masks are intended for use once leaving the home and going out in public, particularly in situations where social distancing (staying at least 6 feet apart from others) may be difficult. If any family member is sick with fever or respiratory symptoms, they should wear a face mask to protect other household members.
- If your child is too young or unable to cooperate with wearing a mask in public, aim to keep them at least 6 feet away from others, and redirect them to avoid making contact with surfaces (e.g. playground equipment, water fountains, etc.) that could harbor the virus. For very young children who may not be able to understand why they can’t run up towards other people or touch things that they shouldn’t, it may be best to keep them at home or in spaces away from other people or common surfaces.
- If you must go outside or to a place where you’re unable to socially distance with an infant, cover the infant carrier with a blanket, which helps protect the baby but still gives them the ability to breath comfortably. Do not leave the blanket on the carrier in the car or any time when the baby is not being supervised.
- Children with severe intellectual or respiratory impairments may not be able to tolerate a face mask for long, so special precautions may be needed for these children, including monitoring with a pulse oximeter if available and/or keeping a greater physical distance from others outside the home.
My child has a fever and cough and I’m concerned that they may have COVID-19.
In the case of COVID-19, there is no proven effective treatment or prophylaxis for household members currently available. For individuals with symptoms of mild infection (fever, cough, sore throat without dehydration or shortness of breath), home management and isolation is advised. For those with more concerning symptoms (shortness of breath or labored breathing, chest pain with breathing, concerns for dehydration, fever of 101F or higher for > 72 hours without signs of improvement in height or frequency of fevers) please call your medical provider.
Only go to the emergency department if you or your child is experiencing a true emergency. If you are concerned about possible COVID-19 infection, contact the medical office, urgent care, or emergency department BEFORE going. This allows medical staff to take the necessary precautions to protect themselves and other patients when you arrive.
At this time, Center City Pediatrics is not routinely testing patients for COVID-19.
My child is afraid of wearing a mask/won’t wear one. What can I do?
If your child is scared of wearing a mask, parents should wear masks as well, so your child doesn’t feel alone. Some other ideas to help make masks seem less scary are:
- While wearing masks, look in the mirror and talk about it.
- Put a mask on a favorite stuffed animal.
- Decorate a mask so it’s more personalized and fun.
- Show your child pictures of other children wearing masks.
- Draw a mask on their favorite book character.
- Have your child practice wearing a mask at home first.
For very young children, it’s best to answer their questions simply in language they understand. If children ask about people wearing masks or other face coverings, parents can explain that sometimes people wear masks when they are sick, or to be protected from getting sick. Last, an important way to reassure children is to emphasize how you are taking steps to stay safe during this time, and that wearing a mask can keep all of us safer. Children feel empowered and less afraid when they know what to do to keep themselves safe.
I was exposed to/diagnosed with COVID-19 and I’m concerned about protecting my family. What should I do?
Contact your public health department or your own medical provider as soon as possible. Stay home and avoid visitors until you are instructed on next steps. Information on preventing the spread of COVID-19 in your home or community if you were exposed to COVID-19 and have developed symptoms can be found here. Much is unknown about breastfeeding and COVID-19. The most current advice can be found here.
What about my pets? Can they get sick with COVID-19?
The CDC has received several reports of a small number of pets (including cats and dogs) becoming infected with the virus, as well as a tiger at a zoo in New York. Most of these animals had contact with a person with COVID-19. At this time, there is no evidence that animals play a significant role in spreading the virus that causes COVID-19. Based on the limited data available, the risk of animals spreading COVID-19 to people is considered to be low. However, since animals can spread other diseases to people, it’s always a good idea to wash your hands after being around animals. If an individual has been diagnosed with COVID-19 and has a companion animal, as a precaution it’s recommended to avoid contact with pets and other animals.
More information on COVID-19 and animals can be found here.
Are COVID-19 antibody tests useful for diagnosing infection? Does a positive COVID-19 antibody test mean that a person is immune?
Antibodies are special proteins that an immune system typically makes during the course of an infection to help fight a germ and provide memory against a future reinfection. Tests for the presence of antibodies against COVID-19 (i.e. serology testing) are increasing in availability, due to the rapid development of assays by commercial manufacturers. Some people are asking if this could be helpful in diagnosing if they currently have COVID-19 infection or to determine if they’ve had the infection already and are now “immune.” What can a serology test result tell you? First, it may be more helpful to discuss what it can’t tell you:
- Serology tests may not diagnose a current COVID-19 infection.
Depending on the germ causing the infection and the type of antibody being produced, it may take days to weeks for an antibody response to be detected. When it comes to COVID-19, it may take at least 11-12 days after infection for antibodies to be detected. As a result, serology testing is not as helpful for diagnosing a current infection with COVID-19 but can tell you that you have had the infection at some point in the past. For some people who have trouble with forming antibody responses, such as those with immunocompromising conditions, a serology test might not be helpful for determining past infection.
- Serology tests cannot determine if you’re no longer contagious to COVID-19.
Many viruses continue to be “shed” (or be present and able to spread) in small amounts from respiratory secretions or saliva or feces for a period even after someone has recovered from an infection. It’s currently unknown how long someone is contagious after being infected with COVID-19. There have been some cases of persons who have recovered from COVID-19 and tested negative, weeks later testing positive again. We don’t know yet in those cases if the virus being detected from repeat testing is living virus capable of infection or fragments of dead virus. But there is no evidence at this time that antibody responses mean a person is no longer contagious with COVID-19. Persons who were recently infected and COVID-19 serology positive should still exercise caution to prevent spreading the virus to others.
- Serology tests cannot establish if you’re immune to COVID-19.
When it comes to other human coronaviruses that cause the common cold, reinfections tend to happen over the course of time. For some infections, the production of specific antibodies does not translate into future immunity. Right now, it’s unknown if those who were infected with COVID-19 and produced an antibody response are protected from future infection, and if so, for how long and to what degree they are protected.
- Serology testing may be useful when it comes to a certain type of experimental COVID-19 therapy. While there is still no proven effective treatment for COVID-19, some patients with severe infection may be treated with an experimental therapy using the COVID-19 antibody-enriched plasma of persons who have recovered from infection. Serology testing can help determine if a person might be eligible to donate plasma to someone else for this purpose.
- Serology testing can be used in public health studies to determine how much of a population has been infected with COVID-19. Determining the proportion of a population that has been infected with COVID-19 is an important data point used by public health and government officials to develop effective strategies in controlling the virus in the community.
Until more data emerge, Center City Pediatrics is not routinely ordering COVID-19 serology testing.