Coronavirus disease 2019 (COVID-19) is a respiratory illness that can spread from person to person. The virus that causes COVID-19 is a novel coronavirus that was first identified during an investigation into an outbreak in Wuhan, China.

Note: The following information is current as of April 20, 2020.

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from mild illness (such as the common cold) to more severe diseases such as severe acute respiratory syndrome (SARS-CoV).

Coronavirus disease 2019 (COVID-19) is the illness caused by a newly discovered coronavirus, named “SARS-CoV-2”, that was first identified in Wuhan, China, in December 2019. Since then, thousands of cases have been reported, involving spread to several other countries, including the United States. While most cases of illness are mild, some cases result in death.

The COVID-19 outbreak is being taken very seriously, as new infections are always of public concern. It was declared a “public health emergency of international concern” by the Director-General of the World Health Organization (WHO) on January 30, 2020. On March 11, 2020, WHO declared it a pandemic. The WHO and Centers for Disease Control and Prevention (CDC) are thoroughly monitoring and rapidly responding to the outbreak. Global efforts are focused on containing the spread and mitigating impact.

What we know about COVID-19 is constantly changing. Therefore, it’s important to keep up to date and consult resources from the CDC and WHO.

Current Affected Areas

The epidemiology of COVID-19 outbreak is under close surveillance and is available for daily public review. Situational tracking can be followed at:

Maryland State Department of Health:

https://coronavirus.maryland.gov/

CDC:

Global Map: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/world-map.html

US Map: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

WHO:

Dashboard: https://covid19.who.int/

Situational Reports: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/

Transmission

Person-to-Person Spread

COVID-19 is spread from person to person. A person who is infected with the virus may release small droplets from their mouth or nose, such as by coughing or sneezing. These droplets may land on surfaces or objects that another person may then touch, and later touch their eyes, mouth or nose. It is not certain how long the virus survives on surfaces, but could be hours or days, depending on the environment. People can also become infected by breathing in the infectious droplets in the air. The risk of catching COVID-19 from someone without symptoms is possible.

Feces

While initial investigations suggested the virus might be present in the feces, the risk of this means of transmission appears low and is not felt to be a main feature of the outbreak.

Animals

Although coronaviruses are known to be zoonotic, or transmitted between animals and humans, possible animal sources have not yet been confirmed. Early on, there was an association with seafood and live animal markets in the epicenter of the outbreak in Wuhan, China. However, growing evidence favors person-to-person spread. Still, as the investigation continues, it is advised to avoid direct contact with animals or contact surfaces in live animal markets, and to ensure good food safety practices at all times. There is currently little evidence that companion animals, such as pet dogs or cats, can be infected with or spread COVID-19.

Who is at risk?

While people of all ages can become infected with the new coronavirus, older people and people with certain chronic medical conditions, such asthma, diabetes, and heart disease, appear to be at increased risk of becoming infected. Those with close contact with persons with COVID-19 are at elevated risk of exposure, including caregivers and healthcare workers.

Symptoms & Signs

The complete clinical picture of COVID-19 is not fully understood. These symptoms may appear 2-14 days after exposure to the virus:

  • Fever
  • Dry cough
  • Shortness of breath or difficulty breathing
  • Chills
  • Repeated shaking with chills
  • Aches and Muscle pain
  • Headache
  • Sore throat
  • Runny nose
  • New loss of taste or smell
  • Diarrhea

Symptoms are usually mild and begin gradually. Some people do not experience any symptoms at all. Others, most commonly people with underlying medical conditions like high blood pressure, heart problems, or diabetes, may develop more severe illness. They may develop pneumonia, severe respiratory illness, or death.

The incubation period, or time between catching the virus and the onset of symptoms, is estimated to be 1-14 days, with an average of 5 days.

If you develop emergency warning signs for COVID-19 get medical attention immediately. Emergency warning signs include*:

  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face

*This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.

Diagnosis

There are laboratory tests available to identify the virus that causes COVID-19 in respiratory samples (eg nasal swabs).  Although the supply is improving, it may still be difficult to find available tests.  The CDC has distributed tests to state and local health departments and medical providers may have additional tests from commercial manufacturers. 

If you think you have been exposed or are experiencing symptoms of COVID-19, call your healthcare provider.  Only a healthcare provider can order testing for COVID-19, and there are multiple factors that go into the decision to test and the CDC is continuously updating their recommendations on testing. Keep in mind that there is currently no specific treatment for COVID-19 and many people are able to recover from mild illness at home.

The CDC has developed criteria for persons under investigation (PUIs), which is subject to change when more information becomes available. Clinicians are responsible for reporting PUIs to state health departments, who then report to the CDC.

Healthcare providers should evaluate patient’s clinical features (fever, symptoms of respiratory illness and/or distress) and are urged to obtain a detailed travel history to evaluate epidemiologic risk. PUI criteria can help stratify the need for confirmatory laboratory testing. A confirmed case or diagnosis is made only with PCR-based laboratory testing which detects the presence of the SARS-CoV-2 virus.

Treatment

There are currently no specific medications proven to treat or prevent COVID-19. There are, however, numerous ongoing clinical trials to investigate possible treatments.  Treatment consists mainly of supportive care or care to help relieve symptoms. This may include:

  • Getting plenty of rest
  • Drinking fluids to prevent dehydration
  • Taking medicine such as Tylenol (if appropriate) to relieve fever or pain

Antibiotics are NOT effective against viruses. They only treat bacterial infections. However, some people may receive antibiotics if they have a bacterial co-infection. 

 

Prevention

Vaccines are in development, but there is no current vaccine available for COVID-19. People can protect themselves and others by taking the following precautions:

  • Cover your mouth and nose with a cloth face cover when around others in public
  • Wash your hands frequently and thoroughly for at least 20 seconds with soap and water.  If soap and water are not available, use an alcohol-based hand rub (at least 60% alcohol).  Regular hand washing of bare hands is more effective than wearing rubber gloves in public.
  • Avoid touching your face
  • Practice good respiratory hygiene - cover your mouth when you cough or sneeze. Dispose of tissues immediately.
  • Practice physical distancing and maintain at least a 6 foot distance between yourself and others 
  • Stay home as much as possible.  If you feel sick, stay home except to seek medical attentionIf you have a fever, cough, difficulty breathing, or think you may have been exposed to COVID-19, call your healthcare provider right away.
  • lean and disinfect surfaces that are touched frequently with simple disinfectant to kill the virus
  • Hand dryers are NOT effective means of killing COVID-19.  UV light should also not be used as it can cause skin irritation.

Face masks

CDC does  recommend that everyone now wear a cloth face covering in public places where physical distancing may be difficult to maintain.  The use of simple cloth face coverings may help slow the spread of the virus, especially since some people may have the virus and not know it.  Cloth face coverings should be machine washed regularly depending on how often they are used.  You can find instructions for homemade cloth face coverings on the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html
 
  • Surgical face masks and N95 respirators should be reserved for healthcare personnel and medical first responders.  If you do wear a mask or face covering, be sure to practice diligent hand hygiene and be sure to know how to properly use, clean, and dispose of the mask.  Before putting on a mask, clean hands with soap and water or alcohol-based hand rub
  • Cover your mouth and nose with the mask, making sure there are no gaps between your face and the mask
  • Avoid touching the mask while using it (if you do, clean hands)
  • To remove the mask, remove it from behind, discard it immediately in a closed bin, and clean your hands
Travel

The CDC recommends that travelers avoid ALL nonessential international travel due to the global impact of COVID-19. United States citizens should arrange for immediate return to the U.S. unless they plan to remain abroad indefinitely. Depending on the area of travel, there may be certain guidance and/or restrictions. Please visit the CDC travel webpage or Travel.State.Gov for further information.

The CDC generally does not advise or restrict travel within the U.S. However, it is important to remember that coronavirus disease has been reported in all states and crowded places such as airports may pose an increased risk of infection. There are many factors to consider both before and after travel.

Current Public Health Information

When a new disease is circulating, it is natural for people to be concerned and to ask what they can do to protect themselves and their families. It is important to get information about COVID-19 from reliable public health sources.