What are coronaviruses?
What does "novel" mean?
Who is at risk for infection?
Are pregnant women at higher risk for severe disease?
Are children getting infected? What is the paediatric inflammatory syndrome?
What are the symptoms of COVID-19?
Do people with COVID-19 lose their sense of smell or taste?
What does cough etiquette mean?
Is there a vaccine?
What are variant viruses?
Where does International SOS get its information?
How does COVID-19 spread?
Can a person with no symptoms spread the infection?
Can I get re-infected with COVID-19?
When can someone who has had COVID-19 stop isolating?
Does COVID-19 spread through the air or air-conditioning?
Can the virus be transmitted through packages shipped from an area with COVID-19?
Is protective equipment needed to handle a package shipped from an area with COVID-19?
Can COVID-19 spread through bank notes and coins?
What about pets and other animals?
Can I get infected with COVID-19 from food?
Coronaviruses are a large family of viruses, some of which can infect people. Some cause mostly mild illness, such as the strains responsible for some common colds. Others can potentially lead to severe, or even fatal, disease - such as Middle East Respiratory Syndrome Coronavirus (MERS-CoV), which continues to circulate in some parts of the world. The Severe Acute Respiratory Syndrome (SARS) outbreak was caused by a coronavirus. It caused severe and fatal disease, however, is no longer in circulation. The natural reservoir for coronaviruses is thought to be animal hosts. New strains emerge from this reservoir, infect an 'intermediate' host, and from there infect people. The viruses may then be capable of being transmitted from one person to another. Some are efficient at human-to-human transmission, while others are not.
Novel means new. In this case, the 2019-novel coronavirus was given the name SARS-CoV-2 in February 2020, reflecting that the new virus is related to the SARS coronavirus seen in 2002. The virus is a previously unidentified strain of coronavirus. It is responsible for the outbreak of pneumonia which began in Wuhan, China in December 2019. The disease caused by the virus has been called COVID-19, or Coronavirus Disease-2019.
Everyone can be infected. Most will have a mild illness, and some may not have any symptoms. People who are unvaccinated, and those with underlying medical conditions (including pregnancy), elderly people and compromised immune systems are at higher risk for severe illness.
As more data becomes available, there appears to be an increased risk of severe disease if you are pregnant. Research to date has shown:
- Pregnant women are more likely than non-pregnant women of reproductive age to require ICU admission and mechanical ventilation if they have COVID-19
- Pregnant women with COVID-19 are more likely than pregnant women without COVID-19 to deliver preterm, and to have babies needing neonatal ICU
- Pre-existing comorbidities, advanced maternal age (≥35 years), and high body mass index (≥30) are risk factors for severe COVID-19 in pregnancy
The World Health Organization (WHO) state “Pregnant women who are older, overweight, or have pre-existing medical conditions such as hypertension (high blood pressure) and diabetes are at particular risk of serious outcomes of COVID-19."
The U.S Centers for Disease Control and Prevention (CDC) say “Although the overall risks are low, people who are pregnant or recently pregnant are at an increased risk for severe illness from COVID-19 when compared to people who are not pregnant."
The Royal College of Obstetricians & Gynaecologists advise “Pregnant women who catch COVID-19 are at slightly increased risk of becoming severely unwell compared to non-pregnant women, particularly in the third trimester”. You should always consult your doctor, midwife or other healthcare professional if you have any concerns about your health or healthcare requirements.
Early in the outbreak, it seemed as if young children were not getting the disease very commonly and, if they were infected, they might have mild or no symptoms. This perception persists, in part because paediatric infections can go undetected when symptoms are mild. However, children can - and do - get infected with COVID-19, and they can spread the virus to others. Like adults, they can spread the disease even if their symptoms are mild or absent.
Although it is possible, compared to adults, children are less likely to get severely sick with COVID-19. Their symptoms may look like a typical cold: fever, runny nose, and cough. Vomiting and diarrhoea have also been reported more commonly among children than adults. Most children who experience severe symptoms have other underlying health conditions. However, there is a specific paediatric complication from COVID-19 called MIS-C (multisystem inflammatory syndrome in children and adolescents) which can occur among any infected child, even those who had no initial COVID-symptoms, and typically does not appear until a few weeks after their infection.
Signs and symptoms include persistent fever with no obvious infectious cause, lab results indicating inflammation, and signs of organ dysfunction or shock. This condition can be treated if detected early, but is dangerous when left undiagnosed. Paediatric infectious disease and rheumatology specialist care is necessary and should begin as soon as MIS-C is suspected. Multidisciplinary team care is imperative, and often undertaken in a hospital setting.
Common symptoms include fever, headache, chills (including "rigors" - chills with shaking), fatigue, cough, sore throat, muscle aches, shortness of breath and difficulty breathing. These symptoms are not limited to COVID-19. Respiratory illnesses and pneumonia caused by other organisms (including bacteria) and other viruses (such as influenza) can also cause these symptoms. Other less common symptoms of COVID-19 include nausea and diarrhoea, and loss of the sense of smell and taste. Conjunctivitis (pink eyes due to inflammation of the lining of the eyeball) and rashes have also been reported in some cases.
It is capable of causing severe illness, with kidney problems, neurological and cardiovascular complications, and multi-organ failure, which can be fatal. It is possible that people with underlying health conditions are at higher risk for severe disease.
Some people can have symptoms for months after recovery from the acute symptoms. This has been termed "Long COVID" and is still being studied. Sufferers report ongoing fatigue and having clouded thinking, described as "brain fog".
Yes, some people with COVID-19 can temporarily lose their sense of smell and taste. Some people with COVID-19 may have loss of smell or taste as their only symptoms of the disease. A number of people have persistent loss of smell and taste, and it is unclear whether this may be permanent.
The British Rhinological Society and ENT UK support the website Abscent Nosewell, which provides information and tools to help people with COVID-19-related loss of smell.
Cough etiquette, or respiratory hygiene, is a measure taken to reduce person-to-person transmission of infected droplets. Individuals should distance themselves, cover their mouth and nose with a tissue when coughing and sneezing. It is important that tissues are disposed of correctly (in nearest waste bin) after use and that hands are washed immediately with soap and water or alcohol-based hand sanitizer (containing 60-85% alcohol).
Yes, there are a number of vaccines, with many more in development. For more information see the Vaccine page of this website (membership required).
This is another name for "mutations." By nature, viruses change over time. New variants, sometimes called "strains", arise from these changes. Sometimes they emerge and disappear. Other times, they persist and spread. There have been multiple variants of SARS-CoV-2 recognised since the pandemic began in early 2020. Scientists worldwide look for these changes and study them to see if they will have any impact on how the disease spreads, whether the severity of illness is impacted, and whether treatments and vaccines will work against the changed virus.
While the first cases in Wuhan may have 'jumped' from an animal or environmental source to people, the spread now is from person to person. Infectious particles are expelled when talking, coughing and sneezing. People who are sick, as well as those who do not have any symptoms, can spread the disease. Others are infected via contact (direct or indirect) with these contaminated particles, or by inhaling them.
People who are infected can spread the disease for about two days before they have developed symptoms. People are probably most infectious at the time symptoms first start, even if these symptoms are only mild.
There are a number of studies which show that a significant proportion of people who do not have symptoms but are infected with COVID-19 can transmit the disease. Some data suggest the majority of transmission may be occurring from people who do not have any symptoms.
Yes. Cases of re-infection with SARS-CoV-2 are documented. While some of the second infections have been mild, some have been serious. For more information see COVID-19 Re-Infections
Different locations have different guidance and regulations about when someone with COVID-19 can be released from isolation. Authorities may change the duration for isolation. In some locations, for people to be released from hospital, two negative tests 48 hours apart are required. Most locations require no fever and no other symptoms (or at least an improvement of other symptoms), for 24 to 72 hours. Always follow your local guidance. See the relevant country page of this website for links to official local requirements.
CDC updated guidance in January 2022 as follows:
- People without symptoms can end isolation after 5 days after their positive test, but must wear a well-fitted mask around others for 5 more days after the 5-day isolation period. If they cannot wear a mask, they need to isolate for 10 days.,
- People who had mild symptoms need to isolate for 5 days from the onset of symptoms, and after fever ends for 24 hours (without the use of fever-reducing medication) and symptoms are improving. They must wear a well-fitted mask around others for 5 more days. If they cannot wear a mask, they need to isolate for 10 days.
- People who have moderate COVID-19 illness must isolate for 10 days.
- People who are severely ill (hospitalised) are released from isolation as directed by their medical team.
COVID-19 is spread through droplets from an infected person to someone who is in close unprotected contact. There is evidence that airborne transmission occurs. The United States Centers for Disease Control and Prevention states that transmission through inhalation can occur, and the risk is greatest within 3-6 feet of an infectious person.
In the hospital setting, patients are currently managed in special 'negative pressure' rooms if available, and healthcare workers will take 'airborne precautions' when performing certain procedures.
The Federation of European Heating, Ventilation and Air Conditioning Associations REHVA experts provide guidance on COVID-19 for building services to prevent spread of SARS-CoV-2, with Frequently Asked Questions including the use of UV sterilisation of air.
For more information, WHO has published Q&A on ventilation and air conditioning in public spaces and buildings and COVID-19.
The European Centre for Disease Prevention and Control (ECDC) provides guidance on ventilation of indoor spaces in the context of COVID-19.
This coronavirus is primarily spreading to people who are in close unprotected direct contact with an infected person. The United States Centers for Disease Control and Prevention says "The principal mode by which people are infected with SARS-CoV-2 (the virus that causes COVID-19) is through exposure to respiratory droplets carrying infectious virus. It is possible for people to be infected through contact with contaminated surfaces or objects (fomites), but the risk is generally considered to be low." "In most situations, cleaning surfaces using soap or detergent, and not disinfecting, is enough to reduce risk. Disinfection is recommended in indoor community settings where there has been a suspected or confirmed case of COVID-19 within the last 24 hours. The risk of fomite transmission can be reduced by wearing masks consistently and correctly, practicing hand hygiene, cleaning, and taking other measures to maintain healthy facilities."
The virus may survive on frozen packaged goods, which may be a potential risk to workers who handle frozen foods unless precautions are taken.
Special protective equipment is not needed to handle your personal packages. Routine precautions should be taken with any packages, as the surface may be contaminated. Clean and disinfect the package. Do not touch your face, and ensure you wash your hands after handling.
Theoretically, cash, like any other frequently handled object, could become contaminated with the virus that causes COVID-19. People could potentially transfer the virus to their eyes / nose / mouth via their hands after handling cash. However the main way the disease is spreading is through direct contact with infected people. In 2006, the European Center for Disease Prevention and Control issued a report that in part looked at the risk of bank notes as a potential vehicle for influenza transmission. It concluded that for the general public “handling banknotes and coins is not practically avoidable and will confer no discernible increased risk compared with handling almost any other communal object used in daily life; and compared with exposure to respiratory droplets (coughs and sneezes) and communal hard surfaces and fittings (hand rails, escalator hand belts, door handles, etc.) the ability of money to transmit influenza will pretty much pale into insignificance compared with what else is going on in society at the time. The overwhelmingly important issue will be compliance with frequent handwashing and 'no-touch-face' advice.” Individuals who frequently handle money might have an increased risk and are advised to avoid licking their fingers while counting, and not to touch their face during and after handling money."Again these risks would be significantly reduced across a wide range of occupations by compliance with hand hygiene regimens and 'no-touch-face' advice."
Some animals have tested positive for the virus following close contact with humans who were likely infected. So far, the data shows cats are the most commonly infected domestic animals. They can develop symptoms, and in a lab setting infected cats were able to spread the disease on to other cats. Pet cats have been found infected in Belgium, Hong Kong, China and the United States. Tigers and lions at a zoo in New York were infected by a human caregiver. Several dogs have also tested positive. The United States Centers for Disease Control and Prevention (CDC) issued guidelines for pet owners, including limiting a pet's exposure to people outside its household and reducing their contact with humans who have COVID-19. The World Organisation for Animal Heath's FAQ on pets and other animals is available here. They state, "Currently, there is no evidence to suggest that animals infected by humans are playing a role in the spread of COVID-19. Human outbreaks are driven by person-to-person contact." There is no evidence that poultry, pigs or other livestock animals can be easily infected. Note that tests used on animals are different than those used to detect human infections.
There is no evidence of COVID-19 transmission through food to date, as per the United Nations Food and Agricultural Organization (FAO).
The European Centre for Disease Prevention and Control states "The main route of transmission of coronaviruses in humans is through inhalation of respiratory fluids. There is no evidence to suggest that handling food or consuming food is associated with COVID-19. The risk of infection via this route is therefore considered very low, although it cannot be completely excluded.
Hence, basic hygienic precautions should be taken to prevent food-related infections, including washing hands after the handling of packages and before preparing and consuming food."
Yes. Most cases are mild and can be treated at home with supportive care, aimed at relieving their symptoms. There are some treatments which are used for patients with severe disease, and those who are hospitalised. There are now at least two oral medications which can be used in people who are cared for at home. Many more treatments are in various stages of research and development. For more information see the Treatment page of this website (membership required)
The antiviral medication Tamiflu (oseltamivir) is not effective against COVID-19. Tamiflu is used to treat influenza.
Some authorities have recommended alternative treatments for COVID-19. However, there is no evidence to confirm or disprove the effectiveness and safety of alternative treatments.
Certain medical facilities in China have been designated by the Department of Health as “fever clinics”. These fever clinics manage any patients who suffer from fever and respiratory symptoms. Other facilities are mandated to refer any patients with fever and respiratory symptoms to these dedicated fever clinics.
If you are sick but do not have a fever or respiratory symptoms, then you can be treated in the non-fever clinic facilities.
International SOS advises its members in China who are suffering from symptoms of illness to call the Assistance Centre for advice before seeking care at a medical facility.
Get vaccinated as soon as you are eligible. Get a booster if recommended.
Avoid potential exposure and reduce the spread of infections:
- Wash your hands frequently with soap and water. Use alcohol-based hand sanitiser when soap and water are not readily available.
- Maintain physical distance - keep 1-2 metres (3-6 feet) away from others, even if they appear well. Avoid crowded places. Maintain social distance when greeting visitors. Avoid shaking hands, kissing or hugging. Minimise gatherings with friends and family.
- Wear a face mask (or cloth covering nose and mouth) when in public areas including indoors, even when physical distance is maintained.
- Wear a mask, if you have any symptoms even if only mild and stay home. Seek medical advice following local guidelines.
- Wear a mask if you are taking care of or sharing same living space with a sick person.
- Wear a medical mask if you are at a higher risk of severe illness with COVID-19
- Cover your coughs and sneezes. Do not use your hands, instead use a tissue or your upper sleeve.
- Avoid touching shared objects (light switches, handrails, door handles etc) as much as possible. If you must touch such objects, wash your hands or use sanitiser promptly afterwards.
- Clean and disinfect frequently touched surfaces each day, more often if you think they’ve been contaminated. Use normal cleaning supplies.
- Work from home, where possible.
- Do not travel if you are sick.
Face masks can help reduce the risk of infection and also reduces the risk of infected people spreading the virus. If your location has guidelines for the public, please follow them.
In some locations, authorities are requiring or recommend everyone to wear a mask when in public places. You must comply with any official directives.
For more information see the webpage “Use of masks by the general public”.
Face shields are not substitutes for masks. Under certain circumstances, such as continued close contact with people, individuals may choose to wear a face shield as well as a mask.
Environmental measures aim at reducing transmission of infection and include the routine cleaning of frequently used surfaces and objects; minimising shared objects; and good ventilation. Frequently touched surfaces and objects should be washed with water and detergent, followed by a dilute household bleach solution. These objects /surfaces may include desks, phones, keyboards, doorknobs and toilets. Laundry should be washed according to detergent manufacturer’s instructions at the warmest specified temperature. Shared objects should be kept to a minimum including such things as drinking glasses, eating utensils, towels and linen. Good air ventilation is important in rooms where people gather regularly.
US CDC Cleaning and Disinfecting Your Facility
Safe Work Australia COVID-19 Information for Workplaces - Cleaning
European Centre for Disease Prevention and Control Heating, ventilation and air-conditioning systems in the context of COVID-19
The Federation of European Heating, Ventilation and Air Conditioning Associations REHVA guidance on COVID-19
Where can I find guidance for my workplace?
The International Chamber of Commerce has also published Coronavirus Guidelines for Business.
Many local authorities also provide guidance:
Hong Kong Centre For Health Protection Guidance includes a section for Businesses & Workplace
United States Centers for Disease Control and Prevention COVID-19 Information for Workplaces and Businesses