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 pediatric 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?
What can I do to protect myself?
Should I wear a face mask?
Should I wear a face shield?
What is the difference between quarantine and isolation?
What environmental measures can be taken?
Should we stop face-to-face meetings?
Where can I find guidance for my workplace?
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 also 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.
The disease can move from person to person, but it is not yet known how easily or sustainably it spreads. Scientists are studying the data as it becomes available. The initial cases reported having visited a seafood/animal market, which may have been a source of exposure. However now the main way the disease is spreading is from person to person.
Some people have had a mild illness and recovered. Others have had more severe infections. Critical and fatal cases have occurred. Preliminary evidence indicates that people with underlying medical conditions (including pregnancy), elderly people and those with compromised immune systems may be at higher risk for severe illness.
Earlier information was mixed on this issue however, as more data becomes available, most authorities agree that there is an increased risk of severe disease if you are pregnant. Research to date supports this and 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 Center for Disease Control and Prevention (CDC) say “Although the overall risk of severe illness is low, pregnant people and recently pregnant people are at an increased risk for severe illness from COVID-19 when compared to non-pregnant people.
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 pediatric 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 diarrhea 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 pediatric 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 COID-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. Pediatric 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.
The illness is still being studied. So far, we know that 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. Loss of the sense of smell and taste has also been described. 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.
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).
COVID-19 vaccines have been developed at an unprecedented rate. Over 50 vaccines are in human trials. Some vaccines have received authorisation for use in a number of countries. Several countries have commenced vaccination of priority groups, and many more are expected to commence in coming months. For more information see the Vaccine page of this website (membership required).
This is another, more scientific 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 recognized 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.
See the running News item for in-depth description of known variants of the COVID-19 virus. Although one or two seem to spread more easily, so far none of the known variants are believed to cause more severe illness. The US CDC has a webpage about variants as well.
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. Therefore it is very important for contacts of COVID-19 cases to quarantine themselves at home, and minimise contact with others for 14 days after exposure even if they do not have any symptoms.
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. It is likely that most people who have recovered from COVID-19 develop some immunity, however it is not known if protective immunity lasts for months or years. Cases of re-infection with SARS-CoV-2 are being 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. 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 at least two days. Always follow your local guidance.
In mid-June, the World Health Organization published Criteria for releasing COVID-19 patients from isolation in which they advise "it appears safe to release patients from isolation based on clinical criteria [...] that patients’ symptoms have been resolved for at least three days before release from isolation, with a minimum time in isolation of 13 days since symptom onset."
CDC published a recommendation on duration of isolation and precautions as follows:
- "For most persons with COVID-19 illness, isolation and precautions can generally be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms.
- A limited number of persons with severe illness may produce replication-competent virus beyond 10 days that may warrant extending duration of isolation and precautions for up to 20 days after symptom onset; consider consultation with infection control experts.
- For persons who never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA."
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 CDC advises "Although the virus can survive for a short period on some surfaces, it is unlikely to be spread from domestic or international mail, products or packaging. However, it may be possible that people can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads."
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 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 Center 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, and per the United Nations Food and Agricultural Organization (FAO) and the United States CDC. General food hygiene measures should be observed, especially washing hands thoroughly before preparing or eating food.
There are currently no medications that are proven to be consistently effective in the prevention or treatment of COVID-19 for non-hospitalised patients. Patients receive supportive care, aimed at relieving their symptoms and preventing complications while they recover. There are numerous clinical trials underway investigating existing and experimental medications. 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.
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 social /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 social/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.
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.
The US Centers for Disease Control and Prevention updated their advice on 4 November. “CDC recommends that people wear masks in public settings, like on public and mass transportation, at events and gatherings, and anywhere they will be around other people.” This will not be enforced in the United States, it can be done on a voluntary basis.
All authorities are asking only people who are sick, or if they can't, those in close contact with them, to use a face mask to cover their coughs and sneezes while they are seeking medical attention. Other authorities encourage groups at higher risk for severe complications e.g. older adults or those with underlying illness, to consider wearing a mask. Some authorities have advised to use masks while travelling or working in public places to reduce the chances of droplet transmission.
While surgical face masks may stop people touching their mouth, they do not stop them breathing in the virus, nor the virus entering the eyes. They will also catch some of the droplets that are coughed and sneezed out.
Fitted respirators, such as ‘P2’, 'P3' or ‘N95’ masks, require training and fitting. These are generally not being recommended for use by the public. They may be recommended to be used by those in close contact with infected people, such as healthcare workers or family members caring for sick relatives.
See the World Health Organization’s Q&As on masks
To prevent getting infected with COVID-19: Covering nose and mouth to prevent infection in the general public isn’t “proven” by scientific standards to work. The potential problems – you need to protect infection through your eyes as well, the mask won’t stop droplets that land anywhere else on your face, and if you aren’t meticulous you can transfer virus from the mask to your eyes / nose / mouth or contaminate other people. Potential upside – we do know that used properly, appropriate personal protective equipment does stop healthcare workers being infected.
BOTTOM LINE - Masks should be used along with other preventive measures like social distancing, hand and respiratory hygiene and other precautions. Most important is to avoid exposure (stay at home as much as possible),.Keep any essential face to face interactions as short as possible. Covering your eyes, nose and mouth when you are face to face with others might help prevent infection but you MUST be sure to handle those coverings as ‘contaminated’ items when you take them off – remove carefully, wash your hands, dispose or clean and disinfect in a safe manner. Same goes for your clothes. See details on International SOS webpage on “Use of masks by the general public”.
The effectiveness of wearing a face shield to reduce the spray of droplets onto other people, is not fully understood. The US Centers for Disease Control and Prevention (CDC) “CDC does not currently recommend use of face shields as a substitute for masks.” In their recent interim guidance, the World Health Organization (WHO) advise “In the context of non-medical mask shortage, face shields may be considered as an alternative noting that they are inferior to masks with respect to prevention of droplet transmission.”
Under certain circumstances, such as continued close contact with people, individuals may choose to wear a face shield as well as a mask. If face shields are used without a mask, it is important that the shield covers the sides of the face and below the chin. Disposable face shields should only be used once.
Quarantine is the separation and monitoring of people who have been exposed to an infected person (or have been to an outbreak area) to see if they become ill. This separation helps reduce the risk that the quarantined person will spread the disease. Quarantine generally requires a person to remain in a nominated place or at home for a certain period of time after exposure to a disease. The duration of quarantine will vary depending on the estimated incubation period. For COVID-19, early estimates indicate a quarantine duration of 14 days.
Isolation is the separation of people who are ill with a potentially contagious disease from those who are healthy.
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 Cleaning to prevent the spread of COVID-19
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
A traveller has recently returned from an affected location. What should they do?
If there are local procedures in place from the local health authorities, these must be followed. Many locations are requiring travellers from some or all locations to quarantine themselves for 14 days.
If there are no requirements, anyone who has been in an affected location should monitor their health for 14 days. If symptoms develop, seek medical care according to the local procedure. When travelling to medical care, consider wearing a mask, use private transport, avoid contact with others as much as possible. Ensure you provide your travel and potential exposure history to the medical facility.
If there are local restrictions on gatherings, you must comply with these. Any activity that involves gathering people in close proximity in an enclosed space risks spreading the virus in the event that someone is confirmed infected, there are potentially large numbers of contacts who must self-quarantine for 14 days. Non-essential meetings are best postponed or carried out via remote video link if possible.
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 Resources for Businesses and Employers