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What is the Coronavirus?

by Janet Jonus photo courtesy of the CDC

UPDATE 4/2/2020

Should I wear a Face Mask?

We have been told for weeks that social distancing, staying at home, and having no contact with other people is the best way to stop the spread of SARS-CoV-2. This is still true.

Face Masks are running out in hospitals. Doctors and nurses NEED THESE LIMITED SUPPLIES.

Both of these are still true. However, it is now recommended that everyone should wear a face mask when outside and near other people. In order to save scarce face masks for the professionals who need them, it is recommended we make our own face masks.

For more information on how to make a face mask:

Why has this changed?

We now know the SARS-CoV-2 virus can float around in the air in a form called “aerosol”. Most of the virus is expelled as droplets. Droplets are heavy. They fall to the ground very quickly. (Once they fall down, they contaminate the surface they fall onto. If you touch that surface, you will pick up the SARS-CoV-2 virus on your hands. If you touch your nose, eyes, or mouth the virus will enter you body. If you touch another surface while coronavirus is on your hands, you will spread it to that surface. For more information: )

Aerosol particles are tiny, much lighter than droplets. They can stay suspended in the air for hours. It was thought that normal breathing, coughing, or sneezing was not enough to expel aerosolized particles containing SARS-CoV-2. Now it is believed this IS POSSIBLE. These particles will be dispersed very quickly in the outdoors, but they can linger inside especially in buildings and rooms with poor ventilation.

Will a face mask prevent me from getting the virus?

No face mask will 100% guarantee you do not get the virus. However, it may help you. More importantly, a face mask will prevent YOU from spreading the virus if you are a “silent carrier”. The face mask will keep you from spreading droplets and aerosolized particles.

What is a “silent carrier”?

Between 25-50% of all people are infected by another person who is positive for SARS-CoV-2 but does not know it. These people do not have any symptoms or are pre-symptomatic (meaning they are not sick yet). Anyone around you may be positive for SARS-CoV-2 and you will not know it. They can spread the virus. They can infect you.

If I wear a face mask, does that mean I can go out or not worry about social distancing?

NO! Even with a face mask, you MUST continue to stay at home, stay away from all other people, wash your hands, and keep 6-12 feet away from other people.

What is the Coronavirus?

It has killed thousands of people around the world and disrupted our lives. A few months ago, most people hadn’t even heard of it. Just two weeks ago, most Americans didn’t think much about it. Now most of us are staying home and sheltering in place. Many people are asking “Why?” and “What’s the big deal?”

Family+Fun Pittsburgh’s Mom’s background is in medicine, including time in epidemiology. We are going to try to break down the basics here for you and your kids.

Disclaimer: This article does NOT contain medical advice. If you are feeling sick, or you have any medical questions about your specific condition, contact your doctor. Doctors are asking you to call. Do not show up at their offices. As of this moment, most Doctor’s offices do not have testing kits. If you think you need to be tested, call your doctor for advice.

There is a a symptom self-checker here:  https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html

What is the Coronavirus?

The “coronavirus” is actually one of a type of viruses that have a similar appearance (see above). They have a lot of spiky proteins that make them look like they have a corona around them. There are many coronaviruses.  There are four main subtypes of coronaviruses and three “new” coronaviruses. These new coronaviruses are the MERS-CoV, the SARS-CoV, and the SARS-CoV-2. The SARS-CoV-2 is the coronavirus that is sweeping the world now, the one we know as “the coronavirus”. The disease SARS-CoV-2 causes is called COVID-19 (CoViD-19). SARS-CoV-2 stands for Severe Acute Respiratory Syndrome – CoronaVirus 2. CoViD-19 stands for CoronaVirus Disease from 2019.

Four specific coronaviruses cause what we know as the “common cold” (along with several rhinovirusues).  

Coronaviruses are NOT flu viruses. The flu is caused by influenza viruses. They are completely different from coronaviruses. The flu vaccine will not do anything to a coronavirus. Flu treatments like Tamiflu will not have any effect on the coronavirus. They are like apples and oranges. Both are fruit, but they are not alike.

What is a virus?

Virus are extremely small parasites. They are not alive. They have no cellular structure. They cannot reproduce (make more of) themselves. Since they are not living, they cannot die but they can be destroyed.

Viruses are made up of a protein outer coating with either RNA or DNA inside. (DNA is the base genetic code of all cells. RNA is the messenger of DNA. Both can be used in the replication of viruses.) Basically a virus is genetic code to make more of itself with a protein protective coating. The SARS-CoV-2 is an RNA virus. It has about 30 different proteins in its coating.

Viruses are not alive. They are not living organisms.

How does a virus make more of itself?

It invades a cell and takes over the cellular processes. Once it gets inside the cell, it uses the cell’s mechanisms to make thousands of copies of itself until the cell either dies or explodes (called “lysis”). All of those newly created viruses go out and take over their own cells, and so on, and so on. In theory, a virus will continue to infect new cells until there aren’t any more cells to infect. Luckily, our body has defenses to fight back against viruses.

So viruses are invaders?

Yes. Individual viruses invade cells, take them over, and make more copies of themselves destroying the cell in the process. Cells won’t normally let most things in, but some viruses have the protein “key” to get into a cell. Most viruses can only target a limited range of cells. Many viruses can only infect a specific species, but some can jump from species to species. The SARS-CoV-2 virus is one of those crossover viruses. It jumped from another animal to humans.

How does the body fight back against viruses?

The body has many barriers against infection. These include skin, mucous, acids, enzymes, cilia, and chemicals. Cells have a membrane to protect themselves from infection. The virus tricks the cell into accepting it by having a protein “key”.

Once the cells become infected, the body’s defenses jump into action.

The blood carries several types of white blood cells to the place of the infection. The increase in white blood cells happens within hours of infection. White blood cells engulf and destroy viruses. The white blood cells can get overwhelmed by infection thereby limiting their ability to destroy all of the viruses.

The Immune Response is the main mechanism for destroying viruses. The immune response has two big fighters – Killer T Cells and Antibodies.

Killer T Cells are specialized white blood cells. They kill off infected cells by attaching to the cell, piercing the cell’s membrane, and injecting enzymes into the cell.

Antibodies are created to fight off specific invaders. They can attach themselves to the virus making it impossible for the virus to invade a cell. The viruses are then destroyed by specialized white blood cells. Antibodies are targeted to specific viruses. They have protein elements that bind with the protein coating on the virus.

Many times, the body “remembers” the virus and can respond faster on subsequent infections, decreasing the symptoms felt by the person. Some viruses are similar enough to other viruses that the antibodies used to fight one can be used to fight another.

Other infection responses of the body are fever and inflammation.

The body’s defense against viruses is complicated. There are many variations of white blood cells, antibodies, and helper cells. They all work together to take down a virus, but the response itself can cause damage to the body’s cells, tissues, and organs.

What is immunity?

Immunity means your body has the ability to fight off an infection.  Adaptive Immunity is an acquired form of immunity. You can acquire immunity by several methods. If you get sick, your body’s immune response develops the resources necessary to fight off the virus. A vaccine causes your body to make an immune response to the infectious agent. Your body builds up the cells and the antibodies to fight that specific infection. When the virus comes back and attacks you, your immune response is somewhat ready to go. Ideally it can fight off the infection before it takes hold and causes any damage to the body or body tissues.

We do not know if people who have been infected with SARS-CoV-2 will have acquired immunity. We do not know if they can be infected a second time. Current thinking is there will be some acquired immunity for a short period of time (measured in months, not years), but nobody really knows. Everyone is hoping there is some acquired immunity so we can slow the spread of the coronavirus. If a vaccine is developed, it will probably  be a yearly injection, like the flu vaccine. As more information becomes available, I will update this article.

Why is the coronavirus so bad?

There are several reasons why this particular virus is so bad.

First, it is a new virus. We do not know a lot about this particular variation of the coronavirus, but we do know a lot about other coronaviruses. We use this information to help us understand SARS-CoV-2, but we have not had enough time to study it.

Note: A Case Study from Australia was released on March 16, 2020 detailing the immune response of a single patient. You can read it here: https://www.nature.com/articles/s41591-020-0819-2

Another study about the half-life and length of contamination is available here: https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v2

There is an article about the infectious shedding of virus by asymptomatic and pre-symptomatic individuals: https://www.statnews.com/2020/03/09/people-shed-high-levels-of-coronavirus-study-finds-but-most-are-likely-not-infectious-after-recovery-begins/

Second, this is a new virus. Nobody has any immunity to it. With the flu, many people have some level of immunity. Many people get the annual flu vaccine. This provides a level of immunity to the seasonal flu. Many people have already had the flu viruses in circulation. This provides a level of immunity too. You can still get re-infected, you may still get sick, but your body will “remember” how to fight the strain of flu. This happened in the H1N1 pandemic of 2009. Many older people had some immunity to H1N1 as it was similar to a flu that had circulated when they were younger. The SARS-CoV-2 virus has never circulated before. Any person can get it.

Third, there is no herd immunity. As described above, once a person gets a specific viral infection the body “remembers” it. The same person can get infected again by the same virus, but the immune response is usually faster, limiting the amount of infection. If the response is fast enough, the person does not have enough virus in their bodies to spread it to other people. If enough people have immunity, the virus stops spreading because it cannot infect enough people to keep spreading. We do not know if there will be an acquired immunity to SARS-CoV-2, so we do not know if we will develop a herd immunity.

Fourth, people with SARS-CoV-2 shed a lot of virus, enough to infect other people, when they have no symptoms or very mild symptoms. People who are highly infectious are walking around shedding virus, infecting other people before they even know they are infected.

There is also a strong possibility something specifically about SARS-CoV-2 that makes it very infectious, but we do not know enough about it right now to say this definitively.

Since there is no herd immunity or individual immunity, this makes SARS-CoV-2 very dangerous as it spreads rapidly and we have no way to stop it.

If viruses aren’t alive, how do they survive outside of the body?

The protein coating on the virus makes a shell that lets it survive outside of a host for some period of time. Some viruses are very weak outside of the host. Others can last for days.

There is a new study (read it here: https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v2

AN IMPORTANT NOTE: While the following numbers look bad, keep in mind cleaning these surfaces and your hands will break down the virus, making it no longer infectious.

The study shows SARS-CoV-2 survives on cardboard up to 24 hours after exposure but half of the virus is gone within 3.46 hours.

The virus stays on plastic and metal for up to 72 hours (3 days). Half of the virus is gone from plastic in 6.8 hours and from metal in 5.6 hours.

Copper had the shortest times of tested surfaces with a survival of virus at 4 hours but half of the virus gone after 48 minutes.

The study indicates SARS-CoV-2 stays in the air in an aerosolized form for three hours. However, the virus’ half-life, or rate of decay, is around an hour and six minutes. This means that while there was still virus detectable in the air at 3 hours, half of the virus was gone after an hour and ¾  of the virus was gone after two hours.

UPDATED 4/2/2020: There is new evidence suggesting the SARS-CoV-2 CAN BE AEROSOLIZED through breathing, sneezing, and coughing. This is NOT definitive, however this would explain how SARS-CoV-2 is spread so easily. IF aerosolized particles are present, you could breath them in. Since we do not know for sure, it is now recommended ALL PEOPLE WEAR FACE MASKS when outside, near other people.

Soft items like clothing are not good carriers for viruses, but they should be taken off and washed before you walk around your home. Shoes should be left outside or cleaned and disinfected. Take a shower when you get home before you do anything else. At the very least, wash your hands.

OK, now I am scared. Does this mean my amazon order is covered in the coronavirus?

It is not likely. While the virus can survive on cardboard for up to 24 hours, as the box moves through the system it is exposed to heat and cold, both of which can deactivate the virus. It is also going to take more than 24 hours to get to you. If the stuff inside has virus on it, it too may have been weakened by heat and cold. If your UPS driver coughs all over your box as he brings it to your door and he is SARS-CoV-2 positive, then yes there is virus on your box.

The best advice is to disinfect everything that comes into your house- orders, mail, groceries, etc. I just stood out at my mailbox and disinfected the mail before I brought it into the house. Nothing comes into the house until it is disinfected. (We have immunocompromised family members.) Nobody outside of the immediate family comes into the house at all. We have been doing this for over a month.

How do you kill a virus outside of the body?

The first step to removing the coronavirus is cleaning the surface with soap and water. Cleaning reduces the numbers of viruses on the surface. Once clean, the SARS-CoV-2 virus can be neutralized (everyone says killed but viruses aren’t alive, so they cannot be killed but you can think of this as “killing” the virus) by wiping down the surface with one of several disinfectants.  The surface must stay wet for at least ten minutes and then be allowed to air dry.

Bleach – This is our go-to as it is cheap and simple. Mix 1/3 cup bleach with I gallon of water or 4 teaspoons bleach with a quart of water.

Alcohol – 70% alcohol products will neutralize the virus

Commercial products – The EPA has published a list https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2

Note: You MUST wash any food items before you eat them in case some of the disinfectant gets on the food.

Will I die if I get the coronavirus?

COVID-19 has higher rates of death than other infections, at least from the information we have at this point.  Many people have mild to moderate symptoms. The number is estimated to be about 80%. These people either have no symptoms, mild symptoms, or moderate symptoms. UPDATE 4/2/2020: Even people with mild symptoms can have lasting effects from COVID-19. People with moderate symptoms have been shown to have moderate pneumonia. Some of these people have had long-term damage to their lungs. We do not know how many people are in this group. Since there has not been widespread testing of the general population or of many people with mild symptoms, we really do not know.

The other 20% have moderate to severe symptoms. These people usually do not get better without medical care. Many of these people end up on ventilators in the ICU. As of this writing, the WHO statistics say the mortality rate is 3.4% for anyone infected.

IMPORTANT NOTE: Up until March 18th, it was thought those at greatest risk for severe complications were the elderly and those with pre-existing conditions. New information out of France and Italy and the US  is showing younger people are getting severely sick with COVID-19. Here in the US, 20-45% of all COVID-19 patients in the hospital are in the 20-44 year old age group. The only group with larger numbers in the hospital is the 65-84 year old age group. Right now, we can say that COVID-19 can infect anyone, of any age and anyone of any age can get seriously sick, and die, from COVID-19.

If so many people don’t get really sick from the coronavirus, why is everyone so worried?

The SARS-CoV-2 virus is highly contagious. Anyone can get it. We have no immunity to it. It spreads even before a person knows they are infected. It also has the potential to kill a larger number of people who get infected with it compared to other viruses.

One of the most common comparisons is with the seasonal flu. Every year, about 9 to 45 million Americans get the flu. (There are about 327 million Americans.) So 2.75% to 13.75% of Americans get the flu every year. We have a flu vaccine. Many people have some acquired immunity to the flu. There are immunological barriers to the spread of the flu (the shot and acquired immunity). Yet many Americans get the flu.

Nobody has immunity to SARS-CoV-2. Estimates are 60%-80% of all Americans will be infected with SARS-CoV-2. That is 196 million to 261 million Americans who will catch the coronavirus. Obviously, this is drastically more than the flu numbers. Anyone who compares SARS-CoV-2 to the flu is selling a false equivalency. The percentages are so much higher.

Just to carry on with the statistics, if 196 million Americans get infected, 39 million of those people with have moderate to severe cases requiring medical care and hospitalization.  Of those 196 million people, if the actual mortality rates are just 1%, 3.9 million will die.  If the mortality rates are 2%, the deaths will be 7.8 million people.

Why is the world shutting down?

The world is shutting down because we are trying to minimize the spread of the SARS-CoV-2 virus. To put it bluntly, we do not have 39 million hospital beds or ventilators. We do not have the medical capacity to take care of that many people. We do not have enough hospital beds (about 924,000) or ICU beds (about 60,000) in the US. Many of those beds are already in use by people who have had heart attacks, or strokes, or cancer, or injuries. We do not have the equipment. We do not have enough doctors and especially nurses to take care of a surge of people.

Italy has been hit very hard by COVID-19. They have been triaging patients. This means they have to decide which patients to treat and which patients they cannot treat. These are not always the sickest patients.

Here in the US, our hospitals are running out of supplies to treat patients. Doctors and nurses are getting sick, leaving fewer and fewer professionals to care for patients.

By shutting things down and keeping people away from each other, we are hoping to slow down the rate of infection so we have enough medical supplies and beds.

Why can’t I go to work or school?

We are practicing social distancing. By “sheltering in place” and staying home, we are trying to slow down the spread of the virus.

If an infected person does not have any contact with other humans, the virus they are carrying will not have anyone new to infect. In theory, if every SARS-CoV-2 positive person never had any contact with any other person, the infection would stop with them. Since SARS-CoV-2 positive people are able to infect other people before they have symptoms, it is nearly impossible to tell who is spreading the virus.

We are “sheltering in place” and “social distancing” to keep everyone from having contact with each other. This means you cannot take your kids to the playground or on playdates. Yes, I know they are bored, but for this to work, we all must keep away from all other people.

What does it mean to “shelter in place”?

States have ordered shelter in place for their citizens. This usually means to stay in your own home, with no person-to-person contact with anyone else. Some states have closed all non-essential businesses including restaurants, bars, museums, libraries, casinos, theaters, playgrounds and parks, and any place humans gather. Restaurants are only allowed to have To-Go and Delivery.

Grocery stores, pharmacies, medical providers, car mechanics and garages, banks, delivery services, gas stations, household repair services (plumbers, electricians, etc.), are the types of places that can stay open. Every state is different and the lists change. Check with your state’s list. (Pennsylvania residents can check the list here: https://www.scribd.com/document/452553026/UPDATED-Industry-Operation-Guidance-March-20-2020 )

Most states allow people to leave their homes to go grocery shopping and to take walks (or walk the dog) as long as you continue to practice social distancing.

What is social distancing?

Social distancing means do not get physically close to other people. The recommended space between people is six feet in all directions.

There is a reason six feet is the recommended distance. When a person coughs, the droplets from their nose and mouth travel around 3 feet. When a person sneezes the droplets travel about six feet. UPDATE 4/2/2020: New studies have shown the virus can be spread through aerosolized particles. These can spread much farther than six feet.

Social distancing is not being taken seriously by many people, but it is a key first step to stopping the spread. Remember, each of us is responsible for making sure we do not let the virus enter our bodies. Stay away to stop the spread.

What else can I do to stop the spread?

Stay at home. Try to no go out unless it is necessary.

If you get sick, stay at home and contact your doctor. If you get sick or if you have COVID-19, quarantine yourself and every individual you live. Do not go out at all.

If you are around other people practice social distancing.

Clean everything you come in contact with. Clean your home with soap and water and a disinfectant. Clean everything you bring into your home. Clean everything you touch outside of your home. Clean all surfaces. Clean everything.

Wash your hands after you touch any potentially unclean surface. Wash your hands after you come in contact with people. Wash your hands before eating or preparing food. Wash your hands after using the bathroom or changing diapers. Wash your hands after handling garbage. Wash your hands after blowing your nose, coughing, or sneezing. Wash your hands frequently. Do not touch your face.

Cover your cough or sneeze securely with a tissue and then throw it out. Wash your hands immediately.

To properly wash your hands, use soap and warm water. Lather up your hands, cleaning all sides, and then rinse completely. Wash for at least 20 seconds. Dry your hands with a clean, disposable paper towel.

Take care of your health. If you have underlying health issues, get them under control. Stay healthy. Eat well and get rest and exercise. (Yes, gyms are closed so work out at home or take a walk if you are allowed to do so.)

How do I get a coronavirus test?

First, you must talk to a doctor. There are still a very limited number of tests available. (As I write this, a full month after the first US case, we still have only tested about 130,000 people.) If the doctor feels you should get a test, they will try to find a place for you to get tested. Once again, these places have a limited ability to test people.

If you can actually qualify for a test, a nasal swab will be taken. (A large q-tip-like swab will be inserted into your nose to collect mucus. Yes, it is not very pleasant.) Tests can take 3-4 days to get results. While you are waiting, you will be asked to quarantine yourself in your home, away from all other members of your family.

Why is testing so important?

We do not know how widespread the virus is.  We do not know who has it. We do not know where it is. We do not have a good idea of how many people are infected or how sick they get. We do not even know if people who have symptoms have COVID-19 or another illness.

We need to test a lot of people, not just those who are very sick. We need to test the mildly sick. We need to test people who have come in contact with anyone who has tested positive for SARS-CoV-2. We need to take sample tests of the general public. If we were able to do this, we would have a better idea of the spread of the virus. We would understand better how it spreads, how contagious it is, who it affects the most.

With this information, we would be able to target areas for shelter in place or lockdowns. We would be able to target communities where the virus was widespread for increased assets for medical care. We would be able to target who had to be in quarantine. Without this information, we have to shutdown wide areas, whole states, of our society. If we had any idea of where the virus was, we would not have to tell everyone to shelter in place.

The problem is, we do not have enough tests. Some areas are running out of swabs and the chemicals needed to run the tests. These areas are cutting back on testing due to the shortages when what we really need to do is test more.

Right now, tests are looking for pieces of theSARS-CoV-2 RNA – or the virus itself. A pre-published, non-peer reviewed study reports researchers have developed a test for antibodies in a person who has been exposed to the virus. This would change testing as we would be able to tell who has been infected, even if they did not have symptoms, and we would be able to determine if they have acquired immunity. The downside is this is a blood test, and it has not been proven to work.

Why isn’t there a vaccine for the coronavirus?

SARS-CoV-2 is a new virus. We still don’t know a lot about it. Labs around the world are studying the virus. We recently found out there are around 30 proteins in the viral coating. (Viruses have between 4 and 200 proteins.) We know the virus carries RNA. Every day, labs are learning more about the virus, but it all takes time.

Vaccines take time to develop. The vaccine must be tested. The vaccine must be tested to make sure it is safe. The vaccine must be tested to make sure it is actually effective, that it does provide immunity to the virus. It takes time.

When will a vaccine be ready?

The best estimates are a vaccine can be ready in 12 to 18 months, so March through September of 2021.

What do I do if I feel sick?

The symptoms of COVID-19 are:

  • Fever
  • Body Aches
  • Cough
  • Shortness of Breath
  • Gastrointestinal illness like nausea, vomiting, or diarrhea
  • Loss of taste or smell
  • Hallucinations or confusion

If you have these symptoms, call your doctor. DO NOT LEAVE YOUR HOUSE. Isolate yourself from other members of your household.  Prepare for a quarantine that will last at least 14 days.

Symptoms that require immediate medical care include:

  • Difficulty breathing or shortness of breath
  • Chest Pain
  • Blue Lips
  • Dizziness or confusion

If you have these symptoms, call 911. Make sure you tell them you may have COVID-19.

If you are told to stay home and self- quarantine, then you must do this. Stay in one room away from other members of your household. Clean anything you touch with soap and water and disinfectant. Avoid contact with pets and animals. They cannot get COVID-19, but they can get SARS-CoV-2 on their fur and transmit it to others who pet them. Cover your coughs and sneezes and immediately wash your hands. Do not share household items like plates, cups, soap, toothpaste, towels, or bedding with anyone else in your household. Monitor your symptoms.

To get out of quarantine you must be cleared by your doctor. Once you have not had a fever for 24 hours without taking any medicine to reduce your fever and no other symptoms, you can be tested. You must have two negative tests, 24 hours apart, without symptoms. If you cannot get tested, you will have to be fever-free, without medicine, for 72 hours and other symptoms must have improved plus it must be a minimum of seven days since your symptoms started.

For complete details, read the CDC site here: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html

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