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What began with a handful of mysterious illnesses in a vast central China city has traveled the world, jumping from animals to humans and from obscurity to international headlines. First detected on the last day of 2019, the novel coronavirus has infected tens of thousands of people — within China’s borders and beyond them — and has killed more than 15,000. It has triggered unprecedented quarantines, stock market upheaval and dangerous conspiracy theories.
Most cases are mild, but health officials say the virus’s spread through the United States appears inevitable. As the country and its health-care system prepares, much is still unknown about the virus that causes the disease now named covid-19.
The Washington Post has spoken to scores of doctors, officials and experts to answer as many of your questions as we can about the newest global health emergency. Here’s what we know so far.
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What is it?
These days, “coronavirus” is often prefaced with the word “novel,” because that’s precisely what it is: a new strain in a family of viruses we’ve all seen before — and, in some form, had. According to the WHO, coronaviruses are a large family of viruses that range from the common cold to much more serious diseases. These diseases can infect both humans and animals. The strain that began spreading in Wuhan, the capital of China’s Hubei province, is related to two other coronaviruses that have caused major outbreaks in recent years: severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
Symptoms of a coronavirus infection range in severity from respiratory problems to cases of pneumonia, kidney failure and a buildup of fluid in the lungs.
Covid-19 spreads more easily than SARS and is similar to other coronaviruses that cause cold-like symptoms, experts have said. It appears to be highly transmissible, and since cases are mild, the disease may be more widespread than current testing numbers suggest.
There have been reports of people transmitting the virus before they show symptoms, but most experts think this is probably not a major driver of new infections. What is concerning, however, is that symptoms can be mild, and the disease can clearly spread before people realize they’re sick.
How deadly is it and who is most at risk?
Public health officials say the novel coronavirus is less deadly than SARS, which killed about 10 percent of people who were infected during the outbreak that began in 2002. But epidemiologists are still trying to determine exactly how deadly covid-19 is.
About 2 percent of reported cases have been fatal, but many experts say the death rate could be lower. That’s because early in an outbreak, mild illnesses may not be reported. If only people with severe illness — who are more likely to die — seek care, the virus will appear much more deadly than it really is because of all the uncounted people with milder symptoms.
Similar to other respiratory illnesses, older people and those with illnesses such as diabetes and high blood pressure are at increased risk. Early studies have also suggested men are at greater risk.
But, as with other diseases, there can be tremendous individual variation in how people respond. There will be people with known risk factors who recover as well as people who develop severe cases for reasons we don’t understand.
There’s also no evidence that children are more prone to contracting covid-19, according to the CDC, and that was also the case with the disease′s cousins, SARS and MERS.
Where has it spread in the U.S.?
How should I prepare?
The virus may be novel, but you don’t need to buy anything new or special to brace for it. Epidemiology experts said the most important aspect of preparedness costs nothing at all — calm.
“Don’t panic,” said Timothy Brewer, a professor of epidemiology and medicine at UCLA. “There’s no value in panicking or telling people to be afraid. Don’t let fear and emotion drive the response to this virus.”
There are some basic precautions you can take, which are the same as what you should be doing every day to stave off other respiratory diseases. You’ve seen the guidance before: Wash your hands regularly. Cover your nose and mouth when you sneeze. And when you’re sick, stay home from work or school and drink lots of fluids.
The CDC recommends washing with soap and water for at least 20 seconds after using the bathroom, before eating and after blowing your nose or sneezing. It also advises not to touch your eyes, nose and mouth and to clean objects and surfaces you touch often.
Another thing you don’t need to do — unless you’re sick or you’re a health care worker — is wear a mask.
“The main point of the mask is to keep someone who is infected with the virus from spreading it to others,” Brewer said.
The CDC agrees, writing on its website: “CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases.”
Where has it spread in the world?
Coronavirus is officially a pandemic. What does that mean?
The World Health Organization has declared coronavirus a pandemic — an announcement that signals the outbreak has defied efforts to contain it.
The WHO’s announcement does not trigger any new funding, protocols or regulations. But it is an acknowledgment of reality. For weeks, the agency hesitated to make the declaration because officials worried it would create widespread panic.
But in ruling it a pandemic, WHO Director General Tedros Adhanom Ghebreyesus noted the scale of the outbreak and said he elected to use the word because some countries have not reacted quickly enough.
“We are deeply concerned both by the alarming levels of spread and severity and by the alarming levels of inaction,” Tedros said. “In the days and weeks ahead, we expect to see the number of coronavirus cases, the number of deaths and the number of affected countries to climb even higher.”
Disease experts use the term “pandemic” to describe when an epidemic has become rampant in multiple countries and continents simultaneously. (The term comes from the Greek word “pan,” meaning “all,” and “demos,” meaning “people.”)
While the word may evoke fear, it describes how widespread an outbreak may be, not its deadliness.
In the past, health experts have used “pandemic” as a signal that efforts to contain an outbreak have failed and that countries should focus their efforts more on mitigating its effects through actions such as getting hospitals ready to handle an influx of patients, stockpiling materials and enacting social-distancing policies.
This outbreak has behaved differently, however, and the WHO has stressed in recent weeks that all countries should focus on containment even as they begin ramping up efforts to mitigate. By working to contain the virus, countries can slow down the spread of the disease and buy time to work more on mitigation strategies.
“It would be a mistake to abandon the containment strategy,” Tedros said. “We have never before seen a pandemic sparked by a coronavirus. And we have never before seen a pandemic that can be controlled at the same time.”
What’s it like to have covid-19?
Symptoms are primarily respiratory. Coughing and shortness of breath are common, according to the CDC. Fever is also possible. The severity of the symptoms depends highly on the patient’s age and immune system.
For the elderly and those with underlying heart disease, diabetes or other conditions, coronavirus can cause pneumonia and lead to organ failure and death. But for most people, cases have been mild, requiring little to no medical intervention.
Carl Goldman, the owner of a California radio station, is one of those people.
“I have the coronavirus,” he wrote in an op-ed for The Post. “And it hasn’t been that bad.”
Goldman, who is in his late 60s, says a bad case of bronchitis a few years ago was much worse.
“This has been much easier: no chills, no body aches,” he wrote of coronavirus. “I breathe easily, and I don’t have a stuffy nose. My chest feels tight, and I have coughing spells. If I were at home with similar symptoms, I probably would have gone to work as usual.”
But Goldman was aboard the Diamond Princess cruise ship, where dozens of Americans were infected.
“If you told me when I left home in January that I wouldn’t be back until March — that, instead, I would be confined for more than 24 days because I’d catch a novel virus at the center of what could become a pandemic — that would have completely freaked me out,” Goldman wrote. “But now that it’s happening, I’m just taking it one day at a time.”
Should I see a doctor?
Not only can you self-manage from the comfort of your couch, but health officials want you to do so. You should stay home if your symptoms can be handled with over-the-counter cold and flu aids from your local drugstore.
If everyone with a cold floods their local emergency rooms, it will be harder for health-care workers to treat patients who are critically ill. Plus, you could pick up the virus in the hospital if you don’t already have it.
But it is a good idea to call your primary-care doctor if you have both a fever and a cough, experts said. And if you have shortness of breath, unremitting fever, weakness or lethargy, it’s definitely time to get in touch with a health-care professional, they say. Those could be signs of pneumonia, which is common in severe cases of coronavirus.
The Centers for Disease Control and Prevention also recommends that you seek medical help if you recently traveled to a coronavirus-infected area or had close contact with a known infected person and have a fever, a cough or trouble breathing.
How can I get tested?
That’s still the $64,000 question.
If you have mild symptoms, you probably don’t need to be tested and probably won’t be. If you are sick enough to be hospitalized, you’ll likely get tested. If you are in the middle group, it’s unclear. Contrary to President Trump’s assertion that anyone who wants a test can get it with doctor’s orders, most people aren’t able to get tested.
Since mid-January the CDC and other labs have tested about 11,000 specimens for the disease— which means the number of people tested is actually far lower, as labs usually test at least two specimens per person, experts say. By comparison, South Korea has been running 10,000 tests per day.
And even as more tests are being manufactured and shipped around the country, many public health labs receiving them don’t have enough staff or equipment to meet the testing need. Some medical centers are beginning to offer their own tests, and some primary care doctors are exploring how to administer the tests in their offices, but many are reluctant because it carries risks for their staff and other patients.
Other hospitals and localities are setting up testing locations away from emergency rooms, clinics and doctors’ offices to minimize the risk of health care workers and other patients being infected. And, in declaring a national emergency, Trump said the administration will work with retailers like Walmart and Target to develop drive-through testing clinics across the country.
How long will I have to social distance?
The most honest answer, according to experts, is: “It depends.” It’s not going to be over anytime soon — a matter of months rather than weeks. And a few key factors will determine just how many months.
First, it depends on when U.S. cases finally reach their peak — a time that’s impossible to predict because of how limited testing remains in America. And even after the peak, we may need drastic actions to keep the virus at bay. It also depends on how the virus behaves, and whether it’ll be affected by the change of seasons like the flu.
But, ultimately, how well America is able to flatten and bend its epidemiological curve of infections depends largely on how willing people will be to sacrifice individual conveniences and on their desire to save the lives of others.
“I don’t know if people are ready now for how long they’re probably going to have to keep up this social distancing," said Natalie Dean, a biostatistician at the University of Florida. "But as they see the hospital situation get more extreme, I think that attitude will change.”
When will it end?
This coronavirus could follow a seasonal pattern, peaking in the winter months. It could infect lots of people now and then recede in the Northern Hemisphere before returning in the fall. It could take hold in the Southern Hemisphere.
“This virus can do anything it wants,” said Allison McGeer, an infectious-disease epidemiologist at the University of Toronto. “That pattern of how it’s going to spread is completely unknown, but it is critical to what the burden is going to be to all of us. … It could be just like another coronavirus, a bunch of colds. It could be like a regular flu season. It’s possible it could be different and worse.”
More questions, answered
Terms to know
Coronavirus: This term refers to a family of seven known viruses that can infect people, ranging from the common cold to severe acute respiratory syndrome (SARS) and the even deadlier Middle East respiratory syndrome (MERS). The name comes from the virus’s shape, which under a microscope looks like a blob surrounded by crown-like spikes.
Covid-19: Sometimes used interchangeably with coronavirus and the official name SARS-CoV-2, covid-19 refers to the disease the virus causes. So SARS-CoV-2 causes covid-19, just as HIV causes AIDS.
Community transmission: This happens when a disease circulates among people in a certain area who did not travel to an affected location and have no close link to other confirmed cases. To date, almost all cases in the United States have been imported by Americans infected abroad or by a spouse or close contact with the virus. But U.S. officials have identified at least one case in California that is being called the first known instance of community transmission.
Asymptomatic transmission: Asymptomatic carriers of the virus are people who show no signs of being sick but have the virus and can spread it to others. It is unclear how common asymptomatic transmissions are with the new coronavirus.
Outbreak: A sudden increase in the number of cases of a disease in a particular place and time.
Epidemic: A large outbreak that spreads among a population or in a region.
Pandemic: An epidemic that has become rampant in multiple countries and continents simultaneously.
“Flattening the curve”: A phrase that experts use when talking about the need to use protective measures to slow the spread of new cases. It refers to the powerful visual illustration seen on a statistical chart. A flattened curve is the difference between a viral outbreak that has the profile of Mount Everest, exploding vertically, and one that slowly unfolds over time — a long, low hill.
Containment: In the early phases of an epidemic, countries often use this strategy of trying to corral and beat back the advance of a virus in hopes of limiting its spread and possibly stamping it out. They restrict movement of people, enact travel bans and quarantine. To use a military analogy, it is treating new cases like a beachhead invasion and surrounding and beating back each new beachhead.
Mitigation: Once it’s clear you’re dealing with widespread transmission that will be difficult if not impossible to contain, authorities begin focusing instead on wider preparations like getting hospitals ready to handle influx of patients, stockpiling materials and enacting social distancing policies.
Isolation: Keeping those who are sick and infected away from those who aren’t is referred to as isolation. Hospitals have taken strict measures to isolate coronavirus patients using isolation wards, ventilators that prevent air from circulating more widely and heavy protective gear for health workers.
Quarantine: Restricting the movement of people who seem healthy but may have been exposed to the virus is known as a quarantine. Americans who were evacuated from Wuhan and cruise ships, for example, have been kept in strict quarantine on military bases for 14 days, which is what experts believe is the virus’s incubation period.
Zoonotic: The new coronavirus was transmitted from animals to people, making it zoonotic. SARS came from civets, which are like cats, and MERS came from camels, but it’s not yet known what animal caused the current coronavirus outbreak. The prime suspect so far is the pangolin.