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COVID-19, the illness caused by the new coronavirus, has dramatically altered life as we know it in the United States. Schools have closed, unemployment has skyrocketed, people grappled with isolation, as well as uncertainty about when it will be safe to resume daily life.
What started as a small outbreak in Wuhan, China, late last year has now spanned the globe. And still, medical and public health officials in scores of countries are racing to find answers and treatments.
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Republish our Essential coronavirus FAQ to help everyone understand what we know from scientists, doctors and public health officials.
This is a guide to what we know about coronavirus, from scientists, doctors and public health experts — a resource that changes alongside our understanding.
Jump to a question
- Who can get novel coronavirus, or COVID-19?
- What happens if you get the virus?
- Who is most at risk?
- What are the most common symptoms?
- How does the coronavirus affect children?
- Should I get or make a face mask?
- What’s the difference between cloth face coverings, surgical masks and N95 respirators?
- How effective are cloth masks at blocking virus particles? Which fabric is best?
- What can be used as a filter in my cloth mask?
- How should I clean and disinfect masks?
- Can I reuse surgical masks or N95 respirators?
- Can I use a face shield to protect against the virus?
- Can UV light kill the virus?
- What should you do if you or someone at home has symptoms?
- Are there any medications or vaccines for COVID-19?
- Do not drink, inject or otherwise ingest disinfectant of any kind.
- When will a COVID-19 vaccine be ready?
- How does novel coronavirus spread?
- Do children spread the virus more or less than adults?
- Can the virus be spread by people who do not have symptoms?
- How many people are asymptomatic?
- What is community spread?
- Can COVID-19 be controlled by herd immunity?
- Can mosquitoes or ticks transmit the virus?
- How often do I need to wash my hands?
- What should I look for when buying hand sanitizer? And why do some smell bad?
- How does it compare to the flu?
- What types of tests are available?
- Who can get tested? How do you get tested?
- What is pool testing?
- What is “social distancing”?
- How can I limit my risk outside my home?
- Can I get the virus outdoors? Do I need to wear a mask?
- What should you do if you think you might be infected, but are uninsured?
- If I’ve already had COVID-19, am I immune? Can I get reinfected?
- How long does it take to recover from COVID-19?
- How long are you contagious with the coronavirus?
- When can I be around other people if I’ve had or think I had COVID-19?
- Where did COVID-19 start and where did it come from?
- Can household pets get COVID-19 or spread the virus?
- Can you catch the virus from touching surfaces?
- How long does the virus last on surfaces?
- Can you get sick from food, restaurant takeout or packaging?
- What is the best way to clean and disinfect surfaces?
- How long does the virus survive on clothing? Should I change my clothes after I’ve been near other people?
- What is contact tracing, and how could it help manage COVID-19? 29
- How do contract tracing apps work?
- When will things reopen or return to normal in the U.S.?
- What are quarantine “pods” or social “bubbles”? Are they safe?
- Will there be a second wave of infection? Are we already experiencing it?
- Is it safe to return to work?
- How are schools planning to reopen? What precautions are they taking?
- Is it safe to travel?
- What risks are associated with flying during the pandemic?
- Is it safe to swim in pools, hot tubs or natural bodies of water? What about water parks or splash pads?
- When should I go to the emergency room during the pandemic?
- When should I go to the doctor during the pandemic?
- Should I take my child to the doctor for a check up or routine vaccinations?
- Is it safe to go to the dentist? When should I go?
- What should you do if you feel scared, anxious or depressed?
- How can I help others?
Who can get novel coronavirus, or COVID-19?
People all over the world and of all ages can get COVID-19 or spread the virus. NBA players, members of Congress and Hollywood celebrities are among the millions of people who have been infected. Fewer infants, children and young adults have died or gotten seriously ill so far, but they are not immune.
Minority racial and ethnic groups have been disproportionately impacted by the coronavirus, according to the CDC and the COVID Tracking Project at The Atlantic, which collects data from every U.S. state and territory. As of mid-June:
- African Americans make up 13 percent of the U.S. population, but account for 19 percent of COVID-19 deaths where race is known.
- Black people and Native Americans are hospitalized five times more than white people. Hispanics and Latinos are hospitalized four times more than white people.
- Hispanics and Latinos make up 18 percent of the population nationally, but test positive for the disease at higher rates than would be expected for their share of the population in nearly every state where data is available.
- Smaller minority groups are also experiencing similar disparities at the state level. In Arizona, Native Americans make up 4 percent of the population, but account for 17 percent of cases and 20 percent of deaths. Asian Americans make up 8 percent of Nevada’s population, but account for 9 percent of cases and 15 percent of deaths.
What happens if you get the virus?
The majority of people recover, according to data from China and other countries. Most people report mild or moderate symptoms. But “mild” is relative — some patients with so-called mild cases have still reported feeling very sick. In the U.S., 19 percent of cases are hospitalized, and 6 percent are admitted to intensive care units, based on a CDC study from March. The death rate for COVID-19 has varied widely country to country, with the U.S. having fewer deaths per 100,000 people than the United Kingdom, Italy, Sweden and France but higher than China, Germany, Canada and Mexico, according to figures tracked by Johns Hopkins University.
Patients with mild to moderate illness may be able to manage their symptoms at home, under the direction of medical professionals, if they have not developed pneumonia or a lack of oxygen in body tissues (hypoxia).
Patients with moderate illness experience lower respiratory disease, such as mild pneumonia. Some may require hospitalization.
Severe and critical cases, which occur at a lower rate, require hospitalization. Patients receive oxygen therapy and may be put on antibiotics if bacterial infection or sepsis is suspected. Patients may undergo pulmonary imaging, such as chest x-ray, ultrasound and CT scans, and echocardiogram (ECG), as well as extensive blood work to monitor organ function.
As COVID-19 is primarily a lung disease, patients with severe or critical illness may also develop associated illnesses such as acute respiratory syndrome (ARDS), septic shock, cardiac dysfunction, cytokine storms, and/or issues related to underlying conditions, according to the National Institutes of Health. These patients may also experience heart, liver, kidney and central nervous system disease.
Critical cases of COVID-19 are life threatening and require placement in intensive care units. Some patients may be put on a ventilator to help them breathe.
Who is most at risk?
Limited data suggests that people at the greatest risk of getting really sick or dying from COVID-19 are older or have pre-existing health conditions, according to the Centers for Disease Control and Prevention.
People of all ages with the following underlying medical conditions are at increased risk of getting severely ill from COVID-19:
- Chronic kidney disease
- Chronic obstructive pulmonary disease (COPD)
- Organ transplant recipients (who have weakened immune systems)
- Serious heart conditions
- Sickle cell disease
- Type 2 diabetes
People with the following conditions might be at increased risk of severe illness from COVID-19:
- Cerebrovascular disease
- Chronic lung diseases, including cystic fibrosis and pulmonary fibrosis
- Hypertension or high blood pressure
- Moderate to severe asthma
- Neurological conditions, including dementia
- Liver disease
- Thalassemia (a blood disorder)
- Type 1 diabetes
- Weakened immune system from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids or other immune weakening medicines
Pregnant women who have the coronavirus are more likely to be hospitalized, admitted to an intensive care unit and put on a ventilator than women who are not pregnant, the CDC says. Their risk of death, however, is not increased. Hispanic and Black pregnant women appear to be disproportionately affected by the virus during pregnancy.
In the U.S., four out of five deaths from the disease have been among people 65 and older. Hospitalization rates also increase with age.
Health care workers — not just hospital doctors and nurses, but everyone who works at a medical facility or provides care and services to the sick and ailing — are at a higher risk of exposure to the coronavirus. As of June, there have been almost 70,000 cases reported among health care professionals. The real number of cases is likely much higher, as only 21 percent of reported results included information that could identify the patient as a health care worker.
What are the most common symptoms?
- Fever or chills
- Dry, persistent cough
- Shortness of breath or difficulty breathing
A smaller number of patients have reported:
- Muscle or body aches
- Sore throat
- Nasal congestion
- Conjunctivitis (also known as pink eye)
- Nausea or vomiting
- Loss of taste or smell
- Rash on skin or discoloration of fingers or toes
From the time you are exposed, symptoms could appear within two to 14 days (but most commonly it’s about four to six days, according to the CDC and WHO). Some people get the virus but appear to have no symptoms, putting them at greater risk for passing it to others. Or symptoms can be easily confused with the seasonal flu, which has also complicated efforts to identify and contain COVID-19.
How does the coronavirus affect children?
People ages 17 and under make up around 5 percent of cases in the U.S. and they generally experience mild symptoms of the disease, according to the CDC. These patients have reported cold-like symptoms (fever, runny nose and cough), plus vomiting and diarrhea. Most patients recover.
Some children who have had COVID-19 or been in close contact with someone who has been infected have developed a very rare inflammatory condition, often weeks later. Doctors believe it’s related to the body’s immune response to SARS-CoV-2, the virus that causes COVID-19. Symptoms of Multisystem Inflammatory Syndrome in Children (MIS-C) include persistent fevers, fatigue, abdominal pain, neck pain, vomiting, diarrhea and rashes. Inflammation occurs across multiple organ systems, including the heart. Most children with the condition require hospitalization. Very few deaths have been reported in hospitalized patients.
Should I get or make a face mask?
Yes. The CDC recommends wearing cloth face coverings in public places, such as grocery stores, where it is difficult to socially distance from others. Some cities, counties and states have mandated that residents wear masks in public.
Wearing masks in public can help limit the spread of the virus. Cloth face coverings are designed to prevent exhaled breath from travelling too far from the person wearing the mask, therefore protecting those around them. This is important because people can have COVID-19 and not have any symptoms. Masks can be made from fabric you already have at home, and some patterns don’t require sewing. After use, masks should be cleaned in a washing machine.
Children under 2 or anyone who is unconscious or unable to remove a mask on their own should not wear face coverings, according to the CDC. Surgical masks and N95 respirators should be reserved for health care professionals or first responders.
What’s the difference between cloth face coverings, surgical masks and N95 respirators?
The main difference between types of face masks is who they were designed to protect. All masks should fit close to the face securely, cover the nose, mouth and chin completely, and allow for unrestricted breathing.
Cloth face coverings, including homemade masks, bandanas and scarves, are used to prevent exhaled breath from reaching other people. The CDC recommends that cloth masks be made of multiple layers of fabric.
Surgical masks are fluid-resistant and designed to protect the person wearing the mask from large-particle droplets and splashes, according to the FDA. They do not completely protect the wearer from contaminants due to their loose fit, but do block the majority of respiratory droplets expelled by the wearer. Surgical masks are disposable and should only be used once.
N95 respirators filter out at least 95 percent of airborne particles, including large and small particles, to protect the person wearing the device. They are designed to fit tightly over the nose and mouth. Due to limited supply, they should be reserved for health care workers and first responders. The CDC has issued guidelines for the extended use and reuse of N95 respirators in medical settings.
Some masks and N95 respirators include a one-way valve or vent that makes it easier to breathe through. These masks continue to block particles from entering the mask – protecting the wearer – but release unfiltered air when the person exhales. They should not be worn in public for this reason.
How effective are cloth masks at blocking virus particles? Which fabric is best?
Cloth face coverings are not as effective at blocking particles compared to surgical masks and N95 respirators, but they can reduce the spread of COVID-19, especially if used widely. (The more people wearing masks in public, the less likely the virus will spread.)
The amount of protection provided by a cloth mask varies based on how well it fits and the material it is made from. Masks should cover the nose, mouth and chin completely and fit close to the face, without gaps. Some masks include a flexible nose bridge, usually made of wire or aluminum strips, so that it fits snugly around the nose. Filter pockets are a common feature, too.
How tightly woven a fabric is, as well as the material itself, is a consideration when selecting or making a cloth mask. To check the weave, hold the fabric up to light. The less light that passes through, the better. Any material is better than none, though, and using multiple layers of fabric will improve its effectiveness. Some fabrics and fabric combinations filter better than others. The most effective fabric at blocking virus particles is thickly woven 100-percent cotton, such as quilting cotton or flannel.
What can be used as a filter in my cloth mask?
Cloth masks should be made of at least three layers, according to the World Health Organization, with a filter sandwiched between the outer- and inner-most layers. Filters can impact the breathability of a mask, so choose one you’re comfortable wearing.
WHO has compiled data from peer-reviewed studies on non-medical mask filtration. Cotton itself can be used but provides lower filtration than other materials. Polyester works well as a filter. Polypropylene – a nonwoven thermoplastic that is available as a fabric – offers the most filtration and you can find it as polypro, as it’s commonly called at fabric stores or other retailers. Tissue paper and paper towel can also be used as an effective filter when folded a few times. Cotton gauze, handkerchiefs and nylon do not provide enough protection, WHO says.
The inventor of the N95 respirator, Peter Tsai, recommends nonwoven shop towels – available at most home improvement stores – as a filter that can be hand washed and reused.
Air filters and vacuum bags can also be used, but they aren’t perfect. Some filters, like those used in air conditioners and air purifiers, can shed small fibers, so it’s best to place them between cotton layers. Vacuum bags can be hard to breathe through, according to Stanford Medicine’s Anesthesia Informatics and Media Lab.
How should I clean and disinfect masks?
Cloth masks should be washed after each use, either by hand or in a washing machine with other laundry. If your mask has a nonwoven filter, remove it before washing. When washing by hand, the CDC recommends soaking the mask in a bleach solution for five minutes. Use five tablespoons of household bleach intended for disinfection per one gallon of room temperature water, or four teaspoons bleach per quart of water. When machine washing, use regular detergent and the warmest water setting that’s appropriate for the type of fabric. You can place the mask in a mesh bag when using a washing machine or dryer to keep them from tangling with other clothes. Dry masks either in a dryer at the highest setting or let air dry completely.
Surgical masks and N95 respirators should not be washed or sprayed with disinfectant. Doing so can damage them and make them less effective.
Can I reuse surgical masks or N95 respirators?
Surgical masks and N95 respirators are intended for one-time use in medical settings. They should be thrown out if they become damaged, are soiled or no longer fit properly.
Because of the limited supply of medical masks, they should be reserved for health care workers and first responders. But, if you already have a medical mask and choose to reuse it, use precaution. Use the ear loops or straps to place or remove the mask, and do not touch the mask’s surface. Store it in a bag or container of its own to keep it from touching other items. Wash your hands before and after handling the mask. You can also wear a cloth mask on top of a medical mask.
Some health care workers have been instructed to reuse and decontaminate masks by placing them in breathable paper bags for a few days until the virus is undetectable, under guidance from the CDC. This strategy is not recommended for the public.
Can I use a face shield to protect against the virus?
You can, but it’s probably not necessary unless you are a health care or dental worker. Face shields are not recommended for everyday activities, the CDC says, as it is unknown whether it keeps your respiratory particles from reaching others. If you choose to wear one, you should also wear a face mask.
Face shields offer protection against the spray of substances, including some respiratory droplets. They also protect the wearer’s eyes. Medical professionals wear them when performing procedures that could propel liquids into the air, or when working close to a patient’s mouth.
Can UV light kill the virus?
Ultraviolet light can likely kill the novel coronavirus, researchers at the National Academies of Sciences, Engineering and Medicine say, but more research is needed.
We regularly encounter UVA and UVB rays in sunlight. They’re what causes sunburns and skin cancer. UVC light from the sun, though, doesn’t reach the Earth’s surface because it has the shortest wavelengths. It’s the most damaging type of UV radiation and can be used to deactivate some viruses and bacteria, including other coronaviruses.
Germicidal UV, produced by UVC light, is already being used to disinfect surfaces in some public transit systems and hospitals, Kaiser Health News reported. It’s also being used to decontaminate N95 respirators, extending their use during shortages.
UV light should not be used to disinfect hands or skin, WHO warns, because the radiation can damage your skin and eyes.
That’s why some facilities install UV lamps well above people’s heads. Upper-room germicidal UV lights, with proper ventilation, can kill or deactivate some airborne viruses and bacteria that’s circulating in a room. But this practice does not protect against larger respiratory droplets expelled by coughs and sneezes or newly produced infectious aerosols. Social distancing and face masks are still necessary for safety.
What should you do if you or someone at home has symptoms?
First and foremost, stay at home even if you’re not the person who is sick. The CDC recommends “social distancing” for two weeks, which is the length of time believed to be the disease’s incubation period. The sick person should stay in a room away from other people, and if possible, use a separate bathroom. Continue to wash your hands, clean and disinfect high-traffic hard surfaces (door knobs, countertops, faucet handles) and don’t share food or drinks.
Contact your medical care provider online or by phone to seek guidance. If you are not experiencing a medical emergency, do not rush to a clinic before you speak with a provider. If you are struggling to breathe, go to an emergency room immediately.
Are there any medications or vaccines for COVID-19?
There are no U.S. Food and Drug Administration-approved drugs or therapies to prevent or treat the disease, though researchers are conducting clinical trials and analyzing data to fill that gap.
FDA granted an emergency use authorization in May to the intravenous antiviral drug remdesivir for the treatment of patients with severe COVID-19. In one trial, the drug shortened the time of recovery in some patients. Statistically, there was no significant difference in death for COVID-19 patients who were treated with remdesivir compared to those who were not.
An inexpensive, widely available steroid called dexamethasone can improve survival for some severely ill hospitalized patients, according to a forthcoming study from British researchers. Deaths were reduced among patients who required breathing machines or supplemental oxygen, but did not seem to help those who were less ill.
Health care workers have been trying to find off-label uses for existing medications that reduce the severity of people’s symptoms with medications designed to treat other ailments — including the antimalarial drug hydroxychloroquine. While President Donald Trump has touted anecdotal evidence that the drug has helped manage some patients’ symptoms, there is no data that proves it is effective in treating or preventing COVID-19. In fact, the FDA revoked its emergency use authorization on June 15, saying “the drug’s potential benefits for such use do not outweigh its known and potential risks.”
Scientists are racing to develop a vaccine against the new coronavirus, but experts say it may take as much as 18 months before one is released to the public. The Trump administration has selected five companies as finalists to develop a vaccine with the support of the government. But basic questions remain about the effectiveness of a vaccine against COVID-19, including how long one would provide protection against the disease.
One potential stop-gap measure that is being tested is convalescent plasma therapy, the century-old practice of using blood plasma of patients who have recovered from disease and injecting it into patients who are ill to speed up their recovery. The therapy is the focus of research in labs and hospitals, and shows early signs of promise though results are not complete.
Pharmaceutical companies and governments around the world are chasing a coronavirus vaccine, fast tracking the usually years-long vaccine development procedure to a few months.
Do not drink, inject or otherwise ingest disinfectant of any kind.
Drinking, injecting or otherwise ingesting disinfectants can cause severe injuries or death.
Read the safety labels on disinfectants or any other cleaning products before using them.
When will a COVID-19 vaccine be ready?
We can’t say for sure. Under Operation Warp Speed, government agencies are speeding the development of vaccine candidates with the goal of delivering 300 million doses of a safe, effective vaccine by January 2021.
In late July, the first large-scale clinical trial began to test whether vaccine candidates work. More Phase 3 trials are expected to begin over summer and into fall. Results from these trials will take months and at least 50% of vaccinated people would need to be protected from COVID-19 for approval by the FDA.
Dr. Anthony Fauci, who directs the National Institute for Allergy and Infectious Diseases, in a July House of Representatives hearing, reiterated that he was “cautiously optimistic” that a vaccine would be available in 2021. The vaccine would not be immediately available for everyone, Fauci said, and officials initially would need to prioritize its distribution. But he said that “within a reasonable period of time, the plans now allow for any American who needs a vaccine to get it within the year 2021.”
How does novel coronavirus spread?
It spreads through secretions released through the mouth or nose of an infected person. Airborne respiratory droplets, like those from coughing and sneezing, can get into the mouths, noses or eyes of people close by. Aerosols – tiny particles that are suspended in the air, like those expelled when talking or breathing – can circulate in rooms with poor ventilation for hours. Droplets or aerosols that land on surfaces are also able to transmit the virus.
To reduce your chances of getting or spreading the virus, practice good hygiene:
- Cover your nose and mouth when you sneeze or cough
- Avoid touching your face
- Avoid touching surfaces
- Wash your hands thoroughly with soap and warm water for at least 20 seconds
Additionally, wear a mask when you are unable to social distance or if you are indoors with people who you do not live with.
As businesses reopen and cases across several states in the U.S. and across the world surge, experts worry that “superspreaders,” a small percentage of infected people are transmitting the virus to a much larger percent, could be fueling the pandemic.
Do children spread the virus more or less than adults?
At this time, it’s believed that children younger than 10 years old spread the new coronavirus less than other age groups, according to a large study from South Korea. However, children between the ages of 10 and 18 are believed to spread the virus at rates similar to adults. Using contact tracing, the study included almost 60,000 contacts of over 5,700 COVID-19 patients while schools were closed earlier this year. The researchers noted the study had a number of limitations, including the possibility that “asymptomatic patients might not have been identified.”
Can the virus be spread by people who do not have symptoms?
Yes. Both pre-symptomatic and asymptomatic people can spread the disease while actively infected with the virus, according to WHO.
A person is pre-symptomatic if they have been infected with the coronavirus and do not currently have any symptoms but will develop them. They may not realize for a couple of days that they are sick.
A person is asymptomatic if they are infected with SARS-CoV-2, but do not experience symptoms while infected. They may never know they are infected unless they are tested. Some people who identified as asymptomatic have reported, in hindsight, having very mild symptoms, WHO says.
How much pre-symptomatic and asymptomatic people spread the virus is unknown. We do know that more airborne respiratory droplets are expelled by coughing and sneezing than by talking. But we don’t know how rare asymptomatic cases are because most people do not get tested unless they experience symptoms or have been in close contact with someone who has tested positive.
On June 9, a spokesperson for WHO suggested that people who did not have symptoms were unlikely to spread the virus. But within hours, the organization clarified its statement, saying it is unclear how prevalent asymptomatic transmission truly is.
How many people are asymptomatic?
We don’t know yet – and may never know. People without symptoms may never be tested unless they have had close contact with someone who has COVID-19. The World Health Organization estimated in early June that “anywhere between 6 percent and 41 percent” of people with the disease may be asymptomatic.
What is community spread?
Community spread is when people have been infected with the virus in an area, including some who are not sure how or where they became infected. Check with your local health department to learn whether there is confirmed community spread of SARS-CoV-19 where you live.
Can COVID-19 be controlled by herd immunity?
Herd immunity is the idea that if a majority of people have been exposed to an illness – either by infection or vaccination – and have gained some immunity, the community resistance will protect those who have not been exposed.
Experts estimate that between 60 to 70 percent of a population – around 210 million people in the U.S. – would need to be immune to develop full herd immunity and stop the spread of the disease.
Dr. Ashish Jha, director of the Harvard Global Health Institute, told PBS NewsHour that herd immunity is a “terrible strategy” for controlling COVID-19. Even if treatment for the disease improves, herd immunity would mean “many, many hundreds of thousands of people dying,” Jha said. “And many, many millions of people getting very sick.”
Can mosquitoes or ticks transmit the virus?
There is no evidence or data that suggests that the new coronavirus can be transmitted by mosquitoes or ticks, according to both the CDC and WHO. Even though SARS-CoV-19 is believed to have originated in another animal, the virus is spreading primarily through person-to-person transmission.
How often do I need to wash my hands?
Wash your hands immediately after blowing your nose, coughing, sneezing, using the bathroom or touching surfaces in a public space. Wash your hands before eating or preparing food and before touching your face. If you’re not sure you’re doing it right, here’s what the CDC recommends:
- Wet your hands with clean, running water
- Rub your hands together with soap — this includes the backs of your hands, between your fingers and under your nails
- Scrub your hands for as long as it takes to sing the “Happy Birthday” song twice
- Rinse your hands under clean, running water and dry them with a clean towel or air dryer
What should I look for when buying hand sanitizer? And why do some smell bad?
Hand sanitizer began selling out in U.S. stores as early as February. Many companies – including more than 800 U.S. craft distilleries, according to The New York Times – have pivoted to meet market demand. In March, the FDA authorized the temporary production of hand sanitizer during the public health crisis as long as companies follow guidelines, including using specific amounts of certain ingredients.
When buying hand sanitizer, inspect the label to make sure that it contains at least 60 percent alcohol (sometimes listed as ethanol, ethyl alcohol or isopropyl alcohol). Products with less alcohol may not work as well, or “merely reduce germs rather than kill them outright,” the CDC says.
The FDA has recalled more than 100 hand sanitizers that have low levels of alcohol and products that are or may be contaminated with methanol.
Many of the newer products that you can buy in-store or online today share an unexpected trait: They stink. That’s because they use denatured ethanol, a form of ethanol that’s more affordable and (unfortunately) unfiltered, a perfume manufacturer told Wirecutter. A bad smell doesn’t mean they are not effective, however.
Remember that hand sanitizer is not a replacement for hand washing. Use it when soap and water are not available, such as after you leave the grocery store, and follow up with proper hand washing soon afterwards.
How does it compare to the flu?
SARS-CoV-2, the virus that causes COVID-19, belongs to the same family of viruses as the common cold, not influenza. But the symptoms can be similar to flu, and the current pandemic has drawn comparisons to the 1918 influenza that killed up to 50 million people around the world.
The flu, which returns every year, sickens many more people in the U.S. than COVID-19 — so far. The CDC believes, however, that the number of coronavirus cases is likely 10 times more than the number of documented cases. Unlike the flu, COVID-19 does not have a vaccine or medications designed specifically to prevent and treat it. Health officials urge you to get a vaccine for the upcoming flu season beginning in September or October, which is when the flu season usually begins.
This coronavirus appears to have a higher mortality rate, based on current data. You calculate that rate by dividing the number who have died from COVID-19 by the number overall who are sick. But because testing is far from adequate, public health officials, especially in the U.S., have trouble with figuring out exactly how many people have this virus.
What types of tests are available?
Two types of tests are currently available: diagnostic and antibody.
Diagnostic tests, often referred to as molecular or PCR tests, detect whether you are actively infected with the virus that causes COVID-19. Mucus samples are collected from a person’s nose or throat. Depending on the testing facility, results may take several days as most must be sent to labs for analysis. These are considered the most reliable tests.
Antigen tests are rapid diagnostic tests that quickly detect the virus. Results are available in minutes, but the tests may not detect all active infections. Positive tests are highly accurate, but there are a higher chance of false negatives compared to other tests. Your doctor may order a molecular diagnostic test if you have symptoms of the disease.
Antibody tests, or serology tests, detect whether you have been previously infected by the virus. A blood test can confirm whether you have antibodies to the coronavirus, which usually develop one to three weeks after infection. Antibodies can help fight off infections, but it is not known whether antibodies to the coronavirus will protect you from getting infected again, or how long they may protect you. A negative test could mean you have an active infection, so follow up with your doctor for guidance.
While most tests are administered by health care professionals either at a medical facility or a designated coronavirus testing site, at-home diagnostic tests are increasingly available. These tests allow for the collection of samples (via nose or throat swabs, or spit) that are then sent to a lab for analysis. While the demand is high for at-home tests, accuracy and affordability issues may limit their use. Some companies are sending health workers to people’s homes to assist with collection.
Who can get tested? How do you get tested?
In most places, it’s not as easy as simply asking for one. It depends on where you live, how many tests are available in your community, how sick you are and if you have reason to believe that you might have the virus. Without an abundance of tests currently available across the U.S., testing may be reserved for those who are presenting respiratory systems, have had contact with someone with a confirmed case of COVID-19 or health care providers who tended to a patient with the virus.
If you have reason to suspect you could have COVID-19, the CDC says you should call your primary care physician, local community health center or urgent care facility. Providers will ask you about your symptoms and, if they believe you should receive testing, advise you as to whether, how and where to seek testing. But multiple people have reported that their doctors have referred them to their state or local health departments for COVID-19 testing, but said they were unable to access a test.
Will I have to pay for a test?
If you have health insurance, the cost of “medically necessary” COVID-19 tests should be fully covered under the Families First Coronavirus Act and Coronavirus Aid, Relief, and Economic Security Act. Most insurers are reimbursed up to $100 for some tests by Medicare. In some cases, patients may be charged for other services performed – like those to rule out other diseases – or for the amount not covered by insurance.
If you do not have health insurance, the cost of a test may also be covered under a federal Medicaid emergency provision, if you live in a state that has implemented the policy. Free testing is available at some locations where local government agencies are picking up the cost.
Can my employer require that I take a COVID-19 test before returning to work?
Yes, law permits employers to require workers to be tested before allowing you to enter the workplace, even if you do not have any related symptoms. They may also ask you whether you have any symptoms and take your temperature. If you do have symptoms, you may be asked to leave.
What is pool testing?
Pool testing physically combines samples from several people into a single sample that is then tested. If the test is negative, all samples are treated as negative. If the test is positive, everyone in that pool is tested individually to determine who has the virus.
This technique allows for broad screening, like workplaces and schools, and could help identify people who are pre-symptomatic or asymptomatic. The risk of false negatives in test pools, however, is greater than in individual tests, according to the FDA. It works best when there is less suspected virus in a population at a given time.
What is “social distancing”?
In short, it means keeping at least 6 feet apart from anyone outside of your household, and limiting your trips to places where you might interact with other people to only what is absolutely necessary. Work from home, if possible, and avoid large gatherings and crowded places as much as possible.
The Trump administration has also advised against gatherings of more than 10 people. And if you are around other people, maximize physical distance from one another, make sure to cover your mouth and nose when you sneeze and cough, and don’t share food or drinks. It is safe to go outside on walks, go to the park (if open) and into nature if you keep your distance from others. And, of course, keep washing your hands.
How can I limit my risk outside my home?
The more closely you interact with others and the longer that interaction, the higher the risk, the CDC warns.
The best way to prevent infection while outside of your house is to practice social distancing, have good hand hygiene and wear a face mask in public.
As people resume activities, the CDC published recommendations to help determine your risk, as well as safety tips:
- Avoid enclosed spaces when possible. Take the stairs instead of an elevator.
- Avoid touching frequently touched items. If you must, wash your hands or use hand sanitizer afterwards.
- When dining out, see if there’s an option to dine outside. If not, make sure tables are at least 6 feet apart.
- At the gym, don’t use items that cannot be cleaned or sanitized after use. Avoid high-fives and elbow bumps.
- Use curbside options at the library or stores.
- At cookouts, use single-serve options and remind people to wash hands before and after eating.
Can I get the virus outdoors? Do I need to wear a mask?
Yes, transmission can happen outdoors, though it’s less likely than indoors. Respiratory droplets disperse much more quickly outdoors. Plus, there’s more space. If you are able to maintain at least 6 feet of space between yourself and others, being outside is relatively safe.
Remember, however, that different activities have different risk levels. For example, walking your dog is less risky than dining at an outdoor patio. That’s because the more closely you interact with others and the longer that interaction, the higher the risk.
You should also wash your hands before and after you are outside. If you are unable to maintain physical distance from others, you should wear a mask. Additionally, some cities, counties and states have mandated that residents wear masks in public.
What should you do if you think you might be infected, but are uninsured?
Health care professionals say that anyone who fears they may have contracted the novel coronavirus needs to seek appropriate care. If you’re uninsured, knowing where to turn can be tricky.
Many local health departments have set up hotlines that can direct patients in the right direction. The Centers for Disease Control and Prevention also has an online “self checker” tool to guide patients to the best care. Some states are also offering special enrollment periods to sign up for health insurance, and even easing some restrictions to temporarily expand Medicaid. Certified navigators at the state level can help guide people through the process of picking a plan on the health exchanges.
If I’ve already had COVID-19, am I immune? Can I get reinfected?
It’s still too early to know if people who recover from COVID-19 can get infected again, the CDC says. Most people begin developing antibodies one to three weeks after infection, but having antibodies does not guarantee immunity.
You should continue to protect yourself and others from the virus until more is known or an effective vaccine is widely available.
How long does it take to recover from COVID-19?
Recovery time varies, but most people who become mildly sick get better in about two to three weeks. Prolonged illness and symptoms can persist in some patients who are not hospitalized for COVID-19, even in young adults without chronic illnesses, the CDC says. People who get severely or critically ill usually recover within three to six weeks.
A small number of people with mild illness have reported symptoms that have persisted for more than 30 days. Some have even tested negative for the disease, despite having COVID-19 symptoms. So far these reports are anecdotal, the CDC has said.
How long are you contagious with the coronavirus?
The length of time the virus remains infectious is not yet known, according to the CDC. The incubation period of SARS-CoV-2 ranges from two to 14 days, and you may become infectious one to three days before developing symptoms. Most people with mild cases of COVID-19 have symptoms for two weeks. Follow your doctor’s recommendations or CDC guidelines to know when you can be around people if you’ve had symptoms of COVID-19 or tested positive, with or without symptoms. You should continue to take precautions to limit the spread of the virus after recovering.
When can I be around other people if I’ve had or think I had COVID-19?
First and foremost, follow your doctor’s advice. If you’ve had any COVID-19 symptoms, the CDC says you can be with others after three days with no fever, an improvement in respiratory symptoms like cough and shortness of breath, and 10 days have passed since your symptoms began. If you did not have symptoms but tested positive, you can be with others 10 days after your test. If you are tested again to see if you still have COVID-19, you can be with others after you test negative twice in a row, at least 24 hours apart.
When did COVID-19 start and where did it come from?
The first-known cases originated in a seafood and poultry market in Wuhan, China, at the end of 2019, before exploding into an official pandemic by mid-March. The virus most likely originated in bats, WHO says, but scientists believe the virus jumped to humans from a different species.
Can household pets get COVID-19 or spread the virus?
A small number of animals, including cats and dogs, have tested positive in the U.S., usually after close contact with someone who has the virus. The risk of animals spreading the virus is low, according to the CDC. There is no evidence people can get the coronavirus from the skin, fur or hair of pets.
Because there is a small risk that sick people can spread the virus to animals, pet owners should limit their pet’s interaction with people outside the household. Keep cats indoors when possible. Keep dogs at least 6 feet away from others when outside. Avoid unleashed activities, like the dog park, and places where social distancing is not possible.
Authorities recommend that any pet owners with COVID-19 avoid contact with their animals as much as possible, including wearing a face covering while caring for them.
If your pet becomes sick or has had contact with someone who has COVID-19, call your veterinarian for guidance.
Can you catch the virus from touching surfaces?
It’s possible to get COVID-19 by touching a surface or object that has the virus on it and then touching your own mouth, nose or eyes. The virus, however, spreads mainly person-to-person through respiratory droplets.
You can reduce your risk by washing your hands often with soap and warm water for at least 20 seconds, especially after you’ve touched an object someone else has touched or handled. If you cannot wash your hands, use hand sanitizer that contains at least 60 percent alcohol and wash your hands as soon as you can. Frequently touched objects – mobile phones, keys, doorknobs and so on – should be cleaned and disinfected regularly.
How long does the virus last on surfaces?
The virus that causes COVID-19 is detectable on some surfaces for days, according to a study published in the New England Journal of Medicine. The longer the virus is on a surface, however, the less of it remains. Researchers do not know how much of the virus it takes to make someone sick. On cardboard, it can last up to 24 hours. On copper, up to four hours. And on plastic and stainless steel, it can last up to 72 hours.
The best way to protect yourself from coronavirus is wash your hands, Dr. Fauci says.
Can you get sick from food, restaurant takeout or packaging?
The risk is likely very low, the CDC says. Because the virus can linger on surfaces, it is important to wash your hands before preparing or eating food. There is no evidence that COVID-19 can be transmitted through food.
What is the best way to clean and disinfect surfaces?
Regularly clean frequently touched surfaces and objects with soap and water to physically remove germs, dirt and impurities. Follow up with an FDA-approved disinfectant that kills viruses – including SARS-CoV-2 – as well as bacteria, fungi and parasites. Read the product’s label and follow all instructions. Many disinfectants require applying the product for a period of time to be effective. Do not mix chemicals.
Protect your skin by wearing reusable or disposable gloves. Make sure there is proper ventilation in case the chemicals you are using produce strong smells. Bleach, for example, smells stronger after it’s been applied to surfaces due to a chemical reaction. Open windows and doors, if possible, and turn on a fan. Store products safely, out of reach of children and pets.
Laundry should be washed at the highest temperature appropriate for the fabric or material. Wear gloves when handling a sick person’s laundry. You can combine that person’s laundry with other people’s items. Use appropriate household cleaners for objects that cannot be laundered, such as rugs and carpets.
Follow the manufacturer’s recommendations when cleaning and disinfecting electronics. If no guidance is available, use wipes or sprays that have at least 70 percent alcohol.
How long does the virus survive on clothing? Should I change my clothes after I’ve been near other people?
We don’t know how long the virus can remain infectious on clothing, but many experts point to a study published in the New England Journal of Medicine in March. The virus was detectable for days on the least absorbent surfaces, like plastic and steel. On cardboard fibers, which absorb moisture like fabric, the virus lasted up to 24 hours.
For most people who practice social distancing and wear a face mask when distance cannot be maintained, it is not necessary for you to change your clothes or shower after you’ve been out. You should always, however, practice good hand hygiene.
According to an interview in The New York Times, airborne viral particles are “unlikely to deposit on clothing because of aerodynamics.” If there are any viral aerosols, they are being pushed away from you as you move, thanks to physics.
You should change your clothes and shower if you’ve:
- had close contact with someone from outside your home who was unmasked
- been coughed or sneezed on
- visited a crowded place where people were not wearing masks
- visited a place where there are sick people
Clothes can be washed according to label instructions to disinfect them, the CDC says. Use the warmest water possible, and dry the laundry on the hottest setting. Do not shake dirty clothes, and wear disposable gloves when handling a sick person’s clothes. Their laundry can be combined with other people’s items.
What is contact tracing, and how could it help manage COVID-19?
Contact tracing is the process of tracking the spread of a disease by interviewing patients or using technology to find out who else may have been exposed. The technique can help slow the spread of COVID-19, save lives and maybe even prevent future waves of the virus.
The process is straightforward, but time-intensive. First, workers contact people with newly confirmed cases of COVID-19 to identify everyone they came into contact with while sick. Then workers reach out to those people to tell them they may have been exposed – while maintaining the privacy of the patient – and that they will need to quarantine. They also explain how to quarantine the right way, how people can protect their families, get groceries and medicine, pay their bills and even find help for domestic abuse.
The technique has been used extensively for prior disease outbreaks elsewhere, but the U.S. currently lacks a nationwide tracing infrastructure. State governments across the country are hiring thousands of people as contact tracers to track the spread of the virus and to help bring it under control. The data collected can also help researchers know which mitigation methods work.
How do contract tracing apps work?
Digital tools to track people’s movements, like those used in Singapore, Israel, South Korea, and in some U.S. states could also help. When a user downloads and enables a contact tracing app, their mobile device will track their location and search for Bluetooth beacons of other users nearby. If someone reports a positive diagnosis in the app, any users who have recently had contact with that person will be alerted.
In May, Google and Apple, together, released an exposure notification solution using Bluetooth technology on mobile devices that public health authorities can use in the contact tracing apps that they are building. Security experts, however, remain concerned about user privacy.
When will things reopen or return to normal in the U.S.?
In April, the Trump administration issued guidelines for states, individuals and employers on how to ease up on social distancing to deal with the coronavirus in areas where COVID-19 are on the decline. Since then, most states have begun to reopen to various degrees. A few – California, Oregon and Tennessee – have only begun reopening regionally.
Because reopening decisions are made on the state and local levels, it can be confusing. Read news from local media and check websites of your local and state governments for current safety restrictions and the latest developments.
It is unknown how long the pandemic will last. Without a vaccine, the virus is expected to continue to spread. Economic effects of the pandemic in the U.S., such as recession and record unemployment, may be felt for years.
What are quarantine “pods” or social “bubbles”? Are they safe?
Some people and families are cautiously expanding their social circles beyond their immediate households and forming “pods,” “bubbles” or “quaranteams” with people who they have decided to treat as safe. The CDC recommends social distancing from people outside of your household, but loneliness and isolation can worsen mental and physical health. Quarantine bubbles can help alleviate those potential health risks while improving quality of life.
When forming a quaranteam, members discuss interactions they’ve had with others outside of their household, how they will socialize with one another and determine rules for interacting with people outside of their circle. Ongoing, open communication is key to keeping everyone safe.
Will there be a second wave of infection? Are we already experiencing it?
As of June 15, coronavirus cases in more than 20 states are rising, while new daily reported cases have held steady for weeks nationally. The movement of virus hot spots from major coastal cities to other parts of the country is part of the first wave in the U.S.
Pandemics have been characterized by waves of activity spread over months, and it’s possible to have a second peak within the same wave. That’s what happened in the 1918 influenza pandemic, WHO says.
Many health experts expect a second wave of cases in the fall, though it’s not inevitable. Some viruses, like influenza, spread more during cold winter months, but SARS-CoV-19 has not been around long enough for researchers to determine if the weather or temperatures affect the spread of the virus. However, people typically spend more time indoors – where it may be harder to social distance and there’s less ventilation – in the fall and winter.
As states decide when and how to reopen their economies, many fear another wave of infections and deaths. PBS NewsHour correspondent William Brangham sat down with Science magazine writer Jon Cohen on April 22 to take viewer questions, and talk about how COVID-19 affects the human body.
Is it safe to return to work?
As long as there is community spread of the virus, there is risk of exposure and infection when interacting with other people. The CDC and the Occupational Safety and Health Administration (OSHA) have issued guidelines for employers on how to prevent and slow the spread of COVID-19 in the workplace. Limit your risk by social distancing when possible and wearing a face mask in public.
Check with your state and local health department for guidance, and consider your individual circumstances to make an informed decision. Are you or someone you live with at high risk of getting severely ill? If you have children at home, are you able to secure safe child care for them?
If you don’t know your employer’s COVID-19 policies, there are several questions you might want to ask. How are they enforcing social distancing? What is the sick leave policy if you or a family member becomes sick? Are screening measures, such as temperature checks or testing, in place? How many people will be working at the same time? What is the procedure if someone becomes sick?
If your employer is not following safety or health guidelines, you can confidentially file a complaint with OSHA.
How are schools planning to reopen? What precautions are they taking?
It’s complicated. Some schools have pushed back starting dates, while others are taking a wait-and-see approach. States have said they plan to reopen for in-person classes. Others will offer a combination of in-person and virtual learning, and still others have committed to online-only classes for the fall.
CDC recommendations to keep students, teachers and school staff safe include closing communal areas, like cafeterias and playgrounds, and spacing desks at least 6 feet apart. When possible, students should be divided into small groups that stay together as much as possible and do not mix. Schools should increase circulation of air, if possible, by keeping doors and windows open. Students should avoid sharing items that are difficult to clean or disinfect.
Reopening schools is both a public health issue and a political issue. While the Trump administration is pushing states to reopen schools, state and local governments must take into consideration the level of community spread, which varies significantly across the country. Children appear to be at a lower risk of getting sick, but they can pass the virus on to others, like their teachers and family members.
Check with your child’s school or school district to find out what the reopening plans are and what strategies they are using to reduce the spread of the virus.
Is it safe to travel?
Travel increases your chances of getting and spreading COVID-19. Staying home is the best way to protect yourself and others from getting sick, the CDC warns. When deciding whether to travel, consider the following:
- Is COVID-19 spreading in your community, along the route and your destination?
- Are you, or anyone you are travelling with or visiting, more likely to get severely ill if infected with the virus?
- Is social distancing possible while you’re travelling, during the trip and after?
- What mode of transportation will you take? Will it require being within 6 feet of others? Will you need to make stops along the way, possibly coming in close contact with people and surfaces?
- Are there any travel restrictions in place between your home and your destination? Do either locations require you to self-isolate for 14 days after travel? Travelling internationally? Check the CDC’s latest travel health notices here.
If you are sick, do not travel. And remember, the virus can be spread by people who do not have symptoms.
If you travel, protect yourself and others by practicing good hygiene, wearing a face mask in public and social distancing. Bring alcohol-based hand sanitizer, face masks and food and water for the trip in case restaurants along your route are closed. Pack supplies to clean and disinfect surfaces in hotels.
What risks are associated with flying during the pandemic?
The CDC warns that all travel increases your risk of getting or spreading COVID-19, but air travel may not be as dangerous as you think. Existing aircraft ventilation systems and new policies help reduce risk, and there are simple things you can do to make flying safer.
“Most viruses and other germs do not spread easily on flights because of how air circulates and is filtered on airplanes,” the CDC says. That’s because the plane’s ventilation system uses outside air and filters to remove contaminants from cabin air continuously. The system, however, does not protect from large virus particles that land on surfaces. The CDC now recommends that the system is kept on while the plane is cleaned between flights.
New cleaning guidelines have also been issued for airlines to follow if a symptomatic passenger is identified during or immediately after a flight.
Because social distancing may not be possible in security lines, airport terminals or on the plane, travellers should wear a face mask at all times. Many airlines now require them for travellers ages two years or older.
If you do choose to fly during the pandemic, you can lessen your risk by doing the following:
- Choose shorter flights instead of longer flights when possible
- Wear a face mask at all times and never let it fall below your nose or chin
- Avoid touching your eyes, nose and mouth
- Wash your hands before and after the flight, and after using the bathroom
- Bring hand sanitizer and use it after touching frequently-touched surfaces
- Stay seated and avoid moving around during the flight
- Turn on the air vent above your seat to improve ventilation
Is it safe to swim in pools, hot tubs or natural bodies of water? What about water parks or splash pads?
There is no evidence that the coronavirus can be spread to people through recreational water, the CDC says. Additionally, water treated with chlorine or bromine should kill SARS-CoV-2, the virus that causes COVID-19. If there is community spread of the virus, however, precautions should be taken to limit the spread of the virus, including at public pools and beaches.
If you go to a public swimming facility or venue:
- Stay at least 6 feet away from others, even in the water, and avoid crowded areas.
- Wear a cloth mask when you are not in the water. (Don’t wear one in the water. It can be dangerous.)
- Wash your hands or use hand sanitizer frequently, especially after using the restroom and before eating.
- Avoid sharing items – like food, coolers, sunscreen and toys – with people you do not live with.
When should I go to the emergency room during the pandemic?
If you or a family member experience symptoms of serious or life-threatening conditions – such as chest pain, difficulty breathing or severe injury or trauma – go to an emergency room immediately or call 911. Otherwise, contact your primary care physician or an urgent care provider to determine treatment options.
Some people may be delaying emergency care unrelated to COVID-19, the CDC says, as ER visits declined 42 percent in April. In serious cases, this could result in complications or deaths.
When should I go to the doctor during the pandemic?
If you are sick, stay home and contact your medical care provider online or by phone to seek guidance. If you are not experiencing a medical emergency, do not rush to a clinic before you speak with a provider.
For non-emergency care, checkups and ongoing treatments, contact your primary care doctor or specialist so that they can evaluate the best way to treat you. If you do not have a primary care doctor, you can contact a local urgent care provider for guidance.
Your doctor may choose to provide treatment remotely – this is called telemedicine – either face-to-face over video chat, on the phone or by email. To get the most out of the conversation, be prepared to summarize your issue for a nurse and make a list of your symptoms and any questions you have.
In-person visits may still be necessary for some patients and health conditions, like allergy shots and dialysis. If your doctor wants you to come in, protect yourself and others by following their instructions, wearing a face mask and social distancing.
Should I take my child to the doctor for a check up or routine vaccinations?
Contact your child’s pediatrician for guidance. Routine baby and child checkups should continue to be done in person, the American Academy of Pediatrics says, including complete physical exams, lab work, hearing and vision tests, fluoride treatments and vaccines. They recommend telemedicine when in-person treatment is not necessary.
Fewer childhood vaccines have been administered during the pandemic, the CDC says. Delaying vaccination increases the risk for outbreaks of vaccine-preventable diseases, including meningitis and measles. If your child has missed a vaccine or checkup, the AAP recommends scheduling an appointment.
Is it safe to go to the dentist? When should I go?
While the coronavirus is primarily spread through close contact from person-to-person by airborne respiratory droplets, there are currently “no data available to assess the risk of SARS-CoV-2 transmission during dental practice,” the CDC says.
Dentists are used to thinking about infection control. The American Dental Association has issued additional recommendations to limit the spread of the virus. Cleanings may take longer because the dentist may use hand tools instead of ultrasonic scaling, which produce aerosols. They may use additional suction devices or rubber dental dams, too.
If you are experiencing a dental emergency – uncontrolled bleeding, pain or swelling in the mouth, or a broken tooth – you should call the dentist to arrange for treatment.
Most dentists have resumed cleanings and other routine visits after pausing non-emergency treatment at the start of the pandemic. Contact your dental office to find out if they are seeing patients and whether you should make an appointment.
What should you do if you feel scared, anxious or depressed?
Even if you are in isolation, find ways to stay connected. Lean on technology, if you have it, to reach out to people you trust and who can appreciate the ups and downs of being human in these times.
Stick to your daily routine as much as possible: take a shower, get dressed and stick to a general schedule.
You should also exercise, eat healthy food and sleep regularly, the WHO has urged, telling the public to “pay attention to your own needs and feelings” during these stressful times.
Consuming endless amounts of news about COVID-19 can ramp up your anxiety. Set times during the day to check in on developments, and pay attention to news and information from trusted sources to help you prepare and stay safe.
How can I help others?
Counterintuitively, the best way to help others and society at large right now is to isolate yourself, stay home as much as possible — even as states and cities make moves to open up public life and commerce — and avoid the unintentional spread of the virus. You’ll be helping everyone, particularly those in the highest-risk groups and health care workers.
READ MORE: How to help others in the COVID-19 crisis
— Additional reporting by Isabella Isaacs-Thomas, Erica R. Hendry, Gretchen Frazee and Dorothy Hastings.