Questions About COVID-19 Answered

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Through illness, community and national lockdowns, and economic downturn, the COVID-19 pandemic has upended the lives of billions of people worldwide. At Britannica we have been fielding questions about the pandemic from readers, and we’ve had a few questions of our own. Here are answers to some of our readers’ and our own questions about the COVID-19 pandemic.

Because the COVID-19 pandemic continues to evolve, some of this information may have changed since this article was last updated. Get the most up-to-date information from the Centers for Disease Control and Prevention and the World Health Organization.

What is COVID-19?

COVID-19 stands for coronavirus disease 2019, a mild to severe respiratory illness. COVID-19 is caused by a coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

How is COVID-19 transmitted?

COVID-19 is transmitted primarily through contact with infectious material, particularly respiratory droplets that enter the environment when an infected person sneezes or coughs. People nearby may inhale or come into contact with these droplets, resulting in disease transmission. Infection may also occur when a person comes into contact with a contaminated surface and then touches his or her mouth, nose, or eyes.

For more information on COVID-19 transmission, visit the Centers for Disease Control and Prevention’s (CDC’s) How COVID-19 Spreads.

I’ve heard that the COVID-19 virus probably started in a “wet market” in Wuhan. How does that work?

A wet market* is a place where fresh fish and meat and other animal products are sold. Live animals, such as chickens and pigs, are sometimes slaughtered at wet markets, and dead and live wild animals, such as bats, raccoon dogs, snakes, or civets, may be sold. These markets are described as “wet” because, in general, the countertops and floors of the stalls are covered with water, blood, and waste parts of animals. 

Even if persons selling goods at wet markets are diligent about cleaning and disinfecting surfaces, wet markets are nonetheless places of unusual human-animal interaction. Wild animals, even species that are “farmed” and then brought to a wet market to be sold, are reservoirs for a wide range of diseases. When these animals are brought together in the same environment with humans at wet markets, the potential for exposure to blood contaminated with infectious viruses—and the potential for those viruses to jump from animals to humans, giving rise to new diseases—increases dramatically.

A number of infectious diseases that have given rise to epidemics and pandemics in humans originated in animals. Examples include Ebola, avian influenza, and SARS. In fact, as many as 75 percent of newly emerged infectious diseases in humans have come from animals. These diseases spread to humans as a result of contact with infected bodily fluids from animals, including saliva, blood, and feces, as well as contact with infected surfaces, including soil and objects within animals’ habitats.

Whether coronavirus disease 2019 (COVID-19) originated in a wet market in Wuhan, China, is unknown. It seems plausible, because the virus’s genetic material was found in a wet market in Wuhan known as the Huanan seafood market, where wild animals and live animals were sold and animals were openly slaughtered. Some 27 of the first 41 reported cases of COVID-19 had direct exposure to the market. However, 14 of those 41 cases had no market connection.

Scientists suspect that the virus came from bats, but it might not have jumped directly from bats to humans. Rather, an intermediate host or population, such as a civet or pangolin or even a specific bat population, may have had a role. These types of animals frequently are sold at wet markets (even though trade in pangolins is illegal), raising further questions about the impact of the Huanan market on the origin and early spread of COVID-19.

Is there a cure for coronavirus?

At the moment there is no cure for infection with the coronavirus behind the COVID-19 pandemic. However, different types of drugs are being tested in human patients for their ability to fight off infection or to reduce the severity of disease. Examples include an antiviral drug known as remdesivir, a drug used for pancreatic inflammation called camostat mesilate, and the therapeutic antibody regeneron. Also, a number of vaccines are being developed and investigated for their ability to prevent COVID-19.

Find out more about the prevention and treatment of COVID-19 at the CDC’s How to Protect Yourself & Others.

If a vaccine is created for COVID-19, will the federal government or other governments in the United States make it mandatory for citizens and residents to be vaccinated?

State governments have the authority to adopt and enforce laws that would make vaccination against COVID-19 mandatory, either absolutely or as a condition of receiving some public service or benefit. Currently, for example, all U.S. states require children to be vaccinated against various diseases as a condition of admission to public schools—though all states also permit medical exemptions, and almost all states permit some nonmedical exemptions for religious or other personal beliefs. Since the early 20th century the Supreme Court has upheld such laws as legitimate exercises of state police power (i.e., the limited power of states to regulate or restrict the rights of individuals within their jurisdictions to protect the general welfare, understood to include public health).

Although the protection of public health is traditionally the responsibility of the states, the federal government may issue its own regulations for that purpose. Under the amended Public Health Service Act (1944), or PHSA, for example, the surgeon general, with the approval of the secretary of health and human services, “is authorized to make and enforce such regulations as in his judgment are necessary to prevent the introduction, transmission, or spread of communicable diseases from foreign countries into the States or possessions, or from one State or possession into any other State or possession.” Regarding persons moving or likely to be moving from state to state, such regulations “may provide for the apprehension and examination of any individual reasonably believed to be infected with a communicable disease” and the detention of infected persons “for such time and in such manner as may be reasonably necessary.” Although the PHSA does not explicitly authorize the surgeon general to mandate the vaccination against communicable disease of all residents of the United States, it is reasonable to assume that such authority is implied in this and other provisions of the law.

It is also possible that Congress could pass a constitutionally valid federal law requiring universal vaccination on the basis of its Article I power to regulate interstate commerce (see commerce clause). Whether the federal government will attempt to prescribe or legislate universal vaccination against the COVID-19 virus depends on many factors.

Additional reading: Vaccine Exemptions and the Federal Government’s Role

How do antibodies combat coronavirus infection?

When an individual becomes infected with the coronavirus SARS-CoV-2, the cause of coronavirus disease (COVID-19), the body produces antibodies that neutralize the virus to prevent it from causing further harm to cells and tissues. These antibodies help the individual recover from SARS-CoV-2 infection. Their detection via antibody testing forms the basis of novel diagnostic tests under development for COVID-19.

Researchers are investigating the possibility of isolating antibodies against SARS-CoV-2 from the blood of recovered patients and using them for the development of convalescent plasma. Convalescent plasma could be used to prevent SARS-CoV-2 infection in health workers and to halt disease progression, particularly in elderly patients and in patients with weakened immune systems.

Learn more about SARS-CoV-2 antibodies and convalescent plasma:

Treatment of 5 Critically Ill Patients with COVID-19 with Convalescent Plasma (JAMA)

Convalescent Plasma as a Potential Therapy for COVID-19 (The Lancet)

Research Program on COVID-19/SARS-COV-2 (Rockefeller University)

What would it take for a population to get herd immunity to COVID-19? I've heard 60% would have to be infected. That’s a lot of death?

The percentage of a population that needs to develop immunity to an infectious disease in order for herd immunity to take effect depends on the contagiousness of the disease. The more contagious the disease, the greater the proportion of a population that needs to be immune in order to minimize the spread of illness. For most diseases, herd immunity is achieved only after 70 to 90 percent of a population is immune.

What percentage of the population would need immunity to ensure herd protection against coronavirus disease 2019 (COVID-19)? This estimate depends on several factors, including the basic reproduction number (R0; the number of people likely to become infected by a single case). In March 2020, on the basis of data from China, R0 for the causative virus, SARS-CoV-2, was estimated to be 2.2, meaning each person who became infected was likely to spread the illness to at least two other individuals. Based on this R0 value, scientists have estimated that at least 60 percent or possibly even 70 percent of a population would need immunity before herd protection took effect.

Keep in mind, however, that R0 can change. Lockdowns, quarantines, and social distancing measures can significantly reduce R0, giving the impression that a far smaller proportion of the population would need to be immune. If the value is underestimated, the proportion of the immune population may need to increase to 75 or 80 percent to achieve herd immunity. The true R0 for COVID-19 probably will not be known for some time yet.

Herd immunity against COVID-19 can be achieved in two ways: exposure to the virus and vaccination. Because the disease can be severe and fatal, intentionally infecting oneself or others is ill-advised and would result in numerous otherwise preventable deaths. Even for young healthy people who become infected, there could be long-term consequences from COVID-19 infection, including impaired lung function that could lead to disability in the future. Society is much better off waiting for a vaccine, even though it could be a year (from May 2020) until a safe and effective vaccine against COVID-19 becomes available.

What are key recovery symptoms following COVID-19 infection and successful treatment? Is a person who has recovered immune for life?

Survivors of severe coronavirus disease 2019 (COVID-19), particularly those who were hospitalized, are likely to suffer long-term effects. In fact, researchers suspect that survivors of severe COVID-19 infection who required mechanical ventilation might never fully recover. Ventilator use is associated with severe muscle atrophy and weakness, which significantly impact survival and quality of life.

In addition, some COVID-19 patients who have been hospitalized have experienced neurological symptoms, including severe fatigue and altered consciousness. Delirium has been observed in many patients as well, possibly as a side effect of medication. Delirium and lingering psychological issues, including depression and anxiety, can prolong and complicate recovery. Following the outbreak of severe acute respiratory syndrome (SARS) in 2003, which was also caused by a type of coronavirus, more than half of all survivors in a study were still dealing with psychological stress one year later.

Whether infection with SARS-CoV-2, the coronavirus that causes COVID-19, confers lifelong immunity remains unknown. If the virus does not mutate, then anyone who carries antibodies against it is likely to be immune. However, many highly infectious viruses mutate, and they do so quickly. If SARS-CoV-2 mutates, it could reinfect survivors.

The World Health Organization (WHO) declared COVID-19 a global pandemic. What can I do to protect myself (and others) from the virus?

The best way to protect yourself against coronavirus infection is to wash your hands. Handwashing with soap and water, scrubbing for at least 20 seconds followed by thorough rinsing and drying, clears your skin of viruses that may be on your hands. Avoid touching your face as well, since this is the primary way in which viruses on your hands get into your body. You can also protect yourself by maintaining physical distance (at least six feet) between yourself and others in public spaces and by adhering to travel restrictions and following guidelines to avoid large social gatherings.

For more information on how to protect yourself during the COVID-19 pandemic, read the World Health Organization's Coronavirus Disease (COVID-19) Advice for the Public

How much of the population will the coronavirus pandemic actually affect?

While it is difficult to estimate just how many people will be affected by the COVID-19 pandemic, it is likely that a significant proportion of the world's population will be infected in the coming months. Actual cases of illness probably are already significantly higher than confirmed cases. Mathematical modeling of reported infections and the movement of people in China suggests, for example, that a large proportion of infections in the country were undocumented before travel restrictions and other control measures were implemented in late January 2020. A researcher involved in the modeling study said that as many as six out of seven COVID-19 cases are not documented and that for every 150,000 confirmed cases, the actual number of cases might be closer to 1,000,000.

In the United States alone, estimates suggest that some 160,000,000 to 214,000,000 people could become infected during the outbreak. COVID-19 deaths in the United States could amount to between 200,000 and 1,700,000 million people.

Research also suggests, however, that following guidelines to prevent coronavirus transmission, such as handwashing, adhering to travel restrictions, and social distancing, can help limit the number of people who become infected.

Learn more about what you can do to help stop the spread of COVID-19 at the CDC’s How to Protect Yourself & Others.

Why are older adults and those with underlying illness at greatest risk of COVID-19 infection?

Individuals at greatest risk of COVID-19 infection include older adults and persons with chronic illness, largely because of weakened immune function. Older adults are at increased risk because, for many people, after age 60 or 70, immune function declines. With age, the systems that fend off infectious agents wear down, leaving individuals more susceptible to infection. Many older persons also are affected by chronic diseases that further weaken the immune system.

Underlying health conditions and chronic illnesses can also render individuals susceptible to a dangerous immune reaction known as a cytokine storm. Cytokines are proteins that normally help combat infections. In a cytokine storm, however, these proteins are rapidly overproduced, leading to severe inflammation and organ failure.

Research shows that persons with underlying health problems are especially vulnerable to COVID-19 infection and complications. Respiratory inflammation in response to coronavirus infection appears to be especially pronounced in these individuals. Shortness of breath, attributed to respiratory inflammation, is a common symptom of COVID-19.

Learn more about the symptoms of COVID-19: https://www.cdc.gov/coronavirus/2019-ncov/downloads/COVID19-symptoms.pdf

How do vaccines work? Are there certain types of vaccine models that are more effective?

Vaccines work by imitating infection to encourage the body to produce antibodies against infectious agents. In doing so, the immune system adds to its memory, so if the body ever encounters the same infectious agent again, it is ready to fight it off.

There are several different types of vaccines. The most effective ones are those that produce long-lasting immunity. Live, attenuated vaccines, in which the infectious agent is alive but weakened, closely mimic natural infection and therefore produce strong immune responses. Subunit vaccines, which are generated from parts of infectious agents (often surface proteins) that stimulate an immune response, also generally produce long-lasting immune protection.

Likewise, DNA vaccines, in which vaccine containing segments of the agent's genetic material is injected into the body, where cells then use the genetic information to produce the immune-stimulating proteins, are associated with long-lasting immunity. DNA vaccines are relatively inexpensive and simple to produce. RNA vaccines consisting of mRNA (messenger RNA) are similarly cheap and fast to produce. However, no RNA vaccines have ever been licensed, and so for now they remain inferior to other methods of vaccine development.

Learn more about vaccines:

Understanding How Vaccines Work (CDC)

Vaccine Types (U.S. Department of Health and Human Services)

Unlocking the Potential of Vaccines Built on Messenger RNA (Nature)

Why can’t we use a disinfectant to fight a virus once it’s in our body?

Disinfectants are not to be used internally and can cause great damage to the human body if ingested or injected. Most disinfectants, like Lysol and bleach, are formulated to destroy viruses and bacteria on household surfaces and are not meant to be safe for human cells. Many carry warnings specifically against ingestion and urge users to wear gloves and to avoid getting these strong chemicals in the eyes because the mechanism that makes them effective against bacterial cells and virus particles can also work against the cells of your own body. A disinfectant cannot differentiate between healthy human cells and disease-causing invaders, and even skin-safe medical antiseptics, like those used before surgery, are not meant to be ingested. These chemicals, properly used, destroy loose virus particles and bacteria that have not yet infiltrated a human body, and this is one of the key differences between them and a thoroughly vetted medicine that is formulated for a specific cellular interaction. 

Even if disinfectants could somehow be ingested safely (which they cannot!), the disease-causing germs are not passively sitting on the surface of your digestive tract, lungs, or blood vessels. A chemical cannot just wash over them and break them down. Viruses are much, much smaller than human cells and actually enter the host cell to force the cell to copy the genetic information of the virus. A disinfectant chemical passing through your body would not be able to disentangle the virus from the infected cells without causing great bodily harm.

This is one of the reasons viruses are so tricky to treat. Antibiotics, which work against bacteria, can target the various cellular structures or processes that bacterial cells use to attack a body, rendering them useless. A virus, however, is not alive, and antiviral medicines are complicated to formulate. A drug that could be flushed through the lungs to treat a viral infection would certainly not be known as a disinfectant. 

What countries are most prepared for a pandemic? What makes those countries better prepared?

The countries that are most prepared for a pandemic are those that are wealthy, but even they are not fully ready for an outbreak of the novel coronavirus. Citing the Global Health Index, a 2019 report ranking the countries prepared for an outbreak, Business Insider notes that such countries as the U.S., the U.K., the Netherlands, Australia, and Canada are at the top of the list. These rankings are based on several categories, including prevention, detection, rapid response, strength of the health system, adherence to international norms, and the country’s overall environment. Yet, The New York Times notes that the U.S. is far short of recommendations outlined in a 2005 federal government report, which estimated that 740,000 respirators would be needed in case of an outbreak. A 2010 study found that only about 62,000 ventilators were available across hospitals in the U.S. and about 10,000 in the Strategic National Stockpile. Moreover, the U.S. has already received criticism over its response to the novel coronavirus pandemic, including poor testing and lack of access to health care services.

At the other end of the spectrum, developing-world countries do indeed fare worse than wealthy nations during a pandemic. A 2017 Brookings Institution blog article states that low- and middle-income countries have few resources to monitor outbreaks and weaker health systems that lack the ability to manage a surge in cases. The authors speculate that if a pandemic like the 1918–19 Spanish flu were to occur, there could be 62,000,000 deaths worldwide and that 96 percent of them would be in low- and middle-income countries.

Apple and Google are talking about using our phones to track the spread of COVID-19. How did we track previous epidemics or pandemics?

Apple and Google intend to apply advanced technological tools to help track the spread of COVID-19, but they will actually use an old and simple method of epidemiology known as “contact tracing.” Contact tracing is the process of identifying people who have come into contact with an infected person so that those contacts can be monitored, receive timely treatment if infected, and take precautions to prevent the spread of the disease.

Contact tracing has long been one of the primary ways public health officials prevent, study, and address epidemics, and the development of modern methodical tools for contact tracing goes back to the mid-1800s. Typically, the primary way of tracing contact has been through conducting interviews and surveys that ask infected persons about their movements and with whom they have been in close contact. Interviews and surveys are still being used to track the spread of COVID-19, and, in fact, the effective employment of these methods has contributed to the successful containment of the outbreak in places such as Singapore and Hong Kong. But effective contact tracing can be laborious, expensive, and time-consuming, especially considering the impossibility of a person providing a complete picture of all their movements and contacts.

By using the tools at their disposal, Apple and Google can help identify and notify people who have come into contact with the infected person without relying primarily on the knowledge or memory of the infected person. Such tools can also trace and notify contacts with greater immediacy and with less coordinative work, thus increasing both speed and efficacy while also reducing cost and interpersonal contact.

What's the difference between self-quarantine and self-isolation when it comes to COVID-19?

Self-isolation and self-quarantine are two ways in which people can help stop the spread of COVID-19. The difference between these two measures is whether or not a person or group of people is known to be infected or sick with COVID-19. In self-isolation, individuals who are already infected or sick separate themselves from healthy individuals. In self-quarantine, individuals who may have been exposed to COVID-19 separate themselves from others and remain confined to an area for a period of 14 days. During this time, individuals monitor themselves for symptoms, restrict their movements, and keep their distance from others.

* A note on the term wet market: Usage in English-speaking countries in the West during the COVID-19 pandemic seems, by and large, to have applied this term to any market in Asia that sells animals. As Mary Hui has pointed out in Quartz, though, “Wet markets, as they are widely known across Asia—in particular Hong Kong and Singapore—do not sell wildlife.…The markets are ‘wet’ because they don’t primarily sell ‘dry’ goods like packaged noodles, though some wet markets also have stalls selling dry grains and legumes.” A more precise label for a market that sells live animals may be wildlife market, though, as Hui also recognizes, this too can lead to tortuous linguistic gymnastics. She cites the Oxford English Dictionary’s announcement in 2016 of wet market as a new entry, among Hong Kong English words, to support her nuanced approach. Collapsing these culturally specific distinctions can result in discrimination and offensive stereotypes, as the World Economic Forum’s Peter Beech warns. Should the Huanan market be called a wet market or a wildlife market—or, perhaps, something else, such as a farmers market? While the nuance is important, use of these terms is in flux during an evolving global crisis; the focus of the question and answer about “wet markets” is about the mechanism of transmission. —J.E. Luebering

Some of these questions were originally answered by Britannica’s editors on Britannica’s Beyond.

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