Get Our Newsletters Let’s Talk About the Novel Coronavirus COVID-19 may be the defining (and scariest) global crisis of our time. Your best defense is knowledge and preparedness. Minus any fake news. by Erin L. Boyle Health Writer November 4, 2021 Medical Reviewer Vincent A. Covelli, D.O. ON THIS PAGE BasicsCommon SymptomsLess Common SymptomsSeverity of COVIDLong COVIDTransmissionCOVID-19 VaccineComirnaty (Pfizer-BioNTech Vaccine)Moderna VaccineJ & J VaccineBooster ShotsThird COVID Vaccine DoseCOVID Booster and ScienceCOVID Vaccines Pending ApprovalFully Vaccinated GuidelinesVaccine EligibilityNew VariantsIncubation PeriodCOVID-19 & Older AdultsCOVID-19 & PregnancyCOVID-19 & ChildrenRisk With An Underlying Health ConditionAdditional COVID RisksWhat to Do If You Have COVIDHow to Get TestedWhen to Get TestedSelf-QuarantineTreatmentCOVID Treatments to AvoidWhen to Get HelpPreventionMasksCOVID vs. Flu WE ARE NOW approaching the second winter of the pandemic, and the novel coronavirus that causes COVID-19 is responsible for extraordinary pain and sorrow. Some 740,000 Americans have been lost to this modern-day plague, and an estimated one in three people who caught the virus are reporting “long-haul” symptoms. All told, it’s been a run of severe ups and downs. A recent, anxiously anticipated “up” was the approval from the Centers for Disease Control and Prevention (CDC) in early November to give emergency use authorization (EUA) of the Pfizer/BioNTech’s COVID vaccine for 28 million American children ages 5 to 11. More “up”s include the full approval of the same vax in people 16 and older from the U.S. Food and Drug Administration (FDA), plus new treatment possibilities in the works, including an oral antiviral medication and long-acting antibody therapies that reduce the risk of hospitalization and death from the virus. Then there are the downs … including the highly contagious mutant Delta variant that spread rapidly across the U.S. in the summer 2021, causing the CDC to reverse its May 2021 stance green-lighting vaxxed Americans to drop their masks and take part in pre-pandemic activities without worry. You’ve likely also heard about “breakthrough” cases, or COVID infections in the fully vaccinated, whose risk of getting sick remains low: about one in 5,000. The current crop of vaccines are holding their own, although federal health officials are recommending booster shots for some populations and third (and possibly even fourth) shots for the immunosuppressed community. As President Joe Biden signed executive orders for extensive vaccine mandates in the early fall 2021, you may be left with many questions about this ever-evolving story. Our regularly updated coronavirus guide, led by a panel of top infectious disease doctors and citing dozens of leading-edge studies, answers them all so you can protect yourself, and others, with the very latest information available. MORE TOP ARTICLES ON COVID-19 COVID Vaccines and FertilityAntiviral Drugs For COVID-19COVID-19 VariantsCoronavirus and Autoimmune DiseaseWhat’s My COVID Risk Right Now?COVID-19 Delta VariantEndemic vs. Epidemic vs. PandemicCOVID-19 Prevention COVID-19 Our Pro Panel We went to some of the nation's top experts in infectious disease to bring you the most up-to-date information possible. Amesh A. Adalja, M.D. Internist specializing in infectious diseases and critical care University of Pittsburgh Medical Center Pittsburgh, PA Jeanne D. Breen, M.D. Infectious disease specialist, Assistant Clinical Professor, Laboratory Medicine Yale School of Medicine New Haven, CT John Swartzberg, M.D. Clinical Professor, Emeritus UC Berkeley - UCSF Joint Medical Program, Infectious Diseases & Vaccinology Division, UC Berkeley School of Public Health Berkeley, CA COVID-19 Frequently Asked Questions Can coronavirus be carried by dogs or cats? Yes, cats and dogs can get coronaviruses, but they can’t give you their versions. Although it's rare, there is some What Is Coronavirus? So, just what is this illness? The novel coronavirus is a new disease strain in a family of viruses called “coronaviruses,” which were discovered in the late 1960s. They cause everything from mild to severe upper-respiratory tract illnesses (plus a range of other documented symptoms) and are zoonotic, meaning they’re transmitted from animals to people. The name comes from the way the virus looks under a microscope: It has crown-like—or “corona,” the Latin word for crown—spikes on its surface, to better grab hold of our cells. Humans experience seven different strains of coronaviruses. Turns out, it’s quite likely you’ve already had one of them—the common cold. COVID-19 (SARS-CoV-2) This latest version—now a pandemic (meaning it’s spread around the world)—is called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) because of its similarity to the coronavirus strain that caused the severe acute respiratory syndrome 1 (SARS-COV-1) epidemic, which occurred in 2002-2003, and infected over 8,000 people from approximately 29 countries and resulted in over 770 deaths. The illness that the SARS-CoV-2 virus causes is COVID-19. It was first reported in December 2019 in the city of Wuhan, China, in the Hubei province, and new research, published in Clinical Infectious Diseases in June 2021, suggests that SARS-CoV-2 may have been present in the U.S. earlier than first thought, also in December of that year. Most of us colloquially call it “the coronavirus,” and technically that’s accurate because it is a member of that viral family. But for the record, the correct name for the virus is acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Nikki Cagle SARS-CoV and MERS-CoV Two other severe strains of coronavirus—severe acute respiratory syndrome (SARS-CoV, or just SARS) and Middle East Respiratory Syndrome (MERS-CoV, or just MERS)—broke out in the last two decades in more than 20 countries, leading to some 1,600+ deaths. While COVID-19 seems more infectious than those two, it also seems less deadly (in terms of the amount of people who died after contracting those infections), which is not always as great as it sounds… easier transmission results in more cases, making it harder to stop the infection, hence how it became a pandemic. The transmission source of this coronavirus disease is currently under investigation, but it’s possible it started in bats. From there, it’s theorized, it moved to humans. In May 2021, President Joe Biden released a statement saying he’d asked intelligence officials to report back to him in 90 days regarding where the virus had originated. This following speculation that the virus might have started in an accidental release from the Wuhan Institute of Virology—known as the “lab leak” theory, which hasn’t yet been discounted—or proven. Common Coronavirus Symptoms Since the start of the pandemic, the World Health Organization (WHO) has defined a suspected case of COVID-19 as a person who meets both clinical (which is fever AND cough; or any three or more of these symptoms: fever, cough, general weakness/fatigue, headache, myalgia, sore throat, coryza, dyspnoea, anorexia/nausea/vomiting, diarrhea, altered mental status) and epidemiological criteria (meaning you’re in an area with high transmission of the disease, or you work in any healthcare setting). According to the CDC, symptoms are often mild and begin gradually, and first appear two to 14 days after exposure to the virus (though most cases occur approximately four to five days after exposure). However, as you’ll see from the percentages below, not everyone who has COVID-19 experiences those symptoms, or even any of the symptoms. Here’s the thing to understand about COVID-19: The severity and duration, or whether you get any specific symptom at all, is based on how your immune system handles the disease. It’s why it’s so difficult for doctors to give specifics about how long chills will last or how bad a cough might be. Maddeningly, the coronavirus likes to get personal. Which is why the Delta variant is so confounding. This more transmissible strain has now been documented in up to 93% all current U.S. COVID cases. Its symptoms are reportedly similar to (but tend to present faster than) early COVID symptoms (outlined in detail, next) from the original strain but can also include more cold-like symptoms, including: Cough Congestion Runny nose Sore throat As we learn more about the Delta variant and studies are released, we’ll share more data on Delta-specific symptoms. For now, according to the CDC, the most commonly cited symptoms of COVID-19 are: Fever This is the most prevalent symptom, occurring in about 88% of people in one of the largest collections of COVID-19 cases, a report from WHO of 55,924 laboratory-confirmed COVID-19 cases in Wuhan, China. These results are from earlier in the pandemic (February 2020), yet later results reported by the CDC (collected in 16 states from 199 patients from January to June 2020) still showed fever as a prominent symptom in COVID (80% in the CDC report). Our normal body temp is around 98.6 degrees Fahrenheit. A fever is defined as above 100.4 degrees Fahrenheit. Cough About 67% of people in Wuhan had this symptom, with 84% experiencing it in the CDC report later in the year, which has been described as a dry cough that happens intermittently. That said, your cough might be different. It might be dry and called “unproductive,” meaning with no mucus. Or it might be wetter, producing mucus whenever you cough. You might cough so much, it hurts. You might not. Another reason why this virus can be so difficult to pin down. Shortness of Breath This symptom was reported in about 18% of cases in Wuhan, but more in the CDC report (57%). According to the U.S. findings, shortness of breath was more commonly reported by hospitalized than non-hospitalized patients (82% versus 38%). Your immune system response and health risk factors will establish your baseline risk for this, as well. So, say you have emphysema: You might be short of breath during the day already. But if you’re an athlete, you wouldn’t feel winded until you ran a distance, or ran at top speed. Both are typical. What isn’t typical? If you have a hard time breathing while doing daily activities that don’t typically cause an issue. Then it might be COVID-19-related. Fatigue You know the deep exhaustion that can hit during the flu? This feels the same, and about 38% of people with COVID-19 experienced it in early Wuhan data, with 62% reporting fatigue in the newer CDC data. Sputum Production Occurring in 33% of cases in the WHO report in Wuhan (the CDC report didn’t include this symptom), this mix of saliva and mucus is coughed up from the respiratory tract. Sore Throat This is typical throat pain, like the kind you might have with a cold. About 14% of people in Wuhan with COVID-19 had a sore throat. (The CDC update didn’t include this symptom either, but by widely reported evidence, it happens—and is increasingly common as a symptom of the Delta variant). Muscle Pain Muscle aches occurred in 14.8% of cases in Wuhan, according to the WHO report on symptoms there, and far more in the CDC report of 16 U.S. states—63%. Called myalgia, the areas where you feel muscle pain and ache can vary. Inflammation could play a big role in this pain, according to a 2021 study in Skeletal Radiology. Imaging could help your doctor learn more about what’s going on to cause muscle pain after COVID, and send you to the right specialist to treat the pain, study authors say. Possible areas you might have musculoskeletal involvement/pain with COVID could include: Hip pain Knee pain Neck pain Shoulder pain Joint Pain Can COVID cause joint pain? The short answer: Yes. The long answer is, called arthralgia, data from China showed joint pain happened in 14.9% of cases, according to a study published in The Lancet Rheumatology on October 5, 2020. However, study authors say that data on the rheumatic and inflammatory manifestations, including arthritis, of COVID-19 are still “scarce.” That’s confirmed in a blog on OrthoInfo, from the American Academy of Orthopaedic Surgeons, written by a physician who says that the virus might worsen existing arthritis—but long-term effects are as yet unknown for this symptom. It’s been reported anecdotally that sore joints are a real issue of COVID, both during the acute part of the infection and as a long-term symptom. The 2021 study in Skeletal Radiology outlines how chronic rheumatologic diseases triggered by SARS-CoV-2 are reported in the literature, including systemic lupus erythematosus, dermatomyositis, Graves’ disease, rheumatoid arthritis, and psoriatic spondyloarthritis. Headaches Feels like your basic, pounding headache, but it’s coupled with other COVID-19 signs. (So you’d know it’s not just a stress headache from all the bad news.) Thirteen percent of cases include headaches as a symptom in Wuhan; 59% reported headaches in the CDC report. Headaches are increasingly common as a symptom of the Delta variant. Chills Oh, that familiar feeling you get with the flu. It happens with COVID-19 too, in about 11% of people in Wuhan and 63% in the U.S., sometimes involving full-body shakes. Different people will have them for different durations. New Loss of Sense of Smell (Called Anosmia) and Taste (Called Ageusia) While these symptoms have not been as common as other COVID-19 symptoms, they do occur frequently enough to gain attention. The prevailing scientific explanations are that because the loss of taste and smell occurs mostly in the absence of nasal congestion, it’s most likely due to direct damage to the nerves of smell and taste. Return of sensation varies, and has been reported to occur anywhere from three weeks to one year after infection (and some people haven’t yet gained back sensation). One of the early studies on this subject, published in Clinical Infectious Diseases on August 1, 2020, reported that of 59 hospitalized patients with COVID in Milan, Italy, 20 (33.9%) reported at least one taste or smell (a.k.a. olfactory) disorder, and 11 (18.6%) had both. Younger, female patients had a higher reporting rate for these issues then older, male patients. However, these age and sex differences have not been confirmed in other studies. Nausea or Vomiting You can see why people keep saying the coronavirus is like the flu. The symptoms are similar. While nausea and vomiting happen with COVID-19, they’re not always routine: 5% of patients threw up or felt like they might in Wuhan and in the newer U.S. data, 13% experienced vomiting. Nasal Congestion and/or Runny Nose Stuffy noses can happen with COVID-19, but they’re not as typical as other symptoms, occurring in nearly 5% of cases studied in Wuhan. However, congestion and runny nose are two increasingly common symptoms of the Delta variant. Diarrhea There’s no doubt about it, GI issues are a real problem with COVID, far more than we first realized: About 50% of people with the illness experience at least one or more GI problem. In Wuhan, about 7% had diarrhea, but in the U.S. group, it happened in 38% of patients. One study published on March 30, 2020, in the American Journal of Gastroenterology even found that some people with a mild form of COVID-19 experience diarrhea first—with COVID's typical respiratory symptoms not showing up till days later, or ever. Nikki Cagle Less Common Symptoms of Coronavirus There are other symptoms that have been reported anecdotally by doctors and people who’ve tested positive for COVID-19. They include: Conjunctival Congestion Otherwise known as "pink eye," this is when your eyes are red and a watery discharge keeps flowing out of them. A study out of Wuhan of 216 hospitalized children with COVID-19 showed how 22.7% (49 kids) had this symptom. There is also a well-documented connection between pink eye and respiratory viral infections, according to the Cleveland Clinic. Hemoptysis This is an awful one. It’s when you cough up blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. It occurred in 0.9% of cases in the large China patient group. Rashes and Toe Bumps Dermatologists are researching peculiar new skin rashes that may be linked to COVID-19. Some coronavirus patients are reporting red and purple bumps on their toes, which are painful to the touch and can become inflamed within a matter of days. This condition, which most commonly occurs in young people and seems to appear before other symptoms, has been informally nicknamed “COVID toes.” In addition, several other forms of rash (like full body hives) are increasingly being reported. How Bad Is COVID? The good news throughout the pandemic has been (and seems to hold true with the Delta variant for vaccinated people), that more than 80% of people with COVID-19 have mild, uncomplicated illnesses and don’t need to go to the hospital. The not-so-great news: About 14% develop severe disease requiring hospitalization and oxygen support, and, of those, up to 30% require admission to an intensive care unit (ICU). COVID Long Haulers (PASC) Then there are the growing number of COVID-19 “long-haulers.” Also known as post-acute sequelae of COVID-19 (PASC), or in the patient community, long COVID or long-term COVID, its reach still remains uncertain. National Institute of Allergy and Infectious Diseases Director Anthony Fauci, M.D., has estimated 25% to 35%—or more—of those who have COVID might have symptoms beyond the acute stage of either mild or more serious infection (which is typically two to three weeks after illness onset). Specifically, the term generally refers to symptoms that develop during or after acute COVID-19 illness, continue for four or more weeks, and are not explained by an alternative diagnosis. It is not yet known whether long-COVID represents a new syndrome unique to COVID-19 or overlaps with recovery from similar illnesses. And it’s not just adults who are impacted by long-term COVID symptoms—kids are experiencing them, too, with specialty clinics opening up at children’s hospitals around the country and the world. One study, published in April 2021, found that 42.6% of 129 children, 18 years old and younger, experienced at least one long-haul symptom 60-plus days after infection. A June 2021 white paper from FAIR Health (a health care nonprofit) looking at the private health care claims of nearly 2 million COVID-19 patients found that 23.2% had at least one post-COVID condition. The nonprofit’s analysis of these records also found that COVID cases of all severity—from those who were hospitalized with COVID to those who were asymptomatic—experienced post-COVID conditions. All ages, from children to seniors, were impacted by long-term COVID symptoms, results found. In addition, with long-term COVID, some people have some symptoms that just don’t stop. In fact, many hospitals in the U.S. are setting up COVID clinics to help patients receive multidisciplinary care for the wide range of symptoms people can face. One study, published in April 2021 in The Lancet Psychiatry, found that six months after a COVID-19 diagnosis, one in three patients had experienced a psychiatric or neurological illness, including anxiety, strokes, or dementia. Dr. Fauci has said that lingering issues from COVID are “highly suggestive” of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), according to a JAMA article, which is a real concern. Currently, there is no cure or U.S. Food and Drug Administration (FDA) -approved treatment for ME/CFS (which you might know from its former name, chronic fatigue syndrome). In December 2020, Congress approved $1.15 billion in funding to the National Institutes of Health (NIH), for researchers to investigate long-term COVID. As scientists and doctors race to gain answers, to date some 166,000 long-haulers gather on Facebook forum Survivor Corps and other social media groups and platforms to discuss their experiences, offer support, and help collect patient-lead research into long-term symptoms. COVID Long-Hauler Symptoms One study in The Lancet looked at 1,733 Chinese patients with COVID and found that 76% of people (more women than men) still had at least one symptom six months after first getting sick with the virus. Symptoms included: Anxiety Depression Fatigue Muscle weakness Sleep difficulties According to the Mayo Clinic, other long-hauler COVID symptoms can include: Cough Chest pain Fast or pounding heartbeat Headache Loss of smell or taste Memory, concentration, or sleep problems Rash or hair loss Shortness of breath People around the world are reporting that these COVID symptoms are lingering. Some are seriously ill months after first getting sick. Others are struggling with COVID as a chronic illness, never fully rebounding from fatigue, cognitive issues (known as “cog fog”), unusual heart rhythms, shortness of breath, and additional documented ailments for weeks or even months after the initial onset of illness. No matter how you slice it, there is a growing community of people around the globe who are frustrated and struggling. Some are healthcare workers who were exposed to heavy viral doses with limited personal protective equipment (PPE) early on in the pandemic, according to a JAMA report. As you can see, the way this illness plays out is a bit all over the place. COVID-19 can cause life-threatening symptoms, worsening to pneumonia; it may cause long-term, possibly chronic symptoms; or you can feel just fine and still have this virus. How Is COVID-19 Transmitted? Since the start of the pandemic, the CDC and WHO have reported that the main way people are infected with COVID-19 is through exposure to respiratory droplets carrying infectious virus. Let’s explore how you can be exposed to COVID droplets, according to the CDC: Droplet Transmission We know the virus can spread through close contact with those who have the infection, from exposure to small-, medium-, or large-sized droplets of the coronavirus that are expelled into the air when an infected person coughs, sneezes, talks, shouts, or even sings, and you inhale their expelled mucus or salvia into your lungs. There is some evidence that suggests louder talking and singing (like one does at choir practice or in loud bars) puts more droplets into the air, creating a higher viral load and upping transmission risk. This type of transmission occurs when you are close to an infected person, at first reported as generally within six feet, although a November 2020 study published in the Journal of Korean Medical Science found droplet transmission of more than 21 feet away between two people who were indoors but not interacting. Wearing a mask whenever possible around other people whose vaccination status is in question, and avoiding crowded areas and indoor areas with poor ventilation and air flow, is your best way to avoid droplet transmission. Airborne Transmission This means that small droplets and particles of COVID-19 can become aerosolized and hang in the air across distances greater than six feet (think of it like invisible clouds of cigarette smoke) in poorly ventilated spaces for minutes up to possibly three hours, according to research published in The New England Journal of Medicine in March 2020. The CDC’s updated guidance on this, as of early May 2021, includes info on activities that raise this risk, such as being in areas with inadequate ventilation and around people with increased exhalation (like when they’re singing or shouting or taking part in physical activity), as well as prolonged exposure to those things for more than 15 minutes. So, if someone with COVID expels infected droplets (maybe by sneezing), walks away, and then you walk into those (now airborne) droplets without knowing how someone infected was there before you spreading the virus, there’s a possibility that you can catch COVID. Which is a sobering thought. And more reason than ever to not only wear a mask but to wear a good mask, one that provides adequate coverage. Like a N95, K95, or even two masks at once. (We’ll talk face masks in more detail soon.) Contact Transmission This infection pathway is exactly what it sounds like: People can pick up the virus by touching other infected people or surfaces that are contaminated, then touching their hands to their nose, eyes, or mouth. This is why the CDC recommends that you wash your hands after touching such surfaces, and avoid shaking hands or physical contact with others outside your household. But contact transmission doesn’t seem to be a common way that the virus spreads (despite what experts first thought), the CDC reports. In fact, in April 2021, officials announced updated guidance on cleaning and disinfecting, saying that “in most situations, regular cleaning of surfaces with soap and detergent, not necessarily disinfecting those surfaces, is enough to reduce the risk of COVID-19 spread.” Disinfecting is only recommended in indoor settings (like schools and homes), where someone has COVID or is suspected of having COVID in the last 24 hours. Other Possible COVID-19 Transmission Pathways It’s important to note that these transmission pathways are not mutually exclusive, and that information about COVID-19 is ever-evolving. As more people around the world get the illness, health care professionals share what they’re learning in real time, and researchers and major health organizations rush to publish the latest accurate data, we’ll continue to share all updates with you. Here’s how you may get it (but we’re not sure): Feces. Officials are recommending that anyone in your house with the virus use their own bathroom—if possible—to reduce potential infection of others in the house. Early research seems to indicate that the virus is “shedded,” or released, through your stool, and since one COVID-19 symptom is diarrhea, experts are studying whether it’s transmitted through feces. While theoretically possible because of fecal shedding, to date, there have been no reliable data or evidence to conclusively demonstrate fecal transmission of the COVID-19 virus. Urine. Nobody knows yet whether it’s a transmitter, either; it was one way the 2003-2004 SARS virus was shed, so more research is underway. As for fecal transmission, to date, there have been no reliable data or evidence to conclusively demonstrate urine transmission of the COVID-19 virus. Here’s what’s unlikely (but uncertain): Sexually. While you can get this novel coronavirus from kissing—in which you share saliva droplets mouth-to-mouth—it is still a question mark whether it can be sexually transmitted. A small study found it in the semen of men diagnosed with the disease, but there was no evidence partners were infected this way. Mother-to-baby. When a pregnant woman passes a virus on to her baby, it's called vertical transmission. Studies on COVID-19 have found both positive and negative correlations in this regard. We’ll talk a little more about this later on. Blood. Unlike other viruses, like Hepatitis C, it doesn’t appear that you can be infected with COVID-19 through blood exchange. Water. Certain diseases, such as cholera, can be caught by drinking water infused with harmful bacteria. COVID-19 doesn’t seem to transmit through H20. Food. It appears that food won’t give you the virus, so takeout should be OK—though if you want to double-down on safety, you can recook your eats and bring them up to temperature (depending on the specific kind of food) to ensure all pathogens are killed. Is There a Vaccine for COVID-19? Why, yes there are—three, actually, two of which are approved for emergency-use in the U.S., with another given the full, official green light by the FDA. And there are more almost certainly on the way here (and others available worldwide). Operation Warp Speed—which includes the Department of Defense, the Biomedical Advanced Research and Development Authority (BARDA), and other U.S. government agencies—was created, in part, for the successful development and distribution of safe and effective vaccines. This initiative is helping accelerate the vaccine approval process, safely and effectively in the U.S., which may help explain why vaccine rollout seems to be happening so quickly for a virus that’s less than two years old. Originally, 125 potential vaccine candidates for COVID-19 were considered, but that’s been narrowed to the current offerings as more research was conducted and companies dropped out. And now, with the late August 2021 FDA approval of the first-ever COVID vaccine from Pfizer-BioNTec, now newly named Comirnaty (koe-mir’-na-tee), the pioneering work of scientists, researchers, and others has achieved what the FDA dubs a “key achievement for public health.” Vaccine Mandates With the official approval of Comirnaty and some 80 million Americans eligible for vaccination who haven’t yet received it, President Biden announced sweeping vaccine mandates in September 2021 that could impact 100 million Americans. They include requiring: Employers with 100 or more employees demand their workers either get vaccinated or be tested for COVID weekly. Companies could be fined up to nearly $14,000 per violation by the Occupational Safety and Health Administration (OSHA), which is overseeing this sector of the mandates. OSHA officials will first need to issue an “emergency temporary standard” (ETS) before setting an official vaccinate-by-deadline, which may come in early November (with another 75 days after that until the likely official deadline). But officials in some states are threatening to challenge this requirement in court, so when it’s put into effect might hinge on the outcome of lawsuits. Employers to give employees paid time-off to get vaccinated. All federal workers and contractors to be vaccinated (although religious and medical exemptions are still happening), a mandate that was already in place—the updated change is that now there is no option for opt-out testing. The deadline for vaccination is November 22. Health care workers at hospitals receiving Medicaid and Medicare funding and other health care settings are to be vaccinated. As of early October 2021, a deadline has yet to be set. Educators in federal Head Start programs to be vaccinated. Deadline still to be determined, as well. President Biden also asked that governors require vaccinations for school teachers and staff. In nine states (California, Connecticut, Hawaii, Illinois, New Jersey, New Mexico, New York, Oregon, and Washington), Washington, D.C., and Puerto Rico, vaccination requirements now exist for K to 12 school staffs. (Of note, currently California is the only state to require students to be fully vaxxed, with a July 1, 2022, deadline for all students in grades 7 to 12, with another deadline of six months after full EUA is given for younger children.) Tension has built between those who choose not to vax—for a variety of reasons—and those who do (and keep in mind that all children under 5 will likely soon be the only age group not eligible for COVID vaccination). For some, however, vaccination already might be a requirement for some aspects of daily life. In New York City, Mayor Bill de Blasio announced in early August 2021 that the city will require people dining inside restaurants, working out at a gym, or drinking at a bar to show proof of vaccination. The city is also requiring all municipal employees be vaccinated with a first shot by October 29, with a testing option for unvaccinated workers eliminated. And the U.S. military required members to receive the COVID-19 vaccine beginning in September. The latest group to join this growing list of vaccine mandates are major universities and colleges for the 2021-22 fall semester. Comirnaty (Pfizer-BioNTech COVID-19 Vaccine) This vaccination is manufactured by Pfizer, an American pharmaceutical company, and BioNTech SE, a German biotechnology company. It’s called a messenger RNA (mRNA) vaccine, and it doesn’t have any live virus in it. Instead, it works by telling our cells how to make a spike protein that causes an immune response in our bodies. This produces all-important antibodies to the virus (which then fight off the virus when you encounter it). For otherwise healthy individuals, it's given as two shots, ideally 21 days apart, in the muscle of the upper arm. The CDC's updated guidelines say that the second dose can be delivered up to six weeks after the initial shot is given. For the immunosuppressed population, the CDC recommends a third shot be given at least 28 days after the second shot to help produce an adequate antibody response. It’s FDA-approved for the prevention of COVID-19 in those 16 years and older (including those who are pregnant and breast/chest-feeding). It’s still available with emergency use authorization (EUA) in those 12 to 15 years old and as a third dose in certain immunocompromised individuals. With the CDC’s early November 2021 decision to grant EUA approval for the vaccine in children ages 5 to 11 based on the double shots' 91% efficacy, COVID vaccinations will expand once more, leaving only those 4 and younger without a vaccine. A need for vaccines in school-aged kids (according to officials) follows steadily increasing hospitalizations in children since the start of the school year (5- to 11-year-olds currently make up 39% of COVID cases in individuals ages 18 and younger, with 8,300 hospitalizations and 146 deaths). Officials are now testing it in children 4 and younger, and will likely soon approach the FDA with clinical trial findings, officials say. It doesn’t contain eggs, preservatives, or latex. It can now be stored in a refrigerator at 2°C to 8°C (35°F to 46°F) for up to one month. In the early days of its distribution, thawed, undiluted vaccine vials could be stored in the refrigerator for only up to five days, so this change by the FDA definitely makes its administration less of a challenge than when it first rolled out. Possible Comirnaty (Pfizer-BioNTech) Vaccine Side Effects The most common side effects are pain, swelling, or redness on the part of your arm where you received the injection, or chills, tiredness, and headache in the rest of your body. These typically happen within a day or two of receiving the vaccination, according to the CDC, and can happen within seven days as mild to moderate symptoms. Mild to moderate side effects like fever, chills, tiredness, and headache were most common after the second dose. Another potential side effect that’s been reported in the media (but not yet conclusively proven) is a change in people’s menstrual cycles, something that’s likely not a concern unless vaginal bleeding/menstrual irregularities are unusual for you, like if you’re in menopause (and in that case, see your doctor, experts advise). A small number of people did experience more severe side effects than those listed above, which were defined as impacting their ability to do their daily tasks. Keep in mind that side effects in this case are generally a good thing—they’re typically your body’s immune system responding to the vaccine, developing immunity against the virus—the whole point of the vaccine. If you have side effects, be sure to report them to a government vaccine safety monitoring system, so that info can help researchers know and understand what people are experiencing with not just Pfizer-BioNTech’s vax, but all the vaccines available. An easy and simple way to do that? The CDC’s V-Safe After Vaccination Health Checker, a smart-phone app that helps you track any and all side effects of COVID vax in real time. Someone from the CDC might even call and check on you and seek more info, depending on your responses to the app’s web surveys. In clinical trials of the Pfizer-BioNTech vaccine, it was 95% effective at preventing laboratory-confirmed COVID-19 illness in those without evidence of previous infection. A study published in The New England Journal of Medicine in December 2020 found that COVID prevention protection with the Pfizer-BioNTech vaccine didn’t begin until 12 days after the first shot—a week later, it’s 52% effective. And then, a week after your second (and final) vaccination, it reaches its full effectiveness. For those most vulnerable to the worst outcomes with COVID—people over 70—data from Public Health England show that with the Pfizer-BioNTech and Oxford-AstraZeneca vaccines, protection against symptomatic COVID, four weeks after the first dose, ranged between 57% and 61% for one dose of Pfizer-BioNTech and between 60% and 73% for the Oxford-AstraZeneca vaccine. For those in the 80+ age range, results were even better: A single dose of either vaccine appeared to be more than 80% effective at preventing hospitalization, three to four weeks after people received the vax. And the Pfizer-BioNTech vaccine might lead to an 83% reduction in deaths from COVID-19. To date, the vaccine is showing good efficacy, in two shots, against the newer variants like the Delta variant, but researchers are still investigating the shots and newer mutations. The data has differed from country to country with the Delta strain, and we’ll talk about the possibility of the need for additional Comirnaty shots in our booster section. (And keep reading to learn more about COVID’s new variants.) We should note that recent studies have demonstrated that the Pfizer-BioNTech vaccine remains effective against even the Delta variant. A clinical trial done in the UK, published in The New England Journal of Medicine on August 12, 2021, showed that the effectiveness of two doses (as recommended; NOT one) of Comirnaty was 93.7% among persons with the Alpha variant and 88% among those with the Delta variant. On August 18, 2021, the CDC released data that confirmed this. It showed that while vaccines’ ability to prevent infection have reduced since the Delta variant became predominant, they remain effective against severe symptoms, with the estimated effectiveness against hospitalization due to Delta variant holding firm at approximately 95% over a six-month period, in everyone except elderly nursing home residents with underlying medical conditions and those who are immunosuppressed. Possible Allergic Reactions to the Comirnaty (Pfizer-BioNTech) Vaccine Very important to note: You shouldn’t have this vaccination if you’ve had a severe allergic reaction (anaphylaxis) or an immediate allergic reaction to any ingredient in an mRNA COVID-19 vaccine, or are allergic to polyethylene glycol (PEG) and polysorbate. You might have read about a statistically small (but still unsettling) number of allergic reactions to the vaccine. Here’s what we know: The CDC has reported that from December 14 to 23, 2020, the Vaccine Adverse Event Reporting System (VAERS) found 21 cases of anaphylaxis after 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine (or 11.1 cases per million doses) and of those, 71% happened within 15 minutes of vaccination. If you’ve had a reaction to a previous vaccine or experienced anaphylaxis previously, make sure to be observed by healthcare personnel with access to equipment and supplies to treat that for 30 minutes after the shot, according to the Cleveland Clinic. If you have other allergies (as long as they aren’t PEG or polysorbate), you can get your shot and simply be observed for 15 minutes to be sure you don't have a reaction. Comirnaty (Pfizer-BioNTech) Booster Shot Read our booster shot section for more info on a third dose of the Pfizer-BioNTech mRNA vaccine. Moderna’s COVID-19 Vaccine This vaccine is manufactured by American pharmaceutical/biotech company ModernaTX, Inc. It’s also a mRNA vaccine (and it works the same way as the Pfizer-BioNTech vaccine). It’s given as two shots, ideally 28 days apart, also in the muscle of your upper arm. In late January 2021, the CDC updated its guidelines to say the second dose could be delivered up to six weeks after the initial shot is given. Just like Pfizer-BioNTech's mRNA shot, a third shot is now authorized by the CDC and FDA to be given to the immunosuppressed population, including: people receiving active treatment for tumors and cancers of the blood, transplant and stem cell recipients, people taking medications that suppress the immune system, those with moderate to severe primary immunodeficiencies, people with advanced or untreated HIV, and those undergoing active treatment with high-dose corticosteroids. It’s recommended for people 18 years and older (and pregnant plus breast/chest-feeding people too), but new data in adolescents aged 12 to 17 show that, with a milder case definition 14 days after the first dose, the vaccine has 93% efficacy. After two doses, the vaccine was 100% efficient, meaning none of the 3,732 participants had COVID. While the Pfizer-BioNTech and Moderna shots appeared to have similar efficacy (around 95%) in early data, over time, it appears that the Moderna shot might be more protective: A study published in The New England Journal of Medicine in late September 2021 found it was 96.3% effective in preventing symptomatic illness in health care workers, compared to 88.8% for Pfizer. Separate data from the CDC found that while Moderna’s effectiveness against hospitalization remained stable in a four-month period, Pfizer’s fell from 91% to 77%. More research is needed to determine the full picture in comparing these two vaccines’ efficacy, experts say. It doesn’t contain eggs, preservatives, or latex. It also needs to be shipped and used in the same way of the Pfizer-BioNTech vaccine—cold and quickly. Possible Moderna Vaccine Side Effects It has very similar potential side effects to the Pfizer-BioNTech vaccine for the same reason (your immune system is responding as it should). They include pain, swelling, and redness in the area of the arm where you receive the shot, and chills, tiredness, and headache throughout your body. They were common by seven days after the vaccine was given, and most were mild to moderate, though some severe effects were seen in a small group of people—and they were most common after the second dose. In the company’s application for authorization filed on December 17, 2020, it reported that the immunization had a protection rate of 51% at two weeks after the first dose and 94% at two weeks after the second dose. Again, if you have a serious or immediate allergic reaction to the vaccine in the first dose, then you shouldn’t get the second shot. If you’re allergic to polyethylene glycol (PEG) and polysorbate, you shouldn’t have the vaccine, either. See info above about allergies in this type of vaccination. Moderna Vaccine in Children Under 12 Moderna was the first vaccine tested for the safety and effectiveness of their injection in children ages 6 months to less than 12 years old. The company announced the start of its "KidCOVE study" on March 16, 2021, in 6,750 children in the U.S. and Canada, and as of early fall 2021, the results look good. Interim analysis showed a “robust neutralizing antibody response” following two doses of the vaccine at a lowered 50 µg dose level. It also had a “favorable safety profile.” The company has filed for an EUA with the FDA for the vax in children aged 12 to 17. Is the Moderna Shot Effective Against Variants? The same CDC data released August 18, 2021, looking at Comirnaty’s effectiveness against the Delta variant showed that Moderna remained effective against severe symptoms too, with the estimated effectiveness against hospitalization due to this highly transmittable variant holding firm at approximately 95% over a six-month period, in all persons except elderly nursing home residents with underlying medical conditions and immunosuppressed people. And a late August 2021 research letter published in JAMA found that the Moderna vaccine produced higher immune cells levels than the Pfizer-BioNTech shot. The research, looking at 2,499 Belgian health care workers receiving two doses of both mRNAs (1,647 of whom took part in the study), found that after people’s second dose, the Moderna shot results in 2,881 units per milliliter (U/mL) of antibody titers among previously uninfected volunteers, while the Pfizer-BioNTech shot resulted in 1,108 U/mL antibody titers in the same population. Moderna Vaccine Booster Shot Read our booster shot section for more info on a third dose of the Moderna mRNA vaccine. Johnson & Johnson’s Janssen’s COVID-19 Vaccine This vaccine was developed by the U.S. multinational corporation’s Janssen Pharmaceuticals, a pharmaceutical company headquartered in Beerse, Belgium, that Johnson and Johnson (J&J) owns, in combination with Beth Israel Deaconess Medical Center in Boston. It was approved for emergency use by the FDA in late February 2021, but on April 13, 2021, the CDC and FDA released a joint statement calling for a “pause” in the use of the vaccine “out of an abundance of caution” so officials could review six reported U.S. cases of a blood clot called cerebral venous sinus thrombosis (CVST), combined with low levels of blood platelets (thrombocytopenia), after receiving the shot. Key to note: Treatment for this particular blood clot isn’t typical, further complicating things. Per the CDC and FDA: “Usually, an anticoagulant drug called heparin is used to treat blood clots. In this setting, administration of heparin may be dangerous, and alternative treatments need to be given.” This blood clot, known as an “adverse event,” happened in women between 18 and 48 years of age, with symptoms occurring six to 13 days after they received the J&J vaccination. As of April 12, some 6.8 million doses of the J&J vax had been administered in the U.S. While only six cases out of this group are considered an “extremely rare” adverse event, the reactions were severe, and all such adverse vaccine events are taken seriously and investigated, officials say. After review, on April 23 both agencies gave the green light for the J&J rollout to start up again, effective immediately, only with a warning to women 50 and under that they may be at higher risk for this very rare complication. Possible J&J Vaccine Side Effects If you received the J&J shot and you’re concerned, what are the warning signs that something could be wrong? According to the CDC and FDA, contact your health care professional if you experience any of these symptoms after receiving the J&J vaccine: Abdominal pain Leg pain Severe headache Shortness of breath within three weeks after getting the vax The “pause” came after vaccine sites in several states temporarily stopped administering the J&J vaccine in the spring 2021 due to the complication—and in Europe, officials at the European Medicines Agency (EMA) announced an investigation into post-vaccination blood clots with the vax there. But, again, this vaccine is no longer being "paused" and is now available to any American adult who wants it. What’s New About the J&J Vaccine? The latest on this vaccine? Unconnected with the April blood clot concern, on July 13, 2021, FDA officials say they revised their vaccine recipient and vaccination provider fact sheets to include a warning about an “observed increased risk” of Guillain-Barré Syndrome (GBS), a rare autoimmune disease, in a small amount of people after vaccination. FDA officials cited VAERS data, which had 100 preliminary reports of GBS after about 12.5 million J&J doses were administered. Of those, 95 cases required hospitalization, and one person died. Symptoms typically happened within 42 days after the jab. Cases were mostly reported about two weeks after vaccination and mostly happened in men, 50 years and older. If you have any of these symptoms, receive medical help right away: Difficulty with bladder control or bowel function Difficulty with facial movements, including speaking, chewing or swallowing Double vision or inability to move eyes Difficulty walking Weakness or tingling sensations, including in the arms and legs, especially if it isn’t getting better and is going to other areas of your body More Info About the Johnson & Johnson Vaccine: This is a single-dose vaccine, so it’s injected into your arm once. That gives it a big advantage over all the other COVID-19 vaccines currently approved for emergency use in the U.S. (Pfizer-BioNTech's and Moderna’s) that each require two doses. Another way it differentiates itself from the first two vaccines on the market in the U.S.? Technology. It is a viral vector vaccine (similar to the AstraZeneca/University of Oxford vax) with a modified adenovirus instead of mRNA. The type of viral vector used in this case is the adenovirus, a common virus that’s like a cold. This vaccine type, first developed in the 1970s, delivers key instructions to our cells with a modified type of a different virus, called the vector. Here’s how the CDC explains it: “For COVID-19 viral vector vaccines, the vector (not the virus that causes COVID-19, but a different, harmless virus) will enter a cell in our body and then use the cell’s machinery to produce a harmless piece of the virus that causes COVID-19. This piece is known as a spike protein and it is only found on the surface of the virus that causes COVID-19.” Our immune system then kicks in, knowing that this spike protein virus doesn’t belong in the body and must be attacked. It launches a defense with antibodies and other immune cells to stop what it thinks is an infection. This teaches our bodies to protect against any future encounter with the actual spike protein COVID-19 virus. Again, per the CDC: “The benefit is that we get this protection from a vaccine, without ever having to risk the serious consequences of getting sick with COVID-19.” This makes it more shelf-stable than mRNA vaccines, and can stay in a normal refrigerator for up to three months. It was studied in people 18 years and older. J&J Vaccine Side Effects Side effects usually happened on the day of immunization or the next day, typically resolving within 24 hours, and were mostly mild-to-moderate. They included fatigue, headache, muscle pain and muscle ache, and injection site pain. Just like with mRNA vaccine technology, a response is a good thing, because it usually means your body’s immune system is creating the antibodies you need to fight a COVID infection. Results from the company’s Phase 3 ENSEMBLE study show that the vaccine was 85% effective in preventing severe disease across all regions studied, and showed protection against COVID-19 related hospitalization and death 28 days after vaccination. This study, conducted in eight countries across three continents, found that the 28 days post-vaccination, level of protection against moderate to severe COVID-19 infection was 72% in the U.S., 66% in Latin America, and 57% in South Africa. Possible Allergic Reactions to the Johnson & Johnson Vaccine You shouldn’t have this vaccine if you’ve had a severe allergic reaction to any of its ingredients (it does not include any preservatives): o 5x1010 virus particles of the Ad26 vector encoding the S glycoprotein of SARS-CoV-2. 2.19 mg sodium chloride 0.14 mg citric acid monohydrate 2.02 mg trisodium citrate dihydrate 0.16 mg polysorbate-80, 25.5 mg 2-hydroxypropyl-B-cyclodextrin, 2.04 mg ethanol Each dose may also contain residual amounts of host cell proteins (≤0.15 mcg) and/or host cell DNA (≤3 ng) COVID Booster Shot After the FDA authorized a third shot for the immunosuppressed population on August 12, officials also authorized a booster shot of any of the three vaccines available in the U.S. Here are the requirements to receive a booster for each one: Pfizer-BioNTech Booster Shot Requirements This shot can be given to these groups six months after receiving their last/second shot: Individuals 65 years of age and older Individuals 18 through 64 years who are at high risk of severe COVID-19 Individuals 18 through 64 years of age with frequent institutional or occupational exposure to SARS-CoV-2 that puts them at high risk for COVID complications. Moderna Booster Shot Requirements This shot can be given as a booster at least six months after the “primary series” or two shots were given for those: Individuals who are 65 years of age and older Individuals 18 through 64 years of age who are at high risk of severe COVID-19 Individuals 18 through 64 years of age who have frequent institutional or occupational exposure to SARS-CoV-2 J&J Booster Shot Requirements This shot should be given at least two months after the initial shot to: Individuals who are 18 years of age and older The CDC provides more specific information on each category eligible (with some helpful booster shot FAQs) on its website. Just to clarify, the booster shot is a third shot (for Pfizer and Moderna) and a second shot for J&J. However, it’s not considered to be a booster, per se, for the immunocompromised population, the most vulnerable among us, because people in this group often failed to achieve high enough levels of antibodies (and therefore, protection) from the initial two-shot dose. It’s less of a “boost,” then, and more of a three-dose protocol. Booster shots for the other groups listed above are meant to increase waning antibody levels that were initially high and then dropped over time. Heterologous Booster Dose or Mixing and Match COVID-19 Booster Shots And now, according to the FDA, you can “mix and match” your booster shot (called a heterologous booster dose), meaning you can mix the type you get, so maybe you’d prefer the J&J shot (since it works in a different way than the mRNA shots) if you had the Pfizer-BioNTech shot or Moderna shot first. Or vise versa. The CDC reports that the choice is up to you, depending on your own preference. Some experts are saying that mixing shots might be a good idea based on the different vaccine technologies, but that getting the same shot you got before will also likely boost your immunity. Booster shots will be free and available at 80,000 locations. If you haven’t heard from the place where you received your first two shots about a booster, reach out and see if you can receive the third shot at the same place. Or, visit vaccines.gov or call 1-800-232-0233 to learn where you can receive a booster shot. Immunosuppressed Groups and a Third COVID-19 Shot As of August 16, 2021, the CDC officially recommends a third shot (given at least 28 days after the second one) for the following vulnerable groups: Anyone receiving active cancer treatment for tumors or cancers of the blood Organ transplant recipients Those who've received a stem cell transplant within the past two years Those who are taking medication to suppress the immune system People with moderate to severe primary immunodeficiencies Anyone with advanced or untreated HIV infection Those undergoing treatment with high-dose corticosteroids that suppress immune response Then, in October 2021, CDC officials said that certain immunocompromised populations might even need a fourth shot, but didn’t give any official recommendations on the matter (if you think you might need a fourth shot, talk to your doctor). This came after study data showed that 44% of those who were fully vaccinated but immunocompromised accounted for about 44% of breakthrough COVID cases that needed hospitalization, showing the real need for a potential additional shot. The CDC did say that those who had a third dose of Pfizer or Moderna's mRNA vaccines can now have a booster dose of Pfizer, Moderna, or J&J at least six months after completing their third dose. What Is the Science Behind COVID Booster Shots? In July 2021, Pfizer-BioNTech officials announced that their shot appeared to show slight declines in efficacy in preventing infection and symptomatic disease six months post-vaccination. However, it stayed strong at preventing serious illness and death. Its makers say data from the Israel Ministry of Health in Israel with the Delta variant demonstrates this dip in efficacy—hence, its recommendation that a “booster” shot, or one additional shot of the vaccine, be given to everybody. However, the CDC and FDA initially said not so fast—otherwise healthy Americans didn't yet need boosters, based on available data. The WHO agreed, imploring richer countries to share those much-needed vaccine doses with countries that have not yet received initial jabs for their at-risk populations, including the continent of Africa, where only 1.7% of its 1.216 billion people have been fully vaxxed. Even so, Pfizer-BioNTech has been conducting an ongoing trial of a booster dose, with initial data showing an extra dose given six months after the second vaccine dose improving protection against virus variants five to 10 times more than the two primary doses alone. Why might this be the case? The booster causes the amount of antibodies to COVID in a person’s blood to increase, and officials think waning antibodies might be causing the vaccine to be less effective over time. Also in July 2021, the FDA asked the vax companies to add additional children to its COVID-19 vaccine trial for under-12-year-olds to better help determine efficacy and risk of inflammatory conditions, including myocarditis (a condition with inflammation of the heart’s muscle) and pericarditis (inflammation of the heart’s outer lining). More than a thousand reports have been made to VAERS of cases of such inflammation of the heart, mainly in male adolescents and young adults 16 years or older after receiving mRNA COVID-19 vaccination (both Pfizer-BioNTech and Moderna). These cases are considered rare after more than 177 million people have received at least one dose of COVID vaccine in the U.S., and most people recovered well, the CDC reports. What Other Vaccines Are Pending Right Now? These vaccinations are currently in study (and could be released if/when they’re deemed safe in the U.S.): AstraZeneca/University of Oxford’s COVID-19 Vaccine (a.k.a, Vaxzevria in Europe) This vaccine candidate, as yet unapproved in the U.S., was approved in the UK in January, and is now distributed in countries around the world under its newly minted name in Europe, Vaxzevria. It was developed by the British–Swedish multinational pharmaceutical and biopharmaceutical company in partnership with the University of Oxford in Oxfordshire, UK. If/when it’s approved in the U.S. (officials say they plan to apply for FDA emergency-use authorization in April), the U.S. government plans to buy 300 million doses for distribution. But, again, that's only if the vaccine gains the official FDA nod. Multiple European countries temporarily suspended use of the AstraZeneca shot in mid-March 2021 after reports of 37 cases of dangerous blot clots in the more than 17 million people who’ve received the vaccine in the European Union and UK. Later in the spring, the EMA’s safety committee found that “unusual blood clots with low blood platelets should be listed as very rare side effects of Vaxzevria.” “EMA is reminding healthcare professionals and people receiving the vaccine to remain aware of the possibility of very rare cases of blood clots combined with low levels of blood platelets occurring within two weeks of vaccination. So far, most of the cases reported have occurred in women under 60 years of age within two weeks of vaccination. Based on the currently available evidence, specific risk factors have not been confirmed,” officials say. They recommend that those who’ve received the vaccine receive immediate medical assistance if they develop symptoms including: Shortness of breath Chest pain Swelling in the leg Persistent abdominal pain Neurological symptoms, such as severe and persistent headaches or blurred vision Tiny blood spots under the skin beyond the site of injection Vaxzevria continues to stay in the news, with data released by the company in late March finding that it had an overall efficacy of 79% against symptomatic COVID, while completely preventing severe disease or hospitalization. However, the company was soon after accused by U.S. medical officials of manipulating data to make the vaccine look more effective. In response, makers of the AZ vax officially corrected its efficacy rates to 76% at preventing COVID-19. Dr. Fauci described the slightly shifting rates as “an unforced error” before reassuring the public that despite all the drama, “this is likely a very good vaccine.” More about this vax: The AstraZeneca/University of Oxford vaccine is viral vector technology (like the J & J vax). In the UK, the AstraZeneca/University of Oxford vax was approved for use in people 18 years or older in two doses given within four to 12 weeks of each other. It’s injected into the muscle of the upper arm. Side effects were reported as typically mild, and resolved after several days. Very common symptoms (meaning they may happen in more than one in 10 people) include: tenderness, pain, warmth, redness, itching, swelling, or bruising at the injection site; feeling unwell; fatigue; chills or feeling feverish; headache; nausea; and joint pain or muscle ache. Common symptoms (meaning they may affect up to one in 10 people) include: a lump at the injection site; fever; vomiting; and flu-like symptoms (including high temperature, sore throat, runny nose, cough, and chills). Uncommon symptoms (so these may happen in up to one in 100 people) include feeling dizzy; decreased appetite; abdominal pain; enlarged lymph nodes; excessive sweating, itchy skin, or a rash. Like we’ve said before, while side effects are never fun, they’re typically a good thing, showing that our immune system has responded to the vax and is working as it should. You shouldn’t have the shot if you’re allergic to any of its contents, according to officials. The vaccine in the UK contains: L-histidine L-histidine hydrochloride monohydrate Magnesium chloride hexahydrate Polysorbate 80 Ethanol Sucrose Sodium chloride Disodium edetate dihydrate Water for injections Novavax’s COVID-19 Vaccine This American vaccine development company has been moving right along with its NVX-CoV2373 vaccine. With excellent results reported in the company’s large clinical trial in late spring 2021, officials announced they plan to seek regulatory authorizations in the third quarter. More about this vax: The vaccine is made from a stabilized form of COVID-19’s spike protein with the company’s recombinant protein nanoparticle technology. It also includes Novavax’ patented saponin-based Matrix-M adjuvant, an addictive that works to boost the body’s immune response. The vaccine is injected into a muscle in the arm. It’s given in two doses, with the second dose administered 21 days after the first. It’s currently being studied in people 18 years and older. One small study found the second shot had more side effects than the first, with swelling and pain at the injection site both cited as common side effects. It’s easier to distribute and store than the mRNA vaccines because it can keep up to three months in a normal refrigerator. In June 2021, officials announced results from PREVENT-19 (the PRE-fusion protein subunit Vaccine Efficacy Novavax Trial | COVID-19), a phase III trial. It found the vax had 100% protection against moderate and severe disease and 90.4% efficacy overall in 29,960 participants across 119 sites in the U.S. and Mexico. As more data becomes available, we’ll have more information on side effects and possible allergy concerns, plus who shouldn’t have the vaccine. CoronaVac COVID-19 Vaccine Developed by Chinese biopharmaceutical company Sinovac Biotech, this vax is approved for emergency use in Indonesia, Turkey, Brazil, Chile, Colombia, Uruguay, and Laos (final results from its phase 3 trials are not yet available) as well as for the general public in China as of February 6. More on this vax: It’s an inactivated, or dead, version of a coronavirus strain isolated from a patient in China, chemically prevented from replicating in our cells, yet still causing an immune response. It’s given in a two-dose regimen in a two-week interval. The most common side effect was pain at the injection site. This vax is currently in stage III clinical trials in Brazil, Turkey, and Indonesia. In Brazil, it’s been found to be 50.65% effective against COVID-19 disease (results are from its use in 12,396 medical workers older than 18 years as of December 16, 2020, with 253 cases recorded), but had a 91.25% success rate in Turkey, from preliminary analysis of 29 cases, and a 65.3% efficacy rate in the Indonesia trial. (Results in Brazil might have been lower than the other two countries because of its current epidemic case load there, and emphasis on medical workers.) Sputnik V COVID-19 Vaccine Currently being developed in Russia, preliminary data on this vaccine was released in early 2021—and in April 2021, India approved the vax for use there. More on this vax: It’s a viral vector vax based on two different viruses belonging to the adenovirus family, Ad26 and Ad5, modified to contain the gene for making the SARS-CoV-2 spike protein. It’s being administered in people 18 and older. Researchers published findings in The Lancet of 20,000 people that show the vaccine to be about 91% effective. ZyCoV-D Vaccine The Drug Controller General of India (DCGI), has just granted an EUA to the world’s first and only human DNA COVID-19 vaccine known as ZyCoV-D. The vaccine reportedly has been tested on almost 30,000 participants across Phase I, II, and III studies, and is the first vaccine in India to be tested on 12 to 18-year-olds. Interim analysis showed ZyCoV-D to have a primary efficacy of 66.6% for symptomatic PCR-positive COVID-19 infection. No moderate cases of Covid-19 were observed in the vaccine arm of the study after administration of the third dose, suggesting 100% efficacy for moderate disease after the dosing course is complete (but important to note, the vaccine hasn’t yet been studied in the US). Important differences between this Indian vaccine and the Pfizer-BioNTech and Moderna vaccines of America include: Three doses of the Indian vaccine are required and it can be stored at 2-8 degree Celsius and has shown stability at 25 degree Celsius, compared to the Pfizer-BioNTech and Moderna vaccines that require two doses and must be kept at extremely cold temperatures, making transport and storage challenging in some localities. Should I Wear a Mask and Social Distance After Being Fully Vaccinated? We know: The CDC told you back in May 2021 that if you were fully vaxxed, you could ditch your masks and return to normalcy. But in late July, the agency updated those guidelines to the following: “CDC recommends that all people, regardless of vaccination status, wear masks in public indoor settings in areas of substantial or high transmission,” officials say. The CDC shares a map of areas of substantial or high transmission, so check out where you live and what your transmission rates are there. (As you can see, some areas are now moderate to low transmission, but most of the U.S. is still red, or high, transmission.) However, you don’t have to wear masks outside, even in public settings, when you jog, go biking, or gather in small groups if you’re vaccinated. But … the CDC does caution that in those states/areas with high/substantial levels of COVID cases, you should consider wearing a mask in crowded outdoor settings and in activities where you’ll have close contact with others who are not fully vaccinated. Face masks are still required on planes, buses, trains, and other forms of public transportation traveling into, within, or out of the United States, and in places like airports and stations. However, the government agency advises delaying travel until you’re fully vaccinated, because travel “increases your chance of getting and spreading COVID-19.” As of early November 2021, 221 million people, or 66.7% of the total U.S. population, have received at least one dose of vaccine, and about 192.5 million people, or 58% of the total U.S. population, have been fully vaccinated. The CDC is now also listing totals and percentages of the population who’ve received boosters (and since they just started, expect lower numbers): More than 18.6 million people have done so to date (that’s 9.7%). Masking and the Delta Variant As we surf out of (hopefully) the current Delta wave and get to a new normal that sticks, experts say, is to get fully vaxxed as soon as the vaccine is available to you (in addition to masking and socially distancing, if possible). New masking and social distancing mandates are important because viruses rely on an infected host (humans in the case of SARS-COV-2) to survive and replicate. Since mutations and the creation of new mutant variants occur only during viral replication in an infected human, the only way to prevent the rise of new variants is to stop the spread of infection, without which more variants—both “homegrown” and foreign—are a real possibility. Vaccination, masking, and social distancing together offer the maximum protection possible against infection and therefore replication, mutations, and the evolution of new and potentially more dangerous variants. When Can You Get the COVID-19 Vaccine? Now. (That is, if you’re 12 years of age or over in the U.S., soon to possibly be 5 and over with the Pfizer-BioNTech emergency use authorization, or EUA, likely pending.) The CDC, in partnership with other institutions, has a helpful VaccineFinder, which can assist you in finding vaccines by zip code. If you don’t see locations near you, try searching online for your local hospital system, urgent care clinic, or calling your local primary care physician office to see if they know of where you can get a shot. Unique places have been hosting vaccine drives, from churches to county fairs, and some states have even been offering free stuff as added incentive. New Variants of COVID-19 Surely you've heard of it by now—the mighty variant Delta. But it’s not the first mutation (and likely won’t be the last). Even as news of vaccinations brought hope to the world in returning to a “new normal” beyond the pandemic, we learned that COVID-19 had mutated in late 2020/early 2021—which can happen with a virus, especially when there are lots of cases to act as a kind of breeding ground, if you will, for new mutations to form. (To quote a movie about dinosaurs: “Life finds a way.”) To avoid stigmatizing any country where a variant might be discovered (and perhaps not originate), the WHO announced in late May 2021, that COVID mutations would be renamed to letters from the Greek alphabet. The CDC has identified four “variants of concern” (or VOC), mutations that show evidence of an increase in being transmitted, more severe disease, significant reduction in neutralization of antibodies from vaccination or previous infection, reduced efficacy of treatment or vaccines, or failure in diagnostic detection. Those are: Alpha (B.1.1.7, once called the UK variant) Beta (B.1.351, B.1.351.2, B.1.351.3, once called the South African variant) Delta (B.1.617.2, AY.1, AY.2, AY.3, once called the Indian variant) Gamma (P.1, P.1.1, P.1.2, once called the Brazilian variant) New variants being closely watched include Lambda (found in Peru, also called C.37), Mu (found in Columbia and also known as B.1.621) ), and Delta Plus (found in India, also called AY.4.2.). In the U.S., there are documented mutations in California (B.1.427/B.1.429CAL.20C), or the Epsilon mutation; Ohio (various strains); and New York City (B.1.526), or Iota. Another concerning thing? Something called a double mutant coronavirus variant, which has features of the Epsilon variant as well as the Gamma and Beta variants; it was found in the San Francisco Bay area. We’re still learning more about this strain and its implications, so it’s too early to tell what impact such a thing might have. One mutation is causing a lot of issues: the E484K spike mutation. It’s not a new variant but instead occurs in different emerging strains, including in variants from around the world. Dubbed an “escape mutation,” it helps the virus get past our immune defenses. It might prove to be a real foe against monoclonal antibody treatments and current vaccines, so companies are racing to test their formulations against this formidable mutation. The good news in vaccines? Both Pfizer-BioNTech and Moderna vaccines should protect against this mutation, the companies report, while trials for the Johnson & Johnson vax in Latin America showed it was slightly less effective there than in the U.S. and elsewhere in the world, but still worked. On February 17, The New England Journal of Medicine reported that Pfizer-BioNTech’s vax protects people against the new strains, including the Beta variant. And, back in late January, Moderna announced its vax also worked against the UK and South Africa strains. In addition, the AstraZeneca/University of Oxford vax (not yet approved in the U.S.) was almost 75% effective in mild to moderate cases of the Alpha variant of COVID-19 in phase II and III trials, according to a preprint study in The Lancet. However, one concerning piece of news? Pfizer-BioNTech’s vaccine may not be as effective as researchers initially thought against the Beta variant, according to an Israeli study of 400 people who tested positive for COVID-19 14 or more days after receiving one or two doses of the vaccine, as well as an additional 400 unvaccinated people who also tested positive. The Beta variant was found in 1% of all those studied, yet was eight times higher among those who received two doses of the vaccine vs. those unvaccinated (5.4% and 0.7%, respectively). Researchers cautioned that the study had a small sample size of people with the variant, was not yet peer-reviewed, and was not designed to detect overall vaccine effectiveness against any one variant. Let’s break out the details about the new strains: Alpha Strain (B.1.1.7) There is some speculation that this strain, at least, may also be more serious. In late January 2021, scientists from the UK’s New and Emerging Respiratory Virus Threats Advisory Group (Nervtag) concluded there was a “realistic possibility” that this particular variant had become more deadly, though the group is not yet ready to confirm it. Beta Strain (1.351) According to several 2021 studies, this strain may be able to evade detection by antibodies in the immune system, causing issues with treatments and vaccines. In February 2021, South African government officials announced that the AstraZeneca vaccine would no longer be distributed in the country because preliminary data showed it offered only minimal protection against mild to moderate illness thanks to this variant. The country turned, instead, to the J&J vaccination, which provided better results against the country’s COVID variant. In addition, Moderna has been developing a booster vaccine against the Beta strain with the intention of (potentially) giving it down the line after the first round of immunizations are completed. Delta Strain (B.1.617) The infamous Delta variant, which was discovered in India during the country’s spring 2021 COVID-19 surge, has been dubbed a new double mutant variant (though it actually has far more mutations than just two, at 13 in total). It has features of the variants first identified in California, South Africa, and Brazil. It’s also in the U.S. now—and how. Responsible for more than 99% of cases in the country and finally appearing to subside in early fall 2021, with cases dropping by a third since late summer, this variant has overtaken earlier Alpha variant and the original “wild” COVID strain. And little wonder: It’s highly contagious, with the CDC reporting that it’s more contagious than the common cold, the flu, and nearly as much as chicken pox, according to an internal document and a recent report on NPR. One scientist called it “one of the most contagious respiratory viruses that we know of.” A recent study found that, on the day when the virus is first detected, viral loads in Delta infections were 1,000 times higher than earlier strains—in both unvaxxed AND vaxxed people (a key finding that seems to have helped the CDC decide to reinstate masks in high/substantial areas of transmission in the U.S.). As we’ve mentioned, our available vaccines seem to be holding their own against Delta: The Pfizer-BioNTech vaccine has been 96% effective against hospitalization with Delta, according to UK data, and the Moderna and Johnson & Johnson vaccines are showing only slightly reduced efficacy. Still, you might have heard about breakthrough cases in fully vaccinated people who have caught the Delta strain of COVID. Israel has been hit hard by the variant (and the UK and other countries have been, too—it’s been found in about 130 countries in the world now), and up to half of new infections from the Delta variant are found in people who are either vaccinated or have already recovered from COVID, according to news reports. About 90% of newly infected people are over the age of 50 and were fully vaccinated. But let’s put it all into proper context—in an environment with people still unvaxxed (say, children), the virus can still spread easily. And in those same populations that have high levels of vaccination in adults who CAN be vaxxed, like Israel (with more than 78% of people eligible for vaccination inoculated and nearly 600,000 who’ve had a third booster shot), you’ll have higher numbers of people vaccinated who can catch the virus. Remember, the vaccines never promised 100% efficacy and don’t prevent against highly transmitted diseases, but they are effective against severe illness and death, so they’re still working even when you might catch a milder case of COVID after being vaccinated. In the U.S., the CDC released info from one breakthrough case study, which happened in July 2021 when 469 people caught COVID-19 in Provincetown, MA, which had vaccination coverage of 69%. About 74% (346 people) of those cases happened in fully vaccinated people. This data helped guide the CDC to once again recommend that we all mask up. The Delta variant, which is driving breakthrough cases, is infecting more kids than earlier strains did in the start of the pandemic. (See our children and COVID section.) Delta Plus Strain (AY.4.2) This mutation of the highly transmissible Delta strain appears to be even more contagious than its original strain. It’s now accounting for 10% of all COVID cases in the UK. Experts are closely watching that country and its Delta plus cases to see how quickly and widely it spreads to determine just how much of a threat it is to our future (and hopeful) return to a new normal. Gamma Strain (B.1.1.28.1, or P.1) This strain might’ve been the cause of a sharp resurgence of COVID cases in the Brazilian city of Manaus in December 2020, according to researchers. It had been estimated that 75% of the population there already had COVID, which should’ve meant people in the city had immunity and, therefore, protection against the infection, but that did not prove the case against this new strain. It has traveled around the world since. Lambda Strain (C.37) This virus has been circulating in South American in recent months, wreaking havoc on the continent, especially in countries with high COVID rates like hard-hit Peru. It’s been detected in other countries around the world too, including the U.S. According to a recent pre-print article, critical mutations in the spike protein might make this strain more infectious than the Alpha and Gamma variants. Only time will tell which is more infectious: Delta or Lambda. In the same article, researchers looked at the effectiveness of CoronaVac (also known as the Sinovac COVID-19 vaccine), an inoculation common in China, with this strain. They found that it might not be as effective as it had been against earlier strains. Meanwhile, more data is needed about mRNA effectiveness against this new mutation. Mu Strain (B.1.621) Named a “variant of interest” by the WHO in late August 2021, this mutation, first detected in Columbia in January 2021, has spread to countries like Chile, Peru, South Korea, Japan, parts of the U.S. (including the highest numbers in California, Florida, Texas, and New York), and elsewhere around the world. WHO officials say more research is needed into the mutation, to determine how vaccines might do against it. Epsilon Strain (CAL.20C) A strain was identified in Southern California that MIGHT be contributing to their spike in cases in early 2021, according to results from Cedars-Sinai. Called Epsilon, researchers there are not yet sure if it’s more deadly. This strain is independent of the UK and South Africa variants but appears to be just as transmissible. The study’s authors estimate that this variant likely emerged early in the pandemic to now account for half of all COVID cases in the U.S., and suggest it continues to be closely monitored to study its characteristics. It appears to be more transmissible because of a mutation that allows it to bind more easily to human receptor cells. It now makes up more than 50% of cases in 44 counties in California. Ohio Strains On January 19, Ohio State University announced it had identified what it calls the Columbus strain, or COH.20G/501Y. Yet another Ohio strain, called COH.20G/677H, has been identified as a new variant that is unique from the Columbus strain, according to researchers at Cold Spring Harbor Laboratory. Both strains are thought to have been circulating since December 2020. No specifics are yet known about either variant, but their genetic makeup is similar to the UK and South Africa strains, meaning they may be extra contagious. Iota Strain (B.1.526) This strain, first detected in the city and beyond in November 2020, is a cause for concern because it has that “unique set of spike mutations” (yep, the previously mentioned, and worrisome, E484K spike mutation) causing so much havoc with strains around the world, according to a 2021 pre-print study. These might cause issues for current interventions, researchers say, but we don’t know how much trouble this variant might cause—yet. Taken all together, these mutated strains of the virus mean that, even as we learn more about vaccine efficacy against them in real time, we need to remain vigilant by wearing face masks, avoiding crowds, maintaining social distancing, and frequently washing our hands, all to help stop the spread. How Long Is the Incubation Period of the Coronavirus? The signs and symptoms of COVID-19 set in between two and 14 days after first exposure with the earlier, “wild” strain, and researchers are testing the new strains to make sure that holds. It’s this wide range that makes the virus so tricky to contain: People can be walking around with the virus and not know it. And it appears that this disease can still be spread before you have symptoms, or even if you never show symptoms. We’re not sure exactly how many people are what’s called asymptomatic, or don’t have symptoms, but the CDC reports that data suggests “asymptomatic infections can be common.” All of which circles back to the three important ways to lessen the impact of the virus: Social distancing by 6 feet, wearing a mask, and avoiding crowds. If you do get COVID-19 symptoms, researchers found that the median incubation period—the time between when you’re exposed to the virus and when the first signs appear—is just over five days, and that a person is most infectious four to seven days after they catch COVID-19, per a study published in the Annals of Internal Medicine in May 2020. The researchers also reported that 97.5% of people who develop symptoms do so within 11.5 days of infection. Symptoms often start mild and gradually, then increase in intensity. Research from China of 44,000 people showed the disease course was: Mild to moderate (mild symptoms up to mild pneumonia): 81% Severe (dyspnea, hypoxia, or more than 50% lung involvement on imaging): 14% Critical (respiratory failure, shock, or multiorgan system dysfunction): 5% Why Does COVID-19 Seriously Impact Older Adults? It’s true: People who are 60 and older are at high risk for serious complications from COVID-19, based on data from Wuhan. In the U.S. alone, 68.7 million Americans are 60 and above. Why is age likely an issue with COVID-19? As you get older, your immune system responds more slowly to infections, which can increase your chance of becoming sick. Your immune system has fewer immune cells at 60 and above, so you heal more slowly, too. In the U.S.? A staggering eight out of 10 deaths from COVID-19 have been in those 65 and older. Still, this doesn’t mean younger people shouldn’t remain vigilant, or do all they can to prevent themselves from being infected. Out of the nearly 410,000 deaths reported in the U.S. by mid-January 2021, nearly 63,000 people under the age of 65 were included in that grim tally. Are Pregnant Women or Newborns at Higher Risk for COVID-19? In late September 2021, CDC issued a release that “recommends urgent action” for pregnant and lactating women to receive the COVID vaccine immediately after the highest number (22) of COVID-19-related deaths in pregnant women in a single month of the pandemic happened in August. And, according to the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, and the CDC, both pregnant and lactating women who meet the criteria we’ve outlined here should be able to safely receive either vax. To date, there’s been more than 125,000 laboratory-confirmed COVID-19 cases reported in pregnant women, including more than 22,000 hospitalized cases and 161 deaths. With data from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) showing that approximately 97% of pregnant women hospitalized with COVID, for illness or labor and delivery, were unvaccinated, the need for vaccines in this population is vital, according to the CDC. Unvaccinated women might also be at an increased risk for adverse outcomes, including preterm birth (delivering your baby sooner than 37 weeks). Newborns can get COVID, too. Just how, though, remains murky—the jury is out on transmission from mother to baby before, during, or after birth. For now, the likeliest transmission path is from a newborn’s exposure to respiratory droplets from a mother, other caregivers, visitors, or healthcare personnel with COVID-19, reports the CDC. Most newborns with the virus have had mild or no symptoms. COVID-19 and Breastfeeding One thing to note: Breastfeeding does NOT seem to transmit COVID through breast milk. It’s recommended that if you have a newborn and COVID, if someone else can care for the child while you isolate and recover, that’s optimal (and you can wash your hands for 20 seconds, wear a mask, and hand express or pump breast milk, if you want to breastfeed)—but if you need to care for your newborn and you can while sick, be sure to wash your hands before touching the baby (or use hand sanitizer with at least 60% alcohol) and wear a mask when within 6 feet of the little one (you can also breastfeed your baby while doing this). Just keep in mind that children younger than two should not wear a mask or face shield for safety reasons. COVID-19 Risk for Children Can COVID be dangerous for kids? New research from the CDC shows that Delta isn’t necessarily more dangerous for children, but with more transmittable infections in the community, more children are getting sick (and with more kids sick, that increases the chances that one will have a more severe case). Neonatal intensive care units (NICUs) and pediatric ICU’s (PICUs) have been filling up across the country, in states like Louisiana, Florida, Texas, with a rise in hospitalizations in children 17 and under with the Delta strain. Many respiratory-based illnesses, such as the flu, are concerning for the oldest and youngest among us. While COVID-19 is a big worry for the elderly, it’s uncertain exactly how it affects toddlers, preschoolers, and school-age children. Earlier in the pandemic, researchers found elevated levels of a biomarker related to blood vessel damage in children who had COVID, including those that had minimal or no symptoms, which they related in a study published December 8, 2020 in Blood Advances. They report that they’re not yet sure exactly what these results mean, but they merit more research to discover the short- and long-term side effects of this illness on children. And, about 12.5% of those with COVID in the U.S. are kids (for a total of 2.5 million), according to the American Academy of Pediatrics. Multisystem Inflammatory Syndrome (MISC-C) in Children A troubling trend has been the rise in cases of multisystem inflammatory syndrome in children, or MIS-C, with 1,659 cases reported in New York as of October 2020, including 26 deaths. MISC-C causes severe inflammation in the lungs and abdomen, with some children experiencing blood clotting and heart failure, too, according to a report in the journal Radiology. Symptoms vary and may take weeks—or potentially longer; no one yet knows—to show up. And while many of the hospitalized children tested negative for an active COVID-19 infection, they did test positive for antibodies. Fortunately, readily available corticosteroids can usually successfully treat most inflammatory symptoms of MIS-C. Thrombotic Microangiopathy (TMA) in Children The researchers in the December 2020 Blood Advances study also found a high proportion of children who had COVID met the clinical and diagnostic criteria for thrombotic microangiopathy (TMA), a rare, serious medical condition where the smallest blood vessels in our body’s organs, like the kidney and brain, are damaged. “Long-haul” symptoms in children are another growing concern. Can Children Transmit COVID-19? It’s also possible that children can get the virus and become vectors, or transmitters of the disease, especially to people at high risk, including their grandparents and older relatives. Case in point: A large study from South Korea documents that while children under 10 tend to spread the disease at lower rates than adults, the same is not true for tweens and teens between 10 and 19, who transmit the virus at least as well as their parents, teachers, and other grownups do (even when the kids remain asymptomatic themselves). Another report in JAMA Pediatrics shares that while up to 40% of all those infected show no symptoms, asymptomatic children can shed virus, or potentially be contagious, for up to 21 days. It’s important to note: As with adults, children who have underlying health conditions (we’ll talk more about this in the section below regarding adults) might be at increased risk, and the standard precautions against infection that adults take are also a child’s best protection. But please note: Masks should not be used in children under 2, to prevent suffocation. How Does the Coronavirus Impact People With Underlying Health Conditions? In America, 60% of people wrestle with at least one chronic health condition—and six in 10 is no small group. Unfortunately, this puts you at higher risk of serious complications from the coronavirus. And according to the CDC, the more underlying medical conditions you’ve got, the greater your risk for severe illness from COVID-19. Just what does severe illness mean, anyway? The CDC defines it as hospitalization, admission to the ICU, intubation, or mechanical ventilation, or… death (so clearly, not great). In one study based on Wuhan data, researchers found that people with COVID-19 who also had at least one additional medical condition—such as heart disease or diabetes—had a 79% greater chance of needing intensive care or a respirator (or both) to recover, or of dying. About one out of every five people who gets COVID-19 becomes seriously ill and might need to be hospitalized. We know how scary this is. That’s why it’s so important to be informed and to practice preventative safety measures (which we’ll get into soon). Cancer If you have cancer, you’re at an increased risk for having severe illness with COVID. Again, as with so many things related to this virus, we’re learning more and new things every day. A study out of the UK published in The Lancet in August 2020 found that the type of cancer you have might impact how severe your experience with COVID is—they found worst cases in those with blood cancers, particularly leukemia (which comes with more than twice the risk of death from COVID). As of now, we’re not sure if having a history of cancer increases your risk. Cardiovascular Disease The death rate for people in Wuhan with heart health issues and COVID-19: a staggering 10.5%. As we learn more about this virus and how it impacts the body, we’re finding that its inflammatory reaction can impact our blood vessels, causing blood clots, and heart damage (including heart attacks, even in young people). One study of 100 patients in Germany, published in JAMA Cardiology on July 27, 2020, found cardiac involvement in 78% of patients and ongoing myocardial inflammation in 60% of patients—and that didn’t even factor in the severity of the illness or co-existing conditions. Having high blood pressure (known as hypertension) might also raise your risk for severe COVID. An estimated 103 million Americans have high blood pressure, according to the American Heart Association (AHA), which is providing precautions for heart disease patients and others. Here are a few of the cardiovascular disease types that might be impacted, courtesy of the CDC: Cardiomyopathies Coronary artery disease Heart failure Pulmonary hypertension Chronic Autoimmune Illnesses Those that involve the lungs can run the risk of more serious cases of COVID-19. These include: Interstitial lung disease Lupus Pulmonary hypertension Scleroderma Chronic Respiratory Diseases A stat on just one of these: The fatality rate for people with chronic obstructive pulmonary disease (COPD) in Wuhan was 6%. Having moderate to severe asthma puts you in another at-risk population, because lung capacity is already compromised. If you have moderate to severe asthma, call your doctor and discuss whether you need an extra inhaler on hand in case you end up with COVID-19. Other chronic lung conditions that might increase your risk for severe disease include: Cystic fibrosis Pulmonary fibrosis Other chronic lung diseases Diabetes Some 30.3 million Americans, or 9.4% of the population, have this condition. The American Diabetes Association is offering tools to keep yourself safe during this pandemic if you have diabetes. Which is important, in light of statistics. According to the Chinese Center for Disease Control, in Wuhan the fatality rate was 7.3% for people with diabetes, and the newest research points to severe illness in both types 1 and 2, the CDC reports. With diabetes, it’s tougher to fight any infection, and circulation issues can lead to organ issues, making it harder for you to heal when hit with something like this illness. Genetic, Hemoglobin, and Cognitive Disorders According to the CDC, a range of disorders may increase your risk for severe outcomes from COVID-19. They include: Dementia. If you have dementia from Alzheimer’s disease or other dementia-related disorders, you could be at higher risk for infection and more severe COVID outcomes, the CDC says. Down syndrome. The CDC added this genetic chromosome disorder to the list of high-risk conditions in late 2020. There could be a multitude of reasons for severe COVID in those with the disorder, but outcomes are bleak regardless: Research looking at a cohort of 8 million people (4,043 of whom had Down syndrome) out of the UK, published on October 21, 2020, found that adults with Down syndrome were at nearly five times the risk to be hospitalization with COVID and 10 times the risk for related death. Sickle cell disease (SCD). This new addition to the list puts you at potential risk for severe illness from COVID-19, according to the CDC. Other hemoglobin disorders, like thalassemia, potentially raise your risk for bad outcomes, as well. Liver Disease Speaking of liver disease, if you have chronic liver disease alone, like alcohol-related liver disease or nonalcoholic fatty liver disease, you might be at increased risk of severe COVID. Cirrhosis, which scarring of the liver, might put you at particular risk. Medically Weakened Immune Systems Are you a cancer patient on immunosuppressive drugs, like some forms of chemotherapy? Or taking a biologic medication for Crohn’s disease or rheumatoid arthritis? You’re also at higher risk for COVID-19. Others Who Are Immunocompromised According to the CDC, this could include people: who’ve had bone marrow or organ transplantations; who have immune deficiencies or poorly controlled HIV or AIDS; who are on kidney dialysis (chronic kidney disease at any stage is believed to potentially heighten your risk for severe COVID); or who have prolonged use of corticosteroids or other immune-weakening medications. (Talk to your doctor if you’re concerned about your condition and medication.) People Who Smoke or Vape Smoking—whether it’s tobacco, marijuana, e-cigarettes, or vaping—can damage your lung’s natural defenses, making them more susceptible to respiratory illnesses like COVID-19, according to the Mayo Clinic. Long-term smoking compromises lung function and can cause lung disease. So much is still unknown about COVID-19 and the risks of underlying medical issues, so we’re not sure if this applies just to current smokers or past smokers too, but the good news is that your lungs begin to heal as fast as a month after you stop smoking. Now is the time to pursue smoking cessation programs to help your lungs start that process. People Who Are Overweight, Obese, or Severely Obese The CDC’s at-risk guidelines include people of any age with obesity, or a body mass index of 30 or greater. More concerning, the CDC says that severe obesity, defined as a BMI above 40, is linked to even greater risk for severe COVID. Why? According to a small study published in Nature Reviews Endocrinology, it may have to do with respiratory dysfunction. Because obese people are more likely to have weaker respiratory muscles, lower lung volumes, and more airway resistance, it’s harder for them to fight off the respiratory distress brought on by COVID, which ups their chances of developing pneumonia. Obese people are at additional risk if they have diabetes, renal failure, or liver disease, especially if uncontrolled. Even if you aren’t in a high-risk group for the virus, it’s still better not to have it. Clinicians conducted a 15-year prospective cohort study examining patients who had the first SARS virus, finding long-term bone and lung issues, which could very well be an issue with COVID-19, too. Preliminary data from Wuhan and Hong Kong appears to show potential long-term effects of the disease, too, with diminished lung capacity for some COVID-19 patients. Polycystic Ovary Syndrome (PCOS) Some experts are calling for this women’s health issue to be considered a risk factor for COVID. One study found that those with PCOS had a 51% higher chance of confirmed or suspected COVID-19 infection than those without. Featured Collections Chronic During COVID GO! Other People at High Risk for COVID-19 Beyond age or pre-existing medical conditions, there are three additional things, per the CDC, that can elevate your risk of exposure: Being a healthcare worker. Medical professionals put themselves in harm’s way during infectious epidemics to care for the sick—it’s no different with COVID-19. This includes doctors, nurses, and anyone else working in hospitals, ERs, nursing homes, long-term care facilities, clinics, and other places with coronavirus patients. Close contact. In other words, people who are taking care of someone or live in the same house as someone who’s tested positive for COVID-19. Community spread. This means if you live in or just visited a place where lots of people have tested positive for the illness. What Should I Do if I Have the Coronavirus? Say you have symptoms of COVID or know you’ve been around someone who does have COVID recently. What do you do next? These three steps can help. Calm yourself (as much as you can). As we’ve mentioned, about 80% of cases turn out just fine, without special treatment needed. And in those 20% of cases that are more serious, you can get better. Don’t rush out. Before you speed off to your doctor’s office or the local emergency room, stop. If you do have COVID, you could transmit it to others. We know this might be tough when you’re scared and feeling badly, but consider your own health, too: You don’t want to expose yourself to other illness if you’re already sick with something. Call your healthcare professional, asking your doctor’s office, urgent care clinic, or emergency room what you should do in light of your symptoms and possible recent exposure to someone who had it. Another place you might be directed to: your local health department; they’re helping with testing. The National Association of County and City Health Officials has a handy directory of local health departments, by state, that can lead you to the right person to speak to about finding out if your symptoms are COVID-19 or the flu or a cold. How Do You Get Tested and Diagnosed With COVID-19? Search online to see where available PCR testing might be close to you—you can now make online appointments at area pharmacies for no-contact testing, at local hospitals, or possibly in your doctor’s office. Rapid result kits (also called antigen tests, not to be confused with antibody testing, which is different) are now available online, as well, with some kits offering results in as little as about 10 minutes. But keep in mind that PCR testing is considered the “gold standard” for COVID testing, and while the rapid testing kits can offer quick peace of mind (depending on where you live and the backlog of cases, it might take days for you to receive your PCR test results), the kits might not be as effective at giving correct results for asymptomatic cases (say you want to test because you’ve just spent time with someone who tested positive for COVID) or with variants like Delta. Types of COVID Tests There are two kinds of tests for COVID: a viral/diagnostic test (tests for current infection) or antibody test (tests for past infection). Of the viral tests for diagnosis, there are also two types, according to the National Institutes of Health: Antigen Test (or “Rapid Test”) This gives us results in about 15 minutes. But, while it’s fast, it’s also more likely to give you a false negative result. If you have COVID symptoms but a negative antigen test result, you might need this test. Molecular Test Also called a PCR (which stands for polymerase chain reaction) test, it’s considered the best COVID test available, because it’s the most reliable and accurate. This one can take up to a week to provide results. It’s a nasal swab (called a nasopharyngeal swab by the pros) is done by a tester, who takes a sample from your nose using a special swab, or possibly by yourself (some testing locations, like pharmacies, will provide you with the swabbing materials via their drive-thru window, instructing you on how to swab yourself). You might’ve had this done for the flu. It can be unpleasant because it feels like the wire-like swab goes so deep into your nose, it touches your brain, as people anecdotally report. But rest assured: It does not go that far up. It goes up your nasal cavity just high enough for the best sample. It might cause you to sneeze, or your eyes to water. Additional Coronavirus Testing Methods If you end up at the hospital without having been tested first, healthcare professionals might use a different method of testing. They’ll decide which test is best based on your abilities (if you’re unconscious, for instance, any test that requires your assistance, like coughing into a cup, isn’t possible) and their preferences. The testing options include: Blood. Known as a rapid serum antibody testing for IgM and IgG, this is done using a finger prick and results take about 10 min. Nasal aspirate. Your health care provider injects a saline solution into your nose. Then, they remove the sample with gentle suction. This might feel a little funny as it happens. Sputum test. You cough into a cup for this test, releasing sputum, a thick mucus coughed up from your lungs. Easy enough, right? Or they might use a special swab to take a sample of mucus from your nose if you can’t cough anything up. Tracheal aspirate. This one features a thin, lighted tube (called a bronchoscope) that’s put down your mouth and into your lungs for a sample to be collected there. There could be some discomfort with this test. When to Get Tested for COVID-19 Here are the CDC’s current guidelines for when you need to get tested for the virus: If you have symptoms of COVID-19 (see list above). If you are not fully vaccinated (meaning, fully immune) and you've have had close contact (within six feet for a total of 15 minutes or more over a 24-hour period) with someone with confirmed COVID-19. Please note: If you're fully vaccinated and show no COVID-19 symptoms, you don’t need a test following exposure to someone with COVID-19. If you've tested positive for COVID-19 within the past three months and recovered, you won't need a test, either, after exposure, as long as you don't develop new symptoms. If you've done activities that place you at higher risk for COVID-19 because you couldn’t physically distance to avoid exposure, including: travel, attending large social or mass gatherings, or being in crowded or poorly-ventilated indoor settings. If you've been asked or referred to get tested by your healthcare provider, or state, tribal, local, or territorial health department. How Long to Isolate With COVID-19 So, you’ve tested positive for COVID-19. Hopefully your disease remains mild and doesn’t require any expert intervention. Here’s what to do now to protect other people: If you had no symptoms, mild symptoms, or moderate symptoms with COVID, isolate for: At least 10 days since you first had symptoms and At least 24 hours with no fever without fever-reducing medication and Other symptoms of COVID-19 are improving (keep in mind that loss of taste and smell might linger for weeks or even months with long-term COVID and don’t need to dictate your isolation ending). If you have severe symptoms (like, you were admitted to a hospital and needed oxygen), then isolate for possibly up to 20 days after you first got sick—talk to your healthcare professional about next steps. Early in the pandemic, doctors required a test-based strategy to discharge a COVID-19 patient from the hospital–if you tested negative twice within a 24-hour period, you’d be free to leave. Over the summer 2020, guidelines had been updated based on research that shows a person is most contagious early on in their COVID-19 illness progression. You should still quarantine for 14 days after an exposure to someone who has COVID-19. If you never develop symptoms nor test positive 10 days later, however, you’re in the clear (also, after day 7 from receiving a negative test result, with the test happening on day 5 or later, you can stop quarantine). Just keep watch for up to 14 days for symptoms. This area is a rapidly moving target so we need to keep up with the changing guidelines as they evolve. But it can be very easy to lose track of all the moving parts, we know. COVID-19 Treatment Exciting news in the COVID treatment world dropped in early October 2021 with several possible remedies on the horizon. Molnupiravir The first, from Merck and Ridgeback Therapeutics, is an oral antiviral called molnupiravir (originally developed for the flu). It reduced hospitalization or death risk by about 50% in COVID patients with mild to moderate cases and at least one risk factor associated with poor disease outcome. It was also effective against the Gamma, Mu, and Delta variants. The drug was so effective in its phase 3 MOVe-OUT trial that the companies plan to apply to the FDA for emergency-use authorization ASAP. The drug is also being investigated for post-exposure prophylaxis in a global phase III study, the MOVe-AHEAD trial. Long-Acting Antibody (LAAB) And, speaking of prophylaxis (which means, simply, the prevention of the virus): Another exciting new potential drug is AstraZeneca’s long-acting antibody (called LAAB, or AZD7442), for prophylaxis of symptomatic COVID-19. The company filed for FDA emergency-use authorization for the drug in early October 2021 after the PROVENT pre-exposure prophylaxis trial demonstrated that it reduced risk of developing symptomatic COVID-19 by 77% (95% confidence interval (CI): 46, 90), compared to a placebo. Adding to the positive results: More than 75% of PROVENT’s study participants had co-morbidities placing them at risk for severe COVID outcomes or a reduced immune response to vaccination. Both drugs appear to be well-tolerated. Veklury (Remdesivir) Currently, there is only one drug approved (through emergency use authorization) for treating COVID-19 requiring hospitalization and supplemental oxygen therapy: Veklury (remdesivir). But there’s no specific treatment for COVID-19 if your case is less severe (which is considered not requiring supplemental oxygen even if hospitalized). Nor is there a treatment specifically just for COVID-19 (Remdesivir predates the virus and was designed to treat other viral infections). And Remdesivir’s main benefit in COVID-19 seems to be in shortening hospital stays. The FDA has recommended using baricitinib (BIIa) or tocilizumab (BIIa), combined with dexamethasone alone, or dexamethasone plus remdesivir, for the treatment of COVID-19 for certain hospitalized patients (requiring supplemental oxygen therapy and not responding to dexamethasone plus remdesivir) because of scientific evidence supporting its use. We can’t use existing antibiotics to treat the virus itself, because they’re for bacterial infections—there’s nothing in a virus that an antibiotic can target and attack. Antibiotics are only indicated if a COVID-19 patient develops a secondary bacterial pneumonia on top of their COVID-19 illness—of which COVID-19 patients are at high risk. In these cases, they’re treated with both COVID-19 medicines and antibiotics. What’s needed is an antiviral. But currently there’s no antiviral specifically for this new disease. Medications in Trial for COVID-19 Along with creating and rolling out effective vaccines (more on those in a moment), a solid, effective treatment could help. WHO officials launched the updated Solidarity PLUS trial on March 23, 2020, a worldwide study aiming to uncover the best treatment, fast, for COVID-19 and is now examining artesunate, imatinib, and infliximab as treatment for the infection. Researchers and healthcare professionals in the field first investigated hydroxychloroquine sulfate, which was quickly determined to potentially cause serious side effects without providing promising results, as well as chloroquine phosphate, another medication originally developed to treat malaria but now commonly used to treat lupus. So far, it hasn’t shown much efficacy, either. COVID Treatments to Avoid Ivermectin Another medication that has been in the news but doesn’t appear to have good data to show its safe efficacy for COVID treatment (and prevention)—ivermectin, the anti-parasite medication, used commonly in veterinary medicine, as well as in human medicine—which can be downright dangerous in the wrong doses when using animal formulations (there’s a human formulation too), according to the FDA. Officials have been advising people not to use ivermectin without their doctor’s care, even as states have reported increased calls to local poison control hotlines. Like in Mississippi, where officials report that Mississippi Poison Control Center calls have recently increased in volume—and at least 70% of those have been about taking ivermectin bought at livestock supply centers. Overall in the US, the National Poison Data System (which collects data from the 55 poison control centers in US) found a 245% jump in reported exposure cases from July to August, with 1,143 ivermectin exposure cases between January1 and August 31, 2021 (a 163% over the same period last year!). Taking large doses of this medication can be dangerous, the FDA reports, so please don’t. Other Dangerous COVID Treatments Another thing not to do: Putting hydrogen peroxide into a nebulizer and breathing it in, which has been touted online as a COVID prevention/treatment. It’s not, say Asthma and Allergy Foundation of America officials in a recent statement. They quote the Agency for Toxic Substances and Disease Registry, which states that “Hydrogen peroxide can be toxic if ingested, inhaled, or by contact with the skin or eyes.” Azithromycin, an antibiotic used to treat bacteria pneumonia and several other bacterial infections, was also tried, tested, and discarded, as were two HIV drugs, Ritonavir and lopinavir. And be sure no to: Use iodine to prevent or treat COVID, either to gargle or inhale. Too much iodine can lead to thyroid problems (including thyroid cancer) and burning of the mouth, throat, and stomach; fever; stomach pain; nausea; vomiting; diarrhea; weak pulse; and coma. Other Therapies for COVID-19 Other therapies include the use of convalescent plasma from COVID-19 patients who have recovered (which has been shown in various studies to quicken recovery among the seriously ill and decrease mortality rates). Azithromycin, an antibiotic used to treat bacterial pneumonia and several other bacterial infections, was also tried, tested, and discarded, as were two HIV drugs, Ritonavir and lopinavir. In June 2020, UK researchers announced the welcome results of a major clinical trial: Dexamethasone, a cheap, widely available corticosteroid, significantly reduced mortality among severely ill people with COVID-19 by an astonishing one-third in patients who were already on ventilators, and by one-fifth among patients who’d been given supplemental oxygen. However, for those who were not sick enough to require respiratory support, no benefit (and even some harm) from the drug was reported. It appears timing this treatment to the right stage of the disease may be key. And, as we learned in early October 2020 when President Donald Trump tested positive for COVID-19 and was treated at Walter Reed National Military Medical Center, experimental new therapies called monoclonal antibodies were used on him. Several monoclonal antibodies have since been developed and granted EUA by the FDA and are widely available to the public now. Monoclonal antibodies target the spike protein which the virus uses to attach to human cells to initiate infection. Three monoclonal antibody products for the virus currently have EUAs from the FDA for the treatment of mild to moderate COVID-19 in nonhospitalized patients with laboratory-confirmed COVID-19 who are at high risk for progressing to severe disease and/or hospitalization. (Just keep in mind that an EUA does not constitute FDA approval). These products are: bamlanivimab plus etesevimab; Casirivimab plus imdevimab; and Sotrovimab. The FDA also updated the EUA for casirivimab plus imdevimab as post-exposure prophylaxis for certain individuals who are at high risk of acquiring SARS-CoV-2 infection and, if infected, are at high risk of progressing to serious illness. Monoclonal Antibody Therapy The following classes of patients are considered as potential candidates for monoclonal antibody therapy: Aged ≥ 65 years Obesity (BMI > 30) Diabetes Cardiovascular disease (including congenital heart disease) or hypertension Chronic lung diseases (e.g., chronic obstructive pulmonary disease, moderate-to-severe asthma, interstitial lung disease, cystic fibrosis, pulmonary hypertension) An immunocompromising condition or immunosuppressive treatment Being overweight (BMI 25–30) as the sole risk factor Chronic kidney disease Pregnancy Sickle cell disease Neurodevelopmental disorders (e.g., cerebral palsy) or other conditions that confer medical complexity (e.g., genetic or metabolic syndromes and severe congenital anomalies) Medical-related technological dependence (e.g., tracheostomy, gastrostomy, or positive pressure ventilation that is not related to COVID-19) So, What Happens if You’ve Got COVID-19 Now? If your symptoms have just cropped up and are mild at the start and continue that way, here’s what you should do: Talk to your doctor. Speak to her by phone regularly, especially if your symptoms worsen, you are concerned, or you’re at high risk for negative outcomes with COVID-19. Isolate yourself from others. Do this for 10 days after symptom onset, as long as your disease remains mild to moderate. If your symptoms become more severe, needing hospitalization, the CDC advises a possible 20-day isolation period to ensure you do not infect others (talk to your doctor when you can about how long you might need to isolate). Drink plenty of fluids. This help your body maintain its overall health. Rest. Rest. Rest. Did we mention you should rest? Take over-the-counter pain meds. This might include acetaminophen (Tylenol) to combat the fever, joint pain, and headaches. There’s been controversy over the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), after French doctors observed worsening conditions in patients taking them with COVID-19. This is still anecdotal, meaning it hasn’t yet been investigated fully in a study, and WHO officials have said that it’s not yet clear if NSAIDs pose a substantial risk to all COVID-19 patients. To be safe, Tylenol might be preferable for now. Eat anti-inflammatory foods. Load your plate with frozen fruits, vegetables, green leafy things; and take your normal medicine and multivitamin. You need to keep your body as robust as possible to fight this virus, and research has shown that a healthy diet can have a positive effect on overall well-being. Practice self-care. If you’re strong enough, meditate: It’s been shown to have many health benefits, including reduced blood pressure and decreased oxygen utilization. Many apps, including Calm and Headspace (which is offering some of its services free to people, including teachers and healthcare professionals), can help you with this. Don’t drink alcohol. It can tamp down your body’s ability to fight infection. You’ll likely do these things at home to help prevent overcrowding of hospitals if your case is mild or moderate. For many people, the symptoms eventually subside, and you get better without treatment. It can take time—up to two to three weeks (and, for some, longer) to feel better. When Should You Seek More Medical Help for COVID? Contact your healthcare provider or emergency room immediately if you have severe symptoms: Blood-oxygen reading (from a pulse oximeter) of 92% or below Bluish lips or face New confusion or an inability to arouse Persistent pain Pressure in the chest This sounds morbid, but it’s need-to-know: In Wuhan, those who ended up dying of the coronavirus had severe trouble breathing. If you start to show symptoms of pneumonia—which include worsening cough, increased trouble breathing, and high fever (103 to 104 degrees and above)—call 911 and tell them that you have, or are being evaluated for, COVID-19. However—and this is important—many ER docs across the U.S. have reported examining a high number of seriously ill COVID-19 patients who they describe as being “happy hypoxics,” meaning those admitted were not complaining of severe shortness of breath, dizziness, or confusion, even when their blood-oxygen levels were dangerously—sometimes, even life-threateningly—low. So, if you are sick at home with this virus, be sure to regularly check your own blood-oxygen levels with a pulse oximeter, which you can purchase online or from any drugstore. A normal reading is 94% to 100%. A reading of 85% is dangerously low so don’t wait—get to the ER. Anything under the 92% range is worth a call to your doctor. (But take a few consecutive readings first to make sure you’ve got an accurate reading.) Be sure to put on a facemask before emergency medical services arrive to help reduce the risk of spreading the disease, as much as you can, for the emergency responders. At the hospital, you could be given oxygen or put on a ventilator depending on how intense your case is. COVID-19 Prevention We’re not sure yet if having the virus once prevents you from getting it again: Experts say that past experience with coronaviruses suggests you’d develop an immunity to it, but that’s preliminary thinking that requires more research. First off, if you’re not vaccinated, always practice social distancing! Quarantining Wuhan, China, brought the number of cases down, so this strategy—staying home and in physical contact with as few people as has helped help flatten (or steepen) the curve. Then follow these tips for coronavirus prevention: Wear a face mask indoors and outdoors in crowds in areas with high and substantial transmission. Avoid gathering in groups, large or small, indoors if you’re not yet vaxxed, especially in poorly ventilated spaces. Everyone should avoid gathering in large groups, indoors and outdoors. Wash your hands—often! Use hand sanitizer, with at least 60% alcohol, when you don’t have access to soap and water. Avoid touching your face, especially your eyes, nose, and mouth. Do Masks Help Prevent the Spread of COVID-19? They do. Wearing a mask reduces the spread of the virus by helping block infected aerosolized droplets from both being expelled and being inhaled, especially among people who have COVID-19 and may not know it yet. How? Surgical masks and cloth face coverings help keep in check droplets from when you and others sneeze, cough, sing, shout, talk, or simply exhale, but may not offer much protection if you’re exposed to smaller droplets, which can make their way through more porous mask materials, or get into the loosened sides of any poorly fitting mask. One great resource for info on masking? The Infectious Diseases Society of America. It shares a website with an overview on mask usage, the data behind doing so, and useful infographics about how to wear masks safely and properly. Last note: If you’re still wearing a mask with a plastic valve (the kind often seen on construction sites), chuck it. This type of mask is not ideal in the fight against COVID-19. While they do filter the air you’re inhaling, they don’t filter the air you’re breathing out. And the main reason we all wear masks is to protect other folks from our own exhaled respiratory droplets. The CDC even states that masks with valves should “not be used where a sterile field must be maintained” (such as an operating room) because of risk of air contamination. You’re better off skipping this type of mask and opting for a homemade cloth face covering, or simply use disposable surgical masks, which are now much easier to find for purchase online. What Are the Differences Between COVID-19 and the Flu? It’s mind-boggling trying to self-diagnose when COVID-19’s symptoms are so similar to the flu, a cold, or even seasonal allergies. But we can’t stress enough, COVID-19 is not the flu. For these reasons: More rapid spread. COVID-19 has been spreading more widely than the flu. How rapidly a disease spreads, or is transmitted, is measured with something called a reproductive number, called Ro (pronounced R-nought or r-zero). The Ro is how many people one infected person will transmit the disease to. For COVID-19? It was between 1.4 and 2.5 people per person, according to the WHO for the first, “wild” strain but Delta appears to be higher. A study published in August 2021 in The Journal of Travel Medicine found the Delta variant Ro as ranging from 3.2 to 8, with an average of 5.08, meaning each infected person would infect three to eight other people with an average of 5 people getting infected. For the flu? It’s 1.3 people for every one person. No immunity to stop it. The flu has been around for years—the first influenza pandemic was in 1580—and while flu strains mutate (which changes the flu’s viral structure, thus leaving more people at risk of catching it), COVID-19 is a brand-new virus. We are what’s called a virgin population to it, meaning we have no herd immunity (when enough people have an illness or receive a vaccine against it, they develop antibodies to it so they don’t all catch and spread it at once). Globally, everyone on earth could get COVID-19, all 7.5 billion of us—which isn’t true of the flu, because if you’ve had some strains of the flu, even years ago, you have antibodies/immunity to it—even if you’re exposed to it again, you won’t likely catch it. Mortality rates are higher: You might hear people say, well, more people die from the flu than COVID-19. With almost 700,000 Americans dead from COVID-19 to date (with social distancing and frequent lockdowns in place), that does not appear to be true. Remember, the flu season typically begins in October or November and ends in May each year in the U.S. Meanwhile, right now, it’s estimated that about 1% to 3.4% of people with COVID-19 are dying, and we don’t know when this pandemic will ease. The mortality rate for the regular seasonal flu is less than 1%. The flu is actually the main point of reference for comparing one serious virus to another. In particular, the 1918 influenza, one of the deadliest pandemics in modern history. Caused by the H1NI flu virus, that disease struck an estimated 500 million people across the globe, killing an estimated 50 to 100 million people (675,000 of those were Americans) in a matter of months. The differences between the 1918 influenza outbreak and COVID-19 are significant. Back in 1918, health authorities had no idea what was happening beyond that it was a bad flu—it wasn’t until 1933, 15 years later, that scientists even knew a virus caused the human wreckage. With COVID-19, scientists in China had identified the sickness sweeping Wuhan as a coronavirus, sequenced its genome to better help find an effective treatment, and pinpointed bats as the likely animal hosts, within two weeks of the virus first appearing. SEE OUR SOURCES Meet Our Writer Erin L. Boyle Erin L. Boyle, the senior editor at HealthCentral from 2016-2018, is an award-winning freelance medical writer and editor with more than 15 years’ experience. 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