1. What are coronaviruses?
Coronaviruses are a large family of viruses, some of which can infect people. Some cause mostly mild illness, such as the strains responsible for some common colds. Others can potentially also lead to severe, or even fatal, disease - such as Middle East Respiratory Syndrome Coronavirus (MERS-CoV), which continues to circulate in some parts of the world. The Severe Acute Respiratory Syndrome (SARS) outbreak was caused by a coronavirus. It caused severe and fatal disease, however, is no longer in circulation. The natural reservoir for coronaviruses is thought to be animal hosts. New strains emerge from this reservoir, infect an 'intermediate' host, and from there infect people. The viruses may then be capable of being transmitted from one person to another. Some are efficient at human-to-human transmission, while others are not.
2. What are the symptoms of COVID-19 infection?
From what we know so far, the virus can cause mild, flu-like symptoms such as:
- Difficulty breathing
- Pain in the muscles
- More serious cases develop severe pneumonia, acute respiratory distress syndrome, sepsis and septic shock that can lead to the death of the patient. People with existing chronic conditions seem to be more vulnerable to severe illness
3. Who is at risk of infection and what are the symptoms of COVID-19?
The disease can move from person to person, but it is not yet known how easily or sustainably it spreads. Scientists are studying the data as it becomes available. The initial cases reported having visited a seafood/animal market, which may have been a source of exposure. However now the main way the disease is spreading is from person to person. Some people have had a mild illness and recovered. Others have had more severe infections. Critical and fatal cases have occurred. Preliminary evidence indicates that people with underlying medical conditions, elderly people and those with compromised immune systems may be at higher risk for severe illness.The illness is still being studied. So far, we know that common symptoms include fever, cough, sore throat, shortness of breath and difficulty breathing. These symptoms are not limited to COVID-19. Respiratory illnesses and pneumonia caused by other organisms (including bacteria) and other viruses (such as influenza) can also cause these symptoms. Other less common symptoms of COVID-19 include muscle aches, headache, nausea and diarrhoea. It is capable of causing severe illness, and some infected people have died. It is possible that people with underlying health conditions are at higher risk for severe disease.
4. How severe is COVID-19 infection?
At this point, there is too little data available to say with certainty how severe COVID-19 is but preliminary findings indicate that it is less fatal than SARS coronavirus.
5. Where can I get tested?
If your doctor believes there is a need for a laboratory test for SARS-CoV-2/ COVID-19, he/she will inform you of the procedure to follow and advise which laboratory can perform the test. Several laboratories in Europe can process SARS-CoV-2 samples.Please turn to your doctor or health authorities for further, more detailed information.
6. Is it safe to fly? Is the plane cabin air clean?
The air inside modern airplanes is filtered to the same standard as in hospital operating rooms, as the air is changed many times through high-efficiency particulate air filters (HEPA filters) that remove 99.97% of airborne viruses and bacteria, according to the International Air Transport Association. However, passengers might beat risk when there is a sick person on board, especially when the person is seated close to them. Transmission is also possible through objects such as toilet door handles that the sick person has touched. The best thing to do in a plane cabin is to practice proper hand hygiene and coughing etiquette, and to keep a distance from people who are coughing or have other respiratory symptoms.
7. What does cough etiquette mean?
Cough etiquette, or respiratory hygiene, is a measure taken to reduce person-to-person transmission of infected droplets. Individuals should distance themselves, cover their mouth and nose with a tissue when coughing and sneezing. It is important that tissues are disposed of correctly (in nearest waste bin) after use and that hands are washed immediately with soap and water or alcohol based hand sanitizer (containing 60-85% alcohol).
8. Will I catch the virus if I go near an infected person who does not have any symptoms?
Professor Tan Chorh Chuan, chief health scientist at the Ministry of Health,Singapore,said the risk of asymptomatic transmission is still unclear, though it is possible that a patient could be shedding viruses through a sniffle or his hands, which have come into contact with respiratory secretions. Prof Tan suggested reducing hand contact by not shaking hands, and by using other forms of greeting. "Clean your hands frequently, especially after you touch a lot of surfaces," he said. Most importantly, people who are sick should stay at home, avoid crowded places and wear a mask if they need to go out, as this reduces the risk for everyone else, he said.
9. What is the safe distance to keep from an infected person?
The WHO advises a distance of at least one metre. If someone infected with the coronavirus coughs within one metre of you, you could breathe in the virus through the droplets in the air.
10. Is there a vaccine?
Not yet. It may take months or years for a vaccine to be developed. Research and testing is underway.
11. Where is the outbreak predicted to spread?
Further imported cases into any location that has travellers from different locations is occurring. Wherever there is an infected person, there is the potential for the virus to spread to people in close contact with them and local outbreaks can occur.
12. Why is the number of cases increasing so rapidly?
Two of the main reasons for the rapid increase in the number of cases are that the virus is spreading from one person to another and that the capacity to detect cases is improving. This is why a sudden increase in the number of cases is often observed during the initial phase of an outbreak of an emerging disease.
13. How long this outbreak will last?
Unfortunately, it is not possible to predict how long the outbreak will last and how the epidemic will evolve overall. We are dealing with a new virus and therefore a lot of uncertainty remains. For instance, it is unknown whether transmission will decrease during the summer, as is observed for seasonal influenza.
14. What is the difference between quarantine and isolation?
Quarantine is the separation and monitoring of people who have been exposed to an infected person (or have been to an outbreak area) to see if they become ill.This separation helps reduce the risk that the quarantined person will spread the disease. Quarantine generally requires a person to remain in a nominated place or at home for a certain period of time after exposure to a disease.The duration of quarantine will vary depending on the estimated incubation period.For COVID-19, early estimates indicate a quarantine duration of 14 days. Isolation is the separation of people who are ill with a potentially contagious disease from those who are healthy.
15. What should I do to protect myself?
- Avoid potential exposure.
- Practice good hygiene measures and safe food practices.
- Avoid direct contact with animals (live or dead) and their environment.
- Do not touch surfaces that may be contaminated with droplets.
- Keep distance from people who are obviously sick.
- Maintain good personal hygiene.
- Wash your hands frequently with soap and water.
- Carry hand sanitiser for use when soap and water are not readily available.
- Some authorities are advising hand sanitisers containing 60-85% alcohol.
- Avoid touching your face.
- Ensure food, including eggs, is thoroughly cooked.
- Do not travel if you are sick.
- Avoid sharing personal items with others. For instance, don't share utensils and drinking glasses at mealtimes.
16. Should I wear a face mask?
If your location has guidelines for the public, please follow them. In some locations, authorities are requiring people to wear a mask when in public places. You must comply with any official directives. In other locations, authorities are asking only people who are sick, or if they can't, those in close contact with them, to use a face mask to cover their coughs and sneezes while they are seeking medical attention. Other authorities encourage groups at higher risk for severe complications e.g. older adults or those with underlying illness, to consider wearing a mask. Some authorities have advised to use masks while travelling or working in public places to reduce the chances of droplet transmission.While surgical face masks may stop people touching their mouth, they do not stop them breathing in the virus, nor the virus entering the eyes. They will also catch some of the droplets that are coughed and sneezed out. Fitted respirators, such as ‘P2’, ‘P3’ or ‘N95’ masks, require training and fitting. These are generally not being recommended for use by the public. They may be recommended to be used by those in close contact with infected people, such as healthcare workers or family members caring for sick relatives.
On the aircraft it is mandatory to wear a face mask by all passengers (including children above 6 years old), only exemptions are passengers with visible sign of disabilities - they should approach the crew for assistance. In any other cases neither medical certificate, nor ID or any other document can be accepted and used to be exempt from wearing a face mask. If you have a flight over 4 hours, we recommend you bring multiple face masks.
17. I would rather wear a mask anyway, so when should I do so?
Wear a mask if you are unwell and need to go out to see a doctor, or if you are taking care of someone suspected of having the coronavirus. If it makes you feel better, you can wear a mask if you are going to ride the public transport or be in a cab for a while, said Professor Wang Linfa, director of the emerging infectious disease programme at Duke-National University of Singapore (NUS) Medical School. "If you're worried about getting the virus in the public transport, then you can wear a mask, but if you're walking on the streets, there's no need to," he said. If you want to wear a mask, make sure you wash your hands before putting it on, and every time you touch it, as you could transfer germs from your dirty hands to the mask. Also make sure that you are wearing the mask properly. It should fit snugly against your face with no gaps to allow the viruses to get through. Change the mask when it becomes soiled or damp, as this reduces its effectiveness. You will have to be prepared to wear masks for at least a few weeks, as the coronavirus problem is not likely to disappear any time soon.
On the aircraft it is mandatory to wear a face mask/face covering by all passengers (including children above 6 years old), only exemptions are passengers with visible sign of disabilities - they should approach the crew for assistance. In any other cases neither medical certificate, nor ID or any other document can be accepted and used to be exempt from wearing face covering.
18. Should I just wear gloves?
You can do so, but this is not necessarily practical. Also, if your gloves are dirty and you touch your face, you can still transfer the virus to your face.
19. Why must I cover my mouth or nose with a tissue when coughing and sneezing?
The virus spreads via droplets. Covering your mouth and nose when coughing and sneezing prevents the spread of germs and viruses. If you sneeze or cough into your hands, you may contaminate objects or people that you touch.
20. Why do I have to wash my hands frequently?
The virus is spread via droplets, and hands may touch surfaces contaminated with the virus. If you touch your eyes, nose or mouth with your contaminated hands, you can transfer the virus to yourself. Washing your hands with soap and water will get rid of the virus if it is on your hands.
21. How about touching doorknobs and lift buttons?
Doorknobs and lift buttons are "high-touch" points, which means that many people would have touched them in a short period of time. So it is possible to get infected by touching a dirty doorknob or lift button. This is why health experts keep emphasising the importance of hand hygiene. You can wash your hands or use a hand sanitiser after touching these spots, and before you eat, for instance. Some people use a tissue to press lift buttons, while others use a pen with a cap, a tip that Prof Wang said he learnt from social media. Remove the ink cartridge before using it, and cap it afterwards.
22. What environmental measures can be taken?
Environmental measures aim at reducing transmission of infection and include the routine cleaning of frequently used surfaces and objects; minimising shared objects; and good ventilation. Frequently touched surfaces and objects should be washed with water and detergent, followed by a dilute household bleach solution. These objects /surfaces may include desks, phones, keyboards, doorknobs and toilets. Laundry should be washed according to detergent manufacturer’s instructions at the warmest specified temperature. Shared objects should be kept to a minimum including such things as drinking glasses, eating utensils, towels and linen. Good air ventilation is important in rooms where people gather regularly.
23. Should I get a flu jab?
A flu vaccine will not help protect you against the coronavirus. There is currently no vaccine to protect against coronaviruses. However, people have been rushing to get flu jabs to prevent them from getting influenza in this outbreak. Most clinics here have run out of the Northern Hemisphere flu vaccines due to overwhelming demand.
24. Should I close all my windows to prevent a spread of the virus?
No. Infectious disease experts suggest keeping windows and doors open to ventilate rooms. This will reduce the spread of diseases.
25. Is it safe to use public transport and to take taxis or private-hire cars?
A private-hire car and taxi companies often provide masks for their drivers and encourage them to disinfect their vehicles frequently. Drivers have been advised to wind down their vehicles' windows when ferrying passengers with flu-like symptoms, and after every completed trip, to improve ventilation in their vehicles. They have also been advised to take their temperature twice a day, once before starting work and at another time in the course of the day. Trains and buses will be disinfected more regularly, especially touch points such as grab poles, overhead handles and seats. Surfaces at public transport stations will be cleaned and disinfected.
26. Is it safe to go shopping?
While it is good practice to avoid crowded areas where possible, shopping activities can still continue if proper hygiene standards are followed closely. Malls have stepped up measures to regularly disinfect common areas, and have made hand sanitizers available to shoppers. Some malls have also ceased all public events, such as workshops and mass exercise activities.
27. Is it safe to stay in a hotel?
Yes, most hotels have stepped up sanitation measures, including thorough cleaning of common areas. Should you have any doubts contact your preferred hotel before travelling for detailed information regarding their respective actions.
28. How does COVID-19 spread?
The World Health Organization states "The spread of COVID-19 between humans is being driven by droplet transmission.The virus is transmitted from a sick person to a healthy person through respiratory droplets when the sick person coughs or talks close to another person. People may have been exposed and infected but are NOT necessarily transmitting the disease. More investigations into potential other routes of transmission are ongoing. What has been reported so far it that the main driver of transmission is droplet transmission from people with symptoms."
29. What should I do if I have had close contact with someone who has COVID-19?
Notify public health authorities in your area who will provide guidance on further steps to take. If you develop any symptoms, it is important that you call your healthcare provider for advice, mentioning that you have been in contact with someone with COVID-19.
30. Does COVID-19 spread through the air or air-conditioning?
So far there is no evidence that this virus is spread through the air or through air-conditioning systems. The patterns of spread are consistent with transmission through droplets from an infected person to someone who is in close unprotected contact. Nevertheless, in the hospital setting, patients are currently managed in special ‘negative pressure’ rooms if available, and healthcare workers will take ‘airborne precautions’ when performing certain procedures.
31. Can the virus be transmitted through packages shipped from an area with COVID-19?
This coronavirus is primarily spreading to people who are in close unprotected direct contact with an infected person. Currently there is no evidence to support transmission of COVID-19 associated with imported goods.
32. Can COVID-19 be treated?
Not specifically. Patients receive supportive care, aimed at relieving their symptoms and preventing complications while they recover. This can include the use of mechanical ventilation if required. There is no specific antiviral therapy against this disease. Antibiotics are only effective against diseases caused by bacteria, not viral diseases like COVID-19.
33. Is Tamiflu useful?
The antiviral medication Tamiflu (oseltamivir) is not effective against COVID-19. Tamiflu is used to treat influenza.
34. Can we use antibiotics to prevent and treat this coronavirus?
Antibiotics do not work against viruses. They are effective only against bacterial infections.
35. What about alternative treatments?
Some authorities have recommended alternative treatments for COVID-19. However, there is no evidence to confirm or disprove the effectiveness and safety of alternative treatments.
PROTECTING THE YOUNG AND OLD
36. What can the elderly, children and others who may have weaker immunity do?
Older people, and people with pre-existing medical conditions such as diabetes and heart disease, appear to be more vulnerable to becoming severely ill with the virus. Dr Edwin Chng, medical director of healthcare provider Parkway Shenton, said that these people should avoid unnecessary visits to clinics and hospitals as far as possible. This is to reduce exposure to bugs, as those with a weaker immune system are more susceptible to infections. They should stay indoors as much as possible, and avoid crowded areas and people who are unwell. Finally, they should wear a surgical mask if they are unwell, and practice good hand hygiene at all times.
37. Children have weaker immunity. Shouldn't they wear masks?
Masks are generally not needed for people who are well, including children, said Associate Professor Thoon Koh Cheng, head and senior consultant of the infectious diseases service at KK Women's and Children's Hospital. He said a child can wear a well-fitted child-size mask when he has a fever, cough or runny nose, or when he is recovering from an illness. To be effective, change the mask regularly, or when it is soiled or wet. Wash hands with soap and water after disposing of the soiled mask properly into a bin, he said.
38. What precautions should I take to protect my children if they are ill?
The advice for unwell children is the same for adults. People who are unwell should seek medical attention promptly, stay at home to rest and avoid crowds.