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COVID-19 | School of Public Health Expert Insights

COVID-19

School of Public Health Expert Insights

Coronavirus Questions and Answers


 

Coronavirus and Variants: The Basics

What is a coronavirus?

Coronaviruses are a family of viruses that typically cause mild respiratory infections like the common cold, but also more severe (and potentially deadly) infections. They are zoonotic diseases, meaning they are transmitted from animals to people.

SOURCE: Global Health NOW

Why is it called a coronavirus?

Coronaviruses are named after the Latin word corona, meaning “crown” or “halo,” because they have “crown-like spikes on their surface,” according to the U.S. Centers for Disease Control and Prevention.

SOURCE: Global Health NOW

What severe diseases are caused by coronaviruses?

A coronavirus that originated in China led to the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003. Another coronavirus emerged in 2012 in Saudi Arabia, causing Middle East Respiratory Syndrome (MERS).

SOURCE: Global Health NOW

What’s the difference between coronavirus, SARS-CoV-2, and COVID-19?

The novel coronavirus responsible for this outbreak is known as SARS-CoV-2. The illness caused by the virus is called COVID-19.

More information can be found here: Naming the coronavirus disease (COVID-19) and the virus that causes it—WHO.

SOURCE: Global Health NOW

Could COVID-19 or a variant have been here before January 2020?

We don’t know yet when the virus first came to the United States. We don’t have any evidence yet that it was here in December but we also don’t have evidence that it wasn’t here.

There has been one case in France that may have occurred in December, but that’s really the only evidence so far that the virus may have been outside of China prior to January.

SOURCE: Jennifer Nuzzo

What symptoms do coronaviruses typically cause? How is COVID-19 different?

Common signs of coronavirus infection include runny nose, cough, fever, sore throat, and shortness of breath.

COVID-19 can cause a wide range of signs and symptoms at varying levels of severity. The most common are fever, dry cough, and tiredness. Other symptoms include shortness of breath or difficulty breathing, muscle aches, chills, sore throat, headache or chest pain.

Other symptoms that aren’t as common include: gastrointestinal symptoms, new loss of smell or taste, skin changes (like lesions), confusion, and eye problems.

SOURCE: Mayo Clinic

Why does COVID-19 cause loss of smell?

Some patients can temporarily lose their sense of smell. This is because the “hook” of cells used by SARS-CoV-2 to latch onto and infect cells is up to 700 times more prevalent in the olfactory-supporting cells lining the inside of the upper part of the nose than in the cells lining the rest of the nose and windpipe that leads to the lungs. The supporting cells are necessary for the function/development of odor-sensing cells.

SOURCE: The Hub

Why does COVID-19 cause shortness of breath?

COVID-19 can cause damage to the lungs that impedes their ability to remove oxygen from the air. A lot of patients develop what’s known as severe acute respiratory distress syndrome.

SOURCE: Jennifer Nuzzo

Does COVID-19 affect the heart?

One of the mechanisms that the SARS-CoV-2 virus uses to enter the lungs, called the ACE2 receptors, lives in the heart as well. When the virus enters the heart, it can cause clots, pulmonary embolism, or clots within the arteries of the heart causing a heart attack.

SOURCE: Public Health On Call

When and how should I seek medical attention?

Via the CDC:
If you develop any of the following emergency warning signs for COVID-19, get medical attention immediately by calling your doctor’s office. Emergency warning signs include (but are not limited to):

  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion or inability to arouse
  • Bluish lips or face

Please call your medical provider for any other symptoms that are severe or concerning to you.

SOURCE: CDC

How are coronaviruses transmitted between people?

Coronaviruses are typically transmitted from person to person through exhalation of respiratory droplets (from the nose and mouth) and close contact. People can contract COVID-19 if they breathe in droplets from an infected person who coughs or exhales droplets. Those droplets can also land on objects and surfaces, and people can then catch the virus from touching those surfaces and then touching their eyes, nose, or mouth. Coronaviruses are typically transmitted from person to person through exhalation of respiratory droplets (from the nose and mouth) and close contact. People can contract COVID-19 if they breathe in droplets from an infected person who coughs or exhales droplets. Those droplets can also land on objects and surfaces, and people can then catch the virus from touching those surfaces and then touching their eyes, nose, or mouth.

Small particles that contain infectious amounts of virus can also remain suspended in the air for a period of time and travel farther distances than larger droplets usually produced when people sneeze or cough.

Wearing a mask, staying at least six feet away from others, and avoiding prolonged contact (more than fifteen minutes) indoors with others are all helpful mitigation factors.

SOURCE: Global Health NOW and Public Health On Call Podcast

When people are asymptomatic, can they spread the virus?

Yes. A lab study suggests that as many as 50% of people who have the disease show no symptoms and are still able to spread the disease.

SOURCE: Gigi Gronvall

How long is an asymptomatic carrier shedding the virus?

Most people with COVID-19 can discontinue isolation 10 days after symptom onset. For people with no symptoms of COVID-19, isolation can be discontinued 10 days after the date of their first positive test.

SOURCE: CDC

If people are asymptomatic, how does the virus get from one person to another?

We’re still trying to understand how asymptomatic transmission happens and the extent to which it happens.

A few ways that we think that the virus spreads: if people are talking to each other from relatively short distances, it’s possible for someone who is infected and doesn’t yet have symptoms to put some virus out there that someone who is standing close by could be exposed to. We also know that some outbreaks have occurred in settings where people are singing. The more you force air out of your mouth, the greater possibility of carrying virus with it.

Transmission has also occurred in very close quarters, like between husbands and wives or roommates. We don’t know exactly how that transmission occurred, but you can imagine any number of ways: if people are touching their mouths and then touching surfaces or something along those lines.

There’s a lot of work that still needs to be done to understand the extent to which asymptomatic transmission happens and how exactly it does.

SOURCE: Jennifer Nuzzo

Is COVID-19 airborne?

New evidence points towards likelihood that the virus may be spread through aerosols that linger, not just droplets that fall.

Droplets caused by coughing and sneezing are still the main source of infection. Remaining six feet away from others means you are less likely to be exposed to droplets.

There can also be fomites, which is infectious material from droplets or aerosols that land on surfaces you might touch. Handwashing is very effective in this circumstance.

SOURCE: Public Health On Call Podcast

What is known about young children and whether they are carriers and can transmit the virus?

Young children can be infected and transmit to others. 

It continues to be the case that children often do not have any symptoms at all. If they do have symptoms, they're quite mild. This makes it hard to understand what transmission looks like in children.

When we look only at symptomatic illness, there's very little evidence of transmission. But when we look at serosurveys, which look at evidence of prior infection, we see that children are infected at rates similar to adults. That suggests that there's more happening underneath the surface than we are able to see. 

There is a rare and dangerous condition in sick children called multi-system inflammatory syndrome in children (MIS-C) which is thought to be caused by an immune reaction to SARS-CoV-2.

SOURCE: Public Health On Call Podcast

Of those infected, what percentage will require hospitalization? And what percentage will require care in an intensive care unit (ICU)?

Hospitalization rates vary by age group and increase with age. Approximately 90% of hospitalized patients have one or more underlying conditions, the most common being obesity, hypertension, chronic lung disease, diabetes, and cardiovascular disease.

SOURCE: CDC

Is COVID-19 worse than the flu?

Yes. COVID-19 is much deadlier than the flu. COVID-19 has a higher severe disease and mortality rate than influenza in all age groups, except perhaps children under the age of 12.

SOURCE: Andrew Pekosz

What does “recovered” mean?

The CDC advises:

You can be around others after:

  • 10 days since symptoms first appeared AND
  • 24 hours with no fever without the use of fever-reducing medications AND
  • Other symptoms of COVID-19 are improving*

*Loss of taste and smell may persist for weeks or months after recover and need not delay the end of isolation.

SOURCE: CDC

What is the possibility of reinfection after you have recovered from COVID-19?

It's difficult to confirm a case of reinfection. You need to have samples of sequencing from the first infection and again from the second infection to actually be able to tell if it's a different variant of the virus and not just the same persistent infection that's coming back. 

There are 26 known cases of reinfection which illustrate that we don't know exactly how long immunity may last for COVID-19. 

The CDC recommends that all people, whether or not they have had COVID-19, take steps to prevent getting and spreading COVID-19. Wash hands regularly, stay at least six feet away from others whenever possible, and wear masks.

SOURCE: Public Health On Call Podcast

Is there evidence of a heightened risk to pregnant women?

Pregnant people might be at an increased risk for severe illness. There may be an increased risk of adverse pregnancy outcomes, such as preterm birth, among pregnant people with COVID-19. Limited evidence suggests that it is not likely for mothers with COVID-19 to spread the virus to babies in their breast milk, but there are precautions mothers with COVID-19 should take if they are breastfeeding. Please visit the CDC resource for precautions pregnant and breastfeeding people can take to reduce these risks.

SOURCE: CDC

What makes this upper respiratory infection caused by an RNA virus any different from hundreds of other upper respiratory infections caused by RNA viruses?

There are two key differences: First, it’s causing severe disease for individuals which causes big strains on the healthcare system.

Second, we just don’t know much about it compared to other RNA viruses that cause upper respiratory infections every day.

SOURCE: Lauren Sauer

Are the new variants of SARS-CoV-2 more transmissable? 

There is some strong data from the UK that suggest the [variant of the] virus is more transmissible. To be sure it's the virus sequence changes that are causing this, we need to see if this variant spreads as easily in other countries. 

There are currently two theories about what, specifically, makes this strain more transmissible. One is that this variant virus is “stickier,” meaning it requires a smaller amount of virus to cause infection because it’s better at adhering to your cells. Another theory is that this variant causes people to harbor more virus particles in their noses and throats, which means more virus is expelled when people talk, cough, or sneeze.

Behavioral and situational factors could help a more transmissible variant spread even further, but wearing a mask, ensuring physical distance, and hand washing will still help. 

SOURCE: Andrew Pekosz

Is there a difference between "more transmissable" and "more contagious?"

Transmission is often used when we talk about populations, while contagious is more often used when we are talking about an individual. They are interchangeable to some degree.

SOURCE: Andrew Pekosz

Is there any change in guidance for how to protect yourself and others from new variants of SARS-CoV-2? 

Masks, social distancing, and hand washing should work against the variants just as well. But higher transmission could mean more cases, which can increase risk for individuals and overwhelm hospital systems again, so it may be necessary to re-implement closures and restrictions to flatten the curve if it starts to rise.

SOURCE: Andrew Pekosz

How common is it for a virus to mutate? Is it unusual to see new variants of SARS-CoV-2 take hold this soon?

All viruses mutate, and SARS-CoV-2 has been mutating at a pretty consistent rate since it entered the human population. 

This new variant has accumulated an extremely large number of mutations compared to other lineages. Usually we can follow the evolution of a virus because we find related viruses with fewer mutations. But with this virus, it seems to have just appeared with a lot of mutations. It will be important to determine how this virus got so many mutations without being identified sooner. 

SOURCE: Andrew Pekosz

Will the new variants eventually be more widespread than the current "wildtype" virus?

If the new variant is more transmissible than other SARS-CoV-2 lineages, it eventually could be the most commonly found lineage of SARS-CoV-2. However, while we still have so many people with no immunity to the virus, we should still see different lineages spreading in different parts of the world. 

SOURCE: Andrew Pekosz

VULNERABLE POPULATIONS

Are some groups at a higher risk for severe COVID-19 illness?

Available information suggests that the following are at a higher risk for severe illness from the virus:

  • People of any age with the following conditions:
    • Cancer
    • Chronic kidney disease
    • COPD
    • Immunocompromised state from solid organ transplant
    • Obesity (BMI of 30 or higher)
    • Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
    • Sickle cell disease
    • Type 2 diabetes mellitus

As you get older, your risk for severe illness increases. For example, people in their 50s are at higher risk for severe illness than people in their 40s. Similarly, people in their 60s or 70s are, in general, at higher risk for severe illness than people in their 50s. The greatest risk for severe illness is among those aged 85 or older.

Other people who may need extra precautions include: racial and ethnic minority groups, people in rural communities, people with disabilities, pregnant and breastfeeding people, people experiencing homelessness, and people with developmental and behavioral disorders. For a full list and recommended precautions, please visit the CDC resource.

SOURCE: CDC

Do higher-risk patients ever have mild coronavirus, or is it always the case that people who are at higher risk get very sick?

They do. Certainly, people of advanced age and people with underlying conditions statistically are among those mostly likely to be hospitalized and die, but that’s not always the case. People in both of those categories also may have mild infection or may become sick and survive their illness.

SOURCE: Jennifer Nuzzo

Should people on immunosuppressive drugs stop taking their medications? 

Most research suggests that individuals on chronic immunosuppressive medicines have a similar likelihood of severe COVID disease, if they get infected, as those who are not on such medications. Individuals concerned about the potential risks of these medicines should talk with their healthcare provider, as well as use evidence-based approaches to reduce the risk of COVID infection such as social distancing and mask wearing.

SOURCE: Caleb Alexander
 

How is COVID-19 impacting people without spleens? (With certain bacterial diseases, people without spleens can get very severe infections.)

There is not specific data around this. In general, we think of people who do not have a spleen or whose spleen is not functioning well as being immunosuppressed. I would be more cautious with those individuals and more aggressive in their care. Those individuals would want to have more social distancing than the average person.

SOURCE: Amesh Adalja

Are women taking oral contraceptives more at risk from blood clotting from COVID-19?

There is an elevated risk of clotting from oral contraceptives. COVID will synergize with whatever other propensity you have to get clots so someone on birth control may be more likely to clot than the average person.

SOURCE: Amesh Adalja

Testing

What are all the different kinds of COVID tests?

Testing for COVID can be divided into two main groups: testing for active SARS-CoV-2 infection or testing for past SARS-CoV-2 infection. Active infection indicates that a person has virus that is replicating and that they could infect others. Past infection indicates that an individual has recovered from COVID-19 and has no actively replicating virus.

To test for active infection, diagnostic antigen or molecular tests are used. 

To test for past infection, serology tests are used. 

Learn more about the specific types of antigen, molecular, and serology tests, how they are collected, and when each should be used here

SOURCE: The Center for Health Security Testing Toolkit

What kind of COVID test should I get?

The Center for Health Security has created a flowchart to help you determine what COVID-19 test type you may need. 

In general, if you may have a current COVID-19 infection and you are experiencing symptoms, you should seek an antigen or molecular diagnostic test. These tests may be referred to with terms like: PCR, qPCR, rRT-PCR, antigen, rapid antigen test, RPA, RT-LAMP, and CRISPR.

SOURCE: The Center for Health Security

Do different variants of SARS-CoV-2 affect testing accuracy?

Because of the diversity and breadth of tests currently available, most diagnostic tests can still be reliably used to diagnose the variant strains. 

SOURCE: The Center for Health Security

What does testing tell us the spread of the virus? What is “percent positive”?

Public health officials rely on testing results to track the state of the pandemic and policymakers use this information to guide decisions on reopening schools and businesses.

Percent positive is the percentage of all coronavirus tests performed that are actually positive, or: (positive tests)/(total tests) x 100%. The percent positive (sometimes called the percent positive rate or positivity rate) helps public officials understand the current level of SARS-CoV-2 transmission in the community and whether or not a community is doing enough testing for the number of people who are getting infected.

SOURCE: David Dowdy and Gypsyamber D’Souza

Why aren’t there enough tests available and will this change?

Earlier in the pandemic, the issues were collection devices—not enough swabs or viral transport media (the fluid that the swab goes in).

Now, the issues are a bit different. The testing process is a very complex system. There are point- of-care tests, which are rapid. And then high-throughput diagnostic tests, which are PCR tests— the ones traditionally done in hospitals, clinical labs, commercial labs, and public health labs. Both those tests are in short supply. Pipette tips—plastic components for test cartridges—are also in short supply.

There’s huge demand from hotspot states and people who want to get tested—so they can go see their relatives or travel, for example. This has been a challenge because we want to make sure we’re using testing for the right reasons and right purposes.

How do we get out of this? One really good answer is we all need to wear masks, distance, and follow the general rules of hygiene. If we do that, we can bring the curve back down. The curve we speak of is about ICU beds and hospitalizations, but it’s actually also about test capacity. We will be able to test as many people as we need to test if we don’t have so much transmission. We are not going to be able to massively ramp up production.

SOURCE: Public Health On Call podcast

If you are tested and the test is negative, do you still have to be quarantined?

Yes. Someone exposed to a person with COVID-19 needs a 10-day quarantine regardless of test results. 

SOURCE: Joshua Sharfstein

What is a 'false negative' COVID test result?

A negative test result from a sample that is truly positive. For example, if a person was truly sick with COVID-19 but received a negative test result, that would be a false negative. 

If a person has had a known exposure to COVID-19 (the CDC defines “exposure” as close contact with someone who has COVID-19), but a negative COVID-19 test, that person should still quarantine and self-monitor for symptoms for 10 days after exposure.

If a person has not had any known exposure to COVID-19 and is not experiencing symptoms, there is no need to quarantine if a test is negative.

If symptoms are present but a person has a negative COVID-19 test, that person should still follow home isolation recommendations. In a clinical setting, doctors and nurses may proceed with precautions as though it is a positive diagnosis.

SOURCE: The Center for Health Security

What is a 'false positive' COVID test result?

A positive test result from a sample that is not truly positive. For example, if a person was truly uninfected but got a positive test result that would be a false positive. 

SOURCE: The Center for Health Security

Can a COVID test read negative if it takes too long to process the sample?

This has not happened with PCR tests. Antigen tests, or those that look for antibodies, could potentially read positive falsely if they are not processed in a certain period of time.

SOURCE: Crystal Watson

 

Prevention and Infection Control

How can I protect myself against coronaviruses?

The CDC recommends the following:

  • Regularly and thoroughly wash your hands with soap and water for at least 20 seconds or clean them with a 60% alcohol-based hand sanitizer. Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Maintain at least six feet of distance between yourself and anyone who doesn’t live in your household. If someone in your home is sick, maintain six feet of distance from the sick person if possible.
  • Cover your mouth and nose with a mask when around others.
  • Cover your mouth and nose with your bent elbow or a tissue when you cough or sneeze, then dispose of the used tissue immediately.
  • Clean and disinfect frequently touched surfaces daily, including doorknobs, tables, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
  • Stay home if you feel unwell. If you have a cough, fever, and difficulty breathing, call your health provider.

There is growing evidence that wearing masks protects the wearer as well as others.

SOURCE: CDC

Does wearing a mask protect me from getting sick?

There is growing evidence that wearing masks protects the wearer as well as others.

Masks—no matter what kind of mask—filter out the majority of viral particles.

SOURCE: Public Health On Call

Are gloves recommended?

Gloves are important in a clinical setting but not needed out and about in everyday life. The most important thing you can do to prevent infection is to wash your hands when you touch surfaces.

SOURCE: Jennifer Nuzzo

Is hand sanitizer effective to protect against COVID-19?

If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.

SOURCE: CDC

Is there anything I can do to prepare just in case I or someone in my household gets COVID?

The best thing you can do is to follow prevention guidelines like wearing a mask, practicing social distancing, and avoiding close contact with others not in your household.

But there are other things you can do to be prepared in the event of illness such as knowing where and how to access testing, having a plan for quarantine and isolation, and understanding your employer's sick leave policy. Read more about how to prepare for COVID here

SOURCE: Johns Hopkins Bloomberg School of Public Health

What should I do if I have a confirmed COVID-19 diagnosis?

If you have a confirmed COVID diagnosis via a positive test, it's important to isolate yourself immediately, answer your phone in case a contact tracer is trying to reach you, and call your doctor or health care provider if you have one.

Read more information on what to do if you have COVID here

SOURCE: Johns Hopkins Bloomberg School of Public Health

How long does COVID-19 stay on your clothes?

The coronavirus may remain detectable for hours to days on surfaces made from a variety of materials, including clothing.

SOURCE: Joshua Sharfstein (via City Leadership Initiative)

Cleaning produce brought home from the grocery store: Should you do anything differently or use any particular cleaning products?

Here is general guidance on fruits and vegetables: (via CDC). There is not specific guidance for coronavirus. In general, the risk of transmission is low, but will be reduced further with cooking.

SOURCE: Joshua Sharfstein

Is takeout food safe? What precautions should people take?

In general, takeout food is low risk—particularly if the food is cooked. You should wash your hands after touching the packages, but the risk of contracting coronavirus from food delivery, takeout, groceries, or mail, is low.

SOURCE: Joshua Sharfstein (via City Leadership Initiative)

Is the public water supply safe from COVID-19?

There is no evidence of transmission through the public water supply.

SOURCE: Joshua Sharfstein

If two people are positive, can they quarantine together or do they have to be separated?

If multiple people in a household have confirmed COVID-19, it’s fine for them to isolate together.

If a household member has COVID-19, that person should be isolated from others in the home, and the entire household should quarantine for 14 days.

SOURCE: Johns Hopkins Bloomberg School of Public Health

What should you do if someone in your household is sick?

If someone in your household is sick, that person should be isolated as much as possible from other household members and all members of the household should follow guidance for quarantining.

SOURCE: COVID-19 Infection Control in Your Home 

Should the general public cover their faces with bandanas or other makeshift masks?

The CDC recommends that people wear masks in public to reduce the risk of asymptomatic spread. Masks should be worn indoors at all times, and outdoors when it is not possible to remain at least six feet away from others.

Surgical masks and homemade cloth masks can help reduce the spread of droplets.

SOURCE: Joshua Sharfstein

Does wearing two masks offer better protection than wearing just one?

If you do not have access to an N95 mask, one way to boost the protection of a cloth mask is by wearing a surgical mask underneath it. 

Important note: This guidance is not intended for a health care workers. That guidance can be found here.

SOURCE: Johns Hopkins Bloomberg School of Public Health

If I've had COVID and my friends have had COVID, can we just get together without masks and social distancing?

It’s still not recommended. It’s believed that after you recover, you are protected from reinfection, but we are again in a particularly bad place in the pandemic, and it is not the time to be taking risks or to rely on things that we hope are true. It’s best to just stay home.

SOURCE: Caitlin Rivers

Is it known why certain people have long-term symptoms, or "long-hauler" COVID? Is it because of their age or underlying conditions? 

It’s not necessarily linked to older age or underlying health conditions. People who are young and previously healthy can experience lingering sequelae, or long-term lingering symptoms, of COVID-19 infection. It’s not really clear what the biological mechanism of that is, but it’s clear that it is a problem and it’s going to be something we’re going to have to be grappling with collectively as we figure out how best to support and care for those people.

SOURCE: Caitlin Rivers

How should I help a friend, neighbor, or family member who is ill?

If they are ill from coronavirus, you can drop off food or other supplies for them, call them, and make sure they’re coping well. If they are getting sicker, you can help them notify their doctor or local public health agency to arrange for medical care.

SOURCE: Tom Inglesby

Are my pets at risk of getting sick?

Keep your pets—just keep your distance if you have COVID-19.

While few pet animals have been shown to carry SARS-CoV-2, and even fewer have gotten sick, it is possible for owners to transmit the COVID-19 virus to their pets. Cats and ferrets may be more likely than other kinds of pets to contract the virus. Some dogs have tested positive too.

The recommendation right now is to keep your distance from pets if you are diagnosed with COVID-19 or have been exposed to someone who tested positive. If you have COVID-19 and your pet is sick, please contact your veterinarian.

SOURCE: Meghan Davis

Is it better to go to the same grocery store several times a week for 15-20 minutes each time, or just once for an hour?

The most important thing when going grocery shopping is for you to take precautions to not be within six feet of someone else for more than 15 minutes, to wear a mask, and to wash your hands after you’ve touched any surfaces. It matters less whether you were there for 15 minutes versus an hour. It’s more about the actions and the physical distancing that you take when you're at the store. It’s also better to go when there are fewer people around.

SOURCE: Crystal Watson

Can you get COVID-19 from second-hand smoke?

If someone is smoking a cigarette and coughing at the same time, maybe, but there’s not a biological mechanism for how the virus would be in the smoke.

SOURCE: Amesh Adalja

Does prone body position help very severely ill coronavirus patients in the intensive care unit?

There are reports that this can be helpful and there are more proning studies going on. The challenge with proning is that it is staffing intensive. You need a lot of staff to put people in the proning position and keep them that way—and a lot of PPE to do this safely.

SOURCE: Lauren Sauer

Wet markets in China are widely believed to be a source of new infections, including coronavirus. Should they be shut down?

Wet markets have come up in a number of contexts—certainly with COVID-19, and the 2003 SARS epidemic was linked to a wet market. The challenge with COVID-19 is that we don’t actually know much about the wet market that was involved. We know that the initial cluster of patients seen by clinicians had an occupational connection there. But we don’t fully know if and how they became infected at the wet market. It’s possible that the virus was circulating in the population and somebody who had it spread it at the wet market. We don’t know that it came from the animals there.

Wet markets have been identified as places of risk for the potential of animal viruses to spill over into human viruses, and there’s an active conversation around what to do about that. Some want to shut them down but worry it will just drive the practice underground in a way that authorities are unable to regulate. Others advocate for more regulatory approaches, so that when they occur, they occur as cleanly as possible.

SOURCE: Jennifer Nuzzo

Immunity

Can people expect to be immune once they’ve had the virus?

There is growing evidence that infection can confer some level of immunity. If SARS-CoV-2 is like other coronaviruses that currently infect humans, we can expect that people who get infected will be immune for months to years, but probably not their entire lives.

SOURCE: Gypsyamber D’Souza and David Dowdy

Is it possible that some people may be exposed and have mild illness but still produce antibodies that could prevent them from getting a more serious infection?

What we know from virology and from animal models is that the less virus you take in—what’s called the inoculum, or the dose—the less likely you are to get sick. We have done this in hamster models. The more SARS-CoV-2 that you give to hamsters, the more sick they get. If you give them less, they get less sick.

In the last month, there is data that even asymptomatic infection does seem to trigger immunity. There are two arms in the immune response: antibodies and T-cells. Antibody response can wane over time, but T-cells are what gives you lasting immunity. Asymptomatic—or mild—infection can give you strong T-cell immunity, which can last for a very long time.

SOURCE: Public Health On Call Podcast

Treatments and Vaccines

What treatments are there for coronaviruses?

The New York Times Coronavirus Drug and Treatment Tracker is following 21 treatments for effectiveness and safety. This resource is updated frequently.

The Novel Coronavirus Research Compendium (NCRC) is a literature curation effort by over 50 faculty members with collaborating institutions that review thousands of papers about COVID-19 research, including treatment, each week.

SOURCE: Johns Hopkins Bloomberg School of Public Health

What progress is being made on therapies or treatments for COVID-19?

There are many studies underway.

One example is convalescent serum, meaning the antibodies made by people who have already recovered from COVID-19. It’s possible that giving these antibodies to people at high risk for exposure (like household contacts or health care workers), or to people early in infection, will be beneficial.

So far, 35,000 people have been treated in the U.S. via the Convalescent Plasma Project. Johns Hopkins recently received $35 million in funding from the Department of Defense for COVID-19 blood plasma trials.

SOURCE: Arturo Casadevall

Will I still need to wear a mask after I get both doses of the vaccine?

Yes, you should still wear a mask, practice social distancing, and frequently wash your hands even if you receive the vaccine. That’s because protection from the vaccine is not perfect, and because it’s still not known if you can still spread the virus to other people once you have been vaccinated.

Restrictions like mask wearing and social distancing will be eased over time as the level of virus in the community drops.

SOURCE: Josh Sharfstein and CDC

Will an MMR booster provide protection from COVID-19?

There is no evidence that an MMR booster will provide any protection from SARS-CoV-2. But, it is still important for people, and kids in particular, to get the MMR vaccine to prevent those diseases.

SOURCE: Crystal Watson

Is there evidence for using hydroxychloroquine as a treatment for COVID-19?

Early questions about whether hydroxychloroquine might be of help to patients with COVID-19 have been addressed by high-quality research, and the results do not support the medication’s use. In June, the U.S. Food and Drug Administration found “no benefit for decreasing the likelihood of death or speeding recovery,” and revoked the medication’s authorization for use in COVID-19.

SOURCE: Joshua Sharfstein

Is it a good idea to get a flu shot?

We’re expecting to have an increase in COVID cases this fall and winter at the same time that influenza occurs annually. It will be important to increase the proportion of the population vaccinated against flu as a means to protect ourselves and our communities, but also to save hospital capacity to treat those with COVID-19.

SOURCE: Public Health On Call podcast

The flu vaccine isn’t 100% effective; some years it may be 25%, 50%, or 75% effective. Will a vaccine for COVID-19 be more effective than the usual flu vaccine?

Regarding flu vaccine effectiveness: There are many different influenza viruses. The vaccines we get in the United States tend to protect us against three or four different kinds, but there isn’t always a perfect match between the vaccine and the viruses circulating in the community. The good news is that even if you got sick after getting the flu vaccine, odds are that you got less sick and had a shorter duration of illness because you got that flu vaccine. Flu vaccines are very good at reducing the chances of having a very severe illness and having a bad outcome requiring hospitalization or potentially leading to death. (Public Health On Call podcast, July 28, 2020)

Regarding COVID-19 vaccine effectiveness: The short answer is that we don’t yet know. The very first people who got the very first vaccine were immunized in March and it’s only July. So we don’t know very much about the durability of the immune response in people. Our hope would be [that protection would last] at least a year or more, and then people might need boosters.

SOURCE: Ruth Karron

What are mRNA vaccines and how are they different from other types of vaccines?

All vaccines deliver a viral protein that causes the person being vaccinated to make an immune response. There are different ways to do this: one is to give the whole, inactivated virus so that is doesn't make the person sick. 

Another way is to deliver the nucleic acid that encodes the protein and let the [vaccinated person's] cells actually make the protein. RNA is the nucleic acid that codes for proteins that cells make. It has all the information needed to be able to synthesize the protein. [mRNA vaccines] deliver the RNA that encodes the viral protein you're interested in and lets the cell actually make that protein to then stimulate the immune system. 

SOURCE: Public Health On Call Podcast

Are mRNA vaccines new?

People have been working on these kinds of vaccines for the last 10 years. 

There are two versions: the [Pfizer and Moderna COVID-19 vaccines] we're dealing with just use the messenger RNA.

There's also a version [that uses] a self-replicating RNA, where it also has the information needed to copy that RNA so you can make more copies of it. They've been worked on mostly for cancer vaccines. 

Both self-replicating and non-self-replicating RNA have been explored for quite a period of time for immunization purposes as well. 

SOURCE: Public Health On Call Podcast

What makes mRNA vaccines so beneficial?

[mRNA vaccines] have several advantages. Because the cell itself is going to make the protein, it's much more likely to be the native protein or have the right properties that the virus would also have. 

Another big advantage is that they're fast to make. If you have the basic platform that [allow you] to insert the sequence for your particular protein of interest, you can just take [that] out and put another one in. It's very fast to substitute in a new, different coding sequence for a protein.

SOURCE: Public Health On Call Podcast

Why were we able to adapt the mRNA platform for the virus that causes COVID-19 but not flu or other viruses? 

They have had prototypes for influenza, for rabies, for a number of other [viruses], but they’ve never gotten to phase 3 testing. I think maybe the need was not so emergent and so critical as it has been here.

[COVID-19] has really motivated [researchers] to move the technology forward fast. But as you say, there’s really been a lot of work that’s been ongoing for the last five to 10 years with this platform.

SOURCE: Public Health On Call Podcast

Will we use the mRNA platform to make other kinds of vaccines?

We're very likely to see other vaccines [using this platform]. [SARS-CoV-2] came along as a brand-new virus, so it opened the way to apply these newer methods.

There are still questions about how durable this immunity is but it’s likely to get applied to more emerging infectious. Where we have other new viruses coming on the scene, it may embolden people somewhat to try it. 

Efforts are underway to develop a "universal" flu vaccine to train the immune system to fight diverse strains of seasonal or pandemic flu. 

SOURCE: Public Health On Call Podcast

If a vaccine is showing "95% efficacy", does that mean that 5% of people who are vaccinated would still get COVID? 

There's a lot of different ways that people calculate efficacy. Think about it as if you were vaccinated and your friend was not vaccinated, and you were both exposed to the same amount of virus. Your risk of coming down with COVID is 95% reduced compared to your unvaccinated friend. 

Some other vaccines offer 50% efficacy. When you think of it in those terms—if you have a 50% reduced risk of coming down with disease [compared to] an unvaccinated person exposed to the same amount of virus—it's still a pretty good risk calculation for yourself. 

95% efficacy is amazing. That's more like the efficacy that we see for childhood vaccines—diphtheria, MMR, tetanus, or measles. 

SOURCE: Gigi Gronvall

How do we know that the vaccines are safe, given how quickly they were developed?

In the United States, the FDA has required the same large clinical trial that it would otherwise require for a vaccine. We didn’t do what some other countries did and approve it just based on some blood test results; we actually looked at tens of thousands of people to see whether or not it prevented the disease.

One of the ways the process was sped up is that the taxpayers put a lot of money into this program—that was run out of the White House—to allow companies to basically start each part of the process right from the beginning.

Typically, what would happen is a company might do one study and see whether it works. If it doesn’t work, then they’re done. If it does work, then they start planning the next phase. And if that phase works, then they start planning the next. Everything is A, then B, then C. But with the money that the taxpayers put forward, the companies were able to do A, B, and C all at once. So, they started that first phase and if that worked, they were ready to get going on that second phase. If it wasn’t going to work, they would have lost all the money [spent] preparing for the second phase.

But what they gained was time. They were able to move from A, to B, to C so much quicker because they didn’t have that period in between where they were assessing and figuring out what kind of investment [would be needed] for the next round.

SOURCE: Joshua Sharfstein

There is misinformation circulating that COVID-19 vaccines contain mercury, anti-freeze, animal blood, or even formaldehyde. What is behind these claims?

COVID vaccines are new, but these kinds of concerns about vaccines go back for a long time. These are often intentionally a misconstruction of information by people who are anti-vaccine. 

Do they include animal blood? Do they include formaldehyde? No, they don't. Some [vaccines] do have preservatives, but all of them have been tested many times and have a good safety record, particularly in the quantities that are in the vaccine. A lot of times, people forget that we ourselves are made up of chemicals, and some of these things in the vaccine, there are sometimes more of them in your own body naturally. 

It's important to be aware of your sources of information about the vaccine and also to recognize that there are groups that are intentionally poisoning the information atmosphere with things that are not true about the vaccine. Some don't really care about vaccines and are not really “anti-vaccine.” They're just really trying to sow discord.

A good hint of whether the information comes from a source that's intending to sow discord is if it makes you angry, if it inspires a powerful emotion. Just take the next step and look at your source. See if [the information] is coming from a place where there are people who are experts in that topic, who can address the concerns but without trying to manipulate you.

I've even heard [the claim] that there was some sort of chip in the vaccine—that is not possible and not something that is in these vaccines

SOURCE: Gigi Gronvall

Can protection from mRNA vaccines work against new variants of the virus?

So far, it looks like the mutations that are in the spike protein in these different variants are not going to let the virus escape the vaccine. This could change—particularly as SARS-CoV-2 continues to spread throughout the world, with each new host creating opportunities for mutation. If these mutations notably alter the protein’s structure, new variants could elude the antibodies elicited by vaccines for other variants.

Fortunately, mRNA vaccines are well-suited for keeping up with sudden changes in the viral landscape. The mRNA itself is manufactured via a standardized process in which the core ingredient is a DNA sequence encoding a specific viral protein. This means vaccine makers can update the vaccine to fend off new strains by simply tweaking the “recipe” to encode a new protein.

If this virus becomes endemic, it might be that new vaccine variants will need to be rolled out to match the variants that take root. 

SOURCE: Gigi Gronvall

Is interferon Alfa 2B an effective treatment? Should we be encouraging our medical community to obtain this?

There are over 30 treatments currently being tested around the world. Interferon Alfa 2B has historically been used to treat diseases such as dengue fever, HIV, and hepatitis. However, no treatments have been demonstrated to be safe and effective in high-quality studies. This treatment, like others, is considered experimental for COVID-19 at this time.

SOURCE: Joshua Sharfstein

What are randomized control trials?

A randomized control trial is a study design where a patient is randomized to either option one or option two, sometimes multiple options, and sometimes one of those options is a placebo. That study design allows us to control for factors that may influence our ability to see the benefits and the risks associated with something like a treatment.

It’s really important in this setting because we don’t know much about COVID-19. The design is how we identify medical countermeasures, vaccines, medications.

SOURCE: Lauren Sauer

Do the COVID-19 vaccinations impact fertility in men and women?

There is no basis for believing that they impact fertility. Of course, all things will be evaluated eventually, but this is a vaccine that has been described as a Snapchat message to the immune system. It is basically some mRNA that gets into the cells, triggers this immune response, and then it degrades, and then it’s gone. It’s a very temporary thing that gets into the body to help the immune system be able to recognize the coronavirus. It would certainly not be anticipated to have any kind of long-term effect like infertility.

SOURCE: Joshua Sharfstein

Should I expect side effects from COVID-19 vaccines?

Side effects may vary with the type of COVID-19 vaccine. We know the most about side effects following vaccination with the Pfizer and Moderna messenger RNA—or mRNA—vaccines. 

The most common side effect is soreness at the site of injection. Other side effects include fatigue, headache, muscle aches, chills, joint pain, and possibly some fever.

SOURCE: William Moss

How long do side effects from COVID-19 vaccines last?

Usually 24 to 48 hours, and no more than a few days.

SOURCE: William Moss

Since COVID-19 vaccines come in two doses, will I experience the same side effects after each dose?

Side effects were more frequent after the second dose in the vaccine trials.

SOURCE: William Moss

Do side effects differ from one manufacturer's vaccine to another?

Side effects are similar after the Pfizer and Moderna mRNA vaccines but could differ with other types of vaccines.

SOURCE: William Moss

Can side effects be more pronounced in people who are at higher risk of severe COVID-19 disease, like those who are older or who have comorbidities?

No—in fact, vaccine side effects have been less frequent and severe in adults older than 55 years in the vaccine trials.

SOURCE: William Moss

How do I know if my side effects are normal or if I should alert my doctor or health care provider?

You will be told about the side effects of the vaccine and when you should consult a health care worker at the time you are vaccinated.

The Centers for Disease Control and Prevention advises that you should contact your doctor or health care provider if the redness or tenderness where you got the shot increases after 24 hours, or if your side effects are worrying you or do not seem to be going away after a few days.

SOURCE: William Moss

Is it safe to take acetaminophen or ibuprofen with vaccination?

There are no known safety issues with taking acetaminophen or ibuprofen with vaccination. Some experts have expressed concern that taking these medications might interfere with the immune response to the vaccine, but there is not data available to address this question directly.

As a result, it is generally recommended to take these medications only if necessary. The CDC says, "If you have pain or discomfort, talk to your doctor about taking an over-the-counter medicine, such as ibuprofen or acetaminophen." People who suffer specific medical complications of fevers should discuss a plan for using fever-reducing medications with their physicians before vaccination. 

SOURCE: Joshua Sharfstein

Is it possible to contract COVID-19 between vaccine doses? 

Yes—and this is why it is important to continue to wear a mask, practice social distancing, and wash your hands. 

The first dose will not provide complete protection, and it will take about seven days after your second dose before you will achieve a full protective level of immunity that develops in about 95% of vaccine recipients. If you are exposed to SARS-CoV-2 before this time, it is possible that you could develop COVID-19. 

Even once you have received both doses of the COVID-19 vaccine, it will still be important to continue practicing public health mitigation strategies like masks and distancing until the pandemic is under control and we know more about how the vaccines prevent transmission. 

SOURCE: William Moss

 

How will I know whether I am experiencing side effects or possible COVID-19 infection?

The side effects of the vaccine typically start within 12 to 24 hours of vaccination, but it may be difficult to tell the two apart if you become infected between vaccine doses.

If you experience side effects that last beyond 48 hours, you should contact your doctor or medical provider for advice. 

SOURCE: William Moss

Why do some COVID-19 vaccines require two doses?

The second dose boosts the immune response so that people can fight off infection of the actual coronavirus. There is clearly some protection from the first shot; how much there is, though, isn’t known. There will be more research done to see whether one shot might be enough, but for now, the evidence is really about two shots.

SOURCE: Joshua Sharfstein

Should people who already had COVID-19 and recovered still be vaccinated?

Yes. We’re going to learn a lot more about the effectiveness of the vaccine for different groups of people, including people who had been exposed before. It’s possible that there might be variations in that recommendation, but for right now, the safer thing to do, and what wound up being recommended, is for people to get the vaccine.

It is quite possible that the vaccination is going to provoke a stronger immune response, more protection for the individual, than getting sick, at least for people who had mild illness, but we don’t know that for sure yet.

SOURCE: Joshua Sharfstein

Do I still have to wear a mask and practice social distancing after I get vaccinated? 

Yes—If there is still a lot of virus out there being passed around, then people probably are going to be asked to wear masks and keep socially distant in order to reduce the spread and prevent the chance that the virus comes into contact with someone who is vulnerable and could get quite sick.

Over time, as more people get vaccinated and as more people take other precautions, the amount of virus is going to go down a lot. When those rates go way down, I think that the restrictions on our behavior might change.

What we don’t understand fully about the vaccine yet is whether it protects against infection. We know for sure that they do a good job protecting against moderate and severe illness, but it’s not really clear yet if people who get vaccinated are still able to transmit the virus to others.

SOURCE: Joshua Sharfstein

 

 

Social Distancing and Other Public Health Measures

Why is the world’s response to COVID-19 so much greater than the response to other outbreaks like H1N1 or SARS?

One reason is that this virus is more easily transmitted than SARS (SARS caused an epidemic in 2003.). People with SARS were most likely to transmit the virus when they were quite ill, so a lot of transmission occurred in health care environments. Once we were able to improve infection control in health care environments, we were able to bring the epidemic under control. The 2009 pandemic caused by the new flu strain H1N1 was similar to COVID-19 in the sense that people transmitted their infections quite easily. But it was a milder virus; it didn’t produce the same level of severe illness or death that we so far have seen with this novel coronavirus.

COVID-19 is not as deadly as SARS was. On average, SARS killed about 10% of the known cases, and the estimates for this virus are much lower. But the fact that it’s so easily transmissible— much more like a flu than SARS—has made response to this pandemic quite difficult.

SOURCE: Jennifer Nuzzo

What metrics should communities be looking at to understand the real-time spread and anticipate the timing of the surge?

What’s going on at your local level can change over time, from week to week, or month to month.

Local or state health department websites can tell you what’s going on in your community. First, look at the number of COVID-19 cases. This number includes those who test positive—and, remember that not everyone who is infected or feels sick will access a test, so that number is just the tip of the iceberg. You want to see what that number of cases is doing over time, note if it is going up or down. Another thing to be aware of if there is major change is the amount of testing that’s going on in your community.

The second number to look at is the number of deaths in the community. There’s been a lot of debate about how to measure COVID-19 deaths, but you’re going to be looking at that trend over time. Not just how many people died today, but over the last week. Hopefully, it is decreasing, signaling lower risk.

This is a live public health moment. Things are changing all the time and no data is perfect, but a lot of data can be really helpful.

The Johns Hopkins Coronavirus map is a good resource to examine the spread in other states and countries around the world. The map is updated in real time as additional information is made available from a variety of sources.

SOURCE: Public Health On Call Podcast

For businesses that remain open, what are best practices to protect employees and customers?

The Center for Health Security has an Operational Toolkit for Businesses Considering Reopening or Expanding Operations in COVID-19. The toolkit includes an instruction manual, business risk worksheet, and an assessment calculator.

SOURCE: The Center for Health Security

Is temperature monitoring effective?

Taking temperatures is a very insensitive and imprecise tool. People can have elevated temperatures for all sorts of reasons that don’t correlate with illness, such as exercise. People can also suppress their fevers by taking Tylenol or other over-the-counter medications.

Having ubiquitous temperature monitors is not likely to be a great benefit and may result in a huge number of false positives and false negatives.

SOURCE: Eric Toner

What are the best ways to do contact tracing?

A great resource on contact tracing is the Johns Hopkins COVID-19 contact tracing course, which is available for free on Coursera. (If you have taken the course, check out this resource of Frequently Asked Questions about contact tracing jobs and opportunities.)

In the U.S., the commitment to contact tracing programs, to getting them to the scale and speed that we need, has really varied by state and by jurisdiction. It’s clear across the U.S. right now that very few places that have the programs, the interventions in place, to keep transmission under control. Contact tracing has to be part of that. But there are other interventions to reduce the number of contacts that people have every day to go along with it.

Contact tracing can only work if you can find cases, and we are still not there with testing in the U.S.

SOURCE: Emily Gurley

Are there effective contact tracing apps or tech platforms?

Contact tracing is critical to managing transmission, but it’s resource intensive and requires a lot of data gathering. This can strain public health departments and areas that can’t recruit or train tracers.

Digital tools can facilitate quick and effective communication and give access to real-time information. Contact tracing tools and apps can follow up with patients, notify individuals of potential exposure, and refer them to testing facilities and care if they develop symptoms. There are also apps that collect user-generated data where users report symptoms or fill out surveys that can help officials map outbreaks.

But these tools may be costly, and there are questions of usability of the platforms. There are also privacy considerations, as some apps require the use of Bluetooth and location sharing.

SOURCE: Smisha Argawal

Reopening

How long will social distancing measures need to be in place?

I don’t think things will be completely back to normal until we have a vaccine, especially for things like mass gatherings. There is a cost to keeping everything closed down—and not just an economic cost, but peoples’ health. There is a psychological impact of being locked up and not being able to live your life that really has to be measured.

Everybody wants to get back to normal, but it’s going to take a little bit of time and it has to be done in a really measured and mindful way.Everybody wants to get back to normal, but it’s going to take a little bit of time and it has to be done in a really measured and mindful way. 

SOURCE: Amesh Adalja
RELATED: National Coronavirus Response: A Roadmap to Reopening

How should we be thinking about schools reopening?

The biggest factor determining risk in schools is what the virus is doing outside of them. In places where you have a very high test positivity, like well into the double digits, that suggests that the outbreak is very widespread and that testing isn't keeping up.

Regardless of whether schools open online, in person, or with a hybrid approach, there will be learning disruptions to consider. COVID-19 is exacerbating growing inequities around achievement, development, and graduation rates.

Schools can also expect a year of uncertainty and should think about plans for positive cases among students, faculty, and staff, or spikes in community transmission. Teachers and parents will need to help children manage distress caused by uncertainty, distance learning, and fear, and school leaders and educators will need to plan for different scenarios.

SOURCE: Johns Hopkins Bloomberg School of Public Health

How can schools develop a COVID-19 testing strategy?

Designing an effective testing strategy will require careful consideration of your group’s goals, resources, and structure. A testing strategy is a tailored plan that not only includes identifying the actual tests used but also describes the steps and factors to address to ensure that testing is rolled out in an effective way. In this section, we identify important factors you that can help you design your own testing strategy.

While a testing strategy will be unique to each organization, group, or individual, a few common factors should be considered when creating any testing plan:

  1. Are you trying to determine a current or past infection?
  2. Would you prefer to have samples collected at home or by a trained professional?
  3. How many people will be tested?
  4. What age groups will be tested?

SOURCE: The Center for Health Security's Testing Toolkit

Disparities

What are the disparities in testing for marginalized communities and how can we address them?

We’ve largely built testing off our health care system, with all the inequities built into it. That’s one of the reasons we’re suggesting a call center that’s available to everyone. Even though this virus started in the United States with people returning from cruises or international travel, the populations at greatest risk are low-income minority communities with high rates of chronic illness and insecure housing and food. The initial attention to people who got coronavirus on cruises and international trips has distracted us from the urgency of providing not just testing, but also follow-up services—food, housing, and other supports—for vulnerable populations. It’s the right thing to do as a matter of justice, but it’s also absolutely critical for control of the disease.

SOURCE: Joshua Sharfstein
RELATED: How Health Disparities Are Shaping the Impact of COVID-19

How should we think about making sure communities of Color have equitable access to vaccines?

The coronavirus disease 2019 (COVID-19) pandemic has had tragic and disproportionate adverse effects on Black, Indigenous, and People of Color (BIPOC) communities across the United States. 

As the COVID-19 vaccination campaign begins, it is critical that vaccines be delivered fairly and equitably—so that everyone has the same level of access to this lifesaving technology. Just as pressing is the need to address longstanding disparities that have created the unequal situation that BIPOC communities are now in.

The Center for Health Security has released a plan for elected and appointed officials that contains the tools to create, implement, and support a vaccination campaign that works with BIPOC communities to remedy COVID-19 impacts, prevent even more health burdens, lay the foundation for unbiased healthcare delivery, and enable broader social change and durable community-level opportunities.

SOURCE: The Center for Health Security's Equity in Vaccination Plan

How should we think about the need for racial and ethnic diversity in clinical trials for COVID-19 vaccines?

It’s critically important that we have racial and ethnic diversity.

We know that COVID causes increased rates of severe disease in Latinx and Black populations and in Native American populations. We will certainly want to be able to offer these COVID vaccines to these high-risk populations and encourage their use. But we need to know how well these vaccines work in these populations—if different vaccines work differently—so that we can offer the most effective vaccines.

SOURCE: Ruth Karron

Why are Black and other communities of Color being hit especially hard by COVID-19?

Before COVID-19, minority communities were already disproportionately impacted by health inequities. People in those communities already have higher rates of obesity, diabetes, heart disease, and lung disease, so these are the folks who were actually going to be at more risk of getting seriously ill with COVID-19. These health inequities result from the financial stresses of being poor and the social stresses of being from a marginalized group with a history of institutionalized, sanctioned mistreatment by law enforcement and other societal institutions.

There’s a confluence of all these different factors—not having access to food, not having access to good quality housing, being crowded in small houses where there are multiple generations and unable to engage in social distancing or stock up on groceries for several weeks at a time, having to use public transportation, to work in essential jobs, and having less access to health care. These are all manifestations of structural racism.

SOURCE: Lisa Cooper

What can be done right now to reduce the toll of COVID-19 on Black and minority communities?

Keeping an eye on the data is an important priority: knowing who is impacted and where they’re impacted.

Communication is also really important—making sure that the public understands why we might be seeing these patterns, and that it’s more about our society and the way our resources and opportunities are allocated than it is about individual behaviors. We need to do what we can to better understand the challenges of those communities, engage with trusted leaders, listen with respect, and show empathy and concern. We need to recognize the remarkable contributions of African American communities and follow our words up with real actions that bring about positive change.

We also need to focus on frontline workers and low-wage workers, and understand their needs—providing protective equipment, safe spaces to work, paid sick leave, hazard pay, or health insurance and access to testing and care. And, we need to provide for people’s basic needs: stable housing, food security, and digital access to education and health care.

SOURCE: Lisa Cooper

MORE INFORMATION

What are good sources of information?

Are there books for people to learn more about the public health response to similar situations?

The Public Health Crisis Survival Guide is for anyone involved in a public health operational role who may have to think about how to manage a crisis and maintain credibility in the face of uncertainty. D.A. Henderson’s Smallpox, the Death of a Disease has great information about operational challenges to confronting the spread of disease and the goal of trying to reduce its impacts on society.

SOURCE: Jennifer Nuzzo

How can I learn more from experts? 

The Johns Hopkins Bloomberg School of Public Health hosts a daily podcast called Public Health On Call, featuring interviews with experts and others on the front lines.