March 5, 2020

The symptoms of the new coronavirus—and who should be tested

Daily Briefing

    As of Thursday, the new coronavirus has spread to nearly 100,000 people worldwide, including more than 100 people in the United States. Here's everything you need to know about the symptoms of the coronavirus disease, COVID-19, and who should be tested for it.

    Our analysis: The 'recurring themes' of disease outbreaks

    About the coronavirus epidemic

    Reports of the new coronavirus first surfaced in early December 2019 in Wuhan, China.

    As of Thursday, officials reported more than 96,800 cases of the virus globally, with most of those cases occurring in mainland China. Officials said as of Thursday there had been at least 3,300 deaths linked to the virus, and all but 287 occurred in mainland China.

    In the United States, state and federal officials as of Thursday reported at least 160 confirmed or presumed positive cases of COVID-19 across 17 states and 11 deaths linked to the virus.

    The symptoms of COVID-19

    While some patients with COVID-19 are asymptomatic, most show symptoms of the virus. However, according to the World Health Organization (WHO), these symptoms tend to be mild. Based on confirmed cases of the disease, WHO data show:

    • 88% of patients experienced fever;
    • 67.7% of patients experienced a dry cough;
    • 33.4% of patients had excessive mucus;
    • 18.6% of patients experienced shortness of breath;
    • 13.9% of patients experienced a sore throat; and
    • 13.6% of patients experienced a headache.

    Some patients also may suffer gastrointestinal problems or diarrhea with COVID-19, according to the New York Times.

    According to Jin Dongyan from the University of Hong Kong, most mild cases of the virus are indistinguishable from a common cold. However, one distinguishing factor, according to Megan Murray, a professor of epidemiology at Harvard Medical School, is COVID-19 "is not usually associated with a runny nose."

    The symptoms of COVID-19 present themselves five to six days after infection, on average, but can show up as little as a day after infection or as much as two weeks later, according to Vox.

    Who should get tested for COVID-19?

    Until this week, CDC had limited testing to individuals who were exhibiting symptoms of infection and had recently visited countries with coronavirus outbreaks, had contact with someone who had a confirmed or suspected case of the virus, or had a serious respiratory illness with no clear cause.

    However, Vice President Pence on Tuesday said CDC will lift all of its current restrictions on testing patients for the new coronavirus, meaning all patients who receive a clinician's order for a coronavirus test can receive one.

    According to CDC, patients in any of the following high-risk groups who have symptoms should immediately seek medical help and be tested for the new coronavirus:

    • Those over 60 years old;
    • Hypertensive patients;
    • Patients with pre-existing breathing problems; or
    • Patients being treated for cancer.

    Similarly, CDC recommends that people who have lived in or have visited an area with a coronavirus outbreak, have had close contact with someone who has lived in or traveled to an area with a coronavirus outbreak, or have had close contact with an infected person immediately seek medical help and be tested for COVID-19 if they show symptoms.

    Amesh Adalja, an infectious-disease expert at the Johns Hopkins Center for Health Security, said patients concerned that they have the new coronavirus should contact the doctor's office or clinic before they arrive so the office can take appropriate precautions.

    Patients who are not in one of the high-risk groups who have symptoms of COVID-19 should manage their illness at home with over-the-counter cold and flu medications, health officials said.

    How is the virus transmitted?

    Given that the virus has only been around for a short time, experts are still studying how exactly COVID-19 is transmitted. Still, experts say four factors that likely influence how the virus is transmitted include how close you are to a person, how much time you spend with that person, whether that person exposes you to viral droplets, and how often you touch your face.

    While scientists don't yet know how long the new coronavirus survives on surfaces, a study from the Journal of Hospital Infection found similar coronaviruses could survive on surfaces for up to nine days under certain conditions.

    How can providers prepare?

    CMS on Wednesday called on hospitals and nursing homes to review and ensure they're using their infection control and prevention policies.

    To help providers, CMS issued two memos intended to answer common questions that hospitals and nursing homes may have about addressing the coronavirus. CMS said the memoranda, for example, address topics such as screening staff and visitors, transferring patients, and precautionary measures intended to protect providers from exposure to the virus.

    CMS also released new guidance that directs State Survey Agencies and Accrediting Organizations to immediately begin focusing hospital and nursing home facility inspections "exclusively on issues related to infection control and other serious health and safety threats, like allegations of abuse," the agency said. The guidance directs surveying and accrediting bodies to inspect thousands of Medicare providers—particularly hospitals and nursing homes—as part of the Trump administration's efforts to combat the new coronavirus.

    In addition, Pence on Wednesday said HHS has designated a lab test for the new coronavirus as an essential health benefit, meaning the test will be covered by private health plans in accordance with the Affordable Care Act, as well as Medicare and Medicaid. Patients enrolled in private health plans still might have to meet certain cost-sharing requirements for the test, CNBC reports (Irfan, Vox, 3/3; New York Times, 3/3; Iati, Washington Post, 3/4; Murphy, New York Times, 3/2; CMS release, 3/4; Cirruzzo, Inside Health Policy, 3/4 [subscription required]; Roubein, Politico, 3/4; Coombs/Feuer, CNBC, 3/4; Lai et al., New York Times, 3/5).

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