Q & A on COVID-19
2. Where do coronaviruses come from?
Coronaviruses are viruses that circulate among animals with some of them also known to infect humans.
Bats are considered as natural hosts of these viruses yet several other species of animals are also known to be a source. For instance, the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is transmitted to humans from camels, and the Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1) is transmitted to humans from civet cats. More information on coronaviruses can be found on the ECDC factsheet.
3. Is this virus comparable to SARS or to the seasonal flu?
The novel coronavirus detected in China is genetically closely related to the SARS-CoV-1 virus. SARS emerged at the end of 2002 in China, and it caused more than 8 000 cases in 33 countries over a period of eight months. Around one in ten of the people who developed SARS died.
The current COVID-19 outbreak caused around 7 000 reported cases in China during the first month after initial reports (January 2020), with a further 80 000 cases reported globally during the second month (February 2020). Of these first 87 000 cases, about 3 000 died. Cases are now being detected in Europe and across the globe. See the situation updates for the latest available information.
While the viruses that cause both COVID-19 and seasonal influenza are transmitted from person-to-person and may cause similar symptoms, the two viruses are very different and do not behave in the same way. ECDC estimates that between 15 000 and 75 000 people die prematurely due to causes associated with seasonal influenza each year in the EU, the UK, Norway, Iceland and Liechtenstein. This is approximately 1 in every 1 000 people who are infected. By comparison, the current estimated mortality rate for COVID-19 is 20-30 per 1 000 people.
Despite the relatively low mortality rate for seasonal influenza, many people die from the disease due to the large number of people who contract it each year. The concern about COVID-19 is that, unlike influenza, there is no vaccine and no specific treatment for the disease. It also appears to be as transmissible as influenza if not more so. As it is a new virus, nobody has prior immunity which in theory means that the entire human population is potentially susceptible to COVID-19 infection.
4. How severe is COVID-19 infection?
Preliminary findings indicate that the mortality rate for COVID-19 is 20-30 per thousand people diagnosed. This is significantly less than the 2003 SARS outbreak. However, it is much higher than the mortality rate for seasonal influenza.
5. What is the mode of transmission? How (easily) does it spread?
While animals are the original source of the virus, it is now spreading from person to person (human-to-human transmission). There is not enough epidemiological information at this time to determine how easily and sustainably this virus spreads between people, but it is currently estimated that, on average, one infected person will infect between two and three more. The virus seems to be transmitted mainly via respiratory droplets that people sneeze, cough, or exhale. The virus can also survive for several hours on surfaces such as tables and door handles.
The incubation period for COVID-19 (i.e. the time between exposure to the virus and onset of symptoms) is currently estimated at between two and 14 days. At this stage, we know that the virus can be transmitted when people who are infected show flu-like symptoms such as coughing. There is evidence suggesting that transmission can occur from an infected person with no symptoms; however, uncertainties remain about the effect of transmission by non symptomatic persons on the epidemic.
Medical information
1. What are the symptoms of COVID-19 infection
The virus can cause mild, flu-like symptoms such as:
- fever
- cough
- difficulty breathing
- muscle pain
- tiredness
More serious cases develop severe pneumonia, acute respiratory distress syndrome, sepsis and septic shock that can lead to death.
2. Are some people more at risk than others?
Generally elderly people and those with underlying health conditions (e.g. hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer) are considered to be more at risk of developing severe symptoms.
3. Are children also at risk of infection?
Disease in children appears to be relatively rare and mild. A large study from China suggested that just over 2% of cases were under 18 years of age. Of these, fewer than 3% developed severe or critical disease.
4. What about pregnant women?
There is limited scientific evidence on the severity of illness in pregnant women after COVID-19 infection. That said, current evidence suggests that severity of illness among pregnant women after COVID-19 infection is similar to that in non-pregnant adult COVID-19 cases, and there is no data that suggests infection with COVID-19 during pregnancy has a negative effect on the foetus. At present, there is no evidence of transmission of COVID-19 from mother to baby occurring during pregnancy. ECDC will continue to monitor the emerging scientific literature on this question, and suggests that all pregnant women follow the same precautions for the prevention of COVID-19, including regular handwashing, avoiding individuals who are sick, and self-isolating in case of any symptoms, while consulting a healthcare provider by telephone for advice.
5. Is there a treatment for the COVID-19 disease?
There is no specific treatment for this disease, so healthcare providers treat the clinical symptoms (e.g. fever, difficulty breathing) of patients. Supportive care (e.g. fluid management, oxygen therapy etc.) can be highly effective for patients with symptoms.
6. When should I be tested for COVID-19?
Current advice for testing depends on the stage of the outbreak in the country or area where you live. Countries across the EU/EEA might be in different scenarios, even within the same country, and testing approaches will be adapted to the situation at national and local level.
National authorities may decide to only test subgroups of suspected cases based on the national capacity to test, the availability of necessary equipment for testing, the level of community transmission of COVID-19, or any other criteria. As a rational approach, national authorities may consider prioritising testing in the following groups:
- hospitalised patients with severe respiratory infections;
- cases with acute respiratory infections in hospital or long-term care facilities;
- patients with acute respiratory infections or influenza-like illness in certain outpatient clinics or hospitals in order to assess the extent of virus circulation in the population;
- elderly people with underlying chronic medical conditions such as lung disease, cancer, heart failure, cerebrovascular disease, renal disease, liver disease, diabetes, and immunocompromising conditions
7. Where can I get tested?
If you are feeling ill with COVID-19 symptoms (such as fever, cough, difficulty breathing, muscle pain or tiredness) it is recommended that you contact healthcare services by telephone or online. If your healthcare provider believes there is a need for a laboratory test for the virus that causes COVID-19, he/she will inform you of the procedure to follow and advise where and how the test can be performed.
Prevention
1. How can I avoid getting infected?
The virus enters your body via your eyes, nose and/or mouth, so it is important to avoid touching your face with unwashed hands.
Washing of hands with soap and water for at least 20 seconds, or cleaning hands with alcohol-based solutions, gels or tissues is recommended in all settings.
It is also recommended to stay 1 metre or more away from people infected with COVID-19 who are showing symptoms, to reduce the risk of infection through respiratory droplets.
2. 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, you should immediately call your healthcare provider for advice, mentioning that you have been in contact with someone with COVID-19.
3. Are face masks effective in protecting against COVID-19?
If you are infected, the use of surgical face masks may reduce the risk of you infecting other people, but there is no evidence that face masks will effectively prevent you from being infected with the virus. In fact, it is possible that the use of face masks may even increase the risk of infection due to a false sense of security and increased contact between hands, mouth and eyes.
4. Is there a vaccine against the virus? How long will it take to develop a vaccine?
There are currently no vaccines against human coronaviruses, including the virus that causes COVID-19. This is why it is very important to prevent infection and to contain further spread of the virus.
The development of vaccines takes time. Several pharmaceutical companies are working on vaccine candidates. It will, however, take months or years before any vaccine can be widely used, as it needs to undergo extensive testing to determine its safety and efficacy.
5. Am I protected against COVID-19 if I had the influenza vaccine this year?
Influenza and the virus that causes COVID-19 are two very different viruses and the seasonal influenza vaccine will not protect against COVID-19.
What is the current situation in the EU regarding COVID-19?
1. How prepared is Europe for COVID-19 and what is the EU doing?
The European Centre for Disease Prevention and Control (ECDC) is in continuous contact with the European Commission and the World Health Organization regarding the assessment of this outbreak. To inform the European Commission and the public health authorities in Member States of the ongoing situation, ECDC publishes daily summaries and continuously assesses the risk for EU citizens. ECDC and WHO have developed technical guidance to support the EU Member States in their response. The European Commission is ensuring the coordination of risk management activities at EU level.
2. Am I at risk of contracting COVID-19 infection in the EU?
This outbreak is evolving rapidly and the risk assessment is changing accordingly. ECDC is continuously assessing the risk for EU citizens and you can find the latest information in the daily updated ECDC risk assessment.
3. How many people have been infected in the EU/EEA?
See the ECDC daily situation update for the latest available information. Given the extensive movement of people and the fact that the virus is transmitted from person to person, further cases are expected in Europe.
4. How long will this outbreak last?
Unfortunately, it is not possible to predict how long the outbreak will last and how the epidemic will unfold. We are dealing with a new virus and therefore a lot of uncertainty remains. For instance, it is not known whether transmission within the EU/EEA will naturally decrease during the northern hemisphere summer, as is observed for seasonal influenza.
5. Should schools and day centres be closed?
The evidence we have to date indicates that COVID-19 does not affect children nearly as much as it affects adults. However, the extent to which children play a role in the transmission of the virus is still unknown. Due to this uncertainty, it is especially important to encourage children to wash their hands carefully to reduce any possible risk of them becoming infected themselves, and then of passing on the virus. If children do become ill, they should be strictly isolated at home.
Depending on local circumstances, local authorities may decide to temporarily close schools and daycare centres to reduce transmission. Wherever this happens, it is important that parents and caregivers are supported, for example by their employers, so they can stay at home and take care of their children.
Information for travellers
1. What precautions should I take if I am visiting an area of local or community transmission?
Travellers visiting areas of local or community COVID-19 transmission should adhere to strict hygiene measures, wash hands with soap and water regularly, and/or use alcohol-based hand sanitisers. Touching the face with unwashed hands should be avoided. Travellers should avoid contact with sick persons, in particular those with respiratory symptoms and fever. It should be emphasised that older people and those with underlying health conditions should take these precautionary measures very seriously.
2. What if I have recently been in an area of local or community transmission?
Travellers returning from areas of local or community transmission should monitor their health for 14 days. People with symptoms should contact their healthcare specialist via telephone first, and indicate their exposure and travel history before seeking medical attention in person. Symptomatic people should avoid contact with others until they have received advice from a healthcare specialist.
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3. What is the risk of infection when travelling by plane?
If it is established that a COVID-19 case has been on an airplane, other passengers who were at risk (as defined by how near they were seated to the infected passenger) will be contacted by public health authorities. Should you have questions about a flight you have taken, please contact your local health authority for advice. The risk of being infected on an airplane cannot be excluded, but is currently considered to be low for an individual traveller. The risk of being infected in an airport is similar to that of any other place where many people gather.
4. Why are people not being checked for COVID-19 at the airport when arriving from areas of local or community transmission?
There is evidence that checking people at the airport (known as entry screening) is not very effective in preventing the spread of the virus, especially when people do not have symptoms. It is generally considered more useful to provide those arriving at airports with clear information explaining what to do if they develop symptoms after arrival.
5. Where can I learn more?
Each EU/EEA country may issue specific advice to travellers to areas with local or community transmission of COVID-19. Consult your local health authority or the Ministry of Foreign Affairs to get advice tailored for residents in your setting.
For an updated list of areas of presumed community transmission, please refer to WHO situation reports for country classification.
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COVID-19 and animals and food products
1. What is the risk of COVID-19 infection from animals or animal products imported from affected areas?
There is no evidence that any of the animals or animal products authorised for entry into the European Union pose a risk to the health of EU citizens as a result of the presence of COVID-19.
2. What is the risk of COVID-19 infection from food products imported from affected areas?
There has been no report of transmission of COVID-19 via food and therefore there is no evidence that food items imported into the European Union in accordance with the applicable animal and public health regulations pose a risk for the health of EU citizens in relation to COVID-19. The main mode of transmission is from person to person.
3. What is the risk of COVID-19 infection from contact with pets and other animals in the EU?
Current research links COVID-19 to certain types of bat as the original source, but does not exclude the involvement of other animals. Several types of coronaviruses can infect animals and can be transmitted to other animals and people. There is no evidence that companion animals (e.g. dogs or cats) pose a risk of infection to humans. As a general precaution, it is always wise to observe basic principles of hygiene when in contact with animals.
COVID-19 and packages
1. What is the risk of getting COVID-19 from packages delivered through the postal system?
A recent study published by The New England Journal of Medicine (NEJM) reported that the causal agent of COVID-19 (SARS-CoV-2) is able to persist for up to 24 hours on cardboard, in experimental settings (e.g. controlled relative humidity and temperature). There is no evidence of the infection being transmitted through contaminated packages that have been exposed to different environmental conditions and temperatures.
2. Are people working in the supply chain including logistics, control services, retail, etc. at risk of getting COVID-19 by handling packages? What measures can be taken to reduce the risk of getting infected in this type of work setting?
People working in the supply chain, including logistics, control services, retail, etc. are not at greater risk to of getting COVID-19 as a result of managing packages. ECDC does not recommend any special measures at supply chain level over and above those addressed to the general public: frequent and thorough hand washing and use of alcohol-based hand disinfectants, keeping a distance from other employees, and not working if showing signs of respiratory symptoms.
3. Are couriers at risk of getting COVID-19 by handling packages? What measures can be taken to reduce the risk of getting infected in this type of work setting?
People working as couriers are not at greater risk of getting COVID-19 as a result of managing packages. Couriers delivering packages at homes are advised to keep a distance from the customer, use alcohol-based hand disinfectant frequently (and always before and after contact with a customer) and avoid working if showing signs of respiratory symptoms.
