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Note from the Editor: The World Health Organization classified COVID-19 as a pandemic on March 11, 2020; this this has resulted in unprecedented and unforeseen effects on the medical world, as well as on the day-to-day lives of the general public. The new classification status allows for an increased likelihood of resources to be allocated to controlling the infection by various government and public health organizations, but this constantly evolving situation will require a concerted and combined effort of all of us to overcome.

As infections with severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) continue to increase, there has been a concurrent increase in news and data, both accurate and inaccurate. Therefore, we have undertaken a review of a considerable amount of this information, and attempted to clarify some of the most recurrent misconceptions. 

For example, “coronavirus” is not the appropriate identifier for the cause of the current infection causing epidemics in >40 countries. Coronavirus is the name of a family of viruses, which cause infections in humans and animals.1,2 The current outbreak is caused by a strain of coronavirus that has been named SARS-Cov-2; the constellation of respiratory symptoms caused by this virus is called Coronavirus Disease 2019 (COVID-19).3

1. COVID-19 is a pandemic.

Although the World Health Organization (WHO) has avoided deeming the virus a pandemic, WHO director-general Tedros Adhanom Ghebreyesus said, “This virus has pandemic potential. This is not a time for fear. This is a time for taking action to prevent infection and save lives now.” A pandemic is described as an epidemic that has progressed to a global scale. The term epidemic is applied for the case of an infection that spreads more rapidly than expected, over a large geographic area.5

2. You can get COVID-19 from products shipped from China.

The United States Centers for Disease Control and Prevention has not found any evidence to suggest that animals or animal products imported from China pose a risk for spreading COVID-19 in the United States.6 While it may be possible that a person can get COVID-19 by touching a surface or object that has the viral particles on it and then touching their own mouth, nose, or eyes, there has been no evidence to support this as the main way the virus spreads. In fact, one study reported that while the virus may live on surfaces for up to 9 days, “Data on the transmissibility of coronaviruses from contaminated surfaces to hands were not found. However, it could be shown with influenza A virus that a contact of 5 [seconds] can transfer 31.6% of the viral load to the hands.”7

3. Any cough-based illness is COVID-19.

It is important to remember that in the United States, it is still flu season, and although it may be wrapping up, it can last through May.8 Further, there are several families of viruses that cause respiratory symptoms; these viruses (eg, rhinoviruses, adenoviruses, respiratory syncytial virus, human parainfluenza viruses) are the cause of the common cold, and circulate year-round.9,10 

When is a cough concerning? If you feel sick with cough, fever and difficulty breathing, and have been in close contact with a person known to have COVID-19, or if you live in or have recently traveled from an area with ongoing spread of COVID-19.6

4. Community spread means anyone, anywhere can get the infection at any time.

The term community spread is used to describe a situation wherein the exact source of an infection cannot be identified.11 This commonly occurs in the setting of an epidemic: once the cases of an infection reach a certain point, a person may become infected without typical risk factors such as travel to an endemic area, or a person has close-contact with a sick person. In this situation, one may not know when or where they encountered an infected individual. This person may also not yet know they are ill, as they may still be in an incubation or asymptomatic stage of the illness. However, contact is still a requisite for transmission, knowingly or unknowingly. Community spread of infections can be ameliorated through the practice of hand hygiene, and staying home when you feel unwell.6,12 

5. Everyone who gets infected with SARS-CoV-2 will die or conversely, only elderly, sick people will die. 

Although the majority of cases that result in death are among the elderly, and individuals with chronic health conditions, COVID-19 has affected mostly all age groups, as well as people with no underlying diseases. There have been no deaths reported among children aged <9 years, who represent only 1% of all cases of infection.13 Individuals aged 10 to 19 years demonstrate a similar incidence, and those aged 20 to 29 years account for roughly 8% of cases.14 People aged 30 to 79 years, however, account for 87% of cases.13

The fatality rate for COVID-19 is also skewed toward the elderly: people aged 70 to 79 years have a fatality rate of 8%, compared with 14.8% among those aged >80 years.13 People with any underlying comorbidity have a higher fatality rate.14 In addition, reports indicate more people of the male sex have been infected; they have also more often presented with more severe infection, and have had higher death rates.14 

6. COVID-19 is more transmissible/deadlier than the flu.

This is tricky. Such statements can seem true if one is only looking at certain pieces of data; but data needs context. For example, the case fatality rate is frequently reported as being higher than that of the flu; however, it has already been demonstrated that fatality rates vary substantially across patient populations. Moreover, comparing a rate of one infection to another when the factors that influence that rate (number of individuals infected and number of fatalities) are so significantly different is cumbersome. Seasonal influenza has a fatality rate of <1%,15 compared with the roughly 2% fatality rate currently reported for SARS-CoV-2. However, any subgroup analyses (eg, individuals who have died) of the roughly 35 million annual cases of the flu will, more often than not, mathematically find a smaller number compared with an analysis of the roughly 114,000 cases of COVID-19.16

However, current data on the transmissibility of SARS-CoV-2 are more reliable in that calculations definitively take into account more variables.17 These data demonstrate that this infection is more transmissible than the flu; preventive measures, however, are the same. For this reason, all major health organizations, government officials, and even mass transit systems stress the importance of washing your hands frequently, coughing/sneezing into the crook of your elbow, and staying home when ill.6,12

7. Facial masks will keep you from getting sick.

The use of facial masks as a preventive measure for COVID-19 is not presently recommended for the general public.18 Healthcare workers who have direct contact with known cases of SARS-CoV-2 are recommended to use an N95 respirator mask, in conjunction with appropriate gowning and gloving techniques, and only in the hospital/clinic setting.18,19 The N95 filtering facepiece respirator functions by removing particles from the air as the individual breathes through the mask.19 Unlike these, other facemasks are only effective at preventing one from inhaling large respiratory droplets. The use of a non-N95 facemask is effective in preventing a person who is feeling unwell, or has a cough/sneeze-based illness from spreading an ongoing infection.

8. You should not travel internationally, at all.

The CDC issues travel recommendations for several infectious diseases, including COVID-19.20 A Warning Level 3 indicates avoidance of all nonessential travel to a given location. An Alert Level 2 advises that people with chronic medical conditions and older adults should avoid travel to such locations. Watch Level 1 means that the CDC does not recommend cancelling travel to such places. Due to the circulation and air filtration system on airplanes, the risk for infection transmission is low; the CDC does, however, recommend conscientious hand hygiene in this case.

Cruise ships put large numbers of people, potentially from a number of countries around the world, in frequent and close contact with each other; therefore the CDC strongly recommends frequent hand washing and avoidance of touching your face, and staying in your cabin and notifying the onboard medical center immediately if you feel unwell. 

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9. Flu or pneumonia vaccines will also help prevent COVID.

There are insufficient data to support the advocacy of the influenza or pneumococcal vaccines to prevent COVID-19.21 While these 2 illnesses have similar symptomology to COVID-19, the vaccines are formulated to be active specifically against the influenza virus and streptococcal bacteria, neither of which contribute to COVID-19. However, it is highly recommended that everyone who is indicated to receive either vaccine does so because it may aid in simplifying the evaluation of potential SARS-CoV-2 infections.21,22 

10. Heat will kill the virus.

Although a few high-ranking government officials have alluded to the possibility that high temperatures will kill the virus, there is not presently enough evidence to state this with scientific certainty. While the rate of most viral infections decreases during the summer months as a result of higher temperatures and humidity, there are 2 important caveats: people are less likely to be in close quarters with each other for lengthy periods, and although countries in the northern hemisphere are entering warmer months, the opposite is true for countries in the  southern hemisphere.23 Further, previous experience with and research on the other Coronavirus epidemics (SARS and MERS) demonstrated that this family of viruses may have little problem surviving in warmer climates.23

References

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  2. Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods Mol Biol. 2015;1282:1-23.
  3. The World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it. Updated February 11, 2020. Acessed March 6, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen
  4. Nebehay S, Shields M. “Fatal mistake” for countries to assume they won’t get coronavirus -WHO chief. Reuters. Published February 27, 2020. Accessed March 6, 2020.
  5. Grennan D. What is a pandemic? [published online March 5, 2019]. JAMA. doi:10.1001/jama.2019.0700
  6. Centers for Disease Control and Prevention. How COVID-19 spreads. Updated March 4, 2020. Accessed March 6, 2020. https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html
  7. Kampf G, Todt D, Pfaender S, Steinmann E. Persistance of coronaviruses on inanimate surfaces and their inactivation with biocidal agents [published online February 6, 2020]. J Hosp Infect. doi:10.1016/j.jhin.2020.01.022
  8. Centers for Disease Control and Prevention. The flu season. Updated July 12, 2018. Accessed March 6, 2020. https://www.cdc.gov/flu/about/season/flu-season.htm
  9. National Institutes of Health. Understanding a common cold virus. Updated April 13, 2019. Accessed March 6, 2020. https://www.nih.gov/news-events/nih-research-matters/understanding-common-cold-virus
  10.  Centers for Disease Control and Prevention. Common colds: protect yourself and others. Updated February 11, 2019. Accessed March 6, 2020. https://www.cdc.gov/features/rhinoviruses/index.html
  11. Centers for Disease Control and Prevention. CDC confirms possible instance of community spread of COVID-19 in U.S. Updated February 26, 2020. Accessed March 6, 2020. https://www.cdc.gov/media/releases/2020/s0226-Covid-19-spread.html
  12. Canadian Centre for Occupational Health and Safety. Good hygiene practices-reducing the spread of infections and viruses. Updated March 6, 2020. Accessed March 6, 2020. https://www.ccohs.ca/oshanswers/diseases/good_hygiene.html
  13. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China [published online February 24, 2020]. JAMA. doi:10.1001/jama.2020.2648
  14. Guan W, Ni Z, Hu Y, et al. Clinical chartacteristics of coronavirus disease 2019 in China [published online February 28, 2020].  N Engl J Med. doi:10.1056/NEJMoa2002032
  15.  Centers for Disease Control and Prevention. Disease burden of influenza. Updated January 10, 2020. Accessed March 6, 2020. https://www.cdc.gov/flu/about/burden/index.html
  16. Johns Hopkins. Coronavirus COVID-19 global cases. Updated March 6, 2020. Accessed March 6, 2020. https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
  17. Swerdlow DL, Finelli L. Preparation for possible sustained transmission of 2019 Novel Coronavirus: lessons from previous epidemics [published online February 11, 2020]. JAMA. doi:10.1001/jama.2020.1960
  18. The World Health Organization. Coronavirus disease (COVID-19) advice for the public: when and how to use masks. Updated March 6, 2020. Accessed March 6, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
  19. Centers for Disease Control and Prevention. Frequently asked questions about personal protective equiptment. Updated February 29, 2020. Accessed March 6, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html
  20. Centers for Disease Control and Prevention. Travel: frequently asked questions and answers. Updated March 3, 2020. Accessed March 6, 2020. https://www.cdc.gov/coronavirus/2019-ncov/travelers/faqs.html
  21. Yale Medicine. COVID-19 (Coronavirus Disease 2019). Accessed March 6, 2020. https://www.yalemedicine.org/conditions/covid-19/
  22. University of Chicago Medicine. COVID-19: what we know so far about the 2019 novel coronavirus. Published on February 13, 2020. Accessed March 6, 2020. https://www.uchicagomedicine.org/forefront/prevention-and-screening-articles/wuhan-coronavirus
  23. Le Page M. Will heat kill the coronavirus?. New Scientist. 2020;245(3270):6-7.