Coronavirus Answers from a Nurx Infectious Disease Doctor

Note: The original version of this post was published on February 27th, and it was last updated on March 30th. Dr. Hall has more recently written about safely socializing during the COVID-19 pandemic.  

What do I need to know about this coronavirus?

Am I at risk?

How should I protect myself?

What is Nurx doing to help?

As all of our daily lives have been disrupted by the emergence of the novel coronavirus threat in early 2020, these are questions Nurx providers are hearing from our patients. As this worldwide pandemic continues to unfold and more is learned about this virus and how it is spreads, we want to direct you to the latest information, allay your fears to the greatest extent possible, and help you think about life, work, and preserving your health in the era of this unprecedented health concern — knowledge about which is evolving daily.

What is the coronavirus? What is COVID-19?

COVID-19 is the infection caused by the novel coronavirus SARS-CoV-2 that was first identified in the Hubei province of mainland China in December 2019 but has now expanded to dozens of other countries, as tracked by the U.S. Centers for Disease Control and Prevention (CDC). Though we commonly refer to it as “the Coronavirus,” in fact this is a name given to an entire family of viruses that infect humans — some of them more benign, and others causing significant illness and sometimes death, usually in people very young, very old, or with compromised immune systems. A coronavirus causes a mild form of the common cold. In 2002-03 a coronavirus called SARS-CoV was a serious one that caused more than 8,000 people to get sick and 774 to die, in 17 countries. SARS was caused by a viral infection of animals called civets and cave-dwelling horseshoe bats in China’s Yunnan province. MERS was a more recent coronavirus threat.

COVID-19 has now caused more than half a million cases and tens of thousands of deaths around the world. These numbers will certainly continue to grow, and updated numbers are tracked by the World Health Organization. Like other viruses seen to affect humans rather abruptly, the present-day coronavirus likely “jumped” to humans in a market in Wuhan, China, where certain wildlife species were illegally sold and then consumed, though the precise source of the virus is still being investigated. 

Following the initial outbreak in China, efficient human-to-human spread has been widely observed, and it is the rate of such human-to-human spread that initially alarmed public health officials. Current estimates hold that every COVID-19 infection will lead to 2-3 subsequent infections, which is a relatively high “reproduction rate” for respiratory viruses. In Italy, where over 10,000 individuals have now died from this infection, the country has adopted rigorous containment measures including quarantine and travel restrictions in order to stem the outbreak.

How big a threat is the new coronavirus in the U.S.?

On March 13, a National Emergency was declared in the U.S. surrounding the emergence and spread of the COVID-19 virus in our country. On March 14, CDC recommended that all gatherings of greater than 50 persons be canceled or postponed for a period of 8 weeks, and two days later the Federal government released new guidelines including avoiding gatherings of more than 10 people, closing schools and avoiding discretionary travel and going to bars, restaurants and food courts. More recently, shelter-in-place orders have become more widespread, and most individuals in the U.S. are now advised to stay home and/or remain distanced from others (by at least 6 feet) when in public..

In the U.S. the number of individuals diagnosed with the COVID-19 coronavirus continues to rise, and we expect it to increase exponentially for a while. While the very early U.S. cases were those returning from Asia after acquiring the infection, as of early March individuals have contracted and thus spread the virus in the U.S. with community spread ongoing at this time. Some communities affected early on are predicting the apex of their rising cases in April. Travel remains restricted and discouraged. On March 11, the White House announced suspension of travel from Europe (excepting the U.K.), along with other recommendations to stem domestic spread of the epidemic. CDC has specific advice on domestic travel posted here. Updated U.S. COVID-19 statistics from CDC can be found here. 

Public health officials at CDC, along with state and local health departments, are vigilantly monitoring transmission. Those who may have been exposed at known points of transmission (i.e., cruise ships, health care facilities), as well as in heavily impacted U.S. communities and locales, are being self-quarantined for the 14-day incubation period of the virus, a duration based on what is known about closely related coronaviruses. Disease investigators are working to identify those who may have been exposed, so that they can be tested and self-quarantined.

What we know for certain is that the threat posed by this coronavirus inside the U.S. will be a dynamic challenge, affected by numerous factors, some still poorly understood: the characteristics of the virus itself, the ability to a deploy rapid and accurate testing at scale that initially was only available from CDC on a limited basis, as well as environmental factors and whether investigational therapy and vaccine options being rapidly studied will be proven effective. 

We will keep the Nurx community updated on anything we think you need to know. 

Am I at risk?

If you are younger than 50 and healthy, your risk of serious health effects from this infection are lower. Most cases of COVID-19 produce mild symptoms and don’t require inpatient medical care. Eighty percent of deaths occurring in people older than 65. The predominance of mild symptomatic disease, along with a prolonged incubation period in some, are among reasons why the virus has been able to efficiently spread, as people continue to go about their lives without knowing they’re infected, transmitting the infection to others.

Risk is significantly greater for people over 60 and those with underlying health issues or chronic conditions, including cardiovascular disease, diabetes and any condition that causes immunosuppression. People who fall into these categories are at greater likelihood of serious illness and even death from COVID-19, and have been advised by CDC to limit exposure to others as much as possible at this time.

Elevated risk of acquiring COVID-19 infection has been defined as having traveled from affected regions of China or other countries identified by CDC — which now include Iran, Italy, and most other European countries — in the last 14 days and/or having had close and prolonged contact with somebody who is a confirmed or suspected case. As more case clusters are identified in the U.S., however, the criteria of who is most at risk will shift, and understanding your actual risk will depend on conditions where you, live, work, and travel.

You are advised to consult local and state health departments for updates pertaining to your geographic area, because public health requires knowledge and vigilance at the local level!

How would I know if I am infected?

Chief symptoms include fever (in approximately 90% of people), along with cough, and shortness of breath — and the respiratory symptoms can be mild to severe. These are the same symptoms you might experience from influenza or other common respiratory illnesses. Other less commonly reported symptoms include sore throat, headache, and cough with sputum or blood present. Some patients have experienced gastrointestinal symptoms such as diarrhea and nausea prior to developing fever and lower respiratory tract signs and symptoms. Presently testing for the COVID-19 virus is being scaled up, but test kit availability remains limited; local health jurisdictions may now test for the virus in addition to CDC. Two major commercial labs, LabCorp and Quest, have made testing for the virus that causes COVID-19 available as of March 9. Newer tests, including those providing results in less than an hour, and others reflecting the antibody status of patients, are now becoming available in the U.S.

Generally testing continues to be prioritized for hospitalized persons and healthcare workers. If you feel you would benefit from a test, the first step is to talk with your primary care provider. Individuals with symptoms described above are urged to call ahead before seeking evaluation in a clinic or emergency room, so that advice can be given over the phone and, if appropriate, steps can be taken to minimize risks to health care workers and other patients should in-person care be required.

Will Nurx test me for the virus that causes COVID-19?

On March 20, Nurx launched a comprehensive home test collection and consultation service for COVID-19, but because of Federal regulatory uncertainty surrounding home tests for COVID, the service was paused pending appropriate clarification from FDA You can read more about our efforts to bring COVID -19 testing to the homes of U.S. patients here. In the meantime, you can search for testing near you through this COVID testing locator , Oscar, or Project Baseline.

Should I be worried about going to work or traveling?

At the moment, specific recommendations vary by locality. CDC recommendations can be found here. Much international travel is being limited, and you should check the CDC travel website as you plan travel.  Countless business and other entities are canceling (or making virtual) upcoming large-scale events and conferences and/or delaying non-essential international, and even domestic, travel — all out of an abundance of caution pending further developments.

These responses will evolve, but for now your focus should be following common-sense advice for avoiding viral respiratory infections, as discussed below.

What about avoiding exposure to others who may be infected?

At this time health officials are recommending “social distancing strategies” even for people at low-risk of experiencing severe COVID-19 disease. These include telecommuting, minimizing contact with visitors and others in the workplace. What is clear is that individuals with respiratory or cold symptoms should avoid others.  

It is important that you follow local and state health departments recommendations in your area for limitations on attendance at public venues or other restrictions.

Are people living with HIV infection at greater risk for COVID-19?

It is not yet clear whether or to what degree people living with HIV are at increased risk of acquiring or developing severe COVID-19 infection, because data are still being collected, and our understanding is evolving as the outbreak expands. In general, people with compromised immune systems are at greater risk of developing more severe COVID-19 illness, but this understanding does not apply to all people with HIV equally. Early studies have suggested those who are older and male are more likely to be affected by COVID-19. Because of effective treatment for HIV, approximately half of those living with HIV in the U.S. are now over 50 years of age.

The extent to which a person with HIV would be at increased risk for developing severe COVID-19 infection is likely related to degree of immunosuppression (reflected by low CD4 count) rather than degree of viral suppression (viral load). Being older and male are likely more important factors than HIV infection itself, for those who are HIV+ with reconstituted immune systems on ART (generally, those with CD4 counts over 300). This was the case with H1N1 influenza in 2009: there was no increased risk of severe disease in those who also had HIV. Those with HIV and CD4s lower 300 may be at increased risk for severe COVID-19 disease, but the magnitude of the increase is unclear. Also, people with HIV and low CD4 counts may manifest the infection differently: milder initial symptoms or faster progression to severe disease. Our understanding will evolve as more people are affected by this virus and among them, more HIV-positive people.

How do I stay informed?

As one of your healthcare providers, Nurx is committed to bringing you updates on major issues that could affect your health, safety, and wellbeing. Other trustworthy sources of information include your state and local health departments and the CDC, which maintains a coronavirus page here, updating the public and healthcare providers on the status of this novel coronavirus, along with recommendations for coping with the infection as our understanding of it advances. Another authoritative source of information is the John Hopkins Center for Health Security.

What steps can I take to protect myself?

If you have not yet been vaccinated for influenza, then you should talk to your primary care provider about getting vaccinated. The flu remains an immediate health threat to the young, old, and those with compromised immune systems. Interrupting the flu’s spread helps the coronavirus situation as well — fewer cases of influenza mean fewer sick people needing care and less confusion about the cause of flu-like illness.

There is a great deal you can do day-to-day to protect yourself. Other common-sense tips recommended by our providers include:

• Frequently washing your hands with soap and water
• Always avoiding touching your eyes, nose or mouth with unwashed fingers – see these tips
• Following sensible cough and sneeze etiquette — instructions here!
• Avoiding close contact with people who are sick. 
• Staying home from work or school and/or away from others if you become sick with symptoms such as fever, cough, or shortness of breath.
• Disinfecting household and workplace surfaces frequently touched by family members or co-workers, such as doorknobs and handles, since coronaviruses can persist on surfaces for as long a week.
• Rescheduling any non-essential medical appointments or procedures to reduce your exposure to sick people and to lighten the load on the healthcare system. Communicating with your healthcare providers through telemedicine, when possible, is a great option at this time.

About the Author

Chris Hall is a board-certified infectious disease physician who is Senior Medical Advisor for Nurx. Learn more about Chris, his commitment to HIV care and prevention, and his work with Nurx.

This blog pro­vides infor­ma­tion about telemed­i­cine, health and related sub­jects. The blog content and any linked materials herein are not intended to be, and should not be con­strued as a substitute for, med­ical or healthcare advice, diagnosis or treatment. Any reader or per­son with a med­ical con­cern should con­sult with an appropriately-licensed physi­cian or other healthcare provider. This blog is provided purely for informational purposes. The views expressed herein are not sponsored by and do not represent the opinions of Nurx™.