All of your questions are answered by medical and / or public health professionals (epidemiologists or health economists) with an MPH and/or MD degree. All of our answers include at least 2 trusted sources. Each answer is reviewed by 2 of our team members according to their specialty and the nature of your question. Finally, before being published each answer is reviewed and edited by a practicing Board Certified MD / MPH and/or a clinical PharmD MPH.
Please note that this is not a doctor/patient relationship and you will not receive a diagnosis. Your questions will be answered as it would apply to the general public.
Meet the response team
The Rocket Doctor team always first tries to find studies that are published in peer-reviewed journals. New research is being published daily, but there are still many unanswered questions about coronavirus.
If we cannot find a study that answers a question, we look for alternative reliable sources of information. We then critically review other news sources, interviews with medical professionals and epidemiologists to find the best available information. We will always provide we used at the end of our answers. Rocket Doctor answers will always be reviewed by two team members and a clinical editor for quality control purposes.
According to the CDC, washing your hands thoroughly with soap and water for at least 20 seconds is the best bet to protect against COVID-19. The physical act of scrubbing those hands combined with the force of the water and soap has the best impact on removing all sorts of things, including bacteria and other possible causes of infection.
If you can’t get access to soap and water, hand sanitizers with >60% ethanol or >70% isopropanol are good substitutes. Because it can be hard to wash with soap and water in a busy hospital, the CDC recommends that healthcare workers focus on sanitizer as above, but incorporate soap and water (for 20 seconds!) as often as possible.
The WHO has good examples of how to wash in text and image, but we think Ellen shows it best! “Ellen Wants to Help Protect You from Getting Coronavirus” https://www.youtube.com/watch?v=8WpFva5PYnU
- The CDC. CDC Statement for Healthcare Personnel on Hand Hygiene during the Response to the International Emergence of COVID-19. https://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html
- The World Health Organization. Clean Care is Safer Care. https://www.who.int/gpsc/clean_hands_protection/en/
There is quite a lot of uncertainty around non-steroidal anti-inflammatories (NSAIDs, which include drugs such as Ibuprofen, naproxen, diclofenac, and others) and their use in COVID-19 patients. This question stemmed from a tweet from the French Minister of Solidarity and Health who advised against the use of ibuprofen based on very limited case reports. There is currently no clear scientific evidence establishing a link between NSAIDs and worsening of COVID‑19.
Current recommendations in the US and the UK do not advise against the use of anti-inflammatories or NSAIDs according to the World Health Organization (WHO), Centers for Disease Control (CDC) and the European Medicines Agency (EMA). Rocket Doctor is monitoring the news daily and will continue to update our site with the most recent information possible.
There have been anecdotal case reports in hospitals in Seattle and other cities that caution against the use of NSAIDs in COVID-19.
At this time, patients should take NSAIDs as prescribed and healthcare professionals should continue to use NSAIDs, but monitor WHO and CDC recommendations daily.
The Pharmaceutical Journal. Advice on NSAIDS and COVID-19. March 17, 2020. https://www.pharmaceutical-journal.com/news-and-analysis/news-in-brief/advice-on-nsaids-and-covid-19/20207839.article?firstPass=false
The BMJ, Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists (03/17/2020): https://www.bmj.com/content/368/bmj.m1086
BBC News, Coronavirus and ibuprofen: Separating fact from fiction (03/17/2020): https://www-bbc-com.cdn.ampproject.org/c/s/www.bbc.com/news/amp/51929628
CBC News, WHO cautions against using ibuprofen to treat COVID-19.
The New York Times, Is Ibuprofen Really Risky for Coronavirus Patients? (03/17/2020) https://www.nytimes.com/2020/03/17/health/coronavirus-ibuprofen.html
Testing is currently available through at least one public health laboratory in all 50 states, as well as the District of Columbia and Guam. Private labs are also participating in coronavirus testing. New tests are being developed, and the US Food and Drug Administration recently gave approval for a new test from Thermo Fisher. Drive-thru testing is available in certain areas, such as New Rochelle, New York. Testing capacity and availability varies by state. If you are seeking the opportunity to be tested, one resource is your state health department.
It is better to avoid in-person contact with grandparents and other older adults even if you and your family have been practicing social distancing and other coronavirus-prevention strategies. This is because the virus is most severe in older adults, so extra precautions should be taken just in case you or a younger family member accidentally transmits the virus. Not all cases of coronavirus are symptomatic, especially in children, which is another reason it is better to connect with grandparents through video chat, phone calls, emails, text, or mail at this time. With that said, it is definitely important and encouraged to remain in contact with family and check in to keep everyone’s spirits up.
Ideally yes, but right now, it might be much better to stay home. Our testing systems in Canada and the USA still aren’t fully in place to withstand everyone coming in (although some are). The best thing to do is to check on your local public health system to understand what is available to your community.
The most common symptoms include fever (experienced by 98% of cases) and cough 76%), difficulty breathing (55%) and muscle pain/fatigue (44%). Less common symptoms include phlegm or blood in cough, headache, or diarrhea.
As of now, it looks like the mode of transmission of this Coronavirus (COVID-19) is through droplets, aka from spit, saliva, coughing etc. These droplets can land on surfaces, and as of now it looks like this virus can survive for 24 hours (or more) on those surfaces. This means that if someone is in an elevator on their own, the main risk is that the virus could potentially be left alive on surfaces, such as the elevator buttons. So, they’re safe to enter the elevator (especially when no one else is in it).
The most important thing for grandparents to do to stay protected is wash hands with soap and water and/or use hand sanitizer immediately after touching any surfaces in the elevator – and don’t touch face, eyes or otherwise until those hands are clean!
This same rule applies to any surface that may have been touched by others in the community (door knobs, hand-rails, tables, etc.) Washing our hands with soap and water for 20 seconds is the best way to kill the virus on hands, but a hand sanitizer with at least 60% alcohol is a good option for when people are on the go.
Fresh air is indeed very important. As long as we are at least 6 feet away from others while outdoors (social distancing!) we should be protected.
- CDC.How To Protect Yourself, 3/17/20, https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html
It’s so important that everyone washes their hands with soap and water! WHO wants us to put in 20 seconds each time, and that should do the trick. In terms of face washing, we want to use the same method as to wash our hands. Soap does not need to be antibacterial to make a difference – it just needs to be soap! Please remember though, soap and water alone does not kill the germs. It’s the mechanism of washing and thoroughly rubbing that does the trick. The CDC recommends regularly washing our face, and a typical face wash should be adequate for sanitizing! Harsh soaps might cause dryness of facial skin.
Most people who become infected with COVID-19 will experience more mild symptoms such as fever, cough and shortness of breath (see https://rocketdoctor.ca/covid-19-faq/). However, in the cases where patients pass away, the most common cause is respiratory arrest from ARDS (acute respiratory disease syndrome) – a condition where the lungs fail, often because of pneumonia from the virus. The lungs become very inflamed and full of fluid, which makes the patients have difficulty breathing. Once it gets very severe, the lungs cannot get enough oxygen into the body. This is why the full name of the virus includes the term “SARS” (Severe Acute Respiratory Syndrome). Other less common causes include heart rhythm abnormalities (arrhythmias), inflammation (myocarditis) and not getting enough blood to stay in the blood vessels because of the infection (septic shock).
The Guardian, Coronavirus: what happens to people’s lungs when they get Covid-19? (03/12/2020): https://www.theguardian.com/world/2020/mar/13/coronavirus-what-happens-to-peoples-lungs-when-they-get-covid-19
The Journal of the American Medical Association, Internal Medicine. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China (03/13/2020): https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2763184
The Lancet. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. (03/11/2020) https://www.ncbi.nlm.nih.gov/pubmed/32171076
**This question was modified to protect patient privacy and help others who may be in a similar situation**
Situations like these are extremely challenging. It is true that the general advice for people who are at high-risk of infection is isolation as much as possible, and that may limit certain types of care. This does come with challenges, and there are not always direct solutions. Often, it is a balance of what is most safe versus the most practical, combined with quality of life. Following the advice from caregivers is very important as they understand the context and situation best, and are constantly provided with the most recent information about patient safety.
Amazon or mail deliveries can carry the virus, as scientists now believe it will survive on surfances for hours or perhaps days. These packages and deliveries can be disinfected with the common disinfectants used on other materials. Make sure the disinfectant is proved to be effective against viruses. Common products used contain rubbing alcohol, which must contain at least 62% alcohol. Other options are 0.1 % sodium hypochlorite (as in regular chlorine bleach) and 0.5% hydrogen peroxide (clorox). Once a good disinfectant like those are used, the virus will be killed in a minute.
Asking someone to the home after a package delivery to disinfect and provide assistance may be one partial solution. If such a person wears a clean mask, gloves, and gown over their street clothing then they will greatly reduce the risk of infection while bringing in packages, after disinfecting them. That person should ensure they have no active symptoms of CoV-2 (cough, fever etc, see https://rocketdoctor.ca/covid-19-faq/).
We hope this pandemic ends soon, and would like to remind everyone that taking care of mental as well as physical health is extremely important in the days and weeks ahead. If there are any concerns, please call local health departments for advice and support.
For additional support, the National Alliance on Mental Illness offers a helpline Monday-Friday from 10am-6pm: 800-950-6264 and a Crisis Text Line that can be reached 24/7 by texting NAMI to 741741.
The Journal of Hospital Infection. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents (01/31/2020)
New England Journal of Medicine. Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1 (03/13/2020) https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v1.full.pdf
National Institutes of Health. New coronavirus stable for hours on surfaces. (03/17/2020) https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces
COVID-19 is known to be spread primarily by droplets, although new research suggests it may also stay in the air for up to several hours.
This means that it can be spread by someone who is infected when they spit, cough, or have a runny nose. The most important thing to consider is whether a surface that person touched, coughed / sneezed on or otherwise was a surface that was touched by the person traveling. Even if contact with the virus on a contaminated surface did happen, an infection can be prevented by washing those hands!
Around airborne spread, an infected person must cough or sneeze to put the virus into the air. However, according to the CDC, most airplanes built after the 1980s have HEPA filters, which are very effective at removing infectious disease, including viruses.
Currently, the Government of Canada recommends that all people returning from any Country around the world self-quarantine for 14-days. Many Countries now have similar policies, but please check for local guidance.
World Health Organization. Key considerations for repatriation and quarantine of travellers in relation to the outbreak of novel coronavirus 2019-nCoV. (02/11/2020) https://www.who.int/news-room/articles-detail/key-considerations-for-repatriation-and-quarantine-of-travellers-in-relation-to-the-outbreak-of-novel-coronavirus-2019-ncov
The CDC. Travel by air, land and sea. https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-by-air-land-sea/air-travel
The Government of Canada. Pandemic COVID-19 all countries: avoid non-essential travel outside Canada. https://travel.gc.ca/travelling/health-safety/travel-health-notices/221
Aerosol and Surface Stability of SARS-CoV-2 as Compared with The New England Journal of Medicine. SARS-CoV-1. https://www.nejm.org/doi/10.1056/NEJMc2004973
Some of the concerns around dogs and COVID-19 may have begun with a Hong Kong “weakly positive” infected dog. This was a single case reported in a COVID positive patient. However, there was no disease seen in the dog and all officials, including Hong Kong and WHO, agree that the dog eventually tested negative (and was released) and there is still no evidence of transmission via dogs. The dog himself died recently according to news reports, but only after being tested negative for the virus. He was 17 years old and likely died of old age!
Something for pet owners to consider is that the virus can survive in animal’s fur / hair. The American Veterinary Medical Association (AVMA) does recommend ensuring that owners wash their hands before and after interactions with their pets, keeping pets clean and well-groomed, and ensuring that their food and water bowls are cleaned and washed regularly with soap and water. In addition, the AVMA and CDC do recommend asking another person in the house to take care of pets in case an owner tests positive for COVID-19.
If there is no one else available, then owners should continue to take care of their pet as they ordinarily would and maintain proper hand hygiene before and after all interactions.
- American Veterinary Medical Association. What veterinarians need to know. (03/16/2020) https://www.avma.org/resources-tools/animal-health-and-welfare/covid-19
- Centers for Disease Control and Prevention. Animals and Coronavirus Disease 2019. (03/16/2020) https://www.cdc.gov/coronavirus/2019-ncov/prepare/animals.html
- New Updates on Low-level of Infection with COVID-19 in Pet Dog. https://www.pets.gov.hk/english/highlights/files/New_Updates_on_Low-level_of_Infection_with_COVID-19_in_Pet_Dog_0503__eng.pdf
South China Morning Post. First dog found with coronavirus has died after returning home virus-free from quarantine, Hong Kong authorities reveal. https://www.scmp.com/news/hong-kong/health-environment/article/3075650/first-dog-found-coronavirus-has-died-after
At this point, socially isolating because of a chronic medical illness is reasonable, especially with the community spread of COVID-19. According to the CDC, those over 60 years or people with chronic underlying medical conditions like heart or lung disease and/or diabetes are at a greater risk of developing more serious complications from COVID-19. A physician should be contacted directly to discuss potential risks and accommodations regarding work from home requests to employers.
If working from home is not an option, staying at least 6 feet (2 meters) from others and practicing good hand hygiene (wash hands for at least 20 seconds with soap and water or use 60% alcohol-based hand sanitizer) can help prevent contraction of the virus. Frequent cleaning of commonly touched areas in the office (such as doorknobs, desks, and light switches) with household cleaning products may also reduce his risk. The Environmental Protection Agency (EPA) has a list of registered disinfectants that meet the EPA’s criteria for use against COVID-19, which is a good place to start when considering which cleaning products to use. Staying up to date on medications and keeping chronic medical conditions well controlled is also very important. This means ensuring a sufficient supply of chronic medications as well as communication with primary care physicians.
Link to EPA registered disinfectants for coronavirus: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
Centers for Disease Control and Prevention. Interim US Guidance for Risk Assessment and Public Health Management of Persons with Potential Coronavirus Disease 2019 (COVID-19) Exposures: Geographic Risk and Contacts of Laboratory-confirmed Cases (03/07/2020) https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html
Centers for Disease Control and Prevention. Interim Recommendations for US Households with Suspected/Confirmed Coronavirus Disease 2019 (03/06/2020) https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcommunity%2Fhome%2Fcleaning-disinfection.html
As a rule of thumb, it is important to follow the public health guidelines given by your local government offices. In San Francisco, a densely-populated city, for instance, folks are recommended to only go outside to take care of essential tasks, such as acquiring food, toiletries and/or medicines, whereas in other cities that are not as densely populated or do not have shelter in place requirements, the recommendations may be more relaxed. Please first check on your local government office’s public health recommendations and follow their guidelines. Utilize the local department of health website and resources to obtain locally relevant guidance.
If there are no strict guidelines about walking outside, taking walks will not only help you get physical exercise, it will also help improve your mental health, which is just as important to cope with this pandemic. The recommendations delivered by sources such as the San Francisco city government is to stay at least six feet away from other walkers/runners to decrease the risk of exposure.
The Baltimore Sun. Johns Hopkins experts are learning more about the coronavirus. Here’s what they want you to know. (03/17/2020) https://www.baltimoresun.com/coronavirus/bs-md-what-scientists-know-about-coronavirus-20200317-wiiloohdznbhld3yosnsbdxefy-story.html
City and County of San Francisco.Stay home except for essential needs. (03/17/2020) https://sf.gov/stay-home-except-essential-needs
Substance Abuse and Mental Health Services Administration. Tips for Social Distancing, Quarantine, and Isolation During an Infectious Disease Outbreak. (2014) https://store.samhsa.gov/system/files/sma14-4894.pdf
There’s no data to show that COVID-19 is spread by food consumption. Using a disinfectant on delivered groceries isn’t necessary unless you’re sharing a space with someone who is immune-compromised, has signs of respiratory illness or has been exposed to the virus. Consider washing non-porous containers with soap and water. If that isn’t practical, be sure to wash your hands, the counter and any other surfaces you’ve touched after you put away the groceries. According to the CDC, you can wash produce with soap and water. Hard-skinned produce can be washed with dish or hand soap. Leafy greens and other vegetables can be soaked in soapy water for 10-15 minutes and rinsed thoroughly.
Please follow the general CDC guidelines when it comes to handling disinfectants/cleaning products, such as wearing gloves and ensuring good ventilation during the use of the cleaning product. Here is a list of U.S. Environmental Protection Agency-approved cleaning/disinfectant products (linked from the CDC): (https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf). Also, make sure to wash your hands thoroughly, per CDC guidelines: https://www.cdc.gov/handwashing/index.html.
Centers for Disease Control and Prevention. Interim Recommendations for US Households with Suspected/Confirmed Coronavirus Disease 2019 (03/06/2020) https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcommunity%2Fhome%2Fcleaning-disinfection.html#disinfect
American Chemistry Council and Center for Biocide Chemicals. Novel Coronavirus Fighting Products.(03/18/2020) https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf
Centers for Disease Control and Prevention. Handwashing – Clean Hands Save Lives. (01/14/2020) https://www.cdc.gov/handwashing/index.html
As of today (3/19/20), there has not been enough data to know how COVID-19 will affect women who are pregnant. Because so much is unknown about this, it may be best to practice extra caution such as good hand hygiene, social distancing and avoiding those with coughs, fever or shortness of breath. Viruses from the same family as COVID-19 and other viral respiratory infections have an increased risk of developing severe illness in pregnant women. Very limited data from Wuhan and Italy does not reflect an increased risk at this time, but until more data is available, pregnant women should take extra precautions.
According to the CDC, children without any preexisting health complications do not appear to be at a higher risk of contracting COVID-19 than adults; children with confirmed COVID-19 cases have generally presented mild symptoms. Currently, the sample size of children between the ages 0-9 have not been large enough for researchers to estimate a case fatality rate for those who are 15 months old. It is always wise to practice caution, due to this uncertainty. You can follow up-to-date information of case-fatality rates by age and by pre-existing conditions here: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_
Centers for Disease Control and Prevention. Pregnancy and Breastfeeding: Information about Coronavirus Disease (03/17/2020) https://www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fspecific-groups%2Fpregnancy-faq.html
Centers for Disease Control and Prevention. Coronavirus Disease-2019 (COVID-19) and Children (03/17/2020) https://www.cdc.gov/coronavirus/2019-ncov/prepare/children-faq.html
Johns Hopkins Medicine. Coronavirus COVID-19 (SARS-CoV-2). (03/15/2020) https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540747/all/Coronavirus_COVID_19__SARS_CoV_2_