COVID-19 FAQs: Infection Risk and Prevention

UPDATED 10/8/2020

Question: Is COVID-19 airborne?

A: In an updated guidance released October 5, the CDC acknowledged that the coronavirus may be transmitted by aerosols, or tiny virus particles that linger in the air for hours. Many experts have been warning about the possibility of airborne transmission, or infection by inhaling virus that’s in the air, for months. Still, the CDC says that current data suggests that most infections are spread though close contact, not aersolized transmission. That said, there have been documented cases where SARS-CoV-2 appears to have been transmitted over long distances or times. These events, however, appear to be "uncommon and "have typically involved the presence of an infectious person producing respiratory droplets for an extended amount of time (more than 30 minutes or hours) in an enclosed space.The CDC also says that indoor spaces with poor ventilation may be a contributing factor to aersolized spread. As such, in addition to social distancing and mask wearing, the CDC recommends against spending time in crowded indoor spaces. 

Health experts stress that this new information highlights the importance of wearing a mask indoors - even if you are more than 6 feet apart from others or there are plexi-glass barriers in place. Some experts even recommend playing it safe and wearing a mask outdoors if you're going to be in prolonged contact with others outside of your household. 

It’s important to remember that SARS-CoV-2 is a new virus, and every day experts are still learning about how it behaves. For now, your best bet is the adhere to the same advice you’ve been hearing for months: keep a safe distance from others, wash your hands frequently and limit prolonged trips in indoor spaces as much as possible.

Question: How does the coronavirus spread?

A: Most experts believe that person to person contact, mainly from respiratory droplets when an infected person sneezes, cough and talks, is the primary way the virus spreads. Infection occurs when people inhale infected droplets or these droplets land in a person’s mouth, nose or eyes. The risk of exposure to infected droplets is much higher when people are in close contact, hence why keeping at least 6 feet or more space between others is so important.

The virus can also be transmitted through surfaces – but the risk is much lower, accounting for about 6% of cases. 

All in all, experts agree that infection risk is much higher indoors than outdoors – virus droplets dissolve more easily in fresh air. As such, limit non-essential trips in shared indoor public spaces as much as possible.
 
Question: How contagious is the virus?       

A: It’s unclear exactly how contagious the coronavirus is, but data show it’s more contagious than other common infections, like the flu. Most people with the flu are contagious for about a day before symptoms show up and may remain contagious for about 7 days. People infected with COVID-19, on the other hand, can spread the virus for about 2 days before experiencing symptoms and may remain contagious for about 10 days after.

Another key reason for increased contagiousness is the large role asymptomatic spread plays in virus transmission. That is, people who are infected but who are not yet showing symptoms (or who will never show symptoms) are more likely to unknowingly spread the virus. Likewise, even if someone is asymptomatic or their symptoms go away, he or she can still spread the virus for at least 10 days after testing positive for COVID-19.

Finally, there is evidence that some people are “super spreaders,” meaning they release larger amounts of virus in the air when coughing, sneezing and talking. Experts believe that “super spreaders” likely only account for a small percentage of infected people, but stress that they may play an enormous role in virus transmission. In fact, some researchers estimate that just 10% of infected people account for about 80 to 90% of new COVID infections.

It’s impossible to know who spreads the virus more easily than others or who has an asymptomatic infection. Protect yourself by maintaining at least 6 feet of distance, preferably more, from others outside your household and wearing a mask.

Question: How deadly is the virus?

A: It’s still unclear. Determining the fatality rate of a virus requires comparing the number of infected people to the number of those who die. This has been especially difficult due to lack of testing and the number of undetected or undercounted infections. That’s one reason reported fatality rates vary from place to place and typically lowered over time as more testing is done.

That said, most data suggests that the fatality rate is about 0.5 – 1.0%, which is about five to 10 times more deadlier than the flu. But that rate doesn’t reflect how deadly the virus is for high-risk populations. Advanced age, being male and having certain conditions like diabetes and hypertension, are all associated with more severe disease and increased death rates. The risk of dying from COVID-19 also can vary considerably depending on ethnicity, access to healthcare and socioeconomic status. More high-quality studies are needed to determine case fatality rate among these different groups.  

Though the virus is very serious, the vast majority of people who get the virus, including people with rheumatic conditions, will recover.  

Question: Am I more likely to get COVID-19 or have complications from the virus if I have autoimmune or inflammatory arthritis?

A: Because the virus is still so new, it’s unclear how it impacts specific groups of high-risk populations.

However, current data finds that the risk for infection and serious complications for people with well-controlled types of inflammatory arthritis is not higher than the general population. Other comorbid conditions, such as obesity and diabetes, are much better predictors of having severe disease.

The key to curbing your infection risk is good disease control. Experts believe that high disease activity can increase the risk for complications. They also stress that secondary bacterial infection that occurs after a viral infection is one of the main concerns for people with autoimmune disease.

It’s important to keep up with healthy habits to manage your arthritis, such getting plenty of sleep, exercising regularly, eating a healthy diet and taking medication as prescribed. There is no evidence that medications, including DMARDs and biologics, are associated with a higher risk. However, there is one exception: Patients taking high doses – 10 milligrams or more – of corticosteroids daily have a higher risk of hospitalization. For that reason, talk to your doctor about the risks of taking corticosteroids. 

Rheumatologists will continue to analyze the data and publish findings, building a body of knowledge about their patients’ risks and outcomes. In the meantime, call your doctor right away if you think you’ve been exposed or are experiencing symptoms like fever, body chills, muscle aches and a dry cough.

Question: How can people with arthritis and autoimmune conditions take to protect themselves during COVD-19 outbreak? 

A: Maintaining 6 ft distance from others combined with mask wearing, good hand hygiene and limiting time in indoor shared spaces is the best way to reduce your chances of infection. Still, physical distancing may be harder for some than others, especially essential workers. If you’re unable to work from home or must venture out often, do your best to give others lots of space, wear a mask and avoid anyone who isn’t wearing one.

There are also employee protections for people with autoimmune diseas, and you may be eligible to apply for medical leave or work from home under these laws.

As mentioned before, practicing healthy habits to keep your disease well-controlled, like taking your medication, getting plenty of rest, exercising regularly and eating a healthy diet, can help reduce your chances of infection, and possibly complications.   

Question: Are masks good protection from infection?

A: By and large, health experts agree: Masks are essential in reducing the spread of the virus.  They help trap virus-laden droplets from an infected person, who sneezes, coughs or talks, from being expelled and becoming airborne.  The primary reason to wear a mask is to protect others if you unknowingly have the virus. However, growing evidence suggests that masks also provide some protection for the wearer as well.

It’s important to remember that masks are not a perfect shield, and the amount of protection for both the wearer and others depends on the type material and fit.

Cloth masks should be washed daily with hot water and detergent. To learn more about the science behind masks, including how tips on choosing a mask, click here.

Question: Are there any supplements I can take to protect myself from COVID-19? 

A: Certain vitamins and minerals are essential for supporting a healthy immune system and may have potential benefits, whether you’re trying to stay healthy or recover. However, talk to your doctor before starting any vitamin, mineral or supplement –especially at higher than recommended daily doses – to make sure it won’t worsen other health conditions you might have and won’t interfere or interact with your current medications.

Remember, no supplement can prevent infection. To learn more about supplements and the extent to which they can support your immune system, click here.