COVID-19

100 Questions About Coronavirus Disease You Need to Know

Everything you need to know about the current pandemic and virus design.

Peter Piot
Microbiologist, specialist in Ebola and AIDS. Director of the London School of Hygiene and Tropical Medicine.

1. Let’s start with the basics. What is a virus?

This is a small piece of the genetic code of RNA or DNA, protected by an external protein coat.

2. How common are viruses?

They are everywhere. If you add together all the viruses that exist in the world, their mass will exceed the mass of living matter – plants, animals and bacteria combined. 10% of the human genome is the DNA of viruses. Earth is actually a planet of viruses!

3. Why is it so difficult to stop the spread of the virus?

Viral particles are incredibly small. After someone has coughed, billions of these particles can float in the air.

4. How small are the viruses?

They are tiny. You will not see them even with a standard microscope. One hundred million new-type coronavirus virus particles will fit on a pinhead. That’s how small they are.

5. What do viral particles do?

They try to invade the inside of a living cell in order to multiply, infect other cells and other hosts.

6. Why do they need it?

This is their way of reproduction. Viruses act like parasites. They capture living cells to make everyone produce new viruses. Once inside, the virus sends hundreds or thousands of copies. As a result, the captured cell often dies.

7. What does it mean to become infected with a new type of coronavirus (SARS ‑ CoV2)?

This means that SARS ‑ CoV2 has begun to multiply in your body.

8. What is the difference between SARS ‑ CoV2 and COVID ‑ 19?

SARS ‑ CoV2 is the virus, and COVID ‑ 19 is the disease that this virus causes.

9. Is it easy for a virus to get inside a living cell?

First of all, it depends on whether the cell has a suitable receptor for a particular virus. Imagine a keyhole and a key. Not every key will fit an existing well. Most viruses are blocked by our immune system or cannot get inside, since we do not have receptors suitable for them. Therefore, 99% of them are not dangerous to humans.

10. And how many types of viruses and how many are dangerous for us?

Of the millions of species, only a few hundred are dangerous to humans. New viruses appear constantly. Most of them are harmless.

11. How many viral particles do you need on average to get infected?

We do not know this yet regarding SARS ‑ CoV2. But usually quite a bit.

12. What does a SARS ‑ CoV2 particle look like?

Like a small string of spaghetti wrapped in a ball and wrapped in a shell of protein. On the shell there are spiky processes protruding in different directions and giving it a resemblance to the solar corona. All viruses of this family look similar.

13. How many coronaviruses affect humans?

In total there are seven coronaviruses that are transmitted from person to person. Four cause a mild cold, but the other three can be fatal. These are viruses invoking SARS, Middle East Respiratory Syndrome (MERS), and the new type of coronavirus (SARS ‑ CoV2).

14. Why is it called a “new type of coronavirus”?

The name means that the virus is new to humans, and this is exactly what we have not seen before. Our immune system has evolved over two million years. But since this virus has never come across to our body, it was not possible to form an immunity to it. Our lack of immunity, the ability of the virus to spread rapidly and its relatively high mortality rate – this is why the appearance of SARS ‑ CoV2 is so worrying for everyone.

15. How often are new viruses worth worrying about?

Rarely. Examples include viruses that cause diseases such as HIV, SARS, Middle East respiratory syndrome. The emergence of a new virus is a very big problem if it can spread easily among people and if it is dangerous.

16. How fast is the new virus spreading?

SARS ‑ CoV2 spreads quite easily from person to person through coughing and touching. It is a virus transmitted by airborne droplets.

17. Are there any other methods of distribution?

According to some reports you can also get infected through feces and urine, but this has not yet been proven.

18. How is a new virus different from previous ones?

It has four important differences:

  • Many infected people do not show symptoms for several days. This leads to two problems: people involuntarily infect others and we don’t know who to quarantine. This is especially troubling because SARS ‑ CoV2 is highly contagious.
  • In 80% of cases, COVID ‑ 19 is mild, similar to the common cold. Because of this, people are not isolated and infect others.
  • According to the symptoms, the disease can be confused with the flu , so many believe that they have it.
  • Most importantly, the virus is very easily transmitted from person to person, because in the early stages it is concentrated in the upper part of the throat. When an infected person sneezes or coughs, billions of viral particles can enter the air and other organisms.

19. Doesn’t it cause pneumonia? What does the throat have to do with it?

The disease often begins in the throat (therefore, a smear is taken from there) and then goes down to the lungs and becomes a respiratory infection of the lower respiratory tract.

20. I often hear the word “asymptomatic.” What does it mean?

That a person has no symptoms of the disease, it does not manifest itself.

21. That is, someone can become infected with this virus and have no symptoms at all?

Unfortunately yes. Many people who become infected have no symptoms during the first few days, and then there are signs of a cold or a slight fever. This is the opposite of SARS, during which a person has obvious symptoms for several days, but you can infect someone only while you are sick.

22. If you have no symptoms, can you infect others?

Unfortunately, yes. Because of this, it is much more difficult to slow down the spread of the virus.

23. What is the likelihood that scientists will create a vaccine that will prevent coronavirus infection?

High enough, but no guarantees. Failure is also possible. For example, scientists have been looking for a vaccine against HIV for 35 years, but it never appeared. I am optimistic and believe that we will receive a vaccine from SARS ‑ CoV2, but it will have to be tested repeatedly for effectiveness and safety, and this takes a lot of people and time.

24. Suppose a vaccine is coming soon. How much time will pass before we can vaccinate millions of people?

Candidate vaccines will appear within a month or two. But because of the need for rigorous testing for efficacy and safety, at least a year will pass before the large regulatory body approves the vaccine and we can administer it to people. And the production of millions of doses will take from one and a half to two years. And this is an optimistic forecast.

25. Why so long?

So much time is taken not by creating a vaccine, but by testing it. As soon as a candidate vaccine appears in the laboratory, it needs a series of clinical trials. First on animals, and then on gradually increasing groups of people.

26. Already have progress?

Just a few weeks after the detection and isolation of the SARS ‑ CoV2 strain, which occurred in early January 2020, vaccine development began. Many governments and companies have allocated funds for this, and scientists from around the world are working on it hastily.

27. Scientists from different countries collaborate or compete?

Both that and another that is not bad. But overall, international cooperation is well supported. This is encouraging.

28. And you can not develop a vaccine faster?

Unfortunately, there is no way to cut the path. The human immune system is complex and unpredictable. Virus mutations may occur. Children are different from adults. Men and women may have a different reaction. We must be sure that the vaccine is 100% safe for everyone who receives it. To do this, the tool is tested in different doses on a wide range of healthy volunteers under carefully controlled conditions.

29. How deadly is the new virus?

Most scientists believe that it kills from 1-2% of the infected. WHO now calls a different figure (more than 3%), but this indicator is likely to decline when it becomes clear how to take into account many undetected and non-serious cases. Mortality is clearly higher among older people and people with chronic diseases.

30. Should I focus on the average mortality rate?

Not really. To understand the risks, it is more important to know that for certain groups of people the virus can be fatal, and for others it is less dangerous, but it can lead to completely different consequences.

31. Then, what numbers to focus on?

In 80% of cases it is an easily occurring disease, but in 20% it becomes more serious. In a bad situation, patients have a high temperature and shortness of breath. As a result, some require hospitalization, and some require a stay in the intensive care unit if their lungs are severely infected.

32. Which groups of people are most at risk?

First, older people like me: I’m 71. The older you are, the higher your risk. It is also elevated for people with chronic diseases such as diabetes, chronic obstructive pulmonary disease, diseases of the cardiovascular system and immunodeficiency.

33. How much higher is their risk of dying?

Their mortality rate rises to 10 or even 15%. And the risk increases when a person has several diseases.

34. Why is the risk so great if there are other diseases?

Because in this case, the immune system is weakened and reacts worse to any virus, and especially to this one.

35. It seems that the virus has little or no effect on children and young people. This is true?

So far it looks like it, but, like with many other COVID ‑ 19 factors, confirmation is needed.

36. If so, why does the virus affect older people more?

We do not know. It will take some time to understand this.

37. Does he still have unusual features?

You can infect others, even if you yourself do not have symptoms and feel good. This is unusual, although it happens with HIV.

38. COVID ‑ 19 is often compared to seasonal flu. Is such a comparison correct? For example, are they equally dangerous?

In the United States, up to 30 million people a year usually become infected with seasonal flu, and less than 0.1% of them die. But this is still a large number of people. In the world, an average of 300,000 people die from influenza per year. A new type of coronavirus is 10–20 times more dangerous, and we cannot protect ourselves from it now with the help of a vaccine.

39. Does a new virus spread as easily as flu?

Yes, it seems.

40. And they have the same reasons? Is the flu also caused by a virus?

Yes. It is caused by the flu virus. But the flu virus and coronavirus are very different. A flu shot will not help against coronavirus, but it will significantly reduce the risk of getting the flu. A common cold, from which there is no medicine or vaccine, is often caused by another type of virus – rhinovirus, and occasionally another coronavirus.

41. How does the disease progress when the coronavirus settles in the body?

Usually it all starts with a cough. Then the temperature rises. Then it rises very much, breathing problems appear.

42. At what point does medical care become a decisive factor for survival?

Usually when there is a very high temperature, and the lungs are so affected by the virus that you have difficulty breathing or need a ventilator.

43. How is the new virus different from diseases such as measles, mumps and chickenpox?

SARS ‑ CoV2 is currently much less contagious and dangerous, but we still don’t know much about it. And the listed diseases are well studied.

44. If coronavirus is not as dangerous as other viruses, why is it so afraid?

Because a new threat that can kill or make us seriously ill, we are very nervous. But the antidote to fear is reliable information. Therefore, I strongly recommend that residents of the United States watch it on the Centers for Disease Control and Prevention website. And in other countries, I advise you to focus on the site of the local ministry of health or WHO.

45. How often is it worth visiting such sites?

Scientists constantly learn something new about the virus and update information, so it’s better to check resources often.

46. ​​Has humanity ever completely destroyed a virus?

Yes. Smallpox, which used to kill millions of people. And we are very close to eradicating polio thanks to the Bill and Melinda Gates Foundation and the governments of many countries. We must not forget how this disease terrorized everyone.

47. How is a new virus spreading around the world?

On roads, air and sea. Today viruses travel by plane. Some passengers may have SARS ‑ CoV2.

48. So, each international airport is a breeding ground for a new virus?

SARS ‑ CoV2 is already present in most countries and not only at major international airports.

49. The epidemic began in China, so those who come from this country are the most dangerous in terms of the spread of the virus in the United States?

The virus appeared in 2019, since then 20 million people have arrived in the United States from around the world. Most direct flights from China were suspended four weeks ago, but this did not stop the virus from entering the country. In China, cases of COVID-19 are now more often imported by people arriving from other countries, and the epidemic in China itself is likely to be on the decline (Peter Piot answered questions on March 12, 2020. – Ed.).

50. In other words, is having a large airport a guarantee that the virus will spread throughout the country in less than three months?

Yes. But this is not a reason to completely cease communication with the world.

51. Why did Japan close schools?

This is done in other countries. Because scientists do not know how much children who can be carriers of the virus accelerate its spread. Japan is trying hard to slow this process down. Children usually transmit viruses quickly because they do not wash their hands and generally do not particularly monitor personal hygiene. They make a great contribution to the spread of influenza, so in many countries schools are closed during epidemics.

52. Are there any medications for coronavirus that can be taken to alleviate symptoms or recover?

There are no drugs found to be effective. Clinical trials of many drugs are being conducted, so I hope that the situation will change soon.

53. What is the likelihood that drugs will be created, and how soon can this happen?

In the coming months, we are likely to find that some of the existing drugs help to recover. That is, we can use drugs that are now used against other viruses, such as HIV. But it will take time and a lot of tests.

54. And what about antibiotics? They are usually addressed in difficult cases.

It is a virus, not a bacterium. Antibiotics act against bacteria, but not against viruses. They can help with secondary bacterial infections, but they themselves do not affect the new virus.

55. What about all the tools that are talked about on the Internet?

Most of what they write about is complete nonsense. More and more fake drugs will appear. Only if the tool was written in many proven sources, you can be sure that it is scientifically confirmed. So be careful not to spread rumors.

56. And the masks? Are they useful?

Very limited and only in certain conditions. For example, depending on the type of surgical mask, less than 50% of viral particles are filtered out. But a mask can reduce the spread of the virus if you yourself are ill.

57. What are their advantages and who should wear them?

A mask close to the face, if worn correctly , will slow the spread of viral particles during coughing. It will not protect you from other people. This is a means of protecting other people from you. To be masked if you have symptoms of a cold means to show respect for others. This item has an additional plus: in the mask you are less likely to touch your mouth, which means you are less likely to bring the virus into the body if it gets into your hands. This remedy is also a must-have for medical professionals.

58. Can something be done so as not to become infected?

Often wash hands, try not to touch the face, sneeze and cough, closing with an elbow or a paper handkerchief, do not shake hands and do not hug. All this reduces the risk. If you become ill, stay home and consult your doctor over the phone about the following steps.

59. Scientists often talk about mitigation. What does it mean?

It is about slowing down the spread of the virus and trying to limit its impact on the health care system, public life and the economy. As long as there is no vaccine, all we can do is slow down the spread. It is very important.

60. How else can you slow down the spread of the virus?

Observe sanitary standards and elementary politeness in relation to each other. Plus, use measures of social distance: work from home, refuse to travel, close schools and cancel mass events.

61. Do some viruses spread more easily than others?

Yes. Worst of all measles. It can be infected if you enter the room in which an infected person visited two hours ago! Therefore, when people stop vaccinating, measles outbreaks occur. This is a very serious illness. The common cold also spreads quite easily. But HIV is much more difficult to get infected, however, 32 million people died from it.

62. What will be needed to stop the coronavirus?

No one knows for sure, but China has proven that it is possible to significantly reduce distribution. To destroy SARS ‑ CoV2 completely, you need a vaccine.

63. How long does it take for a virus to spread across a country the size of the USA?

With ordinary sanitary measures, it seems that the number of infected people doubles approximately every week. So, in about 14 weeks, 50 infected people will turn into a million. Naturally, we can take measures to slow down the process.

64. How effective is hygiene? If people follow the instructions, the number of infected becomes noticeably reduced?

It changes depending on how careful people are. Even small changes are important because they can relieve the health system of unnecessary stress.

65. Could it be that there are thousands of unfixed cases of coronavirus among the population?

Millions of flu cases are reported every year. This year some of them are actually COVID ‑ 19. In addition, many infected people have no symptoms or are very mild, so the answer is yes.

66. What exactly does a positive analysis result mean?

That the virus is present in the biological fluids of the person who passed this test.

67. Does everyone need to be tested as quickly as possible?

Tests for COVID ‑ 19 should be made more accessible, because we still do not know enough about who is infected and how the virus spreads in society. They would help to get important data.

68. Why did the “without leaving the car” testing system appear in South Korea?

Because they are trying very hard to slow the growth of the outbreak, as soon as possible after finding all infected.

69. What is the main symptom, after which you should be wary?

Cough.

70. And the temperature can be determined?

High temperature is an alarming sign, and if it is available, you should seek medical help. But one measurement of temperature at airports and at border points will not help, while many people who are infected are not detected.

71. How many percent of people with a positive test came to Chinese hospitals without fever?

About 30%.

72. Can the virus return to the country after the outbreak there has subsided?

SARS ‑ CoV2 will probably never leave without our efforts, just like smallpox and polio.

73. That is, the only way to cope with it in the long term is global vaccination?

We really don’t know. Global measures may work, but the vaccine is likely to be effective only until the virus mutates too much.

74. Or maybe it’s such that a new virus “burns out”, like some others?

We do not know, but in general this is unlikely. SARS ‑ CoV2 is already established worldwide. Now this is not only China’s problem. Most likely, there are hundreds of thousands of infected, but not yet tested. Like the flu virus, SARS ‑ CoV2 can stay with us for a very very very long time.

75. Will it return ? If yes, then when?

Again we do not know. But this is a very important issue. Most likely, it will be so, but it is too early to talk about this with confidence. The Spanish flu epidemic of 1918–1920 had three outbreaks. Perhaps in China, after the opening of schools and factories, a second wave of coronavirus will take place. But, until we see it with our own eyes, we cannot be sure how SARSCoV2 will behave.

76. Suppose we are lucky in the coming months. What can be considered luck in the current situation?

Warm weather can slow the spread of the virus, although so far we have no evidence that this will be so. Singapore is only a hundred and a few kilometers from the equator, but there the warm climate did not stop the virus. It is likely that SARS ‑ CoV2 mutates into a less dangerous form and fewer people die from it. So it was with swine flu in 2009. But I would not rely on it. Luck would be to quickly find effective drug therapy. Actually, that’s all.

77. Do high-risk people have the same probability of mortality everywhere?

Unfortunately not. Where there are modern, well-equipped hospitals, the mortality rate will be significantly lower due to respirators and fewer secondary infections.

78. How do I find out in which group of patients I will be: with mild symptoms or among those who require hospitalization?

It is impossible to know exactly, but age over 70 and chronic diseases increase the risk of severe illness and death.

79. Should I worry that I will get sick?

If you are not in a high-risk group, I would not worry too much, but I would do my best to avoid infection, because the individual reaction of the body is impossible to predict. Over the next few years, we will all be at risk of contracting the virus, as well as the risk of colds and flu. Therefore, everyone should be ready for self-isolation if necessary.

80. How is this “everyone will be at risk”?

We all communicate with other people, but you can’t argue with biology. I would try to take reasonable precautions, but at the same time I did not focus on anxiety. It definitely won’t help.

81. If in the end everyone gets infected with a coronavirus, why try to avoid it? Now I’ll get sick and will continue to live in peace.

It is necessary to slow down the spread of infection, that is, to reduce the number of new cases and the total number of cases so that doctors can save the most difficult patients. Otherwise, medical facilities will be crowded and will not be able to help people with other serious illnesses.

82. Is it true that after recovery you can become infected again?

We do not know, but it seems that this is possible. There is no complete certainty yet. Need more research.

83. But does permanent immunity, like with measles and mumps, happen?

We do not have an answer to this question yet.

84. Such immunity is very important for recoveries. And for the whole society too? Why?

This is important for developing a vaccine because it relies on the body’s ability to give an immune response and on the stability of the virus. And, of course, in the presence of immunity, the number of those who can become infected will gradually decrease.

85. Will coronavirus become seasonal, like flu?

Little time has passed so far to determine whether SARS ‑ CoV2 will have seasonal mutations and how billions of viral particles will change after passing through millions of carriers.

86. So this virus can mutate on its own and take on new forms with new symptoms?

This is completely unknown. If so, new vaccines will be needed to prevent the mutated versions of SARS ‑ CoV2 from acting.

87. Since a virus naturally mutates, does that mean it can become more deadly? And less?

Yes, both are possible. This is a new virus, so we have no idea how mutations will affect it.

88. If coronavirus becomes an ongoing threat, what does this mean for me and my family?

This means that we will all learn to live in new conditions and we will observe security measures. Now we should be especially attentive to the needs of older family members .

89. They say the virus can live on the kitchen table for nine days. It’s true?

SARS ‑ CoV2 is likely to remain viable on some surfaces for quite some time, but we still don’t know how much.

90. The greatest epidemic of recent times has been the Spanish flu pandemic of 1918–1920. Then it was not a new virus, but a mutated influenza virus. Can you compare SARS ‑ CoV2 with it?

SARS ‑ CoV2 is just as contagious and seems just as deadly, but time will tell. Keep in mind that in 1918 health care was far from what it is now in developed countries, and there were no antibiotics to treat bacterial pneumonia, which became the main cause of death.

91. Is there a chance that all this is a false alarm and in the summer we will be surprised at our panic?

No. Coronavirus has already spread to more than a hundred countries, and it is very easily transmitted. Every day more and more sick people appear. This is not a training alert. It’s real.

92. It is hard to believe that a new virus can suddenly infect millions of people. When was the last time?

With SARS and MERS, but they are not comparable in scale. HIV was a new virus that infected 70 million people, 32 million of whom died.

93. HIV affects poorer countries more. Will it be the same with coronavirus?

Yes exactly. In rich countries, the mortality rate will be much lower, because they are better off with drinking water, respiratory equipment, anti-infection measures, and the like. This could potentially be a huge problem where the health system is poorly developed, such as in Africa. When the virus reaches the most resource-limited countries in the world, the consequences can be disastrous.

94. So you are not very optimistic?

In general, I am optimistic, but at the same time a lot of things cause discomfort and anxiety . I understand that people are afraid, especially if they are at high risk. But there is good news. We are already seeing progress in international cooperation, especially in the field of science and medicine. We see more transparency in government activities and the rapid development of therapeutic agents.

95. And what are your main concerns?

The spread of coronavirus can quickly overload the healthcare system of any country and deprive people of access to medical care. I also fear that an overly acute reaction and fear can harm the economies of countries, and this is additional suffering for people.

96. What should we psychologically prepare for?

Moreover, in each city that launched the test, many “new” cases will be detected, as well as an increase in the number of deaths, especially among the elderly. In fact, these are not new cases of infection, they already exist, just so far they are not known.

97. And what is your hope?

  • Modern biology is developing at an unprecedented rate.
  • Not only the global medical community, but also government leaders are focusing on the threat.
  • We isolated the virus in a few days and quickly sequenced it (determined the amino acid or nucleotide sequences. – Approx. Ed.).
  • I am sure that a cure will appear soon.
  • I hope there will be a vaccine.
  • We live in an information age. This will help everyone – provided that we expose the fake and dangerous news.

98. How prepared are the US for a pandemic?

The US and other high-income countries had plenty of time to prepare. We all learned a lesson from unprecedented mass quarantines in China that slowed the spread of infection.

99. Who are you most worried about?

About countries with limited resources. Every death is a tragedy. When we say that on average 1–2% of those infected will die from coronavirus, this is a very large figure. 1% of a million is 10 thousand people. And I’m worried about the elderly.

But 98–99% of people will not die. Seasonal flu kills tens of thousands of Americans every year, but people don’t panic. Although the flu should be taken much more seriously and vaccinated against it. We learned how to live with seasonal flu and I think we’ll have to learn how to live a normal life in the presence of COVID ‑ 19 until an effective vaccine is available.

100. In the future, new pandemics await us?

Undoubtedly. This is part of the destiny of mankind and an integral element of living on the “planet of viruses.” This is an ongoing battle. We need to increase our combat readiness. That is, seriously invest in preparing for pandemics and create a global fire brigade long before our house is again in fire.

Thank you!

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