Q: Who is at risk for infection with the virus that causes COVID-19?
A: Currently, those at greatest risk of infection are persons who have had prolonged, unprotected close contact with a patient with symptomatic, confirmed COVID-19 and those who live in or have recently been to areas with sustained transmission. For more information, see Risk Assessment.
Q: Who is at risk for severe disease from COVID-19?
A. The available data are currently insufficient to clearly identify risk factors for severe clinical outcomes. Based on limited data that are available for COVID-19 patients, and data from related coronaviruses such as severe acute respiratory syndrome coronavirus (SARS-CoV) and MERS-CoV, people who may be at risk for more severe outcomes include older adults and persons who have certain underlying chronic medical conditions. Those underlying chronic conditions include chronic lung disease, moderate to severe asthma, cardiac disease with complications, diabetes, or immunocompromising conditions. See also Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19) and Information for Healthcare Professionals: COVID-19 and Underlying Conditions.
Q: If my patient has one of the underlying medical conditions listed, what is my patient’s risk and what should I tell my patient?
- There is insufficient information on COVID-19 to determine risk for each underlying medical condition. Epidemiologists at CDC are analyzing data around the clock to help us more precisely understand the risks of COVID-19. Information will be shared as soon as it’s available.
- You know your patient – their overall health and how well their conditions are managed. Use your clinical judgement to evaluate on a case by case basis.
- Tell patients with underlying medical conditions that increase their risk of severe illness or poorer outcomes from COVID-19:
- To stay home as much as possible to reduce their risk of being exposed.
- Encourage patients to closely follow their care plans for management of their chronic disease, including better glycemic or blood pressure control.
- If possible, work with patients to manage their underlying condition to the best of their ability, including ensuring that patients have sufficient medication and supplies. Encourage all patients, regardless of risk, to:
- Fear and anxiety about a disease can feel overwhelming, especially for those who might be at higher risk or are experiencing social isolation, and for healthcare providers that are treating patients at higher risk. Do what you can to take care of your mental health and encourage your patients to do the same.
Q: Are pregnant healthcare personnel at increased risk for adverse outcomes if they care for patients with COVID-19?
A: Pregnant healthcare personnel (HCP) should follow risk assessment and infection control guidelines for HCP exposed to patients with suspected or confirmed COVID-19. Adherence to recommended infection prevention and control practices is an important part of protecting all HCP in healthcare settings. Information on COVID-19 in pregnancy is very limited; facilities may want to consider limiting exposure of pregnant HCP to patients with confirmed or suspected COVID-19, especially during higher risk procedures (e.g., aerosol-generating procedures) if feasible based on staffing availability.
Q: When is someone infectious?
A: The onset and duration of viral shedding and the period of infectiousness for COVID-19 are not yet known. It is possible that SARS-CoV-2 RNA may be detectable in the upper or lower respiratory tract for weeks after illness onset, similar to infections with MERS-CoV and SARS-CoV. However, detection of viral RNA does not necessarily mean that infectious virus is present. There are reports of asymptomatic infections (detection of virus with no development of symptoms) and pre-symptomatic infections (detection of virus prior to development of symptoms) with SARS-CoV-2, but their role in transmission is not yet known. Based on existing literature, the incubation period (the time from exposure to development of symptoms) of SARS-CoV-2 and other coronaviruses (e.g. MERS-CoV, SARS-CoV) ranges from 2–14 days.
Q: Which body fluids can spread infection?
A: SARS-CoV-2 RNA has been detected in upper and lower respiratory tract specimens, and SARS-CoV-2 virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, and SARS-CoV-2 virus has been isolated in cell culture from the stool of some patients, including a patient with pneumonia 15 days after symptom onset. The duration of SARS-CoV-2 RNA detection in upper and lower respiratory tract specimens and in extrapulmonary specimens is not yet known but may be several weeks or longer. Duration of several week or longer has been observed in cases of MERS-CoV or SARS-CoV infection. While viable, infectious SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens, viable, infectious MERS-CoV has only been isolated from respiratory tract specimens. It is not yet known whether other non-respiratory body fluids from an infected person including vomit, urine, breast milk, or semen can contain viable, infectious SARS-CoV-2.
Q: Can people who recover from COVID-19 be re-infected with SARS-CoV-2?
A: The immune response, including duration of immunity, to SARS-CoV-2 infection is not yet understood. Patients with MERS-CoV are unlikely to be re-infected shortly after they recover, but it is not yet known whether similar immune protection will be observed for patients with COVID-19.
Q: How do you test a patient for infection with SARS-CoV-2?
- Clinicians are able to access laboratory testing through a network of state and local public health laboratories across the country. The Association of Public Health Laboratoriesexternal icon provides a list of states and territories with laboratories that are using COVID-19 diagnostic tests. For more information, see Testing in U.S. Clinicians should direct testing questions to their state health departments.
- Several clinical laboratories are receiving authorization for testing from the U.S. Food and Drug Administration (FDA) under an Emergency Use Authorization. They are expected to be able to offer a larger volume of testing for COVID-19. You can contact your current laboratory vendor to find out when the test will be available.
- There are a number of commercially available SARS-CoV-2 diagnostic assays that have received FDA Emergency Use Authorizationexternal icon.
- See recommendations for reporting, testing, and specimen collection at Evaluating and Testing Persons for COVID-19.
Q: Do existing commercially available multiple respiratory virus panels, such as those manufactured by Biofire or Genmark, detect SARS-CoV-2?
A: Not currently. These multi-pathogen molecular assays can detect a number of human respiratory viruses, including other human coronaviruses that can cause acute respiratory illness, but they do not currently detect SARS-CoV-2. In the future, it is expected that these assays will have the ability to detect SARS-CoV-2 in respiratory specimens.
Q: If a patient tests positive for another respiratory virus, should that exclude SARS-CoV-2 as a cause of illness?
A: Patients can be infected with more than one virus at the same time. Coinfections with other respiratory viruses in people with COVID-19 have been reported. Therefore, identifying infection with one respiratory virus does not exclude SARS-CoV-2 virus infection.
Q: Should chest CT be used for diagnosis of COVID-19?
A: Clinicians considering use of chest CT scans for diagnosis or management of COVID-19 patients should consider whether such imaging will change clinical management. The American College of Radiology (ACR) recommends that CT should not be used to screen for COVID-19, or as a first-line test to diagnose COVID-19, and that CT should be used sparingly and reserved for hospitalized, symptomatic patients with specific clinical indications for CT. Appropriate infection control procedures should be followed before scanning subsequent patients. For more information see, ACR Recommendations for the use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infectionexternal icon.
Q: Whom should healthcare providers notify if they suspect a patient has COVID-19?
A: Healthcare Providers should immediately notify infection control personnel at their facility if they suspect COVID-19 in a patient. Providers should then consult with local or state health departments to determine whether patients meet criteria for a Persons Under Investigation (PUI), see Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19).
Q: Should post-exposure prophylaxis be used for people who may have been exposed to a person with COVID-19?
A: There is currently no FDA-approved post-exposure prophylaxis for people who may have been exposed to COVID-19. For information about registered clinical trials of investigational therapeutics for pre or post exposure prophylaxis of SARS-CoV-2 infection, visit ClinicalTrials.govexternal icon.
For more information on movement restrictions, monitoring for symptoms, and evaluation after possible exposure to COVID-19, see Interim US Guidance for Risk Assessment and Public Health Management of Persons with Potential Coronavirus Disease 2019 (COVID-19) Exposure in Travel-associated or Community Settings and Interim U.S Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19).
Q: How are COVID-19 patients treated?
A: Not all patients with COVID-19 will require medical supportive care. Clinical management for hospitalized patients with COVID-19 is focused on supportive care for complications, including supplemental oxygen and advanced organ support for respiratory failure, septic shock, and multi-organ failure. Empiric testing and treatment for other viral or bacterial etiologies may be warranted.
Corticosteroids are not routinely recommended for treatment of viral pneumonia or ARDS, due to the potential for prolonging viral replication, as has been observed with MERS coronavirus and influenza. Corticosteroids should be avoided unless they are indicated for another reason (e.g., COPD exacerbation or refractory septic shock following the Surviving Sepsis Campaign Guidelinesexternal icon).
For information on investigational therapies, see Therapeutic Options for Patients with COVID-19.
Q: Do patients with confirmed or suspected COVID-19 need to be admitted to the hospital?
A: Not all patients with COVID-19 require hospital admission. Patients whose clinical presentation warrants in-patient clinical management for supportive medical care should be admitted to the hospital under appropriate isolation precautions.
Some patients with initial mild clinical presentation may worsen in the second week of illness. The decision to monitor these patients in the inpatient or outpatient setting should be made on a case-by-case basis. This decision will depend not only on the clinical presentation, but also on the patient’s ability to engage in self-monitoring, the feasibility of safe isolation at home, and the risk of transmission in the patient’s home environment. For more information, see Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in a Healthcare Setting and Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for Coronavirus Disease 2019 (COVID-19).
Q: When can patients with confirmed COVID-19 be discharged from the hospital?
A: Patients can be discharged from the healthcare facility whenever clinically indicated. Isolation should be maintained at home if the patient returns home before the time period recommended for discontinuation of hospital Transmission-Based Precautions.
Decisions to discontinue Transmission-Based Precautions or in-home isolation can be made on a case-by-case basis in consultation with clinicians, infection prevention and control specialists, and public health authorities based upon multiple factors, including disease severity, illness signs and symptoms, and results of laboratory testing for COVID-19 in respiratory specimens.
See Interim Considerations for Disposition of Hospitalized Patients with COVID-19. For non-hospitalized persons, see Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for COVID-19, and Discontinuation of In-Home Isolation for Immunocompromised Persons.
Q: Are empiric antibiotics recommended for patients suspected of having COVID-19?
A: Several patients with COVID-19 have been reported to present with concurrent community-acquired bacterial pneumonia. Decisions to administer antibiotics to COVID-19 patients should be based on the likelihood of bacterial infection (community-acquired or hospital-acquired), illness severity, and antimicrobial stewardship issues. For more information, see Diagnosis and Treatment of Adults with Community-acquired Pneumonia: An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of Americaexternal icon.
Q: What antiviral drugs are available to treat COVID-19?
A: There are currently no antiviral drugs approved by FDA to treat COVID-19. See Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19).
Q: Should angiotensin converting enzyme inhibitors (ACE-I) or Angiotensin Receptor Blockers (ARB) be stopped in patients with COVID-19?
A: CDC is currently not aware of scientific evidence establishing a link between ACE-I or ARBs and risk of contracting or severity of COVID-19. The American Heart Association, the Heart Failure Society of America, and the American College of Cardiology recommendexternal icon continuation of ACE-I or ARB medications for all patients already prescribed those medications for indications such as heart failure, hypertension, or ischemic heart disease. Cardiovascular disease patients who are diagnosed with COVID-19 should be fully evaluated by a healthcare professional before adding or removing any treatments, and any changes to their treatment should be based on the latest scientific evidence. Patients who rely on ACE-I or ARBs to treat chronic conditions and have additional questions should speak to their healthcare provider for individualized management.
Q: Do nonsteroidal anti-inflammatory drugs (NSAIDs) worsen the course of disease for people with COVID-19?
A: CDC is currently not aware of scientific evidence establishing a link between NSAIDs (e.g., ibuprofen, naproxen) and worsening of COVID‑19. FDAexternal icon, the European Medicines Agencyexternal icon, the World Health Organization, and CDC are continuing to monitor the situation and will review new information on the effects of NSAIDs and COVID-19 disease as it becomes available. For those who wish to use treatment options other than NSAIDs, there are other over-the-counter and prescription medications approved for pain relief and fever reduction. Patients who rely on NSAIDs to treat chronic conditions and have additional questions should speak to their healthcare provider for individualized management. Patients should use NSAIDs, and all medications, according to the product labels and advice of their healthcare professional.
Q: What do waste management companies need to know about wastewater and sewage coming from a healthcare facility or community setting with either a known COVID-19 patient or person under investigation (PUI)?
A: Waste generated in the care of PUIs or patients with confirmed COVID-19 does not present additional considerations for wastewater disinfection in the United States. Coronaviruses are susceptible to the same disinfection conditions in community and healthcare settings as other viruses, so current disinfection conditions in wastewater treatment facilities are expected to be sufficient. This includes conditions for practices such as oxidation with hypochlorite (i.e., chlorine bleach) and peracetic acid, as well as inactivation using UV irradiation.
Q: Do wastewater and sewage workers need any additional protection when handling untreated waste from healthcare or community setting with either a known COVID-19 patient or PUI?
A: Wastewater workers should use standard practices including basic hygiene precautions and wear the recommended PPE as prescribed for their current work tasks when handling untreated waste. There is no evidence to suggest that employees of wastewater plants need any additional protections in relation to COVID-19.
Q: Should medical waste or general waste from healthcare facilities treating PUIs and patients with confirmed COVID-19 be handled any differently or need any additional disinfection?
A: Medical waste (trash) coming from healthcare facilities treating COVID-2019 patients is no different than waste coming from facilities without COVID-19 patients. CDC’s guidance states that management of laundry, food service utensils, and medical waste should be performed in accordance with routine procedures. There is no evidence to suggest that facility waste needs any additional disinfection.
More guidance about environmental infection control is available in section 7 of CDC’s Interim Infection Prevention and Control Recommendations for Patients with Confirmed COVID-19 or Persons Under Investigation for COVID-19 in Healthcare Settings.
- Clinical Care Guidance
- Therapeutic Options for Patient with COVID-19
- Guidance for Pediatric Healthcare Providers
- Disposition of Hospitalized Patients with COVID-19
- Inpatient Obstetric Healthcare Guidance
- Information for Healthcare Providers: COVID-19 and Pregnant Women
- Ending Isolation for Immunocompromised Patients