COVID-19 frequently asked outpatient questions

Frequently Asked Outpatient Questions
COVID-19 Main Page
Knowledge Based Questions
Everyday Life Questions
Cleaning and Disinfecting
Covid-19 in the Workplace
Public Safety Questions
Travel Related Questions
Pregnancy and COVID-19
Children and COVID-19
Pets/Animals and COVID-19
Keeping Spirits High in Quarantine
Vaccine Related Questions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2] Aisha Adigun, B.Sc., M.D.[3] Neepa Shah, M.B.B.S.[4] Oluwabusola Fausat Adogba, MD[5]​ Vidhi Patel, M.B.B.S. [6] Bosky H. Soni, M.D.[[7]] Indhumathi Venkatasubramani Balaraman,M.B.B.S[[8]] Zaida Obeidat, M.D.[9]Javaria Anwer M.D.[10]

Synonyms and keywords:

Knowledge Based Questions

1) What is COVID-19?

• Coronaviruses are zoonotic, meaning they are normally transmitted between animals and people. The coronavirus disease (COVID-19) is caused by a new strain of coronavirus (SARS-CoV-2) that has not been previously identified in humans. It was first reported to WHO on the 31st of December, 2019 in Wuhan, China.

2) What tests are used to diagnose COVID-19?

• The FDA has so far approved two types of tests for diagnosing COVID-19; a molecular test that detects the virus's genetic material using a lab technique called Polymerase Chain Reaction (PCR) and an antigen test that detects certain proteins that are part of the virus.

3) How accurate are the COVID-19 serology tests?

• CDC’s serologic test is an ELISA-based test to detect SARS-CoV-2 antibodies in serum or plasma components of blood. It uses purified SARS-CoV-2 S protein (no live virus) as an antigen (designed by the Vaccine Research Center at the National Institutes of Health).

• CDC’s serologic test is designed to detect antibodies produced in response to SARS-CoV-2 and minimize cross-reactivity to antibodies generated to other common coronaviruses that cause less severe illnesses, such as colds. However, potential cross-reactivity cannot be completely ruled out.

• CDC’s serologic test has a specificity of greater than 99% and a sensitivity of 96% based on initial performance evaluations. It can be used to identify past SARS-CoV-2 infection in people who were infected at least 1 to 3 weeks previously.

4) Can COVID-19 be transmitted through the air over long distances?

• When a person with coronavirus coughs or exhales, droplets land on objects and surfaces around the person. Other people then catch the virus by touching these objects or surfaces, then touching their eyes, nose, or mouth.

• COVID-19 can be transmitted when people breathe in these droplets. Therefore, it is important to stay at least 2 meters away from a person who is coughing or sneezing.

5) Are face-masks effective against COVID-19?

• The use of face-masks has been demonstrated to slow the spread of COVID-19.
• Studies conducted in community and healthcare settings observed that the use of face-masks was helpful in reducing the spread of the virus.

6) Is COVID-19 serious?

• Although most people with COVID-19 experience mild to moderate symptoms, the disease can cause severe medical complications and lead to death in some people.
• Older adults or people with existing medical conditions are at greater risk of becoming seriously ill with COVID-19.

7) What is the source of the virus?

• Scientists and public health officials are working hard to identify the source of the SARS-CoV-2 which is the virus that causes COVID-19. The initial transmission appeared to be from an animal source, but there has been person-to-person transmission in countries.

8) How does the virus spread?

• The virus that causes COVID-19 is thought to spread mainly from person to person, mainly through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Spread is more likely when people are in close contact with one another (within about 6 feet).

• COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in many affected geographic areas. Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.

9) Can someone who has been quarantined for COVID-19 spread the illness?

• Someone who has been released from quarantine is not considered a risk for spreading, according to the CDC.

10) Are countries with warmer climates immune to COVID-19?

• From the evidence so far, the virus causing COVID-19 can be transmitted in ALL AREAS, including areas with hot and humid weather.

11) How can I help protect myself?

• Due to the unavailability of vaccine, the main stay of prevention lies with minimizing the exposure and limiting the contact with another person.

current guidelines by CDC (Center for disease control & Prevention) are: [11]

• Wearing a mask helps both you and the person you are conversing with by avoiding cross infection, always remember to have a spacing of about 6 feet or 2 meters while you are in a public place or with a person you are meeting even if they seem to be free of any symptoms as there are some studies emphasizing the possibility of spread by asymptomatic people.
• Washing hands with soap and water thoroughly for about 20-30 seconds to allows a brief contact period for the soap to completely wash away the virus frequently between two chores.
• Alcohol based Hand sanitizer are a very good alternative for washing hands, but make sure of the percentage of alcohol is at least 60% or above.
• cough/sneeze to your elbows or in a tissue
• Make sure to discard the tissue you used and wash your hands thoroughly or use a sanitizer following that.
• Every time you go out -maintain social distancing.
• Regularly monitor for any symptoms like fever, breathing difficulties, and be prompt to notify a health care provider if you develop any symptoms.
• If you have a person with COVID illness, isolate them , provide them care and love but maintain a 6 feet or 2 meters distance mandatory.
• People who are vulnerable like children , people over the age of 60, immuno compromised people like pregnant woman, diabetics, pre and post transplant patients, people who are on chemotherapy and people with other co morbidities are requested to strictly follow all the suggested preventive measures to avoid being infected.

12) Can antibiotics treat COVID-19 ?

• No. COVID-19 is caused by Virus SARS-CoV-2 Virus. Antibiotics work only for bacterial infections. However, if a COVID-19 positive person is co-infected with bacterial infection, antibiotics may help.

13) Can you have COVID-19 without a fever?

• Yes, one can be diagnosed with COVID-19 without having a fever. Although a majority of patients diagnosed with COVID-19 have fever as a symptom, there are patients who develop other symptoms like shortness of breath, cough and fatigue without developing a fever.

14) What is the recovery time for COVID-19?

• There is no guaranteed timeline or pattern of symptoms concluded from the studies till now.[[12]]
• However some data shows that the spread/shedding of virus decreases after the clinical onset of symptoms.
• since the recovery time may vary based on the age,immunity,co morbidities - a period of 7-14 days of isolation is usually observed to strictly contain the virus

15) Is there a vaccine for COVID-19?

• No, currently there is no vaccine that can prevent COVID-19.
• Researchers from all over the world are working on developing a vaccine for this virus, and are hopeful that a viable vaccine will be developed in the coming months.

16) Can COVID-19 be spread through feces?

• There is a lot of research being done regarding this, and there is no conclusive evidence that COVID-19 can be transmitted through feces.

17) Can COVID-19 be transmitted through food?

• There is no current evidence that the COVID-19 virus can be transmitted through food.
• It is highly encouraged to frequently wash hands with soap for at least 20 seconds before eating or handling food.
• Additionally, all food packaging and frequently used surfaces should be cleaned and disinfected thoroughly.

18) Can I still have sex during the COVID-19 pandemic?

Information from a study in Mayo Clinic [[13]] concludes that,

• Since the Virus can spread through droplets,irrespective of the sexual activity the virus may continue to spread.
• You may have sex with a person you live with provided they are healthy and negative for any symptoms or risk factors.(Caution:Asymptomatic people may contain the virus)
• It is not recommended to engage in sexual activity with a person you have met newly or briefly.
• In case of any consideration of engaging sexual activity with a person you are not living with - follow measures to avoid transmission of virus like bathing before and after the act, minimizing sexual behavior like oro-genital contact, as there are some evidences of spread of virus through contaminated feaces.
• There is a need for enough data to prove the sexual transmission of virus.

19) Can COVID-19 be transmitted through water?

• There is no evidence that COVID-19 can be transmitted through water.
• Disinfection and chemical treatment of water by water treatment plants has demonstrated the removal of the virus.

20) Can I get sick with COVID-19 if it is on the food?

• There is no conclusive evidence yet to support the occurrence of COVID-19 through food.
• However, it is very important to wash your hands 20 seconds with soap and water for general safety. One should always handle and prepare food with safety.
• Keep the raw meat separate from other foods, refrigerate the perishable foods and cook the meat to the correct temperature so that it kills all the harmful germs.

21) Does drinking alcohol inactivate the coronavirus?

• Drinking alcohol does not inactivate the coronavirus and does not prevent one from catching the virus.
• Additionally, excessive use of alcohol can lead to a weakened immune system, leading to a greater risk of becoming sick.

22) What are the symptoms of COVID-19?

• There are several different symptoms of COVID-19. Below are the majority of them:
  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
• This is not a comprehensive list and it will be updated as more research is conducted.
• Please see your doctor if you feel sick or if you have come in contact with anyone who has been diagnosed with COVID-19.

23) Where do I go to get tested for COVID-19?

• With the availability of viral tests becoming more common, there are several locations to get tested for COVID-19.
• The best way to find a testing location is to visit your state's health department website, which will have a detailed guide on available testing locations.
• Here is the list of all United States state and territorial public health department websites provided by the Center for Disease Control and Prevention (CDC): State and Territorial Health Department Websites
• Several of these testing locations do not charge for getting tested for COVID-19.

24) How can I avoid getting infected with COVID-19?

• Due to the unavailability of vaccine, the main stay of prevention lies with minimizing the exposure and limiting the contact with another person.

current guidelines by CDC (Center for disease control & Prevention) are: [14]

• Wearing a mask helps both you and the person you are conversing with by avoiding cross infection, always remember to have a spacing of about 6 feet or 2 meters while you are in a public place or with a person you are meeting even if they seem to be free of any symptoms as there are some studies emphasizing the possibility of spread by asymptomatic people.
• Washing hands with soap and water thoroughly for about 20-30 seconds to allows a brief contact period for the soap to completely wash away the virus frequently between two chores.
• Alcohol based Hand sanitizer are a very good alternative for washing hands, but make sure of the percentage of alcohol is at least 60% or above.
• cough/sneeze to your elbows or in a tissue
• Make sure to discard the tissue you used and wash your hands thoroughly or use a sanitizer following that.
• Every time you go out -maintain social distancing.
• Regularly monitor for any symptoms like fever, breathing difficulties, and be prompt to notify a health care provider if you develop any symptoms.
• If you have a person with COVID illness, isolate them , provide them care and love but maintain a 6 feet or 2 meters distance mandatory.
• People who are vulnerable like children , people over the age of 60, immuno compromised people like pregnant woman, diabetics, pre and post transplant patients, people who are on chemotherapy and people with other co morbidities are requested to strictly follow all the suggested preventive measures to avoid being infected.

25) Can I still get my scheduled routine vaccinations during COVID-19 pandemic?

• Routine vaccination is an essential preventive care service for children, adolescents, and adults (including pregnant women) that should not be delayed because of the COVID-19 pandemic.

26) Can I still get my recommended diagnostic test (eg colonoscopy)?

• Since the Pandemic has not ended still, routine screening is performed when the benefit outweighs the risk of transmission of virus. It is best to contact your doctor/Nurse practitioner/other Health care provider to discuss the situation individually and determining the risk of delaying the procedure.[[15]]
• Nevertheless,screening tests and procedure has helped us in fighting the cancer,hence it should not be neglected due to pandemic.

27) What is Herd immunity?

• Herd immunity can be defined as the reduction in the number of cases of particular contagious disease/infection in the population which is not previously immunized, aiming to immunize that proportion of population.

28) I got my tonsils removed 3 months back, am I more vulnerable than the general population?

• Currently, there is no research linking the removal of tonsils and the vulnerability of getting sick with COVID-19.
• There have been several studies that have been performed to check the relationship between getting a tonsillectomy and its effect on the immune system. These have found that in a majority of cases, there is no negative effect of removing tonsils on the body's immune system.

29) Is it safe to get a unit of blood transfused? Should I ask for leukocyte washed or irradiated blood to be safe?

• Yes you may receive blood transfusion and you may ask for leukocyte washed and irradiated blood. The process of disinfection of the blood from the virus in this situation are battled in many ways. Adopting new methods of disinfection such as a built-in ultraviolet lamp and the card centrifuge with anti-aerosol or disinfection function may help in enhanced disinfection of blood.[[16]]

30) I have been on HCQ for many years for an autoimmune condition, does that make me immune to COVID-19?

• Studies have shown that the use of hydroxychloroquine for prevention does not decrease the incidence of COVID-19; and does not make one immune to COVID-19.

32) I am a consented organ donor, if I die from COVID-19 can my organs still be used for transplantation?

• Unfortunately, if someone passes away due to COVID-19, their organs are unable to be used for transplantation.
• Although the risk of transmission of the virus through transplantation is low, the American Society of Transplantation current guidance is not to use a COVID-19 positive patients's organs for transplantation.
• This guidance may change in the future as more research is conducted and more information is known about the COVID-19 virus.

34) Should an immunosuppressed patient take any drugs to prevent contracting the virus during their hospital visits?

• Currently, there are no drugs that can be taken to prevent from contracting COVID-19.
• Immunosuppressed patients have weakened immune systems, and have a higher risk of getting sick from COVID-19. These patients should continue their regular treatment plan and continue taking their regular medications.

35) Should the patient who recovered from COVID-19 be asked to avoid sports /Exercises ?

• Since the Virus has the ability to infect the cardiac cells that leads to several different conditions like myocarditis and arrhythmias, a thorough evaluation by a doctor that may include several diagnostic tests like ECG, ECHO and TMT may be performed to assess the functioning of the heart.[[17]] Recommendation may vary from patient to patient based on their severity.
• Moderate to severely affected patients are strictly asked to gradually increase the level of intensity of exertion.

36) Are there any trials to study the long term effects in immunity, relapses, the effectiveness of drugs in patients?

• Yes, there are more than 450 different trials in the United States that are studying different aspects of COVID-19; and researching immune responses and effectiveness of drugs. For a full list of current clinical trials that are being conducted, please visit: COVID-19 Clinical Trials
• Trials being performed to research the immunity response to COVID-19 are primarily being carried out by the National Institute of Allergy and Infectious Diseases (NIAID); amongst others around the world. Example Trial 1 Example Trial 2

37) HCQ in pregnant patient Who lives in covid predominant zone?

• Studies have shown that the use of hydroxychloroquine for prevention does not decrease the incidence of COVID-19; and does not make one immune to COVID-19.

39) Can we consume raw fruits and vegetables?

• Yes, raw fruits and vegetables can be consumed after washing them thoroughly under running water.
• Firmer vegetables like potatoes and carrots should be scrubbed with a brush before consumption.
• Disinfectants, chemicals or soap should NOT be used to clean raw fruits and vegetables, as well as the food packaging containing these foods.

40) What’s a good respiratory hygiene?

• Good respiratory hygiene includes doing the following things to protect yourself and others from spreading the virus:
  • Wear a mask or face covering when outside in a public setting.
  • Cover your nose, mouth and face while coughing and sneezing.
  • Use a hand sanitizer with at least 60% alcohol or wash your hands with soap for at least 20 seconds after touching your mouth or nose.
  • Use tissues and throw them away responsibly after every use.

42) Can I have a Blood transfusion?

• Yes you may receive blood transfusion. The process of disinfection of the blood from the virus in this situation are battled in many ways. Adopting new methods of disinfection such as a built-in ultraviolet lamp and the card centrifuge with anti-aerosol or disinfection function may help in enhanced disinfection of blood.[18]

44) Is air conditioning really bad and does it worsen the spread?

• Like a lot of other things associated with COVID-19, there is not enough research on the correlation between air-conditioning and the spread of the virus.
• One study conducted in Guangzhou, China showed evidence that supported the use of air conditioners increased the spread of the virus BECAUSE of the direction of the air flow.
• It is to be noted that the direction of air flow and the ventilation in a room is more significant than the actual use of air conditioners. A well ventilated room with good air flow is less likely to spread the virus than a closed room with bad ventilation.

45) What measures are taken by airports to control the spread of coronavirus disease?

• In order to detect arriving travelers who are sick, screening upon entry along with other public health measures, such as detection and reporting of ill travelers by airlines, are being implemented.
• CDC is deploying about 100 additional staff to the three airports (SFO, JFK, and LAX) to supplement existing staff at CDC quarantine stations located at those airports.

48) Herd immunity what is it ?

• Herd immunity can be defined as the reduction in the number of cases of particular contagious disease/infection in the population which is not previously immunized, aiming to immunize that proportion of population.

50) Can I undergo elective surgery like hernioplasty, tonsillectomy, appendectomy, cataract now?

• Hospitals are slowly beginning to perform elective procedures like tonsillectomies under the strict guidance prepared by the CDC.
• Conducting such elective procedures is dependent on the local health department guidelines, and the availability of Personal Protective Equipment and Surgical supplies at the hospital.
• Anyone who is going to have an elective procedure performed on them shall be tested for COVID-19 prior to the procedure.
• Please talk with your healthcare provider prior to scheduling any elective procedures.

51) Do people who have got their tonsils removed more prone to COVID-19?

• Currently, there is no research linking the removal of tonsils and the vulnerability of getting sick with COVID-19.
• There have been several studies that have been performed to check the relationship between getting a tonsillectomy and its effect on the immune system. These have found that in a majority of cases, there is no negative effect of removing tonsils on the body's immune system.

Everyday Life Questions

52) How can I get back to work and avoid infection?

CDC has established guidelines for different businesses on how to avoid infection. The information can be found by clicking here. Follow the policies and procedures of the workplace but in general, you should:

• Stay home if you feel sick and understand that no one with symptoms should be present at the workplace. Inform their supervisor if you or your colleagues develop flu symptoms at work. Avoid all non-essential travel.
• Maintain a distance of at least 6 feet from all fellow co-workers, customers, and visitors.
• Wash hands often with soap and water for at least 20 seconds (especially after blowing the nose, coughing, or sneezing). You can also use hand sanitizer with at least 60% alcohol.
• Avoid touching eyes, nose, and mouth.
• Avoid handshaking with people and touching high-touch surfaces in public places such as elevator buttons, door handles, or handrails.
• Minimize handling cash, credit cards, and mobile or electronic devices when possible.

53) Is it safe to workout outside during the COVID-19 pandemic?

• It is safe to work out in the park/open space if you/anyone from your family is not experiencing any COVID-19 symptoms.
• Visit parks that are close to your home.
• Stay at least 6 feet away from others. Maintain social distancing.
• Wash hands for at least 20 seconds with soap and water if you touch any park property. Dis-infect all your workout equipments after your workout.
• If you have any flu symptoms, do not go outside for workout.

54) Is it safe to visit public parks during the COVID-19 Pandemic?

• If the parks in your area are open, you can visit public parks, preferably one near your home to minimize exposure while traveling.
• First, check with the park in advance about the services are available to prepare accordingly.
• Stay at least 6 feet away from others, wear face coverings and wash hands with soap and water or use hand sanitizer with at least 60% alcohol.
• Keeping distance and hygiene practices is also important in swimming pools or water playgrounds.
• Due to the difficult nature of the sanitization of playgrounds, it is advised to be careful in deciding to visit a playground and help children follow guidelines if they accompany you.
• Do NOT go to the crowded parks or do not visit a park if you are sick (tested positive for COVID-19, or were exposed to COVID-19 within 14 days).

55) What do I need to protect myself when I go to the gym?

• Wear a face mask or cloth face covering when interact with other people especially when physical distancing is difficult, and if possible when you walk inside or do low intensity training. Consider doing high intensity training outside with keeping 6 feet distance from others when wearing a face mask is difficult.
• Limit attendance at indoor training training sessions and if you do stay away from other individuals at least 6 feet and wear a face mask that doesn't interfere with your activity.
• Don't shake hands , give high fives, do elbow bumps, or touch others.
• Maintain 6 feet distance from others as much as possible.
• Clean and disinfect equipments wipe down machines and use a hand sanitizer with 60% alcohol.
• Don't share items that cannot be clean, sanitize or disinfect between use like resistance bands or weightlifting belts.

56) My wife and I are above 65 years of age. Is it safe to go to the store?

• People 65 years and older are at higher risk of severe illness if they get infected with the coronavirus so this makes going to the store less safe for you than other people. It is recommended to stay home if possible. Also having an underlying illness of the heart, lung, kidney, liver, diabetes, and cancers further increase the risk at your age.
• WHO recommends you create a list of the basic supplies that you will need for at least two weeks and try to get these delivered where possible. You can also ask family members, caregivers, neighbours or community leaders to help with ordering and/or delivery of groceries or prescription medicines. If anyone must go out, using a face covering, washing hands for at least 20 seconds with soap and water, maintaining at least six feet distance form others are the general recommendations.

57) What is the difference between self-isolation, social-distancing, and quarantine?

• All of the above mentioned are measures to protect everyone and reduce the spread of coronavirus disease 2019 (COVID-19).
  • Self-isolation is used to separate people infected with the virus (have been diagnosed with COVID-19 with or without symptoms, or are waiting for test results, or have cough, fever, or shortness of breath) from people who are not infected. People who are in isolation stay home until it’s safe for them to be around others. If you self-isolate at home, you will stay in a specific “sick room” or area and using a separate bathroom (if available) and stay away from those living with you at home, animals including your pets.
  • Quarantine is used to keep someone who might have been exposed to COVID-19 (no symptoms but recently had close contact with a person with COVID-19) away from others. Quarantine helps prevent the spread of disease that can occur before you know you are sick or if you are infected with the virus without feeling symptoms. If you quarantine, you should stay home until 14 days after your last exposure, separate yourself from others, and especially away from those at higher risk of getting sick from COVID such as elderly, immunocompromised, or diabetics. Monitor your temperature at least twice a day and act for COVID symptoms, and follow directions from their state or local health department.
  • Social distancing also called “physical distancing,” means keeping space between yourself and other people outside of your home. Social distancing is achieved by staying at least 6 feet (about 2 arms’ length) from other people.

59) As a business owner, how can I protect my staff?

• Screen the staff by taking temperature and disinfect hands with soap and water, wear a mask/face cloth, practice social distancing with 6 feet apart, disinfect frequently touched surfaces multiple times in a day and self-monitor for any symptoms of coronavirus like high fever, dry cough, muscle pain, and other flu-like symptoms.

60) I have underlying health conditions, should I go to work?

Older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19. CDC recommends that individuals in such group should:

• Continue your medications and do not change your treatment plan without talking to your doctor.
• Have at least a 2-week supply of prescription and non-prescription medications. Talk to your healthcare provider, insurer, and pharmacist about getting an extra supply (i.e., more than two weeks) of prescription medications, if possible, to reduce trips to the pharmacy.
• Talk to your healthcare provider about whether your vaccinations are up-to-date. People older than 65 years, and those with many underlying conditions, such as those who are immunocompromised or with significant liver disease, are recommended to receive vaccinations against influenza and pneumococcal disease.
• Do not delay getting emergency care for your underlying condition because of COVID-19. Emergency departments have contingency infection prevention plans to protect you from getting COVID-19 if you need care for your underlying condition.
• Call your healthcare provider if you have any concerns about your underlying medical conditions or if you get sick and think that you may have COVID-19. If you need emergency help, call 911.

61) Does cooking kill the corona-virus?

• According to the WHO, at 56 degrees Celsius the heat kills the SARS coronavirus at around 10,000 units per 15 minutes (quick reduction).
• There's also, another study of SARS that says that it becomes non-infectious within 30 minutes at 75 degrees Celsius (about 167 degrees Fahrenheit).

62) Can the corona-virus spread through frozen food?

• There is no evidence so far to support transmission of COVID-19 associated with food. Remember though that, before preparing or eating food, it is very important to wash your hands with soap and water for at least 20 seconds for general food safety.

63) Can people that died from COVID-19 have a funeral?

• Yes, a funeral can be held for a person who died of COVID-19. Remember though that this is a new disease and we are still discovering how the disease spreads in our communities, mostly in the form of droplets and these are not a concern after death. That said, no known risk is currently associated with being at a funeral or visitation service in the same room with the body of someone who died of COVID-19.

64) Can you contract COVID-19 from a package in the mail?

• The CDC recommends limit in person contact if possible by ordering online or on the phone, and avoid person to person contact when receiving deliveries or keep at least 6 feet away from the delivery person.
• Wash hands with soap and water for 20 seconds or use a hand sanitizer with at least 60% alcohol after receiving deliveries or collecting mails.

66) Does smoking cigarettes increase my risk of getting COVID-19?

• The association of smoking and GETTING COVID-19 infection has not been supported by significant research. A few studies describe a possible effect of smoking on increasing ACE-2 receptor a place where COVID-19 virus attaches and cause the infection. More research data is required to be conclusive about the association. However, tobacco smoking (cigarettes, waterpipes, bidis, cigars, heated tobacco products) may be more vulnerable to getting COVID-19, as smoking involves hand to mouth contact (and possibly contaminated cigarettes), which increases the possibility of transmission of viruses from hand to mouth. If cigarette/ water pipes (shisha) involve sharing, they can definitely help COVID-19 transmit.

67) When can I discontinue self-isolation after testing positive for COVID-19?

You can be around others when:

• you have gone 3 days with no fever and
• Respiratory symptoms have improved (e.g. cough, shortness of breath) and
• 10 days since symptoms first appeared

Depending on your healthcare provider’s advice and availability of testing, you might get tested to see if you still have COVID-19. If you will be tested, you can be around others when you have no fever, respiratory symptoms have improved, and you receive two negative test results in a row, at least 24 hours apart.

70) As an employer, can I trust that the patient who returns back to work with a negative COVID-19 report will not put the other employees at risk?

Individuals who have tested negative can be around others when they have no fever, respiratory symptoms have improved, and they receive two negative test results in a row, at least 24 hours apart.

71) How long does the corona-virus last on surfaces?

• According to the studies conducted, coronavirus can last for up to:
  • Hours: 3 hours in aerosols, 2-8 hours on aluminum, 4 hours on copper and 24 hours on cardboard.
  • Days: 2-3 days on plastic and stainless steel, 4 days on wood and up to 5 days glass and ceramics. For paper, the length of time varies per strain of coronavirus but it ranges from a few minutes to up to 5 days. There is not much research about the length of time coronavirus lasts on fabric, but it is probably not as long as on hard surfaces.
• A study in China found shoes soles of ICU staff to contain nucleic acids from the virus. But if the pieces of the virus cause infection, is not clear. There Is no evidence of coronavirus spread through food and water.

74) What are the precautions I can take before I use public transport i.e. Bus, Train, Uber, Ola?

• Clean your hands often, If soap and water are not available,use a hand sanitizer that contains at least 60% alcohol, make sure you cover all surfaces of your hands and rub your hands together until they feel dry.
• Avoid touching your eyes, nose, or mouth with unwashed hands.
• Avoid close contact with others, maintain a safe physical distance of at least 6 feet.
• Wear a cloth face covering in public.
• Cover coughs and sneezes.

76) Are washing and re-using surgical masks effective enough to control the spread of COVID-19?

Cloth face coverings should be washed after each use. It is important to always remove face coverings correctly and wash your hands after handling or touching a used face covering.

77) What can I do if I have an allergic reaction to a mask?

• Itchy rashes from masks will most likely be an irritant contact dermatitis. Using topical steroids, gentle cleansers, heavy moisturizes and avoiding the irritant can help in most cases. If you are using a cloth mask, changing the fabric or the brand of the mask can improve your rash. However, in a few patients, allergic reaction to formaldehydes, metals, rubbers, or glues in masks may also develop. It is important to remind that after wearing a mask it is important to wash your face with a gentle cleanser. If there's a rash, Pat dry gently, then apply a topical steroid cream, followed by one heavy moisturizing creams.

79) How helpful is the commercially available cotton mask?

• It is useful at providing an extra layer to help prevent the respiratory droplets from traveling in the air and onto other people. That being sad, it is most effective when used to keep droplets from sick people away from other people.

80) Is it safe to consume fresh food, fruits, and vegetables that are available in the market?

• The risk of infection by the virus from food products, packaging or bags is very low. Currently, no cases of COVID-19 have been identified where infection was thought to have occurred by touching food, food packaging, or shopping bags.
• The CDC recommends not to wash fresh produce with soap, bleach, sanitizer, disinfectant or any other chemical. Just rinse fresh fruits and vegetables with cold water, scrub firm uncut produce with clean brush.
• Salt, vinegar, lemon juice or lime juice haven't shown to be effective at removing germs.

81) Can I drink water from the tap/ fountain in public places? Do I need to start buying the bottled water?

• You can. As per CDC, WHO and the United States Environmental Protection Agency (EPA), there is no evidence of anyone getting COVID-19 through the drinking water supply. It recommends the citizens continue to use and drink tap water. So the water itself is safe and you do not essentially need to buy bottled water.
• However the surfaces around the fountain including spout and button or lever are like door handles and can be contaminated with coronavirus. When using a water fountain before drinking, run them to draw fresh water.
  • DO NOT place your mouth directly on the fountain. If you intend to fill a water bottle, DO NOT contact/ touch the spout/ mouth of the bottle with the fountainhead.
  • Whether the water fountain has a button or lever, make sure to clean the surface of the device first or you may use your elbow or clean tissue to operate. If you have touched the button or lever, wash your hands for at least 20 seconds with soap and water or alcohol bases hand sanitizer.

83) What is good respiratory Hygiene practice?

• Healthy respiratory hygiene is practiced by covering nose or mouth with a tissue when coughing or sneezing. When coughing, use a mask. Use disposable tissues and discard after use. Use hand hygiene after having contact with respiratory secretions.

86) Are people with pollen allergies more prone to COVID-19?

• Allergies are not a group of diseases that compromise our immunity. That said, no people with pollen allergies are not more prone to COVID-19. That being said, people dealing with allergies may touch their noses more often due to the symptoms of the allergic disease, so allergic patients should be very mindful of their hand`s higiene and avoid as much as possible touching their faces.

87) Is the virus inactivated in extremes of temperatures? Is it safe to boil the tap water and consume? Is it safe to eat ice-cream?

• Yes, it is inactivated at extreme temperatures, especially above 75 degrees Celsius (about 167 Fahrenheit), so it is safe to boil tap water. According to the WHO, there is no evidence that supports that the virus can be spread by eating ice cream.

Cleaning and Disinfecting

• All of the information below has been compiled from the CDC, WHO, and the FDA websites.
• According to a study performed by Arthur Chang et al it was found that there was 20% increase in the number of chemical exposures as reported by the National Poison Data System in the U.S for a period of 3 months from January 2020 to March 2020 as compared to the 3 months duration from January 2019 to March 2019.

89) How do I clean and disinfect surfaces?

• Use soap and water to clean the surfaces which will help in cleaning the dirt. Afterward, use disinfectants to kill the microbes. Here is a list of disinfectants approved by the EPA (the United States Environmental Protection Agency). Always use disposable gloves.

90) What surfaces at home should I disinfect regularly?

• High contact surfaces such as; doorknobs, sinks, dining tables, Phones, Laptops, light switches, keyboards.

91) What products can I use in disinfecting the home?

• Here is a list of disinfectants approved by the EPA (the United States Environmental Protection Agency). The EPA list mentions the EPA registration number not products by brand name. Check your cleaning/disinfectant products for the EPA registration number on the disinfectant.

92) Can I use bleach to disinfect at home?

• Yes, use bleach 5 tablespoons per gallon of water.

93) How often, and when do I clean hands with soap and water while at home?

• Wash hands before and after cooking, eating, cleaning surfaces, laundry, touching any supplies brought from the store.

94) Do I have to separate the laundry of a COVID-19 infected family member?

• You can mix laundry. Be sure to wash hands before and after doing laundry.

95) What precautions can I take as a caregiver to my family in quarantine?

• If you are the caregiver at your house, provide support with basic needs i.e; give medicines as per doctor's advice, give medicines to help with symptoms (i.e acetaminophen to lower fever). It is very important to watch for warning signs like - Trouble breathing, excessive pain in the chest, lack of response to verbal stimulation, confusion, and bluish discoloration of lips. Clean and disinfect the house as per the above recommendations. Have a separate bathroom if possible. Wear disposable gloves and wash hands with soap and water afterward when handling laundry or utensils of infected persons. Limit contact, wear a scarf or cloth face mask when around the sick person at home. Check if you are getting any symptoms like fever, dry cough, muscle pain, and other flu-like symptoms. As a caregiver, you should quarantine yourself for 14 days if you have come in contact with the sick person whether you are symptomatic or not.

96) I don't have symptoms but my family member has tested positive should I quarantine myself?

• Yes

97) How do I clean fruits and vegetables?

• First wash hands before and after washing vegetables with soap and water and thoroughly wash fruits and vegetables in water take extra care if you are eating raw.

98) How can I stay safe while shopping for supplies at the supermarket?

• Wear a mask and try to keep a 1-meter distance from other people. Use disinfectant wipes to sanitize the handle of the shopping basket and trolley handles. After coming home make sure to wash hands after properly cleaning vegetables, and other food products with plastic containers should be sanitized with disinfectant wipes as its found that the corona-virus can stay on the plastic container for 72 hours, 4 hours on the copper vessel and 24 hours on cardboard.

Public Safety Questions

99) Does a mask really decrease my chances of getting infected?

• CDC recommends that people wear a cloth face covering to cover their nose and mouth in the community setting. This is an additional public health measure people should take to reduce the spread of COVID-19 in addition to (not instead of) social distancing, frequent hand cleaning and other everyday preventive action. A cloth face covering is not intended to protect the wearer, but may prevent the spread of virus from the wearer to others. This would be especially important in the event that someone is infected but does not have symptoms A cloth face covering should be worn whenever people must go into public settings (grocery stores, for example). Medical masks and N-95 respirators are reserved for healthcare workers and other first responders, as recommended by current CDC guidance.

100) What kind of face mask gives the best protection against COVID-19?

• The CDC recommends a cloth face covering. A cloth face covering is not intended to protect the wearer, but may prevent the spread of virus from the wearer to others. This would be especially important in the event that someone is infected but does not have symptoms. Medical masks and N-95 respirators are reserved for healthcare workers and other first responders, as recommended by current CDC guidance.

101) What are droplets and aerosols?

• Droplets are too large and heavy, it can stay in the air for a few seconds before settle out of the air onto surfaces, this is usually within 6 feet because of the gravity. Respiratory droplets can contain large amounts of virus.
• Aerosols are tiny virus-filled particles or droplets that allows virus to hang in the air and travel further than droplets.

Travel Related Questions

102) I recently returned from a COVID-19 hot-spot, What do I do?

It is important to remember that anyone who has close contact with someone with COVID-19 should stay home for 14 days after exposure based on the time it takes to develop illness.

103) What precautionary measures can my family and I take when we travel?

• Clean your hands often, If soap and water are not available,use a hand sanitizer that contains at least 60% alcohol, make sure you cover all surfaces of your hands and rub your hands together until they feel dry.
• Avoid touching your eyes, nose, or mouth with unwashed hands.
• Avoid close contact with others, maintain a safe physical distance of at least 6 feet.
• Wear a cloth face covering in public.
• Cover coughs and sneezes.
• Pick up food at drive-throughs, curbside restaurant service, or stores.
• Make sure you are up to date with your routine vaccinations, including measles-mumps-rubella (MMR) vaccine and the seasonal flu vaccine.

105) What should I do if there was a sick passenger on my flight?

• When booking your ticket for a flight be sure to provide your contact information, so you can be notified if you have been exposed to a sick passenger on your flight. The current federal regulations mandate that all pilots must report all illnesses and deaths to CDC before arriving to a U.S. destination. According to CDC disease protocols, if a sick traveler is considered a risk to the public’s health, CDC works with local and state health departments and international public health agencies to contact exposed passengers and crew.

106) Should I delay my vacation?

Due to the world wide spread of the virus, it is advised to delay your vacation. A lot of countries around the world have lockdown protocols in place and international or domestic travel is highly regulated. CDC recommends that all travelers defer all cruise ship travel worldwide. Recent reports of COVID-19 on cruise ships highlight the risk of infection to cruise ship passengers and crew. Like many other viruses, COVID-19 appears to spread more easily between people in close quarters aboard ships.

107) Does a particular mode of transportation increase my risk of contracting COVID-19?

• When using any type of transportation, follow these general principles:
• Practice hand hygiene and respiratory etiquette (hand washing for at least 20 seconds before and once you reach your destination or use hand sanitizer with at least 60% alcohol, avoid touching your eyes, mouth, nose and mouth with unwashed hands, Cover your coughs and sneezes with a tissue or use the inside of your elbow. Throw used tissues in the trash and wash your hands immediately with soap and water for at least 20 seconds or use hand sanitizer with at least 60% alcohol.
• During travel, try to keep at least 6 feet (2 meters) from people who are not in your household — for example, when you are waiting at a bus station or selecting seats on a train.
• Wear cloth face coverings.
• Wear a cloth face covering when physical distancing is difficult.
• Note: Cloth face coverings should not be placed on:
  • Babies and children younger than 2 years old
  • Anyone who has trouble breathing or is unconscious
  • Anyone who is incapacitated or otherwise unable to remove the cloth face covering without assistance
• Cloth face coverings are meant to protect other people in case the wearer is unknowingly infected but does not have symptoms.
• People who are sick or have recently had a close contact (closer than 6 feet for at least 15 minutes) to a person with COVID-19 should not use public transportation and should stay home except to seek medical care.
• Individuals who are at higher risk of severe illness from COVID-19, such as older adults, people with disabilities, and people of any age who have serious underlying medical conditions, should limit their travel.
• If you need special accommodations or assistance while traveling (for example, help with a wheelchair lift or with carrying bags), if possible, take a transportation “buddy” with you (preferably from your household) to help you during travel.

109) Should I wear a face-covering throughout my trip?

• The Center for disease control CDC recommends that everyone wear a cloth face covering over their nose and mouth when in public, including during travel. Wearing a cloth face covering may slow the spread of the virus. Additionally, keeping a safe distance of at least 6 feet of physical distance from others and practicing other everyday preventive measures like hand washing is also recommended.

Pregnancy and COVID-19

113) How can pregnant women protect themselves from contracting COVID-19?

• Pregnant women can protect themselves by adhering to established social distancing and sanitation guidelines:
  • Regular handwashing, and use hand sanitizers with >60% alcohol.
  • Avoid touching the eyes, nose, mouth, and ears.
  • Avoid contact with all sick individuals.
  • Maintain distances of up to 2 meters from others when out.
  • Clean and disinfect frequency touch surfaces i.e: doorknobs, computers, phones, counter-tops.

114) Are COVID-19 outcomes worse in pregnant women?

• Whether or not COVID-19 causes worse outcomes in pregnant women has not been established. It is important for pregnant women to continue to follow all precautions as listed above.

115) Can a mother pass the virus to her unborn child?

• Only a limited number of studies have been conducted to assess whether or not the virus causing COVID-19 can be passed from mother to fetus. From the evidence gathered, the risk of passing the virus to fetuses appears to be minimal, and there have not been any congenital malformations associated with maternal infection with COVID-19. Pregnant women should still adhere to strict social distancing and sanitation guidelines.

116) What should I do if I am pregnant and get sick?

• The most appropriate thing to do would be to call your doctor's office and make them aware of your illness, the symptoms you are experiencing, whether or not you have traveled recently, or been exposed to any sick contacts.
• Do not go to the office as it is important to call first to help limit the spread of the virus. Your doctor will determine if you need testing or will need to come in to be evaluated.

117) Are the risks of known pregnancy complications increased due to COVID-19?

• According to the CDC, there has not been any documented evidence of an increased risk of miscarriage, fetal malformations, or other known pregnancy complications in pregnant women who are infected with COVID-19. The American College of Obstetricians and Gynecologists relying on data from other coronaviruses, such as SARS and MERS, have stated that pregnant women who are infected with COVID-19 may present with a higher risk for some complications, i.e preterm birth. This data is extremely limited, and in fact, the pre-term birth recorded in these patients may not be a direct implication of the virus.

118) I am pregnant, I had severe symptoms like breathlessness and delirium due to COVID-19, should I expect any long term consequences in the mental or physical health of my child?

• With COVID-19 being due to a novel virus, there is limited evidence regarding how it affects pregnancy. Current/recent studies, however, show no evidence of mothers diagnosed with COVID-19 in the third trimester, passing the virus to their babies while in the uterus. Pregnant women who have severe symptoms or complications from COVID-19 may need to deliver their babies sooner than expected. Other than known-complications of prematurity in the infant, there is currently no evidence to suggest that COVID-19 in the mother has any negative consequence on the mental or physical health of the child.

119) I live in a COVID-19 predominant zone, I am asked to take HCQ- is it safe? will it help?

• Data from several studies have shown no added benefit of hydroxychloroquine or chloroquine when treating patients with COVID-19. In fact, adverse maternal effects such as abnormal heart rhythms have been noted. The medication has also been found to cross the placenta and may lead to adverse outcomes in the fetus. Discuss with your health care provider and OB/Gyn for the best recommendation for you.

120) Is Vaginal Birth at home / underwater safe at this point of time?

• Pregnant women should discuss with their health-care providers about their birth plans. Evidence still shows that hospital or hospital-based centers are still safest for childbirth. This helps to tenure that the mother and child get the best care in case of unforeseen complications.

121) When can I resume breastfeeding after recovering from COVID-19 ?

Breastmilk is the best nutrition source for your child. The limited studies on breastfeeding women with COVID-19 have not found the virus in breast milk. Hence you can resume breastfeeding as soon as you are able to. The main concern is the parent or caregiver infecting the baby through respiratory droplets. Precautions should be taken to keep your baby healthy, including washing hands before touching and feeding your baby and wearing a face mask if you are experiencing symptoms or confirmed positive with COVID-19.

• If you have COVID-19 and choose to breastfeed:
  • Wear a cloth face covering while breastfeeding and wash your hands with soap and water for at least 20 seconds before each feeding.
• If you have COVID-19 and choose to express breast milk:
  • Use a dedicated breast pump (not shared).
  • Wear a cloth face covering during expression and wash your hands with soap and water for at least 20 seconds before touching any pump or bottle parts and before expressing breast milk.
  • Follow recommendations for proper pump cleaning after each use, cleaning all parts that come into contact with breast milk.
  • If possible, expressed breast milk should be fed to the infant by a healthy caregiver who does not have COVID-19, is not at high-risk for severe illness from COVID-19, and is living in the same home.

122) Can I donate my frozen Breast Milk to other children after recovering from COVID-19 ? should I disclose my condition?

• Breastmilk is the best nutrition source for your child. The limited studies on breastfeeding women with COVID-19 have not found the virus in breast milk.
• Women who have recovered from COVID-19 and want to donate their breast milk can do so via authorized milk banks. She can choose to disclose her prior condition.

123) Will men's sperm or woman's reproductive health be at risk for future pregnancies if one of them has been tested for positive and recovered from COVID-19?

• Limited studies insinuate that the reproductive health of both men and women can be negatively impacted by COVID-19. This may be due to SARS-CoV-2's pathogenic effect on testicular and testicular tissues that might affect the function of the ovaries and testicles, and the quality of the spermatozoa and oocyte. Further studies are still being conducted.

124) Are lactation classes available during this pandemic?

• To enforce social distancing several health regions have discontinued prenatal and lactation classes. There are now online platforms and support groups where women can confer with providers and peers online and offer recommendations when necessary.

125) Are there any Online New-mom groups that I can join to keep up and share my pregnancy-related anxiety during the shelter-in-place period?

• It is normal for pregnant women to experience increased fears and anxiety during these uncertain times. There are various online platforms that can help new-moms navigate this epidemic together. You can conduct an internet search, or confer with your health care provider or midwife for any recommendations.

Children and COVID-19

126) How can I protect my child from contracting COVID-19?

• According to WHO and CDC you can encourage your child to help stop the spread of COVID-19 by teaching them to do the same things everyone should do to stay healthy.
  • Avoid close contact with people who are sick.
  • Stay home when you are sick, except to get medical care.
  • Cover your coughs and sneezes with a flexed elbow or tissue, then throwing away the tissue into a closed bin.
  • Do not touch your eyes, mouths or noses if you have not properly washed your hands.
  • Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food.
  • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
  • Clean and disinfect frequently touched surfaces and objects (e.g., tables, countertops, light switches, doorknobs, and cabinet handles).
  • Launder items, including washable plush toys, as appropriate and in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely. Dirty laundry from an ill person can be washed with other people’s items.
  • Being alert to symptoms is important to promptly get medical attention when required and avoid complications.

127) Can family members visit my newborn child?

• The best visit during the COVID-19 pandemic is a virtual one, rather in-person. Children do not appear to be at high risk of COVID-19 but any person at any age can get infected. Infants (<12 months of age) may be at higher risk for severe illness from COVID-19 compared with older children. It is better to avoid an in-person visit. If the family members have been sick recently, or are COVID positive or have been exposed to a COVID positive person, they should NOT visit the child. If a member has to visit, precautions such as maintaining a distance and hygiene should be implemented. If a visitor has to touch the baby ask them to wash their hands. The more people the baby interacts with and the longer that interaction lasts, the higher the potential risk of becoming infected with COVID-19.

128) Is COVID-19 transmitted via breast milk? Can I breast-feed my child?

Breastmilk is the best nutrition source for your child. The limited studies on breastfeeding women with COVID-19 have not found the virus in breast milk. The main concern is the parent or caregiver infecting the baby through respiratory droplets. Precautions should be taken to keep your baby healthy, including washing hands before touching and feeding your baby and wearing a face mask if you are experiencing symptoms or confirmed positive with COVID-19.

• If you have COVID-19 and choose to breastfeed:
  • Wear a cloth face covering while breastfeeding and wash your hands with soap and water for at least 20 seconds before each feeding.
• If you have COVID-19 and choose to express breast milk:
  • Use a dedicated breast pump (not shared).
  • Wear a cloth face covering during expression and wash your hands with soap and water for at least 20 seconds before touching any pump or bottle parts and before expressing breast milk.
  • Follow recommendations for proper pump cleaning after each use, cleaning all parts that come into contact with breast milk.
  • If possible, expressed breast milk should be fed to the infant by a healthy caregiver who does not have COVID-19, is not at high-risk for severe illness from COVID-19, and is living in the same home.

129) What is Multi-system Inflammatory Syndrome in Children (MIS-C)? Is it fatal and what precautions are to be taken to avoid it?

• The CDC, as well as several other government agencies, are working with state and local health departments to learn more about the multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 and gather more information as quickly as possible about how common it is and who is at risk. MIS-C in children due to COVID-19 can affect children 0-19 years of age. It is not yet known what causes MIS-C. According to WHO, from the data available, the child is with MIS-C has a fever (for three days or more) AND signs of swelling of multiple organs (can have swelling of hands or feet, lungs, heart, kidneys, brain; red eyes; very low blood pressure; diarrhea; vomiting or abdominal pain) AND is COVID-19 positive or contact with a person with COVID-19. To include other criteria described by WHO the pediatrician may run some blood tests, heart ultrasound, and X-ray and the COVID-19 test to check for inflammation and see if the child has another disease that looks like MIS-C.
• The condition can develop during infection or weeks after COVID- 19 infection and the children can present with just fever or just bad inflammation so if your child has any of these symptoms, other symptoms of COVID-19, or other concerning signs, contact your pediatrician. If your child is showing any emergency warning signs including trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, bluish lips or face, severe abdominal pain, or other concerning signs, seek emergency care right away. It is important to note that children with Kwaasaki disease and other diseases can also have fever and rash.
• So-far the cases of MIS-C are rare. For reasons unknown as yet, some children get sick with MIS-C and others do not. Scientists also do not know if children with certain health conditions are more likely to get MIS-C. MIS-C can be serious and even fatal, but most children who were diagnosed with this condition have gotten better with medical care.
• Scientists are working to better understand the relationship between COVID-19 and MIS-C, parents should focus on preventing the spread of COVID-19 by encouraging and practicing handwashing, social distancing, covering mouth and nose, cleaning and disinfecting frequently touched surfaces and being alert to symptoms.

130) Is it safe to allow my toddler to return to school?

• According to WHO, if your child, the siblings and other family members do not have any symptoms (such as a fever or cough) it is best to keep the child in school unless a public health advisory or other relevant warning or official advice has been issued affecting your child’s school. Schools work in collaboration with local health departments and the decisions about reopening or dismissal are made on a case by case basis, considering the spread of disease in the community. Because of the evolving situation, authorities and parents will need to be flexible and ready to adapt to ensure the safety of every child. Stay in touch with the school about their dismissal and other policies and ask about policies to improve hygiene measures. If your child is sick, notify the school about the child's symptoms and they should stay at home. Teach your children good hygiene practices for a school like frequent handwashing as they will be required to follow precautions and hygiene practices in schools once they reopen.

131) Can my child go to summer camp this year?

• If your country is experiencing community spread of COVID-19, going camping can put your children on risk if they come in close contact with others or share public facilities at campsites or along the trails. Exposure may be especially unsafe in remote areas, without easy access to medical care. If the condition is better in your area and parks or sites are opened, one must practice all hygiene, face-covering and social distancing measures (for night camps, mats or beds be aligned head-to-toe at least 6 feet apart). Kids should bring their own food, use disposable utensils, and eat separate areas and not share other items as well. Children should be in small groups with a dedicated teacher. Sick staff members or campers should not return to camp until they are well and quarantined.

132) Can my newborn child be given a live vaccine??

• If the child is not a suspected or confirmed case of COVID-19, then yes. Some of the live attenuated vaccines administered to babies include MMR, rotavirus, and varicella-zoster vaccine. According to the CDC and UNICEF, routine vaccination, including live vaccines, should not be delayed during the COVID-19 pandemic to save the children from vaccine-preventable diseases. As states begin to reopen, if the vaccination has been missed due to changes in the providers' practice schedules, you can contact the health-care provider to catch-up and keep the child up to date to vaccinations. Strategies to separate well visits from sick visits have been devised by the CDC. They include scheduling visits during different times of the day and limiting the crowding in waiting rooms.

133) How can I differentiate the fever due to vaccine and COVID-19 in a newborn child?

• Differentiation between fever due to COVID-19 and vaccination can be made easy by knowing about the fever usually accompanying the vaccine/shot and keep a track of your child's fever. Fever after vaccination is usually mild (may reach 102° F in which case, the medication must be given); associated with local symptoms such as swelling, pain and redness where the shot was given; and fussiness. Most symptoms start within the first 12 hours after the shot is given. Fever mostly starts after 12 hours and lasts 2 or 3 days. Call the pediatrician if fever starts after 2 days, lasts more than 3 days or returns after being gone for 24 hours.
• A child with COVID-19 may have a fever; no fever or just a fever which can be very high or mild. The child can have other symptoms along with fever such as difficulty breathing, too weak to cry or wake up, vomiting, runny nose, cough and heart problems. If your child has fever and had contact with anyone who was sick, the chances of getting COVID-19 are high and you should consult your pediatrician.

134) Should routine vaccinations/ shots be continued if my child gets COVID-19?

• CDC recommends delaying vaccination of your child if COVID-19 is suspected or confirmed. As soon as your child gets healthy, consult the pediatrician to catch-up on the missed vaccinations.

135) Is it safe for my child to get bone marrow transplant, blood transfusion, donor lymphocyte infusion, and reduced-intensity conditioning?

• Immune therapy or transfusions which can be life-saving for children and should not be deferred or ignored during COVID-19 pandemic. Generally, respiratory viruses are not known to be transmitted by implantation, transplantation, or blood or blood product transfusions. At this time, the potential for transmission of COVID-19 by transfusions is unknown. There is a report of no COVID-19 transmission after the donor got COVID-19 positive after blood donation. Also FDA reports no COVID-19 transmission via blood.
• As a precaution, it is important for the blood donor to be healthy, feel good, and have no fever on the day of donation. Other transfusion precautions must also be followed. If the donor gets COVID-19 positive after donation, the donation center must be informed for the non-transfused blood to be discarded.
• You must consult the pediatrician and shared decision making must be made on a case by case basis as certain transplants require immunosuppression and special care is required to protect the child from COVID-19. Children must follow social distancing and hygiene practices as immunocompromised children are at higher risk of contracting COVID-19.

136) Is it possible that my child has COVID-19 but no symptoms?

• Research shows that most of the children have minimal or no symptoms although a few can have severe symptoms and maybe MIS-C. Severe illness is generally seen in children younger than 1 year of age and children who already have other diseases.

137) Is it safe to allow my child to play in the park/ trek?

• Children can visit parks or treks that are not very crowded and close to their homes. Consider accompanying them to help them follow the guidelines. According to the CDC, you should be careful in allowing children to play in swimming pools and playgrounds as they can be difficult to keep disinfected. If children visit a playground, they should maintain six feet distance from people who do not live with them, wash hands, and should wear a face mask. Bring a hand sanitizer with you if required.

138) What are the other signs I should regularly monitor for other than the temperature of my child?

• Reported symptoms in children include but are not limited to cold-like symptoms, such as fever, difficulty breathing, runny nose and cough that can be dry and with phlegm. The child can also have vomiting, diarrhea, weakness or heart problems.

139) Do pneumonia vaccine, flu shot or BCG vaccine protect my child against COVID-19?

• No. Vaccines against pneumonia,(pneumococcal vaccine and Haemophilus influenza type B (Hib) vaccine), do not protect against COVID-19. There is no evidence that flu shot or BCG protects against COVID-19. COVID-19 is caused by a different virus that required its own vaccine. There is no evidence that the Bacille Calmette-Guérin vaccine (BCG) protects people against infection with COVID-19 virus. There are ongoing clinical trials addressing the and WHO will evaluate the evidence when it is available. In the absence of evidence, WHO does not recommend BCG vaccination for the prevention of COVID-19.

140) Should my toddler use a facemask?

• When out in the community, CDC recommends that everyone 2 years and older wear a cloth face covering to cover nose and mouth. Children younger than 2 years of age should NOT put cloth face coverings due to the potential danger of suffocation. If your child is older but has trouble breathing, unconscious, incapacitated, or otherwise unable to remove the face covering without assistance, it is not recommended for them to use face-coverings.

141) What are the psychological effects of the current situation on children, how do I know my child is under stress and how can I help?

• No doubt, it is a stressful time for all of us and children too. Children can have anxiety, fear of losing loved ones, and even fear of death. According to WHO, children may respond to stress in different ways. Your child may have difficulty sleeping, bedwetting, have pain in the stomach or head, and being anxious, angry, clingy, or afraid to be left alone. Try to gauge their level of anxiety by watching their body language. Your children should be assured they can talk to you at any time and you be there for them. It is also important to:
  • Be supportive and explain to them that they are normal reactions to an abnormal situation. According to their age, explain to them what has happened and what is going on. **Give them clear examples of what they can do to help protect themselves and others from infection. Information should be shared in a reassuring way.
  • Listen to their concerns and take time to comfort them and give them love and attention.
  • Reassure them that they are safe and praise them frequently.
  • If they can not go to school, or are in hospital because they are sick acknowledge that is can be hard and explain to them that it is safe for them and their friends and things will go back to normal.
  • Keep a regular schedule and routine for children which includes studying, playing, and relaxing.
  • Check if they are experiencing or contributing to bullying. It is important for them to know that coronavirus has nothing to do with someone's looks or where they are from.

142) Should the medication being taken be stopped if my child gets COVID-19?

• No. Your child should continue taking medication as prescribed as not taking it could make your child’s condition worse. Any decision should be made after consulting the pediatrician and inform them of the situation.

143) My children spend more time online now, what do I do?

• While online recreation has become a new normal, remember to balance it with offline activities, including time outside, if possible. You can:
  • Keep them safe with open communication about who they communicate with and how. Be alert and ensure your children that they can tell you or any trusted adult if they experience cyberbullying.
  • Work with your child to establish rules on how, when, and where devices can be used.
  • Check that your child’s device has antivirus, proper privacy settings, covered webcams when not in use. Help your child learn to keep personal information private, especially from strangers.
  • Spend time with your child to identify age-appropriate apps, games, and other online entertainment. Help them create opportunities to have positive and supportive interactions with friends and family.
  • Help your child recognize and avoid misinformation and age-inappropriate content that may increase anxiety about the COVID-19 virus. Help them recognize that online advertisements for unhealthy foods or age-inappropriate material can be harmful.

144) Do baby wipes kill COVID-19?

• No. There is no recommendation or proof that baby wipes can kill COVID-19. According to CDC baby wipes may make your hands look clean, they’re not designed to remove germs from your hands. Both WHO and CDC recommend soap and water, or a sanitizer with at least 60% alcohol. Baby wipes are made to not irritate baby skin and the amount of alcohol or surfactant used is minimal and not sufficient to kill COVID-19.

145) My child has Asthma, is COVID-19 a bigger risk to my child?

• CDC explains that there is limited data on which underlying conditions in children might increase their risk of COVID-19 infection or severity. Although it says that people, any age with underlying conditions such as chronic lung disease or moderate to severe asthma, serious heart problems such as congenital heart defects, immunocompromised conditions (such as cancer undergoing treatment), severe obesity (body mass index [BMI]≥40), diabetes, chronic kidney disease on dialysis or liver disease might be at higher risk for severe illness from COVID-19 and should be monitored for symptoms or signs of concern. The underlying conditions can worsen if the child gets COVID-19.

146) Which children are more likely to get COVID-19 and have complications of COVID-19?

• Anybody at any age can be infected with COVID-19. But, with limited data available:
  • Children have fewer complications of COVID-19 as compared with adults.
  • Among suspected or confirmed COVID-19 positive children, infants (<12 months of age) may be at higher risk of severe disease compared with older children.
  • Hospitalization is most common among children aged <1 year and those with underlying conditions such as ( lung disease, heart disease, low immunity, cancer).
  • Girls and boys equally be infected.

Pets/Animals and COVID-19

147) Is it currently safe to adopt an animal from a shelter?

• Based on the limited information available to date, the risk of animals spreading COVID-19 to people is considered to be low. There is no reason to think that any animals, including shelter pets, play a significant role in spreading the virus that causes COVID-19.

148) Can humans contract COVID-19 from animals?

• At this time, there is no evidence that animals play a significant role in spreading the virus that causes COVID-19. Based on the limited information available to date, the risk of animals spreading COVID-19 to people is considered to be low. A small number of pets have been reported to be infected with the virus that causes COVID-19, mostly after contact with people with COVID-19.

• Pets have other types of coronaviruses that can make them sick, like canine and feline coronaviruses. These other coronaviruses cannot infect people and are not related to the current COVID-19 outbreak.

• Since animals can spread other diseases to people, it’s always a good idea to practice healthy habits around pets and other animals, such as washing your hands and maintaining good hygiene. For more information on the many benefits of pet ownership, as well as staying safe and healthy around animals including pets, livestock, and wildlife, visit CDC’s Healthy Pets, Healthy People website.

149) What do I do if my pet gets sick after being in contact with a sick person?

• There is a small number of animals around the world reported to be infected with the virus that causes COVID-19, mostly after having contact with a person with COVID-19. Talk to your veterinarian about any health concerns you have about your pets.

• If your pet gets sick after contact with a person with COVID-19, do not take your pet to the veterinary clinic yourself. Call your veterinarian and let them know the pet was around a person with COVID-19. Some veterinarians may offer telemedicine consultations or other plans for seeing sick pets. Your veterinarian can evaluate your pet and determine the next steps for your pet’s treatment and care.

150) Should my pet be tested?

• No. At this time, routine testing of animals for COVID-19 is not recommended.

151) What should I do if I think my pet has COVID-19?

• Do not take your pet to the veterinary clinic yourself. There is a small number of animals around the world reported to be infected with the virus that causes COVID-19, mostly after having contact with a person with COVID-19. Talk to your veterinarian about any health concerns you have about your pets.

152) Are animals responsible for the COVID-19 outbreak in humans?

• Previous outbreaks of novel viruses i.e. SARS and MERS were traced to horseshoe bats and passed through other species, such as palm civet and camels. Ongoing research is trying to identify the suspected animal source for the COVID-19 outbreak and as well as any other intermediate hists.

153) Is there currently a COVID-19 vaccine for pets?

• At this time, there are no known vaccines for pets.

154) Should my pet wear a face mask in public?

• NO! There is no evidence that face masks will protect your pet from COVID-19. The use of facemasks by pets can cause other breathing difficulties.

Keeping Spirits High in Quarantine

Taking care of your mental health

• Mental health is an important part of overall health and wellbeing. It affects how we think, feel, and act. It may also affect how we handle stress, relate to others, and make choices during an emergency. People with pre-existing mental health conditions or substance use disorders may be particularly vulnerable in an emergency such as a pandemic. Mental health conditions (such as depression, anxiety, bipolar disorder, or schizophrenia) affect a person’s thinking, feeling, mood or behavior in a way that influences their ability to relate to others and function each day. These conditions may be situational (short-term) or long-lasting (chronic). People with preexisting mental health conditions should continue with their treatment and be aware of new or worsening symptoms. If you think you have new or worse symptoms, call your healthcare provider. Look out for free and confidential resources that can help you during this time.

Coping with stress

• Public health actions, such as social distancing, can make people feel isolated and lonely and can increase stress and anxiety. However, these actions are necessary to reduce the spread of COVID-19. Fear and anxiety about a new disease and what could happen can be overwhelming and cause strong emotions in adults and children.Some healthy ways to cope with stress include:
  • Know what to do if you are sick and are concerned about COVID-19. Contact a health professional before you start any self-treatment for COVID-19.
  • Know where and how to get treatment and other support services and resources, including counseling or therapy (in person or through telehealth services).
  • Take care of your emotional health. Taking care of your emotional health will help you think clearly and react to the urgent needs to protect yourself and your family.
  • Take breaks from watching, reading, or listening to news stories, including those on social media. Hearing about the pandemic repeatedly can be upsetting.
  • Take care of your body.
  • Take deep breaths, stretch, or media.
  • Try to eat healthy, well-balanced meals.
  • Exercise regularly.
  • Get plenty of sleep.
  • Avoid excessive alcohol use and drugs.
  • Make time to unwind. Try to do some other activities you enjoy.
  • Connect with others. Talk with people you trust about your concerns and how you are feeling.
  • Connect with your community- or faith-based organizations. While social distancing measures are in place, consider connecting online, through social media, or by phone or mail.

Helping children cope

• Children and teens react, in part, on what they see from the adults around them. When parents and caregivers deal with the COVID-19 calmly and confidently, they can provide the best support for their children. Parents can be more reassuring to others around them, especially children, if they are better prepared. Not all children and teens respond to stress in the same way. Some common changes to watch for include: Excessive crying or irritation in younger children, Returning to behaviors they have outgrown (for example, toileting accidents or bedwetting), Excessive worry or sadness, Unhealthy eating or sleeping habits, Difficulty with attention and concentration.

The following are Ways to support your child:

• • Talk with your child about the COVID-19 outbreak.
  • Answer questions and share facts about COVID-19 in a way that your child can understand.
  • Reassure your child that they are safe. Let them know it is ok if they feel upset. Share with them how you deal with your own stress so that they can learn how to cope from you.
  • Limit your family’s exposure to news coverage of the event, including social media. Children may misinterpret what they hear and can be frightened about something they do not understand.
  • Try to keep up with regular routines. If schools are closed, create a schedule for learning activities and relaxing or fun activities.
  • Be a role model. Take breaks, get plenty of sleep, exercise, and eat well. Connect with your friends and family members.
  • Spending time with your child in meaningful activities, reading together, exercising, playing board games.

References

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