While Hard, Societal Sacrifices Are Measurably Paying Off

The SARS-COV-2 (COVID-19) pandemic has infiltrated almost all aspects of our lives, bringing much of normal societal flow to a grinding halt. Social distancing has restricted contact with others, business closures have reversed economic growth, and other safety and prevention measures have resulted in an abrupt and dramatic change to daily life. Despite these drastic actions, there are still nearly 13 million confirmed cases worldwide and well over 3 million in the United States (U.S.) alone, at the time of this writing. The vast number of COVID-19 infections and, worse, deaths from the virus, begs the question, have the steps we’ve taken made any difference? Is that measurable and, if so, how? Answers to these questions are crucial for a number of reasons. First, the changes we’ve been collectively making are hard. So, knowing whether these steps are saving lives and reducing infections can be motivating. Similarly, some leaders have sown doubt, causing a certain percentage of citizens to ignore scientific recommendations and raising wonder about whether the collective inconvenience, job loss, diminished learning, and isolation are worthwhile or not?

knowing whether these steps are saving lives and reducing infections can be motivating

To address this concern and curb the public skepticism, researchers from the University of Berkeley recently analyzed data to assess the effectiveness of a variety of protective measures across six major epicenters of COVID-19 including the U.S., Iran, France, China, South Korea, and Italy. Gathering 1,717 points of information from the six countries, the researchers assessed the significance of the effect by comparing the growth rate of COVID-19 just prior to the intervention (or interventions) to the change in growth rate soon after the implementation of one or more policies including, but not limited to:

If Nothing Had Been Done, 530 Million People Infected Worldwide

Without any policy action at all, the researchers estimated that the growth rate of COVID-19 infection would have been 43% higher per day across the six countries studied. This would have translated to 14 times more identified COVID-19 infections (i.e. nearly 5 million more cases) in the US alone as of the first week in April. In total, the study predicted that without intervention, there would have been 62 million more confirmed cases (again, as of early April) in the six countries, corresponding to 530 million total infections across the world.

Fig. 4 | Estimated cumulative confirmed COVID-19 infections with and without anti-contagion policies.

The current total of confirmed cases, close to 13 million, pale in comparison to these predicted values if no measures had been implemented in these 6 countries. It is clear that policy measures “significantly and substantially slowed the pandemic” spread. 

A similar study published in Health Affairs, discovered comparable trends in reduced growth rate of infection in the U.S. after implementation of shelter in place orders (SIPO). Following policies until the end of April, the Health Affairs researchers projected that without SIPO, there would have been 10 million more cases across the U.S. and without additional measures of event bans and closures (discussed below), there would have been 35 million more cases. Since two independent studies produced parallel results, we can feel confident about the accuracy of the estimated number of cases averted and lives saved as predicted by these statistical models. In other words, our collective actions and sacrifices, both as individuals and society at large, have mattered and have saved lives.

our collective actions and sacrifices, both as individuals and society at large, have mattered and have saved lives

If Nothing Had Been Done, 530 Million People Infected Worldwide

Both analyses went even further to try to uncover whether specific policies were most influential in mitigating spread of the disease compared with others. According to UC Berkeley and Health Affairs authors, social distancing has been especially impactful for slowing the spread of the virus; but, perhaps, school closures have not had as large an effect. Home isolation and social distancing, per the UC Berkeley analysis, reduced the growth rate of cases of coronavirus by 

-11.31% and -21.81% respectively. The study in Health Affairs also found that the SIPO provided the largest decrease in growth rate of -8% after only 21 days of implementation and that that result, in scientific terms, was statistically significant (p<0.01) – meaning the decline in spreading COVID-19 was definitely from the changed behavior, and not simply luck or chance. Additional actions that have also been emotionally draining and economically difficult, like business closure and quarantining those who test positive for COVID-19, have also effectively slowed the spread of COVID-19. The UC Berkeley experts report that these two actions resulted in a decrease in the rate of COVID-19 growth in the U.S. by -5.35% and -5.92% respectively, and even more in other countries like Italy (-11.40% and -6.06%, respectively). Neither of these studies examine the economic or psychological impact of these various preventative measures, which should be the subject of future research. However, this data makes it clear that while many of these protective measures are costly, challenging, and often unenjoyable, they have successfully stopped the spread of COVID-19.

What Can We Glean?

Both studies make it clear that their reports cannot determine definitively which protective measures are necessary, and which may be obsolete. Rather, these studies aim to shed light on the success of particular measures to slow the spread of COVID-19 and highlight how, all together, worldwide collective efforts have made a massive difference in combating the virus. These results prove that measures such as social distancing and home isolation have significantly slowed the spread of COVID-19, despite some dissenting opinions. In addition, while school closure and cancellation of large gatherings did not show significance or decreases in growth rate, both studies emphasize that these findings should not be interpreted as being unnecessary, nor does the data claim any stake on whether they be applied or avoided for future disease prevention.

The results of these analyses should be comforting since most of the preventative measures have produced what they intended.

The results of these analyses should be comforting since most of the preventative measures have produced what they intended. Through these measures, nations across the world were able to unite to implement meaningful action to slow the spread of COVID-19 and were able to prevent upwards of 530 million global infections. Dr. Kendon Bell, one of the UC Berkeley researchers, stated that as a global population, “we should be very proud” of our teamwork and collective actions to address the pandemic. 

These studies lay the foundation for effective statistical analysis of virus prevention and provide a template for what actions should be considered when facing the next pandemic. Our collaborative efforts to practice social distancing, in particular, and other measures have paid off. We have successfully cared for and protected one another. Let’s continue.

Written & Reported by Robert Shepard; Edited by Dr. Jacki Hart

Will 21-Year-Olds Learn to Take the Pandemic Seriously?

Doug, a 21-year old college student in Boulder, Colorado (CO), tested positive for COVID-19. Unlike others who have had much more serious cases, Doug was lucky. He only showed symptoms for a single day and, thankfully, never entered a hospital or emergency room. In fact, Doug assumed, at first, that he had the flu. 

Reflecting on his experience, Doug describes his main lessons from his quick brush with coronavirus. Doug learned, in large part, that his peers tend to take COVID-19 for granted. In fact, many in his friend group wound up testing positive, including the person from whom Doug contracted the virus. But few have taken it seriously enough to alter their habits and behaviors. 

Despite having had a smooth, easy course without complications, Doug now recognizes how contagious the virus is and tries to communicate with his friends the importance of wearing masks and taking other precautionary measures. Doug bases his newfound caution on the fact that he was exposed to the virus when in the same room with one or more who later tested positive. In fact, as Doug recounts, he was never in direct contact with an infectious person, just in the general vicinity

Even before having any symptoms, Doug sought testing because of this exposure. He found it difficult to locate a site; then, serendipitously, he developed symptoms one day later, which lasted less than 24 hours. Doug was quarantining from the time that he learned of the exposure. Three days after his symptoms began, his test results came back positive. His housemates and several friends, who had also been at that party, all tested positive; but no one had more than short-lived, mild symptoms.

While quarantining with housemates, their community came through with support. Other friends without COVID-19 delivered groceries and other supplies. The day that Doug shared his story with Covid-Recovery.org, he was scheduled to get his follow up test back the next day. He was anxious to know the results because he had stayed out of work for nearly a month. 

few his age seem to be taking the virus seriously enough.

When probed about the opinions of COVID-19 held by his peers, Doug described stories similar to what is shown in popular media: few his age seem to be taking the virus seriously enough. Those in Boulder, CO are still holding house parties, and while they wear masks when entering shops and bars, which are mandated, they’re not participating in strict social distancing. Doug believes that people his age might be convinced to change their behavior if their return to college was in jeopardy. Universities, like all schools throughout the country, are making a range of decisions based on the risks within their regions and many other factors. Part of the problem is that the delay between the risky behaviors that might spread the infection and any rise in rates could preclude students from connecting their actions and the schools’ decisions or altered policies. 

As far as Doug’s own behaviors — even though his case was mild, he carries an important message for people of all ages: listen to your doctors and wear your masks! 

Written & Reported by Robert Shepard
Edited by Dr. Jacki Hart

Katarina’s Choice is Hard but Clear: Protect Her Dad

My Covid Story

Being a 21-year-old college student during a pandemic means, for many, worrying about classes, jobs, and friends. I’m lucky to have access to fast, reliable internet and a quiet, safe place where I took the remainder of my UCLA courses online. For me, the hardest change has been the ongoing worry about ways that I might infect my 74-year-old father since moving back home.

There was little known about the novel COVID-19 virus in the early days, other than the increased risk for serious infection and even death for those older than age 70 or with underlying medical conditions. As I carried those facts in my brain, making my way to LAX on route to live with my parents in Rhode Island, I had a panic attack. Although I was fully covered with latex gloves, an N95 mask, sweatshirt, and sweatpants, and even braided my hair up to be out of the way, the following mantra repeated in mind: “I will never forgive myself if I am the reason my family gets sick.” My plane was crowded, LAX was crowded, and I did not take off my mask for a single second of the 6½ hour flight home. As soon as I got out of the airport I removed all of that disposable PPE (personal protective equipment), threw it into a trash bag, and jumped in the car with my mom.
After two weeks of being home, I was relieved to find that I never showed symptoms nor did anyone in my family. Once those two weeks passed, I still avoided seeing any friends or relatives other than my mom and dad for roughly a month. We all agreed that I would do the food shopping to minimize their potential exposure. Once a week, I put on my mask and gloves armed with hand sanitizer in my pocket and head to the grocery store. I continue to wash everything from the grocery store or leave non-perishable foods outside for a week. My philosophy has been that I can’t be too cautious to protect my parents.
During the lockdown period, the experience was almost easier. There weren’t pressures of choices to make, or friends asking me to go out. The protocol, so-to-speak, was clear cut and unwavering. I recognize, and hope that I don’t take for granted, my privilege of having access to shelter, food, WiFi, privacy, and space. While the stay-at-home order was in place, I didn’t have to worry about going anywhere because there was nowhere to go. The risk of my dad getting infected was minimal as long as I stayed inside. That helped me feel calm and in control.
But now, even with reported cases decreasing in Rhode Island, when I go for a run outside and pass by a biker without a mask, I feel a pang of dread wondering whether there is a chance that I just exposed myself to coronavirus. Sometimes, my anxiety eats at me for hours, admonishing myself for making the choice to go running. I know that the chance of contracting coronavirus outside while exercising with a mask on is very low; but when living with someone who could die if they get infected, worrisome thoughts fly through my head daily. Honestly, I feel exhausted.

I’m a 21-year-old college student; it’s summer, and while all of my friends go to bars and beaches, I stay home.

Now that Rhode Island has opened up its restaurants, bars and beaches, it has been more stressful. I’m a 21-year-old college student; it’s summer, and while all of my friends go to bars and beaches, I stay home. For me, the choice isn’t easy, but it is clear: my dad’s life takes precedence over my ability to socialize and hang out with friends. I think the hardest thing for me has been trying to keep everybody happy. Running or walking outside is essential for my own mental health; but I worry and feel strongly about not doing anything to put my parents at risk. It is challenging to explain to my friends why I don’t feel comfortable going out or spending time with them. People don’t always understand or fully appreciate my concern for my parents’ health.
It hasn’t been the summer I expected; that is true for most people. Removing myself from my usual social life and watching it happen without me can take a toll. It’s difficult to watch my friends having fun as I tune in from a screen. But I feel clear that I would rather miss out on a beach day than cause any harm to my Dad.

Reports Lag Behind Surges of Abuse & Domestic Violence

My Covid Story:

As Law Enforcement Partnership Coordinator at RESPOND, Victoria H has helped 100s of DV survivors from all over the world not only find safety but also success.

Nobody is immune to the impacts of COVID-19 on the way we live, but the consequences can be particularly severe for those suffering from domestic abuse. Numerous studies suggest that levels of violence have increased due to the toxic mix of heightened economic pressures, health-related issues, and “stay at home” rules that increase exposure to tense or already abusive relationships and eliminate a victim’s access to safe spaces during the day. These trends are further complicated by greater difficulties reaching out for help and getting access to the usual support organizations in one’s community.  

Stay-At-Home Rules Leave Jane Trapped

The story of Jane (name changed for privacy), a suburban high school student, begins in a way that is all too common within the foster care system – a teen reaching out to her school for help escaping from an abusive home. From that starting point, Jane faced hurdle after hurdle in her quest for safety because her cry for help took place during the emergence of the COVID-19 pandemic.  

On March 12th, Jane contacted her high school to say that recent “stay at home” rules left her trapped around the clock in an abusive home. Administrators worked diligently to set up a day in court. However, on the day of Jane’s scheduled hearing, courts across her state were shut down indefinitely. In the days that followed, social workers from the Department of Children and Families (DCF) navigated the new rules and managed to find Jane a safe home, only to watch their plans crumble once again – this time because a member of the foster-family tested positive for COVID-19. Luckily, local police worked closely with school administrators and DCF to keep a watchful eye on Jane’s abusive family while the support service agencies searched for another solution.  

Eventually, they found a safe new home for Jane. Nonetheless,

Jane’s harrowing story highlights the range of difficulties faced by those experiencing domestic abuse in the COVID-19 era

Jane’s harrowing story highlights the range of difficulties faced by those experiencing domestic abuse in the COVID-19 era, from the violence and trauma itself to the risk of contracting the virus from a stranger to adjusting to a whole new living circumstance at a time that is already fraught with fear and uncertainty. 

What Do the Experts Say?

Victoria Helberg, an employee at Respond (an organization that works with victims of domestic violence) noted how life during the pandemic makes it hard for those in need to reach out for help or to be identified by the community. Ms. Helberg said that there was a decrease in calls to Respond at the start of the pandemic. This trend may seem counterintuitive. But, as Ms. Helberg explains “people don’t have the opportunity to make calls because they were now at home with their abusive partner.”

people don’t have the opportunity to make calls because they were now at home with their abusive partner.

Ms. Helberg’s experience was echoed by a United Nations (UN) report that there has been a notable decrease in domestic violence reports during lockdown. Confirming Ms. Helberg’s real-life experience, the UN speculates that this is due to the hesitance of women to find help or address these incidents when forced to share their lockdown space with their abusers.

Despite increased difficulties reaching out for help reported by many experts, certain locations have still noted a spike in hotline activity regarding abuse. In Spain, the domestic violence hotline received 18% more calls in the first two weeks of lockdown than in the same period just one month earlier. Similarly, the United States and France reported roughly 30% increases in domestic complaints or occurrences of violence. These numbers are striking; yet, based on Ms. Helberg’s experience and the United Nations report, these statistics likely still underestimate the actual increase in incidents of abuse. For example,

Google noticed a 75% increase in Internet searches regarding support for domestic violence in Australia

Google noticed a 75% increase in Internet searches regarding support for domestic violence in Australia, demonstrating the large sum of victims who have likely been unable to receive help during the pandemic but are scouring the web for help. 

No Safe Space

The surge in cases of domestic abuse is also complicated by a lack of access to safe spaces for victims. Ms. Helberg states that “before, their abusive partner may be off to work, or they would be off to work, and they would have those kinds of moments in between to make [such] calls.” With no access to those private times and spaces today, difficult situations are made worse. Even children witnessing or experiencing abuse would rely more on the safety of schools and other locations for both a break from their homes and a place to get help. 

children witnessing or experiencing abuse would rely more on the safety of schools and other locations for both a break from their homes and a place to get help.

How Nations and Localities are Responding to this Crisis within a Crisis

During this extreme time, nations and local organizations have been taking the issue of abuse and domestic violence seriously. UN Secretary-General Antonio Guterres recently brought to light the importance of countries prioritizing support for those dealing with domestic violence. As a result, in France (for example), grocery stores set up a system using certain signals or code words to let the staff know that they need help. Around the globe, local organizations such as Respond have been helping as well, providing many services 100% virtually, while continuing to keep their shelter program staffed 24/7. 

The COVID-19 pandemic has created numerous additional complications for victims of abuse. At the same time, it is helping to shine a light on the seriousness of the ongoing problem and the need for vigilance. Even post-pandemic, governments and organizations need to continue to uncover the incidents, address the challenges, and create viable solutions to end domestic abuse and temper its devastating impact. 

Written & Reported by Ella Gavin; Edited by Dr. Jacki Hart

The Ripple Effect of Hydroxychloroquine Shortages

My Covid Story:

Like many with health conditions requiring hydroxychloroquine, Anoushka had trouble filling her prescription after many started erroneously using the medication for COVID-19.

On March 21st, Donald Trump tweeted that a combination of hydroxychloroquine (brand name Plaquenil) and azithromycin have “a real chance” to be a cure for COVID-19. Within this same week, fills of hydroxychloroquine/chloroquine rose 214% from the same week in 2019. Soon, the American Society of Health-System Pharmacists was reporting confirmed shortages across the country. When I read news about the stockpiling and hoarding of hydroxychloroquine in late March, I checked my Plaquenil bottle and counted the 13 pills I had left. My local CVS had a shortage, and my refill would be delayed. 

I was in the 55% of lupus patients who were experiencing challenges with filling hydroxychloroquine prescriptions according to a study conducted by the Lupus Foundation of America. Out of the 3,000 study participants between March and May of this year, 25% of the patients were only able to receive a partial refill and more than a 100 people were not able to get a refill at all. For many Americans living with systemic lupus or rheumatoid arthritis, hydroxychloroquine is essential for preventing flares of the disease, reducing symptoms, and protecting against irreversible organ damage.

90% of people living with lupus are women, and women of color are two to three times more likely to develop the disease.

90% of people living with lupus are women, and women of color are two to three times more likely to develop the disease. These shortages have been catastrophic for people who have been unable to travel to larger pharmacies or pay out of pocket for drugs essential to their long-term health and survival. Within the Lupus Foundation of America Study, people reported having to “pay cash out of pocket” for refills, “get [their] refills out of state via friend/family networking”, and just “wait to refill due to $450 cost.”

Separately, it is clear that the risks of hydroxychloroquine as a treatment for COVID-19 far outweigh its potential benefits. The March study (cited by Trump) by French microbiologist Didier Raoult and his colleagues was small and non-randomized, leading the International Society of Antimicrobial Chemotherapy to officially express their concerns about the design and presumptive results. In addition, hydroxychloroquine can prolong the QT interval (a heart rhythm measure) and lead to fatal cardiac arrhythmia. When patients are given this in combination with azithromycin, there is a high risk of them developing serious changes in their heart rhythms.  

Even though the Food and Drug Administration (FDA) revoked their emergency-use authorization of hydroxychloroquine on June 15, the lupus and arthritis communities have not felt the effects of these shortages lightly. Thankfully, the FDA’s safety warning helped decrease the number of corona-related hydroxychloroquine fills across the US. During the past month, I’ve been able to get my medication without waiting too long, as have others with lupus. But, hydroxychloroquine is not the only medication that has been subject to shortages. Certain medications, such as sedatives like midazolam and propofol, are in greater demand because they are essential for patients on ventilators. The increased need is coupled with reduced production given measures taken to slow the spread of the virus worldwide. Compounding supply limitations across the global market, the United States (U.S.) also has significantly fewer generic drugs approved by the FDA than other countries. This not only exacerbates reduced drug availability, it also drives up cost. The Oregon Health and Science University and Mayo Clinic advocate for efficient authorization of generic drugs from outside the U.S. and a funding increase for nonprofit generic drug manufacturing to fix this problem during the current pandemic. These obstacles demonstrate that the scope of the COVID-19 public health crisis and its impacts on individuals, families, and communities go beyond those directly infected by the virus. Sharing the breadth of our experiences and perspectives raises awareness and helps each of us consider informed solutions.

These obstacles demonstrate that the scope of the COVID-19 public health crisis and its impacts on individuals, families, and communities go beyond those directly infected by the virus.

“ Weekly prescriptions from February 16 to April 25, 2020, were compared with those from February 17 to April 27, 2019. Each date on the x-axis refers to the last day of the week. EUA indicates Emergency Use Authorization; FDA, Food and Drug Administration; and WHO, World Health Organization.”

– From Vaduganathan M, van Meijgaard J, Mehra MR, Joseph J, O’Donnell CJ, Warraich HJ. Prescription Fill Patterns for Commonly Used Drugs During the COVID-19 Pandemic in the United States. JAMA. 2020;323(24):2524–2526. doi:10.1001/jama.2020.9184

COVID-19 Testing Overview

While not foolproof, testing is an important tool to help each country, state, and region safely re-open. The data shows us that countries most successful at keeping down the numbers of COVID-19 infections and deaths have applied testing, contact tracing, and robust preventive practices. Together, these measures can help guide us to return, step by step, toward some normalcy in our economic and social lives. The use of testing coupled with key preventive approaches can also help avoid a second surge of millions of additional COVID-19 cases and 100,000s of deaths.

While there are new approaches coming soon, viral testing is generally performed via nasal swab. The sample is sent to the laboratory where a polymerase chain reaction through what’s called (PCR) test is performed to detect genetic material of the virus itself. Contact tracing involves a process to notify those who have been in contact with someone who tested positive for the COVID-19 virus. Contact tracing can also be applied for those who have been exposed to someone who has typical COVID-19 symptoms, but doesn’t get tested and, therefore, carries a presumed COVID-19 diagnosis. Antibody testing (also called serologic testing) is a blood test that checks whether someone has developed immunity to (protection from) COVID-19 at least temporarily. While the antibodies may not be present forever, or the COVID-19 virus might mutate (change) over time, there is scientific evidence suggesting that characteristics of the virus allow for antibodies, if they develop, to help fend off reinfection for a period of time — possibly up to 1 to 3 years. Since COVID-19 is newly discovered and hasn’t been infecting people for very long, more research will emerge as the virus is further studied and better understood.

The amount of testing being conducted varies from country to country, and from state to state. This impacts steps taken in the opening of regions across the globe. Interestingly, there is a form of testing that is talked about less often but may also be applied to guide recovery: Fecal Testing.

Not at Risk; Or So Luiz Thought

My Covid Story:

My name is Luiz. I am 38 years old, young, healthy, physical therapist and Pilates instructor. Because of my profession, I make exercises every day. And because I was not high-risk patient, I was thinking the COVID-19 for me could be like a ‘big’ flu. IT WASN’T! The COVID-19 started with a sore throat, muscles pain and fever like a common flu. I took medicine against fever and it is gone. But the fever came back every day stronger until the medicine didn’t make more effect and the fever stayed continuously between 38-40°C [100.4-104°F].

After 9 days with symptoms, I went to the doctor and I tested positive for COVID-19. In the total it was 12 consecutive days of fever. I also had diarrhea, a lot of vomit, smell and taste lost, nose burning, abdominal pain, muscles pain, heavy eyes, headache, cough and difficulty breathing. I had shortness breath but because my oxygen saturation was 98%, I didn’t need oxygen mask… After 14 days with [treatment from my doctor including LOTS of fluids], the disease, the fever was going out and the symptoms started to decrease. Now I am ok; but I would like to advice you stay home, wash your hands and face all the time, use mask and gloves and hear all the recommendations from healthcare workers. They want to help you!

Swab Testing

Using a long swab that is mildly uncomfortable when placed through your nasal passages, the clinician (e.g. nurse, doctor, or physician assistant) performing the test (wearing protective equipment or PPE) will twist the swab for 10 to 15 seconds (roughly 5 times) in order to get an adequate sample for the lab to look for the COVID-19 virus under the microscope.

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Spread Of COVID-19

COVID-19 is a zoonotic, which means that it can be passed from animal to humans. Although not confirmed, there is strong suspicion that a person contracted it at a “wet” market where perishable items are for sale like fresh meats, poultry, fish, and produce. Rapid spread between people happens in the form of respiratory droplets from sneezing, coughing, or speaking. These invisible droplets land in the air, on surfaces, or on another person. When droplets land on the other person’s mouth, nose or eyes, or they touch a surface where droplets have landed and then touch their face, that next person (or people) can easily catch COVID-19. That’s why spreading is enhanced by proximity — closeness — between people and why masks can protect transmission from one person to the next.

Also contributing to how readily COVID-19 can be spread is that it lives on surfaces for a long time. That is one of several reasons that COVID-19 has been harder to control and contain than other similar viruses. And another reason why washing hands often and well is critical.
Another key reason is that the clinical course – that is, how sick people get when they contract the virus – varies considerably, including that individuals can carry, and therefore spread, the virus without even knowing that they are infected. In other words, they might have no symptoms.

*Photo courtesy of Scientific American

COVID-19 spreads rapidly from person to person because of the Ro number or R-naught. Ro reflects the number of people that one individual can infect through contact. If the Ro for a virus is less than 1.0 (as it was for MERS), spreading can stop on its own. The Ro for COVID-19 is thought to be between 2 and 3. Meaning, for each individual carrying COVID-19, s/he can infect 2 or 3 of their contacts. That’s why the virus spreads rapidly or, as many experts describe, exponentially: 1-> 2-> 4-> 8-> 16-> 32-> 64-> 128 and so on.

COVID-19 Symptoms & Course

Roughly 81% of people infected with COVID-19 will experience symptoms considered to be mild to moderate that fully resolve at home. With that said, you may feel truly awful during this time which generally lasts up to 14 days with fluctuating symptoms. Many describe an overwhelming feeling of being rundown, whole body aches and pains, gastrointestinal symptoms like diarrhea or nausea, and fevers that can go up and down, but tend to climb quite high. Others say they feel “beat up” with “weird” symptoms that may include loss of taste and smell and lack of appetite. Some additional COVID-19 symptoms include headache, cough and sore throat. It’s important to note that while fever is considered a hallmark of the virus, it is not present in everyone infected. 

Cough, too, happens in most (roughly 2 out of 3) but not all people with COVID-19. Shortness of breath is often an indicator that the condition is progressing from mild or moderate to severe; you should be seen and tested.

Once infected, the riskiest time tends to be roughly one week after the start of symptoms – more specifically, between days 5 and 8 after getting sick. At that point, shortness of breath can set in and rapidly worsen. If you are gasping for air, coughing up blood, or experiencing chest pain, you must seek medical care emergently.
Fever and/ or chills
67% (range 59%-82%)
Shortness of Breath
Muscle aches and pains
15% (11%-35%)
Loss of smell and/or taste; loss of appetite
70%; 40%-84%
Stomach symptoms like diarrhea, nausea, vomiting


Interestingly, symptoms tend to cluster. For example, fatigue and loss of smell often go hand in hand, and that combination can herald a milder illness. Similarly, headache, stomach symptoms, and confusion are frequently seen grouped together in older, frailer patients or those who have comorbid risk factors like diabetes. With that said, nothing about COVID-19 is yet fully predictable because there is so much left to learn. The more data and info that we gather, from testing, tracing, and tracking, the more we understand and can help protect everyone.

COVID-19 Risks

About 14% of people who contract COVID-19 develop serious symptoms that require hospitalization and for the remaining 5%, COVID-19 becomes life threatening. We (i.e. the medical community) are still learning much about the symptoms and risks for COVID-19 and its complications that can include severe shortness of breath, heart inflammation, and the potential need for a respiratory machine (called mechanical ventilator) to support breathing.

There does appear to be greater risk to catch the virus and to develop complications if you:

Lingering Syndromes

While COVID-19 symptoms typically last up to 14 days, there are post-viral syndromes that can continue for weeks or even months, particularly for those who have experienced a prolonged course or required hospitalization. Some individuals describe a sensation of pins and needles, ringing in their ears (called tinnitus), lingering breathlessness, dizziness, joint pain and swelling (especially of one’s hands), confusion, and emotional lability. If you’ve “recovered” from COVID-19 (meaning that you’re past the most acute phase and you’ve even now tested negative for the virus), but have persistent symptoms, you are not “crazy” and you are definitely not alone. The data suggests that roughly 5% of those recovering from COVID-19 experience these ongoing symptoms that can ebb and flow for a prolonged period. Loss of taste or smell, emerging as hallmark symptoms of COVID-19, tend to last for 2 to 4 weeks, for example. But, as some patients share, there are even stranger symptoms that can appear well past the infectious stage:

For example, Jonny never knew that he had COVID-19 until unusual bruises appeared on his toes.

Known now as COVID-toes, this happens from inflammation of the small blood vessels in the skin, called chilblains or pernio. Jonny says he feels no pain but has had some mild itching. Because this unexpected finding is fairly common — in conjunction with other COVID symptoms, as part of a post-viral syndrome, or the one and only manifestation of the virus – an international registry has been set up by a dermatologist at Massachusetts General Hospital in Boston. To date, patients from 21 countries have reported COVID-toes specifically. Dr. Esther Freeman reports that there are many other skin manifestations being reported including hives and measle-like rashes.

*Most data to date have suggested that males are at higher risk for complications from COVID-19 than females; however, recent data from Massachusetts specifically suggests the opposite in that state. More needs to be understood before drawing definitive conclusions either way.