COVID-19

What is COVID-19?

COVID-19 is an infectious disease caused by a virus (SARS CoV-2). COVID-19 is short for "coronavirus disease 2019", because the disease was first identified in December 2019.

COVID-19 was first discovered in Wuhan, China, and rapidly spread throughout the world during 2020, causing the COVID-19 pandemic. COVID can cause illness ranging from mild symptoms (or no symptoms), to severe disease requiring hospital treatment, to death.

What are the symptoms of COVID?

The symptoms of COVID-19 can include:

• No symptoms at all (some people can be infected with COVID, and spread it to other people, without having any symptoms of illness).

• A new, continuous cough (coughing a lot for more than an hour, or three or more coughing episodes in 24 hours).

• A high temperature (fever), shivering or chills (rigors).

• Loss of, or change in, sense of smell and taste.

• Breathlessness.

• Feelings of tiredness or exhaustion.

• Headaches.

• Body aches or muscle aches.

• A sore throat.

• Feeling sick or nauseous.

• Diarrhoea.

Many of these symptoms are similar to those of mild viral infections including colds and flu.

In serious cases, COVID can cause:

• Severe breathlessness - for example, feeling very short of breath whilst resting, being too breathless to talk, or becoming very breathless when moving a short distance.

• Chest pain.

• Coughing up blood.

• New or worsening confusion.

• Drowsiness.

How long does it take for COVID symptoms to show?

The average time between being infected with COVID-19 and showing symptoms has been estimated at about 4-6 days, although it has taken from 2-18 days in some cases.

How long does COVID last?

Most people with mild COVID infections feel better within one or two weeks after developing the infection. Much like any other viral infections, it is normal for the cough to take up to three weeks to disappear entirely. People who have been seriously ill - for example, people who needed to stay in hospital or intensive care - are likely to take longer to recover.

Some people have symptoms that last for weeks, months, or years after catching COVID. See the long COVID leaflet for more information.

How long are you contagious with COVID?

Most people will no longer be contagious at five days after developing symptoms of COVID. Some people can be contagious up to 10 days after developing COVID and people who have been seriously ill, or have weak immune systems, may be contagious for even longer. Children and young people tend to be contagious for shorter periods of time.

Most countries have advice or rules about isolation and staying at home, with the aim of reducing the spread of COVID. In the UK, in November 2022, the national guidance was that adults with COVID should:

• Stay at home and avoid contact with other people for five days, counting from the day after a positive COVID test was taken.

• Avoid contact with anyone who would be at high risk of becoming severely unwell with COVID, including people with a weakened immune system, for 10 days.

Children or young people with COVID have been advised to stay at home and avoid contact with other people for three days.

In the USA in November 2022, the Centers for Disease Control and Prevention (CDC) advised that people with COVID-19 should:

• Stay at home and avoid contact with others for five days (counting from the day after a positive COVID test was taken).

• End isolation if their symptoms are improving after five days and have been fever-free for 24 hours.

• Continue to isolate if their symptoms are not improving at five days, until their symptoms are improving and they have been fever-free for 24 hours.

• Isolate for 10 days if they have had moderately severe COVID (causing shortness of breath or difficulty breathing).

• Isolate for at least 10 days, consult a doctor, and consider taking a viral test before ending isolation for people who needed hospital treatment for COVID, or people who have weakened immune systems.

How can you test for COVID-19?

There are two main types of COVID-19 tests. In both cases, these are done using nose or throat swabs to pick up virus particles. The tests are:

• 'Lateral flow' or 'rapid tests'. These can be done at home, by using a small plastic dropper to put a sample of the test solution into a plastic cassette. These give a result within about 15 minutes to 30 minutes depending on the type of test. A positive test is a good indicator of COVID-19 infection. It's possible to have COVID-19 and still get a negative result - one estimate is that about a third of people with symptomatic COVID-19 infection, confirmed via a PCR test, will have a negative lateral flow test.

• PCR tests. These need to be sent to a laboratory, which uses special lab equipment to perform the test. These usually take at least a day to return a result. PCR tests are more sensitive for COVID-19 infection, ie people who have COVID-19 are less likely to get a false negative PCR test.

Neither test can tell the difference between 'live' virus, which is able to infect other people and cause illness, and 'dead' virus, which is harmless; particularly with PCR tests, which may remain positive for several weeks after the infection has resolved and is no longer contagious.

In the UK, only a small number of people are currently eligible to get free lateral flow tests from the government; details can be found on the GOV.UK website (see Further Reading). Lateral flow and PCR tests can be bought, and some countries require proof of testing to enter when travelling.

What causes COVID-19?

COVID-19 is caused by a coronavirus, SARS CoV-2. Other types of coronavirus cause different illnesses, from mild ones such as colds, to more serious conditions such as SARS and MERS.

Since the beginning of the pandemic, new variants of the SARS CoV-2 virus have emerged. These are slightly different versions of the virus which behave in different ways. These have tended to be more contagious (spreading more easily) than the original virus did. There is also some concern that existing vaccines and treatments might be less effective against the variants. However, in some cases, they also seem to be less likely to cause serious illness.

Notable variants of SARS CoV-2 include: the alpha variant; beta variant; delta variant; and omicron variant.

Who is at risk of catching COVID?

Anyone can get COVID-19.

COVID-19 is spread by breathing in virus particles in the air; people who have close contact with lots of other people, particularly in crowded indoor areas with poor ventilation, are more likely to come into contact with the virus. However, anyone can be exposed to COVID-19, especially when rates of infection are high.

Most people have a mild illness that recovers without any medical treatment. However, some people are at higher risk of becoming seriously unwell and dying from COVID-19. Groups of people who have been identified as being at increased risk include:

• People who are have not had vaccinations against COVID.

• People aged over 60, with the risk increasing with age.

• People with type 1 or type 2 diabetes.

• People who are pregnant.

• People from certain ethnic groups; for example, in the UK, in the first six months of the COVID-19 pandemic, infection and death rates from COVID were higher in minority ethnic groups, such as Black and Asian ethnicities, than in White ethnicities.

• People who are overweight or obese.

• People who smoke.

• People with other medical conditions, such as COPD, high blood pressure, and serious mental health conditions.

For most people, getting vaccinated against COVID-19 has made the risk of serious illness and death small. However, some people are at particularly high risk from COVID-19 still, such as people with:

• Down's syndrome.

• Blood cancers (leukaemias and lymphomas).

• Other types of blood conditions (eg myelodysplasia).

• Sickle cell disease.

• Chronic kidney disease (stage 4 or 5).

• Severe liver disease.

• An organ or bone marrow transplant.

• Some types of autoimmune or inflammatory problems, like inflammatory bowel disease or rheumatoid arthritis.

• HIV and AIDS.

• Conditions causing weakened immune systems.

• Medical treatments causing weakened immune systems (like steroid medicines, antibody treatments, or chemotherapy).

• Rare conditions affecting the brain and nerves, like multiple sclerosis, motor neurone disease, Huntington's disease and myasthenia gravis.

• Cerebral palsy.

• Severe or multiple learning disabilities.

How to treat COVID

Most people will make a full recovery with time, and do not need any specific treatments unless they develop signs and symptoms of serious illness. Medicines like paracetamol and ibuprofen can be used to treat symptoms like pain and fever.

In the UK, people who are at very high risk of serious COVID-19 disease may be offered specific antiviral treatments (eg nirmaltrevir/ritonavir (Paxlovid®)) if they have tested positive for COVID-19, to reduce the risk of developing serious disease (see Further Reading).

People who become seriously ill with COVID-19, and are admitted to hospital, may be given:

• Oxygen, if their blood oxygen levels are low.

• Dexamethasone, a type of steroid medicine, if they are given oxygen.

• Breathing support if required - either with specialised masks and machines to aid breathing, or, if this is not working or is unsuitable, with a ventilator to pump air into the lungs. People receiving these will usually need to be in special wards: high-dependency units or intensive care.

• Antiviral treatments, such as remdesivir, nirmatrelvir/ritonavir (Paxlovid®), molnupiravir.

• Monoclonal antibodies- these are used to help treat autoimmune conditions such as rheumatoid arthritis. In this case- they attack the virus' surface to stop it entering the person's cells. Medications such as casirivimab and imdevimab are mostly used.

Other treatments have been promoted for use in COVID-19, such as hydroxychloroquine and ivermectin. The best available evidence shows that these drugs are not effective at treating COVID-19, and may cause harm.

COVID complications

The main cause of death in severe COVID-19 infection is respiratory failure.

Other complications of COVID-19 include:

• Blood clots; people with COVID-19 are at higher risk of developing blood clots in the legs (deep vein thromboses) and in the lungs (pulmonary emboli).

• Lung damage, such as lung fibrosis.

• Heart problems, such as heart failure, inflammation of the heart (myocarditis), and heart attacks.

• Brain and nerve problems, such as strokes, Guillain-Barré syndrome, and infection/inflammation of the brain (encephalitis).

• Prolonged symptoms that last for weeks, months, or years: long COVID.

• In children: a very rare condition causing inflammation throughout the body, called paediatric multisystem inflammatory syndrome.

How to prevent COVID

COVID vaccines may reduce the risk of catching COVID, and the risk of passing it on to other people, but do not fully prevent these from happening. However, they do significantly reduce the risk of developing serious illness or dying from COVID-19.

COVID is spread by close contact with people who have the virus. People with COVID-19 infection release virus particles into the air and on to nearby surfaces when breathing, coughing, or sneezing.

Ways to reduce the risk of catching COVID include:

• Getting vaccinated against COVID-19.

• Meeting other people outside, if possible.

• Ensuring indoor areas are well ventilated when meeting other people inside - eg opening windows and doors to let in fresh air.

• Avoiding crowded places, especially if they are poorly ventilated.

• Wearing a face covering or face mask.

• Washing your hands with soap and water, or hand sanitiser, regularly.

• Avoiding touching your mouth, nose, or eyes without washing your hands first.

• Reducing the spread to others by isolating if you have COVID-19.

• Following any other local public health guidance.