​For more information on COVID-19-Hotline, please visit: ​https://hospitals.aku.edu/nairobi/ForPatientAndVisitors/Pages/COVID-19-Hotline.aspx​​​

FREQUENTLY ASKED QUESTIONS ON COVID-19 (​Coronavirus)

By Prof Rodney Adam, Infectious Disease Specialist and the Chair of Infection Control Taskforce at Aga Khan University Hospital, Nairobi

 

The name and origin of the virus

The name of the virus has rapidly evolved since the first cases in early December 2019 and the recognition that it was a new virus in late December. RNA viruses have been traditionally named after their location of discovery, so the initial designation was Wuhan coronavirus. However, no one wants it named after their place, so the agreed naming of the disease is COVID-19 (COronavirus VIrus Disease-2019) and the virus is coronavirus SARS-CoV-2. The sequence of the virus was released in January and made it clear that this virus is from a bat and related to SARS and MERS, but more closely to SARS; thus, SARS is part of the name. The other bat coronaviruses came to humans via another mammal (civet for SARS and camel for MERS) and that is also suspected for the new virus. The sequence also means that the conspiracy hypothesis about this being a lab-adapted virus are false. It also means that fish or snakes cannot be the intermediate hosts.

 

ABOUT THE COVID-19 ILLNESS

What are the symptoms of COVID-19?

The two main symptoms of COVID-19 are fever and cough. The initial case definition also included shortness of breath, but that is true only for those who are more seriously ill. Runny nose and sore throat are very uncommon, so their presence suggests a different virus. Seek medical attention if you have these symptoms or have travelled to abroad or have been in contact with someone who travelled abroad in the last 14 days or if you have had contact with someone diagnosed with or suspected to have COVID-19. 

What temperature is normal? 

For most people, their temperature ranges between 36 and 37 depending on the time of day and rarely someone's normal temperature may be up to 37.2 or 37.4. With COVID-19 infection, high temperatures, greater than 39 are common but even temperatures of 37.8 can be significant.

​How do I know that I have shortness of breath?

First, shortness of breath does not mean that it's difficult to breathe because of a stuffy nose. It means that when you are breathing normally through your mouth, the activities that didn't bother you now make you feel like you don't have sufficient breath. For example, could you previously walk up a flight of steps and now you are short of breath after only a few steps?

If I have symptoms should I walk into hospital or call first?

No, unless you are sick enough that you might need to be hospitalized. If you do need to be seen, let them know ahead of time. Some hospitals, including Aga Khan will have a special place for evaluation that allows other patients and staff to be kept safe and calling ahead of time helps them accomplish that.

I've seen somewhere that 4 out of 5 spread COVID-19 when they don't have symptoms. Is this factual?

That looks like one of the many myths.

It is worth noting that the first “documentation" of asymptomatic transmission in Germany turned out to be wrong and that patient was symptomatic.

In China, the great majority of transmission was from symptomatic patients. That makes sense in that they are coughing it up and have high viral quantities. Thus, although asymptomatic transmission occurs, it is not a major driver in the epidemic.

I have a cough, should I be tested?

If mild, just stay home and wait until recovered for 3 days before going back to work.

How does SARS CoV-2 (COVID-19) spread?

SARS CoV-2 spreads through droplets which are released when people sneeze or cough. These droplets can only travel up to one meter and cause infection when they contact the mucous membranes of the mouth, nose or eyes. The infection may also spread from contaminated surfaces, but plays a lesser role.

How long is the incubation period for COVID-19?

Incubation period is the time between catching the virus and when the symptoms of the disease start appearing. The average is about five days and ranges from two to 12 days in most cases.

How do I know if I have COVID-19 and not regular cold or flu?

The only way to know if you suffer from COVID-19 is through a special lab test called PCR. The PCR test is currently available through the Ministry of Health. We are also carrying the test at AKUH,N in collaboration with the government. However COVID-19, being a lower respiratory illness does not typically have runny nose or sore throat.

 

COVID-19 TESTING

Who should be tested for coronavirus?

The highest priority people for testing include patients with severe symptoms that may be severe COVID-19, especially for older people or those with heart, kidney and lung disease. The major symptoms include fever and deep cough. Other people include those with exposure to COVID-19 and health care workers. In each case, testing should be done after symptoms develop.

 

I travelled back into the country in the last one month, do I need to be tested for Coronavirus now?

Only if you have symptoms. Even then, there is no medical reason if you are mildly ill.

My children are coming for holidays, should they be tested?

Testing should be done after symptoms develop. In addition, COVID-19 is commonly mild in children so there is no medical reason why most should be tested.​

Should I take a test if I am on self-quarantine?

Only if symptomatic. The test is usually negative when people are asymptomatic and incubating the infection, so wait until symptoms develop.

I have a cough, should I be tested?

If mild, just stay home and wait until recovered for 3 days before going back to work.

 

Quarantine and Isolation

What is physical/Social distancing?

The concept of social distancing has come from observations that in preceding outbreaks, such as the 1918 influenza pandemic, cities that limited large gatherings had fewer cases. Since COVID-19 spreads in a manner similar to that of influenza, the same strategy might work. It is because the virus is spread primarily by respiratory droplets that are produced when coughing. These droplets quickly drop to the ground so that normally a one meter distance is sufficient to protect yourself.

Which activities should physical distancing apply to?

This typically refers to public settings, especially in closed spaces. The risk should be minimal when outside and walking. Within households, physical distancing is appropriate when one person is infected and trying to prevent transmission within the household. That is notably hard to do but should still be done when there are elderly people or those with pre-existing conditions such as heart disease, lung disease and kidney disease.

How far should I be from someone?

It is recommended that you are 1 metre apart.

What is self-quarantine? 

Normally that means separating yourself from others when you are having no symptoms, but have been exposed and are at risk. Right now, that is required by the government for 14 days after travel.

What practical steps should I take when on self-quarantine at home?

It is boring and you may get tired of television, so start a new book you have been waiting to read. Otherwise, watch for symptoms and if mild, continue away from others until 3 days after recovery. If you are more severely ill, come to the hospital but let the people in Accident and Emergency know you are coming so that necessary precautions are taken to protect others. Also wear a mask.

What is isolation?

Isolation refers to separating yourself from others when you have symptoms that may be due to COVID-19. This may be done at home when the symptoms are mild or at a health facility when the symptoms are severe.

​Personal prevention and treatment

How can I reduce the risk of getting coronavirus from infected humans?

It is likely that the transmission of coronavirus is similar to that of other respiratory viruses such as influenza. That means that the infection occurs from contact with respiratory secretions of someone who is infected. That can be from directly touching the infected person or from being coughed on. Then, the droplets from the person coughing land on you and establish infection. That means that the most important thing you can do is proper hand hygiene, either washing with soap and water or using an alcohol-based hand sanitizer when you have contact with someone who might have a respiratory illness. It is very unlikely that walking around with a mask (as many are doing elsewhere) will make any difference.

Will a normal flu shot help me avoid the worst symptoms?

The flu shot is for preventing infection from influenza and will not prevent coronavirus infection. However, the illness caused by influenza is similar to the coronavirus infection, so if influenza is prevented, there is less chance of suspecting that you have the coronavirus when in fact, it is influenza.

If I catch the virus what is the standard treatment?

So far, there is not a specific medication that treats the virus (as is true for most viruses). However, with good supportive care nearly everyone can survive. That includes oxygen when needed and even a ventilator for those who are really sick.

I have a bad cough and would normally not see a doctor for it—but with this going on, should I go?

If you are not sick enough to require medical attention, there are two advantages to not going in. First, by staying at home, you will spread the virus to fewer people. Second, it is common that doctors give antibiotics even when they won't help, such as for a viral respiratory infection, so you can save yourself from an unnecessary antibiotic. You should only be alarmed if you exhibit the two main symptoms of cough and fever and have been in contact with someone suspected to have COVID-19 or who has travelled abroad for the last 14 days. (Even cough or fever within 14 days of contacting someone with COVID-19 infection may warrant not self-isolation).

Given that the virus originated from animals should I stay away from meat and animal products? Should I worry how I handle animals?

The 2019-nCoV coronavirus is originally a bat virus but was likely initially transmitted to humans via another mammal. However, transmission now is human to human, so animal contact will not make any difference for this virus. However, do note that there are other infections that can be acquired from animals. For example, there is anthrax from dead cattle who are then butchered. There is brucellosis from goats, sheep and other animals, and Salmonella from chickens and eggs. And don't forget dogs; if they haven't been immunized, they can transmit rabies when they bite. That means we must be careful with animals, but it will not be a factor to getting the coronavirus.

General Questions

How does SARS CoV-2 (COVID-19) spread?

SARS CoV-2 spreads through droplets which are released when people sneeze or cough. These droplets can only travel up to one meter and cause infection when they contact the mucous membranes of the mouth, nose or eyes. The infection may also spread from contaminated surfaces, but plays a lesser role.

Why doesn't a mask work for protection?

The virus leaves the other person in the form of respiratory droplets. They cause infection when they land on mucous membranes (mouth, eyes).

They may land directly there or they may do it indirectly. That could be from those droplets getting on the infected person's hand; he then touches you and you touch your mouth or eyes. Or he may cough on you and then you rub your eyes. Or it may be droplets that land on a counter next to you and then you touch it and then your face. The virus doesn't survive a long time on an inanimate object.

The above means that the only thing the mask prevents is the virus coming in a droplet and landing on your mouth. It may make a bit of a difference but there are so many exposures it doesn't prevent, that overall it isn't worth using for routine purposes. For people taking care of COVID-19 patients, they wear a surgical mask and if doing high risk procedures, they wear an N95.

Can COVID-19 be treated with antibiotics?

No. COVID-19 is caused by a virus and antibiotics only work on bacterial infections.

Is there any specific treatment for COVID-19?

There is no treatment for COVID-19 yet. The disease is treated symptomatically, which means the symptoms (such as fever and cough) are treated rather than the disease itself.

How serious is COVID-19?

COVID-19 is usually a mild to moderate respiratory (lung) infection. In the elderly or those who are immunocompromised or have other chronic diseases, it may lead to a severe pneumonia and can be fatal. Children and young adults rarely develop serious disease.

What are the mortality rates?

So far, the mortality rates in China have been 2-3% but the true number may be higher or lower and will certainly depend on the level of care provided by the hospital. The mortality was higher in Wuhan than other places, possibly because the health system there was overwhelmed. Most of the people hospitalized in China have been over 40 (including none under 15) and half have had other medical illnesses such as diabetes, heart disease or stroke, making them more vulnerable. So far, 1.5% of those outside China have died. In fact, within China, the mortality has dropped to 0.7%.

What is the risk for health care workers?

There is definitely a risk but the magnitude of the risk is lower than initially thought. In China, the majority of HCW cases were actually acquired within their own households.

How are COVID-19 cases being transmitted in countries with many cases?

In China, about 80% of cases have been acquired through household contact and nearly all the others by close contacts of other types.

 

Aga Khan University Hospital Nairobi preparation

What is Aga Khan University hospital doing for preparation?

If patients come with a potentially contagious illness they will be screened on entry to the facility and when necessary, appropriate precautions will be used.

What level of care will COVID-19 patients receive?

Patients with COVID-19 will receive the level of care that is required for their illness, including intensive care treatment and advanced medical treatment when needed, such as a breathing mechanical ventilation or kidney dialysis.

Where should a patient with suspected COVID-19 go?

All patients who have suspected Coronavirus symptoms and or have a travel history should call our hotline on +254 709 931700 before coming to hospital for guidance.

​For regular updates, check our social media channels; Both Facebook and Twitter @AKUHNairobi​