This is a rapidly changing situation. New information will be added to this article as it comes in. All information compiled from the CDC website and press releases.
COVID-19 is a new disease, and we’re all still learning how it spreads, the severity of the illness it causes, and to what extent it may spread in the United States.
COVID-19 Now a Pandemic, A pandemic is a global outbreak of disease. Pandemics happen when a new virus emerges to infect people and can spread between people sustainably. Because there is little to no pre-existing immunity against the new virus, it spreads worldwide.
The virus that causes COVID-19 is infecting people and spreading easily from person-to-person. Cases have been detected in most countries worldwide, and community spread is being detected in a growing number of countries. On March 11, the COVID-19 outbreak was characterized as a pandemic.
This is the first pandemic known to be caused by the emergence of a new coronavirus. In the past century, there have been four pandemics caused by the rise of novel influenza viruses. As a result, most research and guidance around pandemics is specific to influenza, but the same premises can be applied to the current COVID-19 pandemic. Pandemics of respiratory disease follow a particular progression outlined in a “Pandemic Intervals Framework.” Pandemics begin with an investigation phase, followed by recognition, initiation, and acceleration phases. The peak of illnesses occurs at the end of the acceleration phase, which is followed by a deceleration phase, during which there is a decrease in illnesses. Different countries can be in different stages of the pandemic at any point in time, and different parts of the same country can also be in various stages of a pandemic.
Different parts of the country are seeing different levels of COVID-19 activity. The United States nationally is currently in the initiation phases, but states, where community spread is occurring, are in the acceleration phase. The duration and severity of each phase can vary depending on the characteristics of the virus and the public health response.
The risk depends on characteristics of the virus, including how well it spreads between people; the severity of resulting illness; and the medical or other measures available to control the impact of the virus (for example, vaccines or medications that can treat the illness) and the relative success of these. In the absence of vaccine or treatment medications, nonpharmaceutical interventions become an essential response strategy. These are community interventions that can reduce the impact of the disease.
The risk from COVID-19 to Americans can be broken down into the risk of exposure versus the risk of serious illness and death.
The immediate risk of being exposed to this virus is still low for most Americans, but as the outbreak expands, that risk will increase. Cases of COVID-19 and instances of community spread are being reported in a growing number of states. People in places where ongoing community spread of the virus that causes COVID-19 has been reported are at elevated risk of exposure, with the level of risk dependent on the location. Healthcare workers caring for patients with COVID-19 are at elevated risk of exposure. Close contacts of persons with COVID-19 also are at elevated risk of exposure. Travelers returning from affected international locations where community spread is occurring also are at elevated risk of exposure, with the level of risk dependent on where they traveled.
More cases of COVID-19 are likely to be identified in the United States in the coming days, including more instances of community spread. The CDC expects that widespread transmission of COVID-19 in the United States will occur. In the coming months, most of the U.S. population will be exposed to this virus.
Widespread transmission of COVID-19 could translate into large numbers of people needing medical care at the same time. Schools, childcare centers, and workplaces may experience more absenteeism. Mass gatherings may be sparsely attended or postponed. Public health and healthcare systems may become overloaded, with elevated rates of hospitalizations and deaths. Other critical infrastructure, such as law enforcement, emergency medical services, and sectors of the transportation industry, may also be affected. Healthcare providers and hospitals may be overwhelmed. At this time, there is no vaccine to protect against COVID-19, and no medications approved to treat it. Nonpharmaceutical interventions will be the most important response strategy to try to delay the spread of the virus and reduce the impact of disease.
Global efforts at this time are focused concurrently on lessening the spread and impact of this virus. The federal government is working closely with state, local, tribal, and territorial partners, as well as public health partners, to respond to this public health threat.
CDC is implementing its pandemic preparedness and response plans, working on multiple fronts, including providing specific guidance on measures to prepare communities to respond to local spread of the virus that causes COVID-19. There is an abundance of pandemic guidance developed in anticipation of an influenza pandemic that is being adapted for a potential COVID-19 pandemic.
How it spreads, Person-to-person spread: The virus is thought to spread mainly from person-to-person. Between people who are in close contact with one another (within about six feet). 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.
Can someone spread the virus without being sick? People are thought to be most contagious when they are most symptomatic (the sickest). Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the primary way the virus spreads.
Spread from contact with contaminated surfaces or objects. It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.
How easily a virus spreads from person-to-person can vary. Some viruses are highly contagious (spread easily), like measles, while other viruses do not spread as easily. Another factor is whether the spread is sustained, spreading continually without stopping.
The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in some 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.
Different parts of the U.S. are seeing different levels of COVID-19 activity. The United States nationally is currently in the initiation phases, but states, where community spread is occurring, are in the acceleration phase. The duration and severity of each phase can vary depending on the characteristics of the virus and the public health response.
CDC and state and local public health laboratories are testing for the virus that causes COVID-19. More and more states are reporting cases of COVID-19 to CDC.
U.S. COVID-19 cases include Imported cases in travelers. Cases among close contacts of a known case. Community-acquired cases where the source of the infection is unknown. Three U.S. states are experiencing sustained community spread.
There is currently no vaccine to prevent coronavirus disease (COVID-19). The best way to prevent illness is to avoid being exposed to this virus. The virus is thought to spread mainly from person-to-person.
To protect yourself, you need to clean your hands often. Wash your hands often with soap and water for at least 20 seconds, especially after you have been in a public place, or after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry. Avoid touching your eyes, nose, and mouth with unwashed hands.
Avoid close contact with people who are sick. Put distance between yourself and other people if COVID-19 is spreading in your community. This is especially important for people who are at higher risk of getting very sick.
Who is at higher risk? Early information out of China, where COVID-19 first started, shows that some people are at higher risk of getting very sick from this illness. This includes older adults and people who have serious chronic medical conditions like heart disease, diabetes, and lung disease.
If you are at higher risk for serious illness from COVID-19 because of your age or because you have a serious long-term health problem, it is extra important for you to take action to reduce your risk of getting sick with the disease. Stock up on supplies. Take everyday precautions to keep space between yourself and others. When you go out in public, keep away from others who are sick, limit close contact, and wash your hands often. Avoid crowds as much as possible. During a COVID-19 outbreak in your community, stay home as much as possible to further reduce your risk of being exposed. Contact your healthcare provider to ask about obtaining extra necessary medications to have on hand in case there is an outbreak of COVID-19 in your community, and you need to stay home for a prolonged period of time. If you cannot get extra medications, consider using mail-order for medications. Be sure you have over-the-counter medicines and medical supplies (tissues, etc.) to treat fever and other symptoms. Most people will be able to recover from COVID-19 at home. Have enough household items and groceries on hand so that you will be prepared to stay at home for a period of time.
If a COVID-19 outbreak happens in your community, it could last for a long time. (An outbreak is when a large number of people suddenly get sick.) Depending on how severe the outbreak is, public health officials may recommend community actions to reduce people’s risk of being exposed to COVID-19. These actions can slow the spread and reduce the impact of disease.
Have a plan for if you get sick, Consult with your health care provider for more information about monitoring your health for symptoms suggestive of COVID-19. Stay in touch with others by phone or email. You may need to ask for help from friends, family, neighbors, community health workers, etc. if you become sick. Determine who can care for you if your caregiver gets sick.
Watch for symptoms and emergency warning signs: Pay attention for potential COVID-19 symptoms including, fever, cough, and shortness of breath. If you feel like you are developing symptoms, call your doctor. If you develop emergency warning signs for COVID-19, get medical attention immediately. In adults, emergency warning signs* Difficulty breathing or shortness of breath, Persistent pain or pressure in the chest, New confusion or inability to arouse, Bluish lips or face. *This list is not all-inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.
What to do if you get sick? First, know if you should be tested or worried about COVID-19. If you develop symptoms such as fever, cough, and/or difficulty breathing, and have been in close contact with a person known to have COVID-19 or have recently traveled from an area with the ongoing spread of COVID-19, stay home and call your healthcare provider. If you have severe symptoms, such as persistent pain or pressure in the chest, new confusion or inability to arouse, or bluish lips or face, contact your healthcare, and seek care immediately. Your doctor will determine if you have signs and symptoms of COVID-19 and whether you should be tested.
Community support for older adults. Community preparedness planning for COVID-19 should include older adults and people with disabilities, and the organizations that support them in their communities, to ensure their needs are taken into consideration. Many of these individuals live in the community, and many depend on services and supports provided in their homes or in the community to maintain their health and independence. Know what medications your loved one is taking and see if you can help them have extra on hand. Monitor food and other medical supplies (oxygen, incontinence, dialysis, wound care) needed and create a back-up plan. Stock up on non-perishable food to have on hand in your home to minimize trips to stores.
Take steps to protect others by staying home if you’re sick, except to get medical care. Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow. Throw used tissues in the trash. Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol.
If you are sick: You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then you should do your best to cover your coughs and sneezes, and people who are caring for you should wear a facemask if they enter your room. If you are NOT sick: You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply, and they should be saved for caregivers.
Clean AND disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks. If surfaces are dirty, clean them: Use detergent or soap and water prior to disinfection.
While this virus seems to have emerged from an animal source, it is now spreading from person-to-person in China. There is no reason to think that any animals, including pets in the United States, might be a source of infection with this new coronavirus. To date, CDC has not received any reports of pets or other animals becoming sick with COVID-19. At this time, there is no evidence that companion animals, including pets, can spread COVID-19. However, since animals can spread other diseases to people, it’s always a good idea to wash your hands after being around animals.
You should restrict contact with pets and other animals while you are sick with COVID-19, just like you would around other people. Although there have not been reports of pets or other animals becoming sick with COVID-19, it is still recommended that people infected with COVID-19 limit contact with animals until more information is known about the virus. When possible, have another member of your household care for your animals while you are sick. If you are sick with COVID-19, avoid contact with your pet, including petting, snuggling, being kissed or licked, and sharing food. If you must care for your pet or be around animals while you are sick, wash your hands before and after you interact with pets and wear a facemask.
Create a household plan of action. Talk with the people who need to be included in your plan. Meet with household members, other relatives, and friends to discuss what to do if a COVID-19 outbreak occurs in your community and what the needs of each person will be. Plan ways to care for those who might be at higher risk of severe complications. Get to know your neighbors. Talk with your neighbors about emergency planning. If your neighborhood has a website or social media page, consider joining it to maintain access to neighbors, information, and resources. Identify aid organizations in your community. Create a list of local organizations that you and your household can contact in the event you need access to information, health care services, support, and resources. Consider including organizations that provide mental health or counseling services, food, and other supplies. Create an emergency contact list. Ensure your household has a current list of emergency contacts for family, friends, neighbors, carpool drivers, health care providers, teachers, employers, the local public health department, and other community resources.
Choose a room in your home that can be used to separate sick household members from those who are healthy. Identify a separate bathroom for the sick person to use if possible—plan to clean these rooms, as needed when someone is sick.
Be prepared if your child’s school or childcare facility is temporarily dismissed. Learn about the emergency operations plan at your child’s school or childcare facility. During a COVID-19 outbreak in your community, local public health officials may recommend temporary school dismissals to help slow the spread of illness. School authorities also may decide to dismiss a school if too many students or staff are absent. Understand the plan for continuing education and social services (such as student meal programs) during school dismissals. If your child attends a college or university, encourage them to learn about the school’s plan for a COVID-19 outbreak.
Plan for potential changes at your workplace. Learn about your employer’s emergency operations plan. Discuss sick-leave policies and telework options for workers who are sick or who need to stay home to care for ill household members.
During an outbreak in your community, protect yourself and others by staying home from work, school, and all activities when you are sick with COVID-19 symptoms, which may include fever, cough, and difficulty breathing—keeping away from others who are sick, limiting close contact with others as much as possible (about six feet).
Put your household plan into action. Stay informed about the local COVID-19 situation. Get up-to-date information about local COVID-19 activity from public health officials. Be aware of temporary school dismissals in your area, as this may affect your household’s daily routine. Stay in touch with others by phone or email. If you live alone and become sick during a COVID-19 outbreak, you may need help. If you have a chronic medical condition and live alone, ask family, friends, and health care providers to check on you during an outbreak. Stay in touch with family and friends with chronic medical conditions. Take care of the emotional health of your household members. Outbreaks can be stressful for adults and children. Children respond differently to stressful situations than adults. Talk with your children about the outbreak, try to stay calm, and reassure them that they are safe.
Inform your workplace if you need to change your regular work schedule. Notify your workplace as soon as possible if your schedule changes. Ask to work from home or take leave if you or someone in your household gets sick with COVID-19 symptoms, or if your child’s school is dismissed temporarily.
Take the following steps to help protect your children during an outbreak. If your child/children become sick with COVID-19, notify their childcare facility or school. Talk with teachers about classroom assignments and activities they can do from home to keep up with their schoolwork. Keep track of school dismissals in your community. Read or watch local media sources that report school dismissals. If schools are dismissed temporarily, use alternative childcare arrangements, if needed. Discourage children and teens from gathering in other public places while school is dismissed to help slow the spread of COVID-19 in the community.
ADDED MARCH 16, 2020:
The CDC has asked stated that large events and mass gatherings can contribute to the spread of COVID-19 in the United States via travelers who attend these events and introduce the virus to new communities. Examples of large events and mass gatherings include conferences, festivals, parades, concerts, sporting events, weddings, and other types of assemblies. These events can be planned not only by organizations and communities but also by individuals.
Therefore, CDC, recommends that for the next eight weeks, organizers (whether groups or individuals) cancel or postpone in-person events that consist of 50 people or more throughout the United States.
Events of any size should only be continued if they can be carried out with adherence to guidelines for protecting vulnerable populations, hand hygiene, and social distancing. When feasible, organizers could modify events to be virtual. This recommendation does not apply to the day to day operation of organizations such as schools, institutes of higher learning, or businesses. This recommendation is made in an attempt to reduce introduction of the virus into new communities and to slow the spread of infection in communities already affected by the virus. This recommendation is not intended to supersede the advice of local public health officials.
For more information about coronavirus in Nebraska, check the Nebraska Department of Health and Human Services website HERE or you can call the DHHS COVID-19 Information Line, (402) 552-6645, 8 AM – 8 PM CST – seven days a week.
For information about coronavirus in Kansas, check the Kansas Department of Health and Environment HERE.
For more information about coronavirus in Missouri, the public can call the Missouri 24-hour coronavirus hotline by dialing 877-435-8411 or visit the Missouri Department of Health and Senior Services’ website HERE.