Top Questions

Here are the top questions with answers provided by the Minnesota Department of Health (MDH) and Dr. Craig Bowron, a Twin Cities practicing physician. (Last updated May 22, 2020)
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Symptoms & Testing

Q: When should I seek a coronavirus test?

MDH: Seek testing if you are sick and would normally go in to see a doctor. Otherwise there is no reason to be tested unless you had known contact (for longer than 10 minutes and within 6 feet) with a known COVID-19 case.

Dr. Bowron: First, recognize that the test for active Covid-19 infection (“RT-PCR,” or “PCR”) is different than the test to confirm a prior infection (“serology,” “antibody,” “immunoglobulin”). The CDC has deferred PCR testing strategies to state health departments, and here in Minnesota, the Minnesota Department of Health, health care organizations and hospitals have set an ambitious goal of testing all symptomatic patients. Although testing availability has improved, until it reaches maximum capacity, priority for testing will continue to be given to high-risk people such as hospitalized patients, people living in group homes or nursing homes, those with high-risk medical conditions, those living/working in an outbreak area, etc. Although MDH continues to perform Covid-19 testing, the bulk of it is increasingly being handled by health care organizations and private labs, and MDH is not orchestrating the process. Call your health care provider/organization if you want to be tested.

https://www.health.state.mn.us/diseases/coronavirus/hcp/eval.html

Q: Who conducts COVID-19 testing, and who is currently tested?

MDH: The Minnesota Department of Health Public Health Lab is now conducting testing for COVID-19.

https://www.health.state.mn.us/diseases/coronavirus/hcp/eval.html

CDC recently revised their testing criteria. Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. There are other respiratory diseases circulating in Minnesota, such as flu, so providers will consider things like travel history and other factors when making testing recommendations.

The best place to find information on COVID-19 is the Minnesota Department of Health website:  https://www.health.state.mn.us/index.html

Dr. Bowron: Physicians caring for a patient they believe might require coronavirus testing call the MDH to discuss the patient’s case. If the MDH staff agrees, a sample from both the nose and the mouth are collected by the physician and then sent to the MDH for actual testing. Of course, MDH investigators who identify a “Person Under Investigation” can simply perform the testing themselves.

Q: What is the best way to treat your symptoms?

Dr. Bowron: If you’re sick with Covid, all you can do is stay hydrated and well rested while your immune system rises to the challenge. And well rested doesn’t mean immobile: even limited activity inside your residence can help keep the lungs inflated and muscles strong. You can use over-the-counter medications like you would for the flu or a cold if you want to, but they won’t shorten the illness.

https://www.cdc.gov/coronavirus/2019-ncov/downloads/10Things.pdf

Q: How long can a person with no symptoms carry the virus?

Dr. Bowron: It’s not clear why some people infected with Covid-19 seem to have few if any symptoms, but it appears that the virus follows a similar course: an average of five days after initial exposure, the virus reaches peak levels of infectivity. For most people, that’s when the body’s immune response is beginning to kick in and symptoms first appear. Thereafter, viral levels (and the ability to infect others) steadily fall as the body’s immune system gets the upper hand. According to the CDC, a person is no longer capable of passing the Covid-19 virus when they have improved symptoms, no fever in three days, and seven days have passed since symptoms first began. For those with few symptoms, resolving fever is the only guide.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html#Transmission%20

https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.htm

Q: Has there been new symptoms to be aware of?

Dr. Bowron: Since the COVID-19 outbreak began, the triad of fever, cough and shortness of breath have consistently been the most common presenting symptoms. More recently, the CDC added six other symptoms to that list—chills, repeated shaking with chills, muscle pain, headache, sore throat, and loss of taste or smell. For the most part, these symptoms are nearly identical to what one would experience with the flu or other viral upper respiratory infections, but we’re recognizing that some people can have more atypical features such nausea and diarrhea. Older people just might not seem to be themselves—less interactive, mildly confused, and dizzy. It seems on rare occasion that COVID-19 can make the blood more prone to clotting, leading to strokes, heart attacks. Serious symptoms like chest pain, or sudden weakness—whether COVID-related or not—need serious and prompt attention, so forget about checking your temperature and call 911.

https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

https://khn.org/news/seniors-with-covid-19-show-unusual-symptoms-doctors-say/

https://www.npr.org/sections/health-shots/2020/04/29/847917017/doctors-link-covid-19-to-potentially-deadly-blood-clots-and-strokes

Health Concerns

Q: How long does the virus last on surfaces?

Dr. Bowron: Probably a matter of a few hours, but it depends on the surface. Typically the virus is spread in various-sized respiratory droplets—tiny little snot balls. The mucus in these droplets keep the virus moist and alive. Porous materials like cloth and paper tissue allow air circulation, which dries out the virus and kills it. Non-porous surfaces like stainless steel and plastic do the opposite, allowing the virus extra time to lie in wait.

Q: Can people recover completely?

Dr. Bowron: They can and certainly do. Although those with chronic medical conditions or a more severe coronavirus infection make take longer to fully-recover.

Q: Are there any long-lasting health consequences (especially for those with already compromised immune systems)?

Dr. Bowron: Most people recovering from milder, stay-at-home Covid infections will have generalized symptoms—weakness and easy fatigue, low appetite, lingering cough—that will slowly resolve over days to a couple weeks. People with compromised immune systems or chronic medical conditions are at higher risk of having a more severe bout of Covid and ending up in the hospital. And those who are hospitalized with Covid—particularly if they needed ICU care, or had to be on a ventilator—can have longer recovery issues and perhaps long-term damage. Severe lung infections can some time lead to permanent scarring that causes the lungs to be stiff, leading to chronic breathing problems. The stress of an overwhelming infection can injure other organs such as the heart or kidneys; typically they recover once the infection has passed, but sometimes—particularly for older patients—they never get back to where they were.

Q: If the virus can be transmitted via touching a surface and then touching our face, how is it that the virus could be on food (say coughed or sneezed on by an infected person) and then eaten and not cause the eater to potentially catch the virus?

Dr. Bowron: It’s a good question, and while the scenario it raises is entirely plausible and anatomically logical, according to the CDC, “Currently there is no evidence to support transmission of COVID-19 associated with food.” Yes, food is a surface that infected droplets can land on, like a countertop, door handle, keyboard etc. But as the CDC notes, “In general, because of poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from food products or packaging that are shipped over a period of days or weeks at ambient, refrigerated, or frozen temperatures.” What about take-out food? Assuming the preparer used standard food prep hygiene, it’s the pizza box not the pizza, the sandwich wrapper not the sandwich, etc. that poses the more realistic chance of infection. So transfer the food onto a clean surface or plate, wash your hands, and then bon appetit. That’s a healthy recommendation, even prior to Covid-19’s arrival. https://www.cdc.gov/foodsafety/newsletter/food-safety-and-Coronavirus.html

Q: Is the COVID-19 considered to be an air-born virus?

Dr. Bowron: What we know for sure is that every COVID-19 infection is transmitted via viral-laden respiratory secretions from an actively contagious person. Some of these secretions are indeed airborne, propelled into the air by coughing, sneezing, and perhaps even just talking. If any of these airborne droplets enter the upper airway (via the nose, mouth, and eyes) of a non-immune patient, the virus spreads. This is why masks are protective. But COVID-19 isn’t just airborne. Eventually all airborne droplets will land on a surface, where they might also be joined by secretions from the hands of the infected (beware common surfaces like door handles, keyboards etc.!) If these surface droplets can hitch a ride to the face of a non-immune person, then the infection spreads. This is why hand washing is protective. https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

https://www.cdc.gov/coronavirus/2019-ncov/downloads/2019-ncov-factsheet.pdf

Q: Why does the death rate vary from state to state or country to country?

Dr. Bowron: Death rates are more complicated than they might seem. Death rates can vary because of the quality of health care (both in terms of its availability, its sophistication, and its ability to handle a surge); because of differences in the baseline health of particular populations (the poor and those with underlying health problems begin an infection with less physiologic reserve); or because of logistical challenges of documenting deaths. All of these are particularly true in country-to-country comparisons. Even for countries with sophisticated health care systems, appropriately attributing the cause of death (and therefore, the death rate of any particular disease) can be complicated. If testing is not widely available, many COVID deaths cannot be confirmed, but only suspected. COVID has been particularly mortal for chronically ill, older patients living in nursing homes, who were likely nearing the end of their life span even before COVID arrived. Was COVID simply the last physiological straw that tipped things over, or was it the prime mover—as when a younger, healthy person succumbs? This is part of the reason why, even for something as common as influenza, annual deaths are reported in a very wide range (26,000 to 53,000 for 2018-2019 influenza season).

https://www.cdc.gov/flu/about/burden/2018-2019.html

Higher Risk

Q: What age groups are most at risk?

MDH: Older people and people with certain underlying health conditions like heart disease, lung disease and diabetes, for example, seem to be at greater risk of serious illness.

Dr. Bowron: People of virtually any age have become infected with coronavirus, but nearly 80% of cases in China have been in the 30-69 age range. Most of those who’ve gotten severely ill or died were typically older (starting at age 50 but peaking sharply at over 80) and/or had other medical problems.

Q: Is it less likely for a senior to contract the virus if they have a strong immune system?

Dr. Bowron: There’s good evidence that our immune system ages as we do, but regardless of age, if one’s immune system has never encountered a new (“novel”) virus like Covid-19, the body can offer no resistance when exposed to the virus, and an infection is inevitable. Once infected, most commonly the stronger the immune system the shorter, less intense, and less serious the infection will be. As for the descriptor “senior,” we know that a person’s chronological age (their age in years) is not as important as their biological age, but the former is a lot easier to calculate.

Q: Is it true that people of color are more likely to contract COVID-19?

MDH: People of color and American Indians experience multiple inequities (income, housing, employment, etc) that make them disproportionately susceptible to multiple health issues and chronic conditions. People of color and American Indians, particularly immigrants and refugees, also are often working in industries identified as “essential services or businesses” such as manufacturing, food industry, and may be in environments where COVID-19 may be spread if there is not appropriate preventive measures in place. MDH is working to ensure we have equitable approaches to prevention, information dissemination, and data collection and testing using a health equity lens.

Q: Other than health care facilities what other places seem to be at a higher risk of catching the virus?

Dr. Bowron: Long term care facilities and nursing homes, or “congregate living facilities” such as group homes, correctional facilities, shelters, or residential treatment facilities, are all at higher risk of getting a COVID-19 outbreak. This is because these facilities either contain higher numbers of people living in close proximity, and/or because the residents of these facilities cannot live independently and require frequent assistance from staff. High density living in which self-quarantining is either difficult or impossible makes it easier for the virus to be transmitted.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care-strategies.html https://www.health.state.mn.us/diseases/coronavirus/guidegroup.pdf

Safety Precautions

Q: What does ‘social distancing’ mean, and what steps should I take to do it?

MDH: Social distancing is creating literal and figurative distance between yourself and others in public spaces. Try to stay six feet away from others and avoid crowds when possible.

Dr. Bowron: A virus can only move person-to-person. The further apart those persons are, the harder it is for the virus to spread. If you spread out the dominoes, the chain reaction of falling dominoes stops. To me, social distancing starts with deciding which of our out-of-the-house activities/responsibilities are necessary and which are optional. Consider whether activities can be done remotely via the phone, computer, Skype, etc.

Q: How would I know if I should consider self-quarantine?

Dr. Bowron: If you have symptoms of a respiratory infection, ideally you should “self-quarantine” no matter what is causing the infection—coronavirus, influenza, rhinovirus etc. A simple screening question might be, “Would I want to be working with, or sitting by, or walking next to someone in my condition?” Granted, real-life pressures can make completely removing ourselves from the world quite difficult, but we should all do what we can to protect others. So at a minimum, those with active symptoms should minimize their time out in public, practice excellent hygiene (mask, hand washing etc.) and avoid family, friends, or groups that are more susceptible to coronavirus, such as those with chronic medical conditions. And because people tend to be the most contagious when they are the most sick, the sicker one is, the more isolated one should be.

Q: Is it safe to go to my regular doctor visits at this time?

Dr. Bowron: Regular doctor visits for regular things are being postponed right now. If issues arise such as a prescription renewal or a concern about a newly developing medical problem, call your doctor’s office and they will help you sort through it and develop a plan. If you develop serious symptoms, like chest pain or stroke symptoms, do what you would always do: call 911.

Q: If I order takeout or have my food delivered, am I putting myself (and others) at risk?

MDH: No more so than if you go shopping for groceries. Be diligent in washing hands after handling the bags, and again immediately before you consume the food.

Q: My partner is an essential worker and has to go into work. How can we protect our family and take the proper precautions to prevent exposure?

MDH: Distancing from your partner is the most effective strategy. Is there space to be in separate rooms? Separate floors? Establishing physical boundaries when possible is important. Sanitizing shared spaces and washing hands after touching shared surfaces (ie – refrigerators, door handles, etc) are also effective.

Q: Originally it was said that wearing mask would not prevent anyone from contracting COVID-19. As of recently, more and more people are starting to wear them. Should I start wearing one? Where and when?

Dr. Bowron: The issue of who and who shouldn’t wear masks demonstrates how difficult nuanced public health messaging can be. The gist of the initial message was that, given the limited supply of masks and the low prevalence of the virus in the community, it wasn’t recommended that low-risk individuals wear a mask in low-risk situations. We needed to conserve them for high-risk individuals—health care workers and confirmed infections. We are still in mask-conservation mode, but now that Covid-19 is much more widespread in the community, it’s recommended that everyone wear a cloth mask or facial covering (not a surgical or N-95 mask, please) in situations where social distancing cannot be consistently maintained.

https://www.health.state.mn.us/diseases/coronavirus/prevention.html

Q: How should I clean and disinfect my home?

MDH: Clean and disinfect frequently touched surfaces. Most common EPA-registered household disinfectants will work. If surfaces are dirty, use detergent or soap and water to clean them before disinfecting. The Minnesota Department of Health COVID-19 website has a CDC cleaning checklist to assist in developing a cleaning plan.

Q: Do you have to go through a complete decontamination routine every time you leave your home aside from washing your hands?

Dr. Bowron: Risk is a proportionate thing, although it sometimes feels absolute. The riskier a behavior is, the more benefit there is in avoiding it. Every year, several thousand people die after choking on their food—an unfortunate number, but probably not enough to recommend that everyone chop their food into tiny pieces. COVID is transmitted via inhaling airborne droplets, or by “using” our hands to move respiratory droplets from surfaces to our face. Washing one’s hands after a grocery run (with a mask on) addresses both those two common transmission modes. Could there be some surface droplets on your clothes, or shoes, or grocery bags? It’s possible, and not impossible, but is it very probable? Deciding to go through a “complete decontamination” every time you leave the house depends on how one answers that question, and whether one thinks the effort involved is commensurate with the risk being addressed.

Traveling

Q: Where can I find reliable information on travel?

MDH: CDC is keeping their travel website up to date with the latest travel recommendations. You can find more information at Coronavirus Disease 2019 Information for

Travel: https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html

Dr. Bowron: [As you’ll see on the website…] the highest level of caution is “Warning Level 3: Avoid Nonessential Travel,” followed by “Alert Level 2, Practice Enhanced Precautions.”

Q: Is safe to travel to another state if you are driving or rent a private Airbnb?

Dr. Bowron: The CDC recommends only what they define as “essential” travel: traveling locally on essential errands; or traveling non-locally to provide medical or home care to others, or for a job that is considered an essential service. The general public seems to be defining “essential” much more broadly than the CDC—which likely anticipated that reality, and has provided a list of suggestions/precautions for those who do decide to travel.

https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-in-the-us.html

Traveling to another state and staying in an Air BNB is certainly riskier than staying home, but how much riskier? That depends on how many times one needs to stop on the road. It depends on who and when someone last stayed in the Air BNB, and how well it was cleaned. It depends on whether you use the Air BNB just to quarantine in a new place, and on whether you bring everything you need with you. The risk depends on a lot of different things, including whether everything goes as planned—no car trouble, the Air BNB doesn’t cancel at the last minute, etc. One thing is certain in all this uncertainty: acting cautiously and thoughtfully is our best guard against infecting ourselves and others.