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  • Coronavirus Reports: What We Know, and What We Don't

    Every day there are new developments in the spread of coronavirus — also known as COVID-19 — but there are also debates among experts on how the disease is spread and its impact on people who become infected. While overall risk of catching the disease is low, health care professionals are at higher risk. APTA reminds PTs and PTAs to follow precautions for reducing the spread of infectious diseases — an important aspect of health care to be mindful of at all times, not just during periods of high risk.

    Since the disease first appeared in Wuhan, China, in December 2019, it has affected over 92,000 people in more than 70 countries on every continent. As of the afternoon of March 3, the Johns Hopkins University coronavirus tracker registered 108 COVID-19 cases in the United States, including six deaths.

    Note: at this time all APTA national events are continuing as scheduled. Contact APTA member services if you have questions related to attendance of an upcoming event.

    As with all public health situations, we primarily rely on the Centers for Disease Control and Prevention, the Occupational Health and Safety Administration, and the U.S. Office of the Surgeon General for the best information and preventive strategies.

    Here is a roundup of what is being reported by public health and infectious disease experts:

    The World Health Organization says risk of global spread "very high." (Bloomberg)
    On Monday, March 2, WHO increased its warning of global spread and impact risk from "high" to "very high." In response to the disease's spread, many countries have tightened border controls, restricted flights, shut down schools, and cancelled large events. (The CDC provides a travel update webpage.)

    The average infected patient spreads the virus to 2.2 others. (NEJM)
    Researchers in China estimate that on average individuals with COVID-19 have been spreading the illness to at least 2 people, compared with 3 with SARS. Authors write, "Measures to prevent or reduce transmission should be implemented in populations at risk." According to the CDC, among travel-related U.S. cases there has been "no sustained person-to-person transmission" of symptomatic COVID-19.

    The mortality rate is estimated around 3.4%, but some say it may be less than that. (Reuters)
    While the current mortality rate from COVID-19 is approximately 3.4%, some experts say that the mortality rate could be much lower because many carriers with mild or no symptoms may not be identified.

    Experts are unsure why some recovered patients appear to become reinfected. (Reuters)
    In confirmed cases in Japan and China, some recovered patients have again tested positive for COVID-19 but were not contagious. Experts are uncertain whether these are new infections. People could become reinfected because they didn't build up enough antibodies while they were infected the first time, but it's also possible that the virus could lie dormant and symptoms could reappear again later.

    Debate still is under way about transmission via hard surfaces. (Reuters)
    While experts agree that the virus is mainly transmitted by respiratory droplets in the air — coughing or sneezing on a person — research is ongoing on whether hard surfaces are a significant route of transmission. CDC Director Robert Redfield told Congress, "On copper and steel it's pretty typical, it's pretty much about two hours, but I will say on other surfaces — cardboard or plastic — it's longer, and so we are looking at this." (WHO recommends disinfecting any hard surfaces.)

    The Surgeon General discourages masks for non-health care providers. (CNN Health)
    U.S. Surgeon General Jerome Adams, MD, MPH, asks the public to stop buying face masks to prevent COVID-19 infection. According to Adams, it results in a shortage for the health care providers who need them, and people who wear them incorrectly could actually increase their chance of being infected.

    To keep abreast of evidence-based news on COVID-19, here a few free reputable sources:

    Comments

    • This article was not very useful. There is much better, more detailed, more accurate, more up-to-date information online. The R0 is significantly higher than 2.3. It's more in the 4 to 7 range. NP95 masks will not stop the virus but will decrease the risk of infection. Rather than telling people not to wear masks (which is both ludicrous and selfish), they should be educating them how to wear them properly, ramp up production of masks, and teach people how to fabricate their own masks if the need arises. They should also be educating the public about the use of anti-viral products such as elderberry and certain mushroom formulations, the importance of such things as blood selenium and other mineral and nutrient levels, the use of colloidal silver in a nebulizer, disinfection procedures ranging from alcohol to UV light, etc. They have done none of that. Evidence has shown that the virus can remain on hard surfaces for multiple days. The incubation time is commonly 2 to 14 days but outliers have been infected yet asymptomatic for up to 27 days. For all intents and purposes, the virus is airborne as evidenced by the transmission of the virus through the ventilation system of the Diamond Princess. Droplets can be aerosolized and aerosols infect via airborne mechanisms. Besides the mouth and nose, the infection can also enter through the eyes so eye protection will be needed in an infected environment. Epidemiologists estimate that 70% of the population will eventually be infected so the statement that the risk of catching the disease is low is an absurd one. The virus is most lethal for the elderly with a 14 to 15% CFR for those over 80. Death is most commonly caused by pneumonia including secondary bacterial pneumonia. There is much more. Do your own due diligence because the CDC and WHO have been woefully inadequate in their response. The WHO hasn't even declared this situation a pandemic yet, probably for economic reasons related to pandemic bond issuance. They really think that over 95 thousand people infected in 83 countries and territories with 3,254 deaths and 6,848 in serious or critical condition is not a pandemic? The APTA should be pro-active and cancel events scheduled in the next two months at least. This disease is spreading exponentially and travel in a closed environment such as an aircraft poses significantly heightened risks of infection. Witness the tight controls implemented by places such as Singapore and their success in containing the disease versus the lax controls in this country. The emphasis upon sustaining economic momentum and life-as-normal over protecting life and health is shameful.

      Posted by Brian Miller on 3/4/2020 3:49 PM

    • I haven't heard any mention of asymptomatic carriers of COVID-19. They would make tracking the continuity of the virus more difficult.

      Posted by Howard Peters on 3/4/2020 4:44 PM

    • No disrespect to Mr. Miller but his comments seem a little bit extreme appearing to be more like chicken Little. Overtime we will gain more information and have a better understanding but we need to not panic people.

      Posted by Warren Roberts on 3/5/2020 8:26 AM

    • Howard, I don't know where you are listening or reading but the fact that carriers of COVID-19 are asymptomatic for multiple days is in article after article and is blatantly evident from investigating situations such as the Diamond Princess fiasco. That's why screening individuals for fever, cough, etc. is so ineffective and why the disease continues to spread so rapidly. Here's just one website to get accurate, up-to-date, factual (i.e. non-propagandized) information: https://www.worldometers.info/coronavirus/

      Posted by Brian Miller on 3/5/2020 10:35 AM

    • Actually a spouse of someone who traveled and got the coronavirus was asymptomatic...and has anyone seen those ppl who recovered!? Their lungs are still effected by this. The one guy and his kid that went on Fox news couldn't stop coughing si😷...

      Posted by Rachel ward on 3/6/2020 6:25 AM

    • RE:Brian Miller My son’s fiancee’s family in Singapore have told us that Singapore’s attempts at isolating people has not been successful as people who are supposed to remain in place are going out into the community

      Posted by J Mast on 3/6/2020 4:47 PM

    • If you have information specific to scenarios below that related to COVID-19, I would appreciate it if you commented….. I own a Physical Therapy Practice. Following are what we are doing and questions regarding scenarios I am curious how to handle if/when they arise: We are currently: -Screening new patients who call in: asking if they have been in one of the risk zones in the past 30 days or have been in close contact with someone who has been in those areas and were SICK. Zones include China, Italy, Iran, South Korea. ---If so and no symptoms, we ask they stay home for 14 days from their last exposure and then call back. ---If so with symptoms we tell them to contact doctor and not come in until cleared. -Ask if they are sick, have a fever or cough ---If so, have they seen a doctor and been cleared as non contagious. ---If not, we ask that they stay home until cleared by doctor until symptoms are gone. -We also hand out paper in the office to current and new patients asking the same questions. -We Eblast to all patients sharing information about corona virus and advising patients who answer yes to questions above to see their doctor and reschedule appointments. - we place up signs in the office reminding people to wash hands and not touch face with unwashed hands. - We have purchased more wipes which we offer patients - We have already maintained a clean environment but have increased our cleaning frequency to take extra precautions. I need to get information on how to respond if the following occur: -If we find a patient has no symptoms but ---says he has been in contact with someone who has -----been to corona virus risk zones or ---been in contact with someone who has confirmed corona virus or ---been in contact with someone who is suspected of having corona virus but not confirmed. ---If someone has had corona virus but recovered With respect to these scenarios above, I understand we would tell the specific patient to self-quarantine. However, how would we handle our own staff and all the other patients that this person may have come in contact with? I want to be safe but also don’t want to shut down our company unnecessarily. I also want to be prepared to act quickly if a scenario happens because I anticipate these situations will happen. Are there any other potential scenarios I may be not anticipating that you can advise? I tried calling public health agency in Orange County. It wasn’t much help. She basically said use judgement and shared that unless the person was sick (even if he was in contact with someone who had corona virus) then risk in minimal. She also said that if we are taking standard cleaning precautions and he has not sneezed or coughed and we are washing our hands, we are minimal risk. I interpret this as do nothing but would like to see the position of PPS in these types of scenarios.

      Posted by Richard Coury -> >GUc<K on 3/11/2020 2:52 PM

    • Mr Miller is definitely In overkill mode. Transmission and exposure is not necessarily a bad experience. Overtime, tolerance will be built and as the common cold , it will be minimized. Thousands die of the flu annually and no one seems to care or quarantine in spite of its spread . We simply do not know it’s timeline , and for most this exposure has proven to be mild and for what ever reason not as fatal to children as the annual flu has been . Yes, vigilance if in risk groups, but making your own mask in your garage , ridiculous.. Our bodies are durable, with natural immunity and concern for realistic isolation, this will slow. But as proven by the common cold , this may not disappear Not as fatal as SARS , ( another fatal experience perpetrated by the chinese by the abusive ( illegal wildlife trade)and ignorant food handling methods ), we cannot hide forever.. Destructive to economy ( people’s livelihoods) and quality of life. Media is alarmist and overreactive..

      Posted by John Howish on 3/11/2020 5:00 PM

    • Brian Miller: What are your credentials? Where did you get the 70% infection rate from? Where did you learn the virus was spread through the ventilation system of the Diamond Princess? Thank you.

      Posted by Nancy Lyons -> DNT[@M on 3/12/2020 12:46 AM

    • I want to know if this virus will remain dormant, and if it can be spread through food sources and mosquitos?

      Posted by Stephen on 3/12/2020 10:03 AM

    • Genuine question - if there have been few test available in the US this past winter, how do we know that people haven’t been exposed to it - or have had symptoms of it before? The flu shots were not effective this year. Many people with viruses in our area this winter tested negative for the flu, confounding some of the doctors and nurses I know. Any shot they we are further into this then we realize?

      Posted by Else Sweetin on 3/13/2020 7:46 AM

    • Brian, do you think nebulizer silver is helpful? We use for respiratory illness regularly and that was my plan. Just curious. And you are right on with your thoughts, in my opinion.

      Posted by Cynthia J on 3/13/2020 9:26 AM

    • no need to panic

      Posted by john on 3/13/2020 10:00 AM

    • Actually Mr. Miller's comment was quite thoroughly researched and is in line with what many experts are now saying. But shove your heads back in the sand at your own peril.

      Posted by No thanks on 3/13/2020 1:53 PM

    • Brian Miller, thank you for your comments. Even if other ppl think sticcking their heads in the sand is an effective measure, others of us know better. I welcome all info you can share. We know that the virus messaging must now come thru the white House leaving dress & scientists basically gagged. We also know that the messaging we are & have been getting is often intentionally wrong and/or minimized so as not to rock the economic state. BS. Forewarned is forearmed.

      Posted by Catch 22 on 3/13/2020 9:30 PM

    • Like any virus keeping in mind that germs are everywhere. from the bottom of your shoes to the atm machine. Germs are in every crack and corner of the globe. Yes viruses can be avoided by keeping a clear distance from other people. but what about that atm machine one thing is wash and keep your hands clean even properly cleaning under your finger nails. By keeping your hands clean your chances are so much higher of not catching the virus Many people dont keep this in mind GERMS ARE EVERYWHERE

      Posted by T McCue on 3/14/2020 12:53 AM

    • Hey millers right. I dont know about the elderberry and mushrooms but yes they are saying 70% by the end of this year is likely. Quit watching Faux News to feel better about the world and tune into something moderate and logic based. Trumps very own expert is saying this could get very bad with potentially millions of deaths possible. It does not matter what the flu does or how many people SARS killed, which this is potentially 1000x more infectious than original SARS so even with a lower death or mortality rate it will matter how many people become infected and since this is new aka "novel" aka people have never experienced it it's nothing like the flu there's no immunity in anyone. Wake up. Don't bash others and downplay the threat and say there's no risk. Eating crow might very well be your last meal in this case. If people are that ignorant about the severity of the situation then leave it to survival of common sense.

      Posted by Bill on 3/14/2020 3:14 PM

    • Brian Miller: Bravo! Checking out your site.. wondering who else realized you were right?...

      Posted by SHAUNA j SCHOLLAERT on 3/14/2020 4:34 PM

    • Where did the 70% transmission rate in Mr. Miller’s post come from? In every national population, the infection percentage is in the range of 0.003%. Simply take the number of cases and divide by the population.

      Posted by JRB on 3/15/2020 9:09 AM

    • Thoughts about providing care in home settings? We take precautions, but I am concerned about the increased risk to provider, patient and families when going from home to home during the course of the day.

      Posted by homecare PT on 3/15/2020 2:26 PM

    • Please update the article. As I write this comment it is 3/15/2020 and the situation in the US has changed significantly. People are googling trying to get answers on how to protect themselves and patients and this article is one of the first. Also, please consider that there are only around 500 thousand acute care beds in the United States and well over 67 million adults over the age of 60. There are also an estimated 10 million people out there who are immunocompromised (there will be some overlap between those two groups which will affect totals). There is now very much a sustained transmission that is happening widely and quickly across the country. MOST of the US will indeed be fine but if this continues at the rate that it is going, our hospitals will become completely overwhelmed within a few months. God forbid anyone then have a serious medical emergency and find that the hospital cannot take them. Listen to the data and not the politics or the anxiety about losing money if your patients do not come in due to social distancing. Most of us have caseloads consisting nearly entirely of people within the vulnerable age group. Think ahead and see the bigger picture and act now before it is too late.

      Posted by Maria on 3/15/2020 8:59 PM

    • Dear Mr. Miller, Thank you so much for your comments. You’ve been quite informative . If you don’t mind, where can I obtain information about the mushroom formulations, selenium , minerals , colloidal silver & other things you’ve mentioned. Thank you again.

      Posted by M. Martinez on 3/15/2020 11:12 PM

    • Everyone: APTA is aiming to consolidate coronavirus updates and information on one page whenever possible. It's here: http://www.apta.org/Coronavirus/

      Posted by APTA staff on 3/16/2020 9:14 AM

    • I genuinely believe I had it at the end of December into early January. I tested negative for the flu and had all the symptoms. I couldn't breathe without a nebulizer for 2 weeks straight, had a fever, and the cough lingered for ages. I saw a lot of cases in the US come forth with the same symptoms during this time frame and all had a negative results for the flu. Is it possible this was here in the US far sooner than we thought and no one knew?

      Posted by Martina on 3/16/2020 11:54 AM

    • Thank you Brian and Bill above. I really appreciate the info. I am a free thinker who enjoys common sense. I believe this virus was manipulated in a lab as it had 4 HIV insertions into the protein of its DNA. If the end plates of the spikes of the virus have been manipulated to be 100 to 1,000 times that of SARS, we are dealing with a very serious virus. Still waiting to see if people can develop an immunity so as not to be re-infected. I am not really sure if animals have anything to do with the viciousness or the spread of disease. I think man has more to do with how it's been made so tenacious. If there are ways and means to help our immune systems to fight a herculean task I am all for it. I have seen remarkable recoveries in humans and animals when given what the body demands to fight. Every new advancement in medicine was laughed at before people actually adopted new practices in saving lives. Still the same way today.

      Posted by Barbie Doll on 3/16/2020 1:39 PM

    • I do and truly understand that is coronavirus should be taken seriously by everyone ESPECIALLY RETIRED SENIORS I'M NOT CLOSE TO RETIREMENT YET. But any of you long-standing check collecting Social security elderly that they said maybe ten or more years ago to Social security was in trouble it looks like they may have found a CURE for that problem. Now they just have to figure out CURE for this coronavirus, HEY AND MAYBE EVEN A VACCINATION WHERE THEY CAN MAKE EVEN MORE MILLIONS BY CHARGING UP THE TAXES TO THE PHARMACEUTICALS COMPANIES 😉😉😉🤔 OR JUST MAKING SURE THEY GET THEIR CUT OF THE REVENUE😉😉KB. but it's not an uncommon occurrence what is happening now has happened a number of times number years ago and will continue to happen not only here in other countries also and all we can say is God bless our government did a Republican or Democrat or liberal a dictator whatever kind of state or country is in it's always been this way it's never going to change

      Posted by TNB on 3/16/2020 4:15 PM

    • Live your life people! Trust in god and pray for people infected. Don't relie on so called experts and dead press. God bless you all.

      Posted by Christopher Bates on 3/16/2020 6:18 PM

    • Seems I had the corona virus : low grade fever, chills, body aches, coughing coughing coughing, dry and then tons of mucus for 2 days. Then dry cough again. That was about 3 weeks ago and I still have a dry cough off and on. I even called in sick at work one day (after the body aches set in) which I almost never do. I wish I could be tested for the antibodies then I could know for sure I had it and don't need to be bothered with precautions now. Never smoked and cardio fitness good prior to catching it and I'm rarely sick.

      Posted by Hugh on 3/17/2020 12:11 AM

    • After listening to the syptoms I am wondering when the virus actually began appearing. I had some very simular syptoms back in late Oct. 2019. Came home one night feeling tired and having fills. Woke up in morning with terrible sore throat. Two days later followed by a dry deep cough that eventually entered my lungs for about 6 to 7 weeks. I was so tired of the coughing. It eventually subsided and I feel normal now. I wonder can they test you to see if you have already had the virus?

      Posted by THOMAS JACKSON on 3/17/2020 1:47 AM

    • Actually although it isn't effecting kids like adults the death rate for children younger then 12 is .2 percent which is double that of flu. Also it has less to do with age and more to do with underlying conditions. The receptors from sars covid 2 and 2003 sars both attach to ace2 which are found in the lungs, heart, kidneys, male tested and brain. So if you have serious conditions with any of those or get a big viral load it could kill you regardless of age but most children don't have serious health conditions. Those who do will die just as fast as an older person with the same. On another note since we have research on 2003 sars which is almost identical besides 10 or 20 percent and we know where it can hide out in acr 2 receptors that goes with the theory up top that it is lying dormant with these reinfected patients. Many, many, many viruses do this. If it can find a place to hide or change its form Togo unnoticed it can then have a resurgence and cause another outbreak. I.e. when a herpies type 1 gets a fever blister out of no where 6 years after contracting it. It waits for your bodys immune system to be weak and for you to be under stress and it takes its move. I think this is why the govt is taking this so seriously we have very little idea what this could do, and even at the best figure of 1 percent death rate, and no sneaky dormant virus our world population would dwindle to nothing that's why we need a vaccine and yes folks it's very possible we won't be able to make one ... Take the common cold and aids.. we have been trying at that vaccine for years with now success. It doesn't help with the virus is constantly mutating due to the fact it's adjusting to be in a species that it's not supposed to be in.. makes me so upset because this has happened so many times we had to put band on the animals they aren't allowed to keep in their markets and they are still doing it and putting all of our risks to the country. Our lives stock has shots, and at worse can cause any there strain of influenza or mad cow disease which has no chance in spreading beyond a few people before getting shut down. Point is let's eat animals we are familiar with and familiar with the viruses that lurk inside them and how to make vaccines for them

      Posted by Zach on 3/17/2020 3:45 AM

    • As an owner of an outpatient PT practice, I am trying to find recommendations concerning our businesses. With the likelihood that transmission can also be through airborne means, then we (PTs and pts) are all at higher risk for infection. We see 15-18 pts/day, definitely within 3 feet, and with hand contact, even though we take precautions. I'm torn about what to do at this point. With all the businesses that are being mandated to close, I haven't heard anything about us.

      Posted by Mike Fay, PT on 3/17/2020 5:51 AM

    • Watch the movie the thing, and the second also. Here is your corona virus. A spiked crowned cell that penetrates the cell wall and replicates. Copies!!!! Hand sanitizer is nothing more than alchohol that strips the hands of its vital oils and weakens the immune system. People run around and buy anti-bacterial soap and drench there hands and bodys with it. There is a difference between bacterial and viral. Oh dont use colidial silver because it's a scam, haha. That's a lie. Do your research in depth! All our scientists and doctors and the best advice is to use a mask and germ x. Wake up people! No mention of antioxidants or immune boosters. No topicals, no nothing but germ x and a mask. Are you really believing,

      Posted by Michael on 3/17/2020 2:01 PM

    • Can the corona virus be picked up on shoes and then brought into the home since it falls to the floor then if some body vacuums it can be injected into the air or if you touch the bottom of the shoes,and then touch your face it will be transmitted.

      Posted by Victor Torres on 3/17/2020 4:02 PM

    • Just understand that these number will not make a difference if we don’t follow the simple precautions.

      Posted by Zifan Hotel & Suites on 3/19/2020 8:33 AM

    • The best thing we could all do is stay at home, I can tell you as a doctor. This article was not very useful. There is much better, more detailed and more up-to-date information online This virus is especially risky for the elderly, pregnant women and those with chronic illnesses. They need to take care of themselves. Women especially need to monitor their health after menopause. Additionally, they need to consume vitamins. Which vitamins are the best to protect the elderly you may ask?

      Posted by Menopause Coach on 3/20/2020 4:28 AM

    • I don't think Mr. Miller is overreacting. I think we've dropped the ball and need to take a que from Singapore and South Korea - rapid testing and aggressive testing, not discouraging ppl from getting tested unless they are deathly ill. That only allows the ppl that have little to no symptoms to continue spreading it!

      Posted by Shar M on 3/30/2020 2:09 AM

    • I travelled by Amtrak October 4 to October 10th. Each trip was a 29 hour ride. I came in contact with people all over the world. England, Indonesian, Austrailia, Chinese, Japanese, and likely more than I even know. Two days after returning my middle ear drum busted and 4 days later I was so sick. My cough was a tickle in the back of my throat along with a sore throat. I coughed till I was out of breath and felt like I could not breath. I felt this way for two weeks. Two doctors visits, a shot of steroids and antibiotics....two different times. I am still coughing and finding it hard to breath. I have blown my nose for 3 months. I wake up still coughing and vomiting phlegm... I have to wonder if I caught it on the train...second week of October.

      Posted by Kathy T on 4/2/2020 9:51 PM

    • OTR here, I think perhaps the article should be taken down/removed. Bit out of date and the comments are rather sad.

      Posted by Kristin Larsen on 4/17/2020 1:15 PM

    • Had a respitory infection in Oct, never ever had a cough like this before, fever ,chills, headache, body aches , could it have been the coronavirus ?

      Posted by Sharon Marie Pawl on 5/1/2020 12:58 PM

    • Check to see how it's working for Singapore now

      Posted by Michael on 5/4/2020 2:39 PM

    • I do NOT understand the controversy on the hydroxy treatment Im an Engineer. Heres something in our tool box that can interfere with virii replication 70 years old. No hype lupas patients dieing from it #2 Where oh where is the virus gonna hide in or until the winter? Assumption asymtomatic people contact unitiated only way i see but im an Engineer not a DR

      Posted by Joseph Madajewski on 5/17/2020 9:59 AM

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