Cause

Transmission
Main article: Transmission of COVID-19

Respiratory droplets produced when a man sneezes, visualised using Tyndall scattering

COVID-19 is a new disease, and many of the details of its spread are still under
investigation.[10][11][12] It spreads easily between people—more easily than influenza but not as
easily as measles.[11] People are most infectious when they show symptoms (even mild or
non-specific symptoms), but may be infectious for up to two days before symptoms appear
(pre-symptomatic transmission).[12] They remain infectious for an estimated seven to twelve
days in moderate cases and an average of two weeks in severe cases. [12] People can also
transmit the virus without showing any symptom (asymptomatic transmission), but it is
unclear how often this happens.[10][11][12] A June 2020 review found that 40–45% of infected
people are asymptomatic.[109]
COVID-19 spreads primarily when people are in close contact and one person
inhales small droplets produced by an infected person (symptomatic or not) coughing,
sneezing, talking, or singing.[12][110] The WHO recommends 1 metre (3 ft) of social distance;
[10]
 the US Centers for Disease Control and Prevention (CDC) recommends 2 metres (6 ft).[11]
Transmission may also occur through aerosols, smaller droplets that are able to stay
suspended in the air for longer periods of time. [14] Experimental results show the virus can
survive in aerosol for up to three hours.[111] Some outbreaks have also been reported in
crowded and inadequately ventilated indoor locations where infected persons spend long
periods of time (such as restaurants and nightclubs). [112] Aerosol transmission in such
locations has not been ruled out.[14] Some medical procedures performed on COVID-19
patients in health facilities can generate those smaller droplets, [113] and result in the virus
being transmitted more easily than normal. [10][12]
Less commonly, when the contaminated droplets fall to floors or surfaces they can remain
infectious if people touch contaminated surfaces and then their eyes, nose or mouth with
unwashed hands.[10] On surfaces the amount of viable active virus decreases over time until
it can no longer cause infection, [12] and surfaces are thought not to be the main way the
virus spreads.[11] The level of contamination required to transmit infection via surfaces is
unknown, but the virus can be detected for up to four hours on copper, up to one day on
cardboard, and up to three days on plastic (polypropylene) and stainless steel (AISI 304).[12]
[114][115]
 Surfaces are easily decontaminated with household disinfectants which destroy the
virus outside the human body or on the hands.[10] Disinfectants or bleach are not a treatment
for COVID-19, and cause health problems when not used properly, such as when used
inside the human body.[116]
Sputum and saliva carry large amounts of virus.[10][11][12][117] Although COVID-19 is not
a sexually transmitted infection, direct contact such as kissing, intimate contact, and fecal–
oral routes are suspected to transmit the virus.[118][119] The virus may occur in breast milk, but
whether it is transmittable to the baby is unknown.[120][121]
Estimates of the number of people infected by one person with COVID-19, the R0, have
varied. The WHO's initial estimates of R0 were 1.4–2.5 (average 1.95); however, a review
in early April 2020 found the basic R0 (without control measures) to be higher at 3.28 and
the median R0 to be 2.79.[122]
Virology
Main article: Severe acute respiratory syndrome coronavirus 2

Illustration of SARSr-CoV virion

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus, first

isolated from three people with pneumonia connected to the cluster of acute respiratory
illness cases in Wuhan.[45] All features of the novel SARS-CoV-2 virus occur in related
coronaviruses in nature.[123]
SARS-CoV-2 is closely related to SARS-CoV, and is thought to have a zoonotic origin.
[42]
 SARS-CoV-2 genetically clusters with the genus Betacoronavirus, and is 96 percent
identical at the whole genome level to other bat coronavirus samples[124] and 92 percent
identical to pangolin coronavirus.[125]

Diagnosis
Main article: COVID-19 testing

Demonstration of a swab for COVID-19 testing

COVID-19 can provisionally be diagnosed on the basis of symptoms and confirmed

using reverse transcription polymerase chain reaction (RT-PCR) testing of infected
secretions or CT imaging of the chest.[126][127]

Viral testing
The standard test for current infection with SARS-CoV-2 uses RNA testing of respiratory
secretions collected using a nasopharyngeal swab, though it is possible to test other
samples. This test uses real-time rRT-PCR which detects the presence of viral RNA
fragments.[128]
A number of laboratories and companies have developed serological tests, which
detect antibodies produced by the body in response to infection.[129] Several have been
evaluated by Public Health England and approved for use in the UK.[130]
On 22 June 2020, UK health secretary Matt Hancock announced the country would
conduct a new "spit test" for COVID-19 on 14,000 key workers and their families
in Southampton, having them spit in a pot, which was collected by Southampton University,
with results expected within 48 hours. Hancock said the test was easier than using swabs,
and could enable people to conduct it at home. [131]

Imaging

A CT scan of a person with COVID-19 shows lesions (bright regions) in the lungs.

Characteristic imaging features on chest radiographs and computed tomography (CT) of

people who are symptomatic include asymmetric peripheral ground-glass
opacities without pleural effusions.[132] Many groups have created COVID-19 datasets that
include imagery such as the Italian Radiological Society which has compiled an
international online database of imaging findings for confirmed cases. [133] Due to overlap
with other infections such as adenovirus, imaging without confirmation by rRT-PCR is of
limited specificity in identifying COVID-19.[132] A large study in China compared chest CT
results to PCR and demonstrated that though imaging is less specific for the infection, it is
faster and more sensitive.[127]

Prevention
Further information: Workplace hazard controls for COVID-19, Pandemic
prevention, preparations prior to COVID-19, COVID-19 surveillance, and COVID-19 apps
Infographic by the U.S. Centers for Disease Control and Prevention (CDC), describing how to stop
the spread of germs

Strategies for preventing transmission of the disease include maintaining overall good
personal hygiene, washing hands, avoiding touching the eyes, nose, or mouth with
unwashed hands, and coughing or sneezing into a tissue, and putting the tissue directly
into a waste container. Those who may already have the infection have been advised to
wear a surgical mask in public.[134][135] Physical distancing measures are also recommended
to prevent transmission.[136][137] Health care providers taking care of someone who may be
infected are recommended to use standard precautions, contact precautions, and eye
protection.[138][139]
Many governments have restricted or advised against all non-essential travel to and from
areas affected by the outbreak.[140] The virus has already spread within communities in large
parts of the world, with many not knowing where or how they were infected. [141]
Misconceptions are circulating about how to prevent infection; for example, rinsing the nose
and gargling with mouthwash are not effective. [142] There is no COVID-19 vaccine, though
many organisations are working to develop one.[143]

Hand washing
Main article: Hand washing
Hand washing is recommended to prevent the spread of the disease. The CDC
recommends that people wash hands often with soap and water for at least twenty
seconds, especially after going to the toilet or when hands are visibly dirty; before eating;
and after blowing one's nose, coughing, or sneezing. This is because outside the human
body, the virus is killed by household soap, which bursts its protective bubble. [22] In addition,
soap and water disrupts the sticky bond between pathogens and human skin which causes
the coronavirus pathogen to slide off the hands/body. [144] CDC has recommended using an
alcohol-based hand sanitiser with at least 60 percent alcohol by volume when soap and
water are not readily available.[134] The WHO advises people to avoid touching the eyes,
nose, or mouth with unwashed hands.[135][145] It is not clear whether washing hands with ash,
if soap is not available, is effective at reducing the spread of viral infections. [146]

Social distancing
Main article: Social distancing measures related to the COVID-19 pandemic

Physical distancing in Toronto, with a limited number of customers allowed inside a store

Social distancing (also known as physical distancing) includes infection control actions

intended to slow the spread of disease by minimising close contact between individuals.
Methods include quarantines; travel restrictions; and the closing of schools, workplaces,
stadiums, theatres, or shopping centres. Individuals may apply social distancing methods
by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and
physically distancing themselves from others.[135][147][148] Many governments are now
mandating or recommending social distancing in regions affected by the outbreak. [149]
[150]
 Non-cooperation with distancing measures in some areas has contributed to the further
spread of the pandemic.[151]
The maximum gathering size recommended by U.S. government bodies and health
organisations was swiftly reduced from 250 people (if there were no known COVID-19
spread in a region) to 50 people, and later to 10. [152] On 22 March 2020, Germany banned
public gatherings of more than two people.[153] A Cochrane review found that early
quarantine with other public health measures are effective in limiting the pandemic, but the
best manner of adopting and relaxing policies are uncertain, as local conditions vary. [148]
Older adults and those with underlying medical conditions such as diabetes, heart disease,
respiratory disease, hypertension, and compromised immune systems face increased risk
of serious illness and complications and have been advised by the CDC to stay home as
much as possible in areas of community outbreak.[154][155]
In late March 2020, the WHO and other health bodies began to replace the use of the term
"social distancing" with "physical distancing", to clarify that the aim is to reduce physical
contact while maintaining social connections, either virtually or at a distance. The use of the
term "social distancing" had led to implications that people should engage in
complete social isolation, rather than encouraging them to stay in contact through
alternative means.[156][157] Some authorities have issued sexual health guidelines for the
pandemic, which include recommendations to have sex only with someone you live with,
and who does not have the virus or symptoms of the virus.[158][159]

Face masks and respiratory hygiene

Main article: Face masks during the COVID-19 pandemic

The CDC and WHO advise that masks reduce the spread of coronavirus by asymptomatic and pre-
symtomatic individuals (Taiwan President Tsai Ing-wen pictured wearing a surgical mask)
The CDC and WHO recommend individuals wear non-medical face coverings in public
settings where there is an increased risk of transmission and where social distancing
measures are difficult to maintain.[160][161][162] This recommendation is meant to reduce the
spread of the disease by asymptomatic and pre-symtomatic individuals and is
complementary to established preventive measures such as social distancing. [161][163] Face
coverings limit the volume and travel distance of expiratory droplets dispersed when
talking, breathing, and coughing. [161][163] Many countries and local jurisdictions encourage or
mandate the use of face masks or cloth face coverings by members of the public to limit the
spread of the virus.[164][165]
Masks are also strongly recommended for those who may have been infected and those
taking care of someone who may have the disease.[166] When not wearing a mask, the CDC
recommends covering the mouth and nose with a tissue when coughing or sneezing and
recommends using the inside of the elbow if no tissue is available. [134] Proper hand hygiene
after any cough or sneeze is encouraged.[134] Healthcare professionals interacting directly
with COVID-19 patients are advised to use respirators at least as protective as NIOSH-
certified N95 or equivalent, in addition to other personal protective equipment.[167]

Self-isolation

Without pandemic containment measures—such as social distancing, vaccination, and use of face
masks—pathogens can spread exponentially. [168] This graphic shows how early adoption of
containment measures tends to protect wider swaths of the population.

Self-isolation at home has been recommended for those diagnosed with COVID-19 and
those who suspect they have been infected. Health agencies have issued detailed
instructions for proper self-isolation. [169][170]
Many governments have mandated or recommended self-quarantine for entire populations.
[171][172]
 The strongest self-quarantine instructions have been issued to those in high risk
groups.[173] Those who may have been exposed to someone with COVID-19 and those who
have recently travelled to a country or region with the widespread transmission have been
advised to self-quarantine for 14 days from the time of last possible exposure. [10][18][174]

Surface cleaning
Surfaces may be decontaminated with a number of solutions (within one minute of
exposure to the disinfectant for a stainless steel surface), including 62–71 percent ethanol,
50–100 percent isopropanol, 0.1 percent sodium hypochlorite, 0.5 percent hydrogen
peroxide, and 0.2–7.5 percent povidone-iodine. Other solutions, such as benzalkonium
chloride and chlorhexidine gluconate, are less effective.[175] Ultraviolet germicidal
irradiation may also be used.[21] The CDC recommends that if a COVID-19 case is
suspected or confirmed at a facility such as an office or day care, all areas such as offices,
bathrooms, common areas, shared electronic equipment like tablets, touch screens,
keyboards, remote controls, and ATM machines used by the ill persons should be
disinfected.[176]