Response to application from respondents Phil Murphy, et al. — Kevin Robinson, et al., Applicants v. Phil Murphy, Governor of New Jersey, et al.
Supreme Court briefDec 3, 2020
Ask Donna
What actually matters in this document.
Text
No. 20A95
In the Supreme Court of the United States
REV. KEVIN ROBINSON AND RABBI YISRAEL A. KNOPFLER,
Applicants,
v.
PHILIP D. MURPHY, ET AL.,
Respondents.
APPENDIX FOR RESPONDENTS – VOLUME I OF IV, PAGES 1-230
GURBIR S. GREWAL
Attorney General of New Jersey
JEREMY M. FEIGENBAUM*
State Solicitor
DANIEL M. VANNELLA
Assistant Attorney General
AUSTIN HILTON
BRYAN EDWARD LUCAS
JUSTINE LONGA
ROBERT J. MCGUIRE
STEPHANIE MERSCH
JESSICA JANNETTI SAMPOLI
MICHAEL R. SARNO
Deputy Attorneys General
December 3, 2020
Richard J. Hughes Justice Complex
25 Market Street, Trenton, NJ 08625
(609) 292-4925
jeremy.feigenbaum@njoag.gov
*Counsel of Record
Counsel for Respondents
TABLE OF CONTENTS
Page
Michelle L. Holshue, et al., First Case of 2019 Novel Coronavirus in the
United States, N. ENGL. J. MED. 382:929–36 (Mar. 5, 2020) ............ R.A. 1
New Virus Discovered
Investigating Pneumonia Outbreak,
Natasha
Khan,
by
Chinese
Scientists
WALL STREET J. (Jan. 8, 2020) ........................................................ R.A. 17
Berkeley Lovelace, Jr. & William Feuer, CDC Confirms First Human-toHuman Transmission of Coronavirus in US,
CNBC (Jan. 30, 2020) ......................................................................... R.A. 1
Centers for Disease Control and Prevention ("CDC"), Coronavirus
Disease
2019
–
Frequently
Asked
Questions,
https://www.cdc.gov/coronavirus/2019-ncov/faq.html (last visited May
26, 2020) ............................................................................................ R.A. 21
Declaring a National Emergency Concerning the Novel Coronavirus
Disease (COVID-19) Outbreak, Proclamation No. 9994, 85 Fed. Reg.
15337-38 (2020)................................................................................. R.A. 60
Prioritizing and Allocating Health and Medical Resources to Respond to
the Spread of Covid-19, Exec. Order No. 13909,
85 Fed. Reg. 16227 (2020) ................................................................ R.A. 64
CDC, How to Protect Yourself & Others, Coronavirus Disease 2019
(COVID-19),
https://www.cdc.gov/coronavirus/2019-ncov/preventgetting-sick/prevention.html (last visited May 26, 2020) ............... R.A. 68
R.A. i
TABLE OF CONTENTS (cont’d)
Camilla Rothe, et al., Transmission of 2019-nCoV Infection from an
Asymptomatic Contact in Germany, N. ENGL. J. MED. 382:970–71 (Mar.
5, 2020) .............................................................................................. R.A. 71
Lea Hamner, et al., CDC, High SARS-CoV-2 Attack Rate Following
Exposure at a Choir Practice—Skagit County, Washington, March 2020,
Morbidity
and
Mortality
Weekly
Report
(MMWR),
https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6919e6-H.pdf (last
visited May 26, 2020) ....................................................................... R.A. 74
Allison James, et al., CDC, High COVID-19 Attack Rate among
Attendees at Events at a Church, Arkansas, March 2020, MMWR,
https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6920e2-H.pdf (last
visited May 26, 2020) ....................................................................... R.A. 80
Isaac Ghinai, et al., CDC, Community Transmission of SARS-CoV-2 at
Two Family Gatherings, Chicago, Illinois, February-March 2020,
MMWR,
https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6915e1H.pdf (last visited May 26, 2020) ..................................................... R.A. 85
Youjin Shin, et al., How a South Korean Church Helped Fuel the Spread
of Coronavirus, WASH. POST (Mar. 25, 2020)................................... R.A. 91
Anna Kim, Glenview Church Hit by COVID-19 Is Now Streaming Service
Online, as Pastor Remembers Usher Who Died of Disease, CHICAGO TRIB.
(Mar. 31, 2020) .................................................................................... R.A. 6
Chris Epp, "I Would Do Anything for a Do-Over": Calgary Church Hopes
Others Learn from Their Tragic COVID-19 Experience, CTV NEWS (May
10, 2020) .......................................................................................... R.A. 111
R.A. ii
TABLE OF CONTENTS (cont’d)
Richard Read, A Choir Decided to Go Ahead with Rehearsal. Now Dozens
of Members Have COVID-19 and Two Are Dead, L.A. TIMES (Mar. 29,
2020) ................................................................................................ R.A. 117
Maggie Holmes, Two People Die of COVID-19 as a Result of Church
Gathering in KCK, KCTV NEWS5 (Apr. 8, 2020) .......................... R.A. 131
Bailey Loosmore & Mandy McLaren, Kentucky County "Hit Really,
Really Hard" by Church Revival that Spread Deadly COVID-19,
LOUISVILLE COURIER J. (Apr. 1, 2020) ............................................ R.A. 134
Mario Koran, California Megachurch Linked to Spread of More than 70
Coronavirus Cases, GUARDIAN (Apr. 3, 2020) ................................ R.A. 137
Dakin Andone & Artemis Moshtaghian, A Person Who Was Covid-19
Positive Attended a Church Service and Exposed 180 People, Officials
Say, CNN (May 17, 2020) ............................................................... R.A. 142
Johns Hopkins Univ., COVID-19 Dashboard, https://coronavirus.jhu.edu
/map.html (last visited May 27, 2020) ........................................... R.A. 147
CDC, Coronavirus Disease 2019 – Cases in the U.S.,
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.ht
ml (last visited May 27, 2020) ........................................................ R.A. 149
N.J. Dep't of Health, New Jersey COVID-19 Dashboard,
https://www.nj.gov/health/cd/topics/covid2019_dashboard.shtml
(last
visited May 27, 2020) ..................................................................... R.A. 156
R.A. iii
TABLE OF CONTENTS (cont’d)
Sheri Fink, Worst-Case Estimates for U.S. Coronavirus Deaths, N.Y.
TIMES (Mar. 13, 2020) ..................................................................... R.A. 158
Ashley Balcerzak, Nearly All Businesses in NJ Are Closed. Why Are
Liquor Stores Considered "Essential"?, MSN (Mar. 29, 2020) ..... R.A. 169
Press Releases, New Jersey Attorney General, Enforcement of COVID19 Restrictions (March 27, 2020; April 1, 2020; April 3, 2020; April 5-9,
2020; April 11, 2020; April 13, 2020; April 15-16, 2020; April 19, 2020;
April 24, 2020; May 8, 2020; and May 22, 2020)........................... R.A. 174
Carlie Porterfield, Church-Related Coronavirus Outbreaks Reported as
Trump Pushes for Reopening, FORBES (May 23, 2020) ................. R.A. 231
Zeeshan Aleem, One German Church Service Resulted in More Than 100
Coronavirus Infections, VOX (May 24, 2020) ................................. R.A. 235
Transcript of the Oral Decision of the Hon. Robert B. Kugler, U.S.D.J.,
Dwelling Place Network v. Murphy, Civil Action No. 20-6281
(June 15, 2020)................................................................................ R.A. 240
CDC,
Coronavirus
Disease
2019
–
About
Masks,
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/aboutface-coverings.html (last visited August 17, 2020) ....................... R.A. 329
Nathan W. Furukawa, et al., Evidence Supporting Transmission of
Severe Acute Respiratory Syndrome Coronavirus 2 While
Presymptomatic or Asymptomatic, EMERGING INFECTIOUS DISEASES 2020;
26(7) (July 2020), https://wwwnc.cdc.gov/eid/article/26/7/20-1595_article
......................................................................................................... R.A. 332
R.A. iv
TABLE OF CONTENTS (cont’d)
Seungjae Lee, et al., Clinical Course and Molecular Viral Shedding
Among Asymptomatic and Symptomatic Patients with SARS-CoV-2
Infection in a Community Treatment Center in the Republic of Korea,
JAMA
INTERNAL
MEDICINE
(Aug.
6,
2020),
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2769
235 ................................................................................................... R.A. 339
Kate Conger, et al., Churches Were Eager to Reopen. Now They Are
Confronting Coronavirus Cases, N.Y. TIMES (July 10, 2020) ....... R.A. 346
Chacour Koop, "It Spread Like Wildfire." How One Man at Church with
COVID-19 Led to 91 Cases in Ohio, KANSAS CITY STAR (Aug. 5, 2020)
......................................................................................................... R.A. 353
Taylor Stuck, Virus Outbreaks in Churches Continue, THE HERALDDISPATCH (Aug. 15, 2020) ............................................................... R.A. 356
Mike Valente, Berea Church Suspends In-Person Services after COVID19 Outbreak, LEX 18 (Aug. 12, 2020)............................................ R.A. 360
Payton Potter, Pastor Addresses Coronavirus Outbreak Linked To
Windham Church, PATCH (Aug. 10, 2020) ..................................... R.A. 363
Jenna Rae, COVID-19 Outbreak at Athens Church, WAFF 48, (Aug. 10,
2020) ................................................................................................ R.A. 367
CDC, Coronavirus Disease 2019 – Cases in the U.S.,
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.ht
ml (last visited Aug. 17, 2020) ....................................................... R.A. 369
R.A. v
TABLE OF CONTENTS (cont’d)
N.J. Dep't of Health, New Jersey COVID-19 Dashboard,
https://www.nj.gov/health/cd/topics/covid2019_dashboard.shtml
(last
visited Aug. 17, 2020) ..................................................................... R.A. 373
Coronavirus in the U.S.: Latest Map and Case Count, N.Y. TIMES,
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
(last visited Aug. 17, 2020) ............................................................. R.A. 375
Madeline Holcombe & Dakin Andone, Experts Say US Is Not Doing
Enough To Contain Covid-19 As Nation Approaches 5 Million Cases,
CNN (Aug. 8, 2020)......................................................................... R.A. 389
CDC, Coronavirus Disease 2019 – Deciding to Go Out,
https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/deciding-togo-out.html (last visited Aug. 17, 2020) ........................................ R.A. 395
Peter Sullivan, Evidence Mounts That Outside Is Safer When It Comes
to COVID-19, THE HILL (May 6, 2020) .......................................... R.A. 400
Tara Parker-Pope, How Safe Are Outdoor Gatherings?, N.Y. TIMES (July
5, 2020) ............................................................................................ R.A. 404
Are Outdoor Gatherings Safe? Here's What Experts Say, ADVISORY
BOARD, (July 17, 2020) ................................................................... R.A. 409
Press Release, CDC, CDC Calls On Americans to Wear Masks to Prevent
COVID-19 Spread, (July 14, 2020) ................................................ R.A. 414
R.A. vi
TABLE OF CONTENTS (cont’d)
Susanna Esposito, et al., Universal Use of Face Masks For Success
against COVID-19: Evidence and Implications for Prevention Policies,
EUROPEAN RESPIRATORY J. (Apr. 21, 2020) .................................... R.A. 419
Xiaowen Wang, et al., Association Between Universal Masking in a
Health Care System and SARS-CoV-2 Positivity Among Health Care
Workers, J. OF THE AM. MED. ASS'N (July 14, 2020) ...................... R.A. 429
M. Joshua Hendrix, et al., Absence of Apparent Transmission of SARS-
CoV-2 from Two Stylists after Exposure at a Hair Salon with a Universal
Face Covering Policy—Springfield, Missouri, May 2020, MMWR (July 17,
2020) ................................................................................................ R.A. 432
Diana Kwon, How Face Masks Can Help Prevent the Spread of COVID19, THE SCIENTIST (July 8, 2020) ................................................... R.A. 436
Trisha Greenhalgh, Face Coverings for the Public: Laying Straw Men to
Rest, J. OF EVALUATION IN CLINICAL PRACTICE (May 6, 2020) ...... R.A. 442
Siddhartha Verma, et al., Visualizing the Effectiveness of Face Masks in
Obstructing Respiratory Jets, PHYSICS OF FLUIDS 32, 061708 (June 30,
2020) ................................................................................................ R.A. 451
Philip Anfinrud, et al., Visualizing Speech-Generated Oral Fluid
Droplets with Laser Light Scattering, N. ENGL. J. OF MED.
(Apr. 15, 2020) ................................................................................ R.A. 460
Abhiteja Konda, et al., Aerosol Filtration Efficiency of Common Fabrics
Used in Respiratory Cloth Masks, ACS NANO (Apr. 24, 2020)..... R.A. 463
R.A. vii
TABLE OF CONTENTS (cont’d)
Jeremy Howard, et al., Face Masks Against COVID-19: An Evidence
Review, PROCEEDINGS OF THE NAT'L ACAD. OF SCI. OF THE UNITED STATES
OF AMERICA (Apr. 10, 2020) ............................................................ R.A. 473
New IHME COVID-19 Forecasts See Nearly 300,000 Deaths by
December 1, However, Consistent Mask-Wearing Could Save about
70,000 Lives, INST. FOR HEALTH METRICS AND EVALUATION
(Aug. 6, 2020) .................................................................................. R.A. 482
Andy Markowitz, State-by-State Guide to Face Mask Requirements,
AARP,
https://www.aarp.org/health/healthy-living/info-2020/statesmask-mandates-coronavirus.html
(last visited Aug. 17, 2020) ............................................................. R.A. 488
Wei Lyu & George L. Wehby, Community Use of Face Masks And
COVID-19: Evidence From A Natural Experiment Of State Mandates In
The US, HEALTH AFFAIRS (June 16, 2020) ..................................... R.A. 510
Christopher T. Leffler, et al., Association of Country-Wide Coronavirus
Mortality with Demographics, Testing, Lockdowns, and Public Wearing
of Masks (July 2, 2020)................................................................... R.A. 518
CDC, Coronavirus Disease 2019 – How to Wear Masks,
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-towear-cloth-face-coverings.html (last visited Aug. 17, 2020) ......... R.A. 603
German Lopez, Just 6 States Meet These Basic Criteria to Reopen and
Stay Safe, VOX (July 22, 2020) ....................................................... R.A. 606
R.A. viii
TABLE OF CONTENTS (cont’d)
Covid Act Now, New Jersey, https://covidactnow.org/state/NJ?s=844163
(last visited Aug. 17, 2020) ............................................................. R.A. 619
Johns Hopkins University & Medicine, COVID-19 Dashboard,
https://coronavirus.jhu.edu/map.html
(last visited Aug. 17, 2020) ............................................................ R.A. 628
CDC, Coronavirus Disease 2019 – Considerations for Wearing Masks,
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/clothface-cover-guidance.html
(last visited Aug. 17, 2020) ............................................................. R.A. 633
Holly Yan, 200,000 people have died from COVID-19 in the US. That's
more than the US battle deaths from 5 wars combined, CNN (Sept. 22,
2020) ................................................................................................ R.A. 639
Joel Achenbach and Rachel Weiner, Experts project autumn surge in
coronavirus case, with a peak after Election Day, WASH. POST (Sept. 5,
2020) ................................................................................................ R.A. 644
IMHE
Model,
https://covid19.healthdata.org/united-states-ofamerica?view=total-deaths&tab=trend
(last visited Sept. 22, 2020) ............................................................ R.A. 648
Mathieu Pollet, Coronavirus second wave: Which countries in Europe are
experiencing a fresh spike in COVID-19 cases?, EURONEWS (Sept. 22,
2020) ................................................................................................ R.A. 654
Associated Press, Eighth death linked to Millinocket wedding outbreak,
(Sept. 19, 2020) ............................................................................... R.A. 659
R.A. ix
TABLE OF CONTENTS (cont’d)
Rachel Needham, Anatomy of an Outbreak: Church Revival Blamed for
Many of Rural County's COVID-19 Cases, RAPPAHANNOCK NEWS (Aug.
29, 2020) .......................................................................................... R.A. 664
Aubrey Whelan & Ellie Silverman, After Philly's First Church-linked
COVID-19 Outbreak, Pastors Urge Prayers for Sick, PHILA. INQUIRER
(Aug. 21, 2020) ................................................................................ R.A. 669
George Stockburger, Chemung County Releases New Details in
Lighthouse Baptist Church COVID-19 Cluster Death, WETM 18 (Sept.
17, 2020) .......................................................................................... R.A. 672
Covid
Act
Now,
New
Jersey,
https://www.covidactnow.org/us/nj?s=1059230 (last visited Sept. 22,
2020) ................................................................................................ R.A. 675
CDC, COVID Data Tracker,
https://covid.cdc.gov/covid-datatracker/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavir
us%2F2019-ncov%2Fcases-updates%2Fcases-inus.html#cases_deathsper100k (last visited Sept. 22, 2020) ......... R.A. 684
CDC,
COVID
Data
Tracker,
https://covid.cdc.gov/coviddatatracker/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoro
navirus%2F2019-ncov%2Fcases-updates%2Fcases-inus.html#cases_deathsinlast7days (last visited Sept. 22, 2020) ... R.A. 688
CDC, COVID Data Tracker,
https://covid.cdc.gov/covid-datatracker/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavir
us%2F2019-ncov%2Fcases-updates%2Fcases-inus.html#cases_casesper100k (last visited Sept. 22, 2020) ........... R.A. 691
R.A. x
TABLE OF CONTENTS (cont’d)
Orion Rummler, CDC Director Suggests Face Masks Offer More COVID19 Protection Than Vaccine Would, AXIOS
(Sept. 16, 2020) ............................................................................... R.A. 700
Dr. Francis Collins, Masks Save Lives, NIH DIRECTOR'S BLOG
(Aug. 25, 2020) ................................................................................ R.A. 703
Colin J. Worby & Hsiao-Han Chang, Face Mask Use in the General
Population and Optimal Resource Allocation During COVID-19
Pandemic, NATURE COMMC'NS (Aug. 13, 2020) .............................. R.A. 708
CDC,
Coronavirus
Disease
2019
–
Social
Distancing,
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/socialdistancing.html (last visited Nov. 6, 2020).................................... R.A. 736
CDC,
How
COVID-19
Spreads,
https://tools.cdc.gov/api/v2/resources/media/407478/content.html
(last
visited Nov. 6, 2020) ....................................................................... R.A. 740
Nevada Declaration of Emergency Directive 022
(June 9, 2020).................................................................................. R.A. 744
CDC, Interim Guidance: Get Your Mass Gatherings or Large Community
Events Ready for Coronavirus Disease 2019 (COVID-19) (last visited
Nov. 6, 2020) ................................................................................... R.A. 750
R.A. xi
TABLE OF CONTENTS (cont’d)
Lindy Washburn, The Second Coronavirus Wave is here in NJ. Here's
Why It's Different from Last Time, NORTHJERSEY.COM (last updated Oct.
21, 2020), http://www.northjersey.com/story/news/coronavirus/2020/10/1
9/covid-nj-cases-second-wave-hits-heres-why-its-differenttime/3676551001/............................................................................ R.A. 757
Brent Johnson, N.J. Reports 2,472 new COVID-19 Cases, 9 More Deaths
— 2nd Time in a Week with more Than 2,000 Cases, NJ.COM (last
updated Nov. 5, 2020) ..................................................................... R.A. 763
Matt Arco, N.J. Reports 2,104 New COVID-19 Cases, 12 New Deaths as
Second Wave Spike Escalates, NJ.COM
(last updated Nov. 5, 2020) ............................................................ R.A. 772
Brent Johnson, N.J.'s Second Wave of COVID-19 Outbreak May Not
Peak Until Early Next Year, Health Official Says, NJ.COM
(Nov. 3, 2020) .................................................................................. R.A. 781
William Wan and Jacqueline Dupree, U.S. Hits Highest Daily Number of
Coronavirus Cases Since Pandemic Began,
WASH. POST. (Oct. 23, 2020) ........................................................... R.A. 786
R.A. xii
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in the
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of 2019
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Editor's Nate: This article was published ors January 31, 2020, at NEJM.crg.
U RlGINAL ARTIC~.E
First Case of2019 Novel Coronavirus in the United
States
M ichelle L. Holshue, M.P.H., Chas DeBolt, M.P.H., Scott Lindquist, M.D., Kathy H. ~ofy, M.D.,
J ohn Wiesman, Dr.P.H., Hollianne Bruce, M.P.H.,Christopher Spitters, M.D., {<eith Ericson,
P.A.-C., Sara V(/i l l<erson, M.N., Ahmet Tural, M.D., George Diaz, f~I.D., Amanda Cohn, M.D.,
LeAnne Fox, M.D., Anita Patel, Pharm.D., Susan I. Gerber, M.D., Lindsay i<im, M.D., Suxiang
Tong, Ph.D., Xiaoyan Lu, M.S., Steve Lindstrom, Ph.D., Marf< A. Pallansch, Ph.D., Wiliam C.
Weldon, Ph.D., Holly M. Biggs, M.D., Timothy M. Uyel<i, M.D., and Satish I<. Pillai, M.C~.et,_al.~ 'for
the Washington State 2019-nCoV Case Investigation Team`
M arch 5, 2020
N Eng)) Med 2020; 382:929-936
DOI: 10.1055/N EJ Moa2001191
Chinese Translation ~~Z~~~1~
Figures/Media
Article
M etrics
20 References
569 Citing Articles
Letters
Related Articles
Summary
https://www.nejm.ol~g/doi/full/10.1056/NEJMoa2001 191
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~ NEJM
United
in the
Novel Coronavirus
of 2019
First
An outbreak of novel coronavirus (2019-nCo~~) that bean in VVuh~n, China, has spread rapidly,
with cases now confirmed in multiple cotllltries. We report the first case of2019-11CaV infectiotl
C011fll"I11eC~ 111 t11e UI11teC~ St~teS 1110 C~eSCrl~e t~1e 1C~e11t1f1C~1tI011, C11ag17OS1S, ~C~111IC~1 COt1I"Se, a11C~
management ofthe case, including the patient's initial mild symptoms at presentation with
progression to pneumonia on day 9 ofillness. This case highlights the importance of close
coordination between clinicians and public health authorities at the local, state, and federal levels,
as well as tale need for rapid dissemination of clinical information related to the care of patients
with this emerging infection.
v
Introduction
N DECEMBER 31, 2019, CHINA REPORTED A CLUSTER OF CASES OF PNEUMONIA IN
people associated with the Huanan Seafood Wholesale Market in Wuhan, Hubei
I~rovince.l On January 7, 2020, Chinese health authorities confirmed that this cluster
was associated with a novel coronavirus, 2019-nCoV.2 Although cases were originally reported to
be associated with exposure to the seafood market in Wuhan, cul•rent epidemiologic data indicate
that person-to-person transmission of2019-nCoV is occurring.3-~~ As ofJanuary 30, 2020, a total of
9976 cases had been reported in at least 21 countries, includilzg the first confirmed case of2019nCoV infection in the United States, reported on January 20, 2020. Investigations are under way
worldwide to better understand transmission dynamics and the spectrum of clinical illness. This
report describes the epidemiologic and clinical features ofthe first case of201.9-nCoV infection
confirmed in the United States.
v
Case Report
On January 19, 2O20, a 35-year-old man presented to an urgent care clinic in Sllohoznisll County,
Washington, with a 4-day history of cough aild subjective fever•. O11 CI1eCIC111~ llli0 tI12 CII111C, t11e
patient put on a mask in t11e ~~~aitillg r-ooln. After- waiting appi-oxilnately ?0 iz~illutes, lle was talcell
lIZtO ~I1 eYZ1I1111~t1011 I001~71 ~IZC~ ll11C~er~uent evaluation by a provider. He disclosed that he had
returned to t~Vasllillgtoll State on )alluar~~ 15 after tr~~veling to visit famil~~ il~ ~~Vtihall, C11in~. The
patient stated that he had seen a health alert from the U.S. Centers for Disease Control and
1?1-evetltioll(CDC)about t11e Izovel corollavirus outbreal: il~ Chula and, because of his syinptoll~s
and recent travel, decided to see a health care provider.
Figure 1.
https://www.nejln.ol-g/doi/full/10.1056/NEJMoa?001 191
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~ NEJM
United
~n the
Novel Col•onavil~us
of 2019
First
Posteroanterior and Lateral Chest Radiographs, January 19, 2020 (I llness Day 4).
Apart from a history of hypertriglyceridemia, the patient was an otherwise healthy nonsmoker.
The physical examination revealed a body temperature of37.2°C, blood pressure of134/S7 mIn Hg,
pulse of110 beats per minute, respiratory rate of16 breaths per minute, and oxygen saturation of
96% while the patient was breathing ambient air. Lung auscultation revealed rhonchi, and chest
radiography was performed, which was reported as showing no abnormalities (Figure 1). A rapid
nucleic acid amplification. test(NAAT)for influenza A and B was negative. A nasopharyngeal swab
specimen was obtained and sent for detection ofviral respiratory pathogens by NAAT; this was
reported back within 48 hours as negative for all pathogens tested, including influenza A and B,
parainfluenza, respiratory syncytial virus, rhinovirus, adenovirus, alld four common coronavirus
strains known to cause illness in humans(HKU1, NL63,?29E, and OC43).
Given the patient's travel history, the local and state health departments were immediately
notified. Together with the urgent care cliiliciai~, the Wasl~iilgtoll Department of Health notified
the CDC E1ne1-gency Operations Center. Altl7oug11 t11e patient reported that he had not spent time
~t the Huanaiz seafood market and repol-ted no known contact with ill persons during his travel to
China, CDC staffconcurred with tl~e need to test the patient for ?019-nCoV o11 t~~e basis of current
CDC "persons under investigation" case definitions. Specimens were collected in accordance with
CDC guidance end included serum and nasopharyngeal znd o1-oph~l-~~ngeal swab specimens. after
specimen collection, t11e patient was discll~rged to home isolation v~~ith active i~~lonitorin~ vy the
local health department.
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On January 20, 2020, the CDC confir~lled that tl~e patient's nasophai-~~ngeal arld oroplzarynbeal
swabs tested positi~Je for 2019-nCoV by real-tinge ~~everse-transc~iptase—polymerise-chair-reaction
(rKT-PLR) assay. In coordination with CDC subject-matter experts, state and local health officials,
emergency medical services, and hospital leadership and staff, the patient was admitted to an
airborne-isolation unit at Providence Regional Medical Center for clinical observation, with health
care workers following CDC recommendations for contact, droplet, and airborne precautions with
eye protection.
O11 admission, the patient reported persistent dry cough. and a 2-day ~listory ofnausea a11d
V01111t1I1g; he reported that he had no shortness of breath or chest pain. Vital signs were within
normal ranges. On physical examination, the patient was found to have dry mucous membranes.
The remainder ofthe examination was generally unremarkable. After admission, the patient
received supportive care, including 2liters of normal saline and ondansetron for nausea.
Figure 2.
~~~p~~~~
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Symptoms and Maximur~r~ body Tem~er~ture~ Acc~~~aing to Day of I llness ar~d Day o~ Hospitalization, J~:nuary
16 to Jaruary 30, 2020.
On da~~s 2 throtlah 5 of hospitalization (days 6 t~~rough 9 ofillness), the patient's vital sighs
rem~ir~ed lal-gely stable, ~~part from the de~~elopl~lel~t ofintermittent fevers ~~ccol~lpanied by
periods cif taclzycat-dia (Figure 2). Tl~e patient continued to report a nonproductive cou~11 al~ld
~~ppeared fatigued. O1~ the afternoon of hospital da~~ ?, the ~~atient passed ~~ loose bowel move~~~lent
hops://www.nejm.ol-g/doi/full/10.1056/NEJMoa2001191
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and reported abdominal discomfort. A second episode ofloose stool was reported overnight; a
sample of this stool was collected for rRTPCR testing, along with additional respiratory
specimens (nasopharyngeal and oropharyngeal) and serum. The stool and both respiratory
specimens later tested positive by rRTPCR for 2019-nCoV, whereas the serum remained negative.
Treatment during this time was largely supportive. For symptom management, the patient
received, as needed, antipyretic therapy consisting of650 mg ofacetaminophen every 4 hours and
6001ng ofibuprofen every 6 hours. He also received 600 mg ofguaifenesin for his continued
cough and approximately 6liters ofnormal saline over the first 6 days of hospitalization.
Table 1.
T~~~ '1. ~ia~4~~c1 E,~ar~4c~ry ~t~~~ef3s„~
AA~~~ure
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jf'CC~if~la ,~3P,' ffC~~ ~4✓~~.-O{.Q;dt~` 3~,7~~.'O::s4'~ a~T`..j)~f;~n, r {t~~~iP ~ 4~:"x.i,3Pi ~s.
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Cl inical Laboratory Results.
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The nature ofthe patient isolation unit permitted only point-of-care laboratory testing initially;
complete blood counts and serum chemical studies were available starting on hospital day 3.
Laboratory results on hospital days 3 and.5 (illness days 7 and 9)reflected leulcopenia, mild
thrombocytopenia, and elevated levels of creatine kinase (Table 1). In addition, there were
alterations in hepatic function measures: levels ofalkaline phosphatase (68 U per liter), alanine
aminotransferase (105 U per liter), aspartate aminotransferase (77 U per liter), and lactate
dehydrogenase (465 U per liter) were all elevated on day 5 of hospitalization. Given the patient's
recurrent fevers, blood cultures were obtained on day 4; these have shown no growth to date.
Figure 3.
Posteroanteriorand Lateral Chest Radiographs, January 22, 2020 (I llness Day 7, Hospital Day 3).
Figure 4.
hops://www.nejl~~.oi-g/doi/full/ 10.1056/NEJMoa?001191
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Posteroanterior Chest Radiograph, January 24, 2.020 (I l lness Day 9, Hospital Day 5).
A chest radiograph talzen on hospital day 3 (illness day 7) was reported as showing no evidence of
infiltrates or abnormalities (Figure 3). However, a second chest radiograph from the night of
hospital day 5 (illness day 9)showed evidence of pneumonia in the lower lobe of the left lung
(Figure 4). These radiographic findings coincided with a change in respiratory status starting on
the evening of hospital day 5, when the patient's oxygen saturation values as measured by pulse
oximetry dropped to as low as 9U% while he was breathing ambient air. On day 6, the patient was
started on sttppletnent~l oxygen, delivered by nasal cannula at 21ite1-s per minute. Given the
changing clinical presentation and concern about hospital-acquired pneumonia, treatment with
vancomycin (a 1750-1ng loading dose followed by 1 g administet-ed intravenously every 8 hours)
end cefepitne (adr~~illisterec~ izltravel~ously evel-y S ho~zrs) was initiated.
Figure 5.
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~~
Y
~,.
fo^S~
y
s~~i
r:t
'~:
Anteroposterior and Lateral Chest Radiographs, January 26, 2020 ~1 11ness Day 10, Hospital Day 6).
On hospital day 6 (illness day 1U), a fourth chest radiograph showed basilar streal~~ opacities i11
both lungs, a finding consistent with atypical pneumonia (Figure 5), and rales were noted in both
lungs on auscultation.. Given the radiographic findings, the decision to administer oxygen
supplementation, the patient's ongoing fevers, the persistent positive 2019-nCoV RNA at multiple
sites, and published reports ofthe development ofsevere pneumonia3~4 at a period consistent with
the development ofradiographic pneumonia in this patient, clinicians pursued compassionate use
ofan investigational antiviral therapy. Treatl~lent with intravenous remdesivir (a novel nucleotide
analogue prodrug in development~o,11) was initiated on the evening of day 7, and no adverse events
were observed in association with the infusion. Vancomycin was discontinued on the evening of
day 7, and cefepime was discontinued on the following day, after serial negative procalcitonin
levels and negative nasal PCR testing for methicillin-resistant Staph~Iococcus au~~eus.
On hospital day 8 (illness day 12), the patient's clinical condition improved. Supplemental oxygen
was discontinued, and his oxygen saturation values improved to 94 to 96%while he was breathing
ambient air. The previous bilateral lower-lobe rales were no 1o11ger present. His appetite improved,
and lze was asymptomatic aside from intermittent dry cough and rhinorrhea. As ofJanuary 30,
200,the patient remains hospitalized. He is afebrile, and all symptoms have resolved with the
exception of his cough, which is decreasing in severity.
Methods
S PECIMEN COLLECTION
CII171C~1 S~JeC1111eI1S f0i" ~~1~)-I1~,OV C~1~~110St1C ~eSt1I1£~ Wele O~Jta111eC~ IIl 1CCOI"d~I1Ce Wlt~1 CSC
~L11C~eIlIZeS.12 N~1S0~~11I~T11~e~~1 ~lI1C~ O10~~11I~~~ngeal swab specimens were collected with synthetic
filer swabs; eac11 stivab was i1~lserted into a separate stel-ile tube containi~lg 2 to 3 ml ofviral
transport medium. Sertu~l was collected i11 a serul~~ separator tube aF1d then centrifuged in
accordance ~~~ith CDC guidelines. The ~lriile and stool specimens wel-e each collected in sterile
specimen containers. Specimens were stored between 2°C al~d 8°C until ready for shipmel~lt to the
CDC. Specimelzs fol~ repeat 201.9-r1CoV testil~g were collected on illness days 7, 11, azld 1.2 and
included nasophar~-ngeal end oropharyngeal swabs, serum, and urine and stool samples.
https://www.nejl~~.oi~g/doi/full/10.1056/NEJMoa2001191
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DIAGNOSTIC TESTING FOR 2019-NCOV
Clinical specimens were tested with an rRT-PCR assay that was developed from the publicly
released virus sequence. Similar to previous diagnostic assays for severe acute respiratory
syndrome coronavirus(BARS-CoV)and Middle East respiratory syndrome coronavirus(MERSCoV), it has three nucleocapsid gene targets and a positive control target. A description of this
assay13 and sequence information for the rRTPCR panel primers and probesl~ are available on the
CDC Laboratory Information website for 2019-nCoV.15
G ENETIC SEQUENCING
On January 7, 2020, Chinese researchers shared the full genetic sequence of2019-nCoV through
the National Institutes ofHealth GenBank databasel~ and the Global Initiative on Sharing All
Influenza Data (GISAID)l~ database; a report about the isolation of2019-n~oV was later
published.1S Nucleic acid was extracted from rRT-PCR—positive specimens (oropharyngeal and
nasopharyngeal) and used for whole-genoine sequencing on both Sanger and next-generation
sequencing platforms (Illumina and MinIon). Sequence assembly was completed with the use of
Sequencher software, version 5.4.6 (Sanger); minimap software, version 2.17(MinIon); and
freebayes software, version 1.3.1 (MiSeq). Complete genomes were compared with the available
2019-nCoV reference sequence (GenBank accession number NC_045512.2).
Results
S PECIMEN TESTING FOR 2019-NCOV
Table 2.
~~ 1 2. R~sc~1t~ ~f ~~~ly~ime R~v~r~~4~~~~cri~t~s+~—~t~lyr~~~:r~s~»~~~r~-~
~r~r~r~~a~ir~s (~~13-r~~aV~.~=
I~Ir~~s~ Day ~
Specirn~r~
Illness Day 7
c#i~n T'~~iri
s~~ #
11lne~~ flay 11
~~I9 t*Jav~[
1[~r~ess flay ~~
i'C~'~~5,~~~
~~~~~~4rf~
~~t.7~E~~~~
t'"d~~~~~~
(mot. 18-2(~~
~Ct, 23-~ ~
~C~, 33-:~ )
~~'~, 3i-~~
F"~+~~~~~'A~~'
~'~J~~"~~~~~
P~~~~~~~Sr~'~
I''~~"~c~~~'4f~
i~r~rr~
P~1~~~ti~c~
J~~~-~ti~r~
~'~c i r~~
F'e~t~~g
t,~~ir~~e
i~`
l~~~tiv~
t~l~'
t`•9
~tt~~
OJT
P+~s tiue
~~t; 3E~-3g~
!'~1~
~`J
~~c~+ 'S E~~.}~l t~~~~~1 ~
'
'..1~''w'
~~s~~~~C~
1~~
#~~I ~4~JY~~
,~~~.~~~r t~~~i~ t~~~~~~hc~l (~t~ ~~~ues indic~t~ &~i~~~r ~~r~l Ic~~c~~. NT ertc~re~ r~t.t tes~~~l.
:
https://www.nejm.org/doi/full/10.1056/NEJMoa2001191
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Results of RearT~r~ne Reverse--franscr~pt~S~--POIV~7~~ruSP-C~a!rl - ReUction ~T"estir~g for t{~e ~~i9 ~~lovei
Coronavirus X2019-r~CoV).
The initial respiratory specimens (nasopharyngeal and oropharyngeal swabs) obtained fi-om this
patient o11 day 4 of his illness were positive for 2019-nCoV (Table 2). The low c~~cle threshold (Ct)
values (18 to 20 in ~zasopharyngeal specimens and 21 to 22 izl oroph~ryngeal specimens) on illl~ess
day 4 suggest high levels of~~irus in these speciil~ens, despite the patient's initial mild syi~nptoln
presentation. Both tipper respil:atory specimens obtained on illness day 7 remained positive for
2019-nCoV, including persistent high levels in a nasopharyngeal swab specimen (Ct values, 23 to
24). Stool obtained or1 illness day %was also positive for 2019-nCoV (Ct values, 36 to 38). Serum.
specimens for both collection dates were negative for 2019-nCoV. Nasopharyngeal and
oropharyngeal specimens obtained o11 illness days 11 and 12 showed a trend toward decreasing
levels ofvirus. The oropharyngeal specimen tested negative for 2019-nCoV on illness day 12. The
rRT-PCR results for serum obtained on these dates are still pending.
G ENETIC SEQUENCING
The full genotne sequences from oropharyngeal and nasopharyngeal specimens were identical to
one another and were nearly identical to other available ?019-nCoV sequences. There were only 3
nucleotides and 1 amino acid that differed at open reading frame 8 between this patient's virus and
the 2019-nCoV reference sequence (NC_04551.2.2). The sequence is available through GenBank
(accession number I~IN985325).1C
Discussion
Our report of t11e first confirmed case of2019-nCoV in the United States illustrates several aspects
of t~lis einer~irl~ outbreak that are Izot ~~et full~~ uncierstooc~, including transmission dynamics and
the full spectrum of clinical illness. Our c~~se patient had tra~~eled to Wuhan, China, but reported
t11~t he glad not visited t~~~e wholesale seafood market or health cafe facilities or had any sicl:
col~tacts during 11is stay In Wuhan. a1tllotlgh t11e sout-ce of his 201.9-nCoV infection is unknown,
evidence ofperson-to-person transmission has been published. Through January 30, 2020, no
secondary uses of2019-nCoV related to this case Have been identified, lout nzorlitori~lg of close
contacts corltinue~."
Detection of 2019-~~CoV RNA i11 specil~~ells from the tipper respiratory tract with low Ct values on
da~~ ~ and da~~ 7 of illl~ess is suggestive of High viral loads and potential for transmissibility. It is
notable that ~~~e also detected Z0~19-nCoV RI~TA i11 a stool specimen collected on day 7 of the
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patient's illness. Although serum specimens from our case patient were repeatedly negative for
2019-nCoV, viral RNA has been detected in blood in severely ill patients in China.4 However,
eYtrapulmonary detection ofviral RNA does not necessarily mean that infectious virus is present,
and the clinical significance ofthe detection ofviral RNA outside the respiratory tract is unknown
at this time.
Currently, our understanding ofthe clinical spectrum of2019-nCoV infection is very limited.
Complications such as severe pneumonia, respiratory failure, acute respirator y distress syndrome
CARDS), and cardiac injury, including fatal outcomes, have been reported in China.~~is~20 However,
it is important to note that these cases were identified on the basis of their pneumonia diagnosis
and thus may bias reporting toward more severe outcomes.
Our case patient initially presented with mild cough and low-grade intermittent fevers, without
evidence ofpneumonia on chest radiography on day 4 of his illness, before having progression to
pneumonia by illness day 9. These nonspecific signs and symptoms of mild illness early in the
clinical course of2019-nCoV infection may be indistinguishable clinically from many other
common infectious diseases, particularly during the winter respiratory virus season. In addition,
the timing of our case patient's progression to pneumonia on day 9 ofillness is consistent with
Iater onset ofdyspnea (at a median of8 days from onset) reported in a recent publication.4
Although a decision to administer remdesivir for compassionate use was based on the case
patient's worsening clinical status, randomized controlled trials are needed to determine the
safety and efficacy ofremdesivir and any other investigational agents for treatment of patients with
2019-nCoV infection.
We report the clinical features ofthe first reported patient with 2019-nCoV infection in the United
States. Ivey aspects of this case included the decision made by the patient to seek medical attention
after reading public health warnings about the outbreak; recognition of the patient's recent travel
history to Wuhan by local providers, with subsequent coordination among local, state, and federal
public health officials; and identification of possible 2019-nCoV infection, which allowed for
prompt isolation of the patient and subsequent laboratory confirmation of2019-nCoV, as well as
for admission ofthe patient for further evaluation and management. This case report highlights
the importance of clinicians eliciting a recent history of travel or exposure to sick contacts in any
patient presenting for medical care with acute illness symptoms, in order to ensure appropriate
identification and prompt isolation of patients who may be at risk for 2019-nCoV infection and to
help reduce further transmission. Finally, this report highlights the need to determine the full
spectrum and natural histor~~ of clinical disease, pathogenesis, and duration of viral shedding
~SSOC11ted W1t11 2019-I1COV lIlfeCt10I1 t0 111fO11T1 CIlI11C11 IZ1a111geI11eI1t a11C~ pUvI1C ~Zealtll C~eC1S10I1
makinb.
hops://www.nejl-n.ol~g/doi/full/10.1056/NEJMoa2001191
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Funding and Disclosures
v
Disclosure forll~s provided by the authors are available with the full text of this article at NE~M.org.
The findings and conclusions in this report are those of t11e authors and do not necessarily
represent tale official position of the Centers for Disease Control and Prevelztion.
This article was published on January 31, ?020, at NEJN1.org.
We thank the patient; the nurses and clinical staffwho are providing care for the patient; staffat
the local and state health departments; staffat the Washington State Department ofHealth Public
Health Laboratories and at the Centers for Disease Control and Prevention(CDC)Division of Viral
Disease Laboratory; CDC staffat the Emergency Operations Center; and members ofthe 2019nCoVresponse teams at the local, state, and national levels.
v
Author Affiliations
From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and
Respiratory Diseases (A.C., L.F., A.P.), the Division ofViral Diseases (S.I.G., L.K., S.T., X.L., S.
Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division ofPreparedness
and Emerging Infections (S.I~.P.), Centers for Disease Control and Prevention, Atlanta; and the
Washington State Department ofHealth, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.),
Snohomish Health District(H.B., C.S.), Providence Medical Group (I~.E.), and Providence Regional
Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington
School of Medicine, Seattle (C.S.) —all in Washington.
Address reprint requests to Ms. Holshue at the Washington State Department ofHealth I~ublic Health
Laboratories, 1610 NE 150th St., Shoreline, WA 98155, or at michelle.holshue(a~doh.wa.gov.
A full list ofthe members ofthe Washington State 2019-nCoV Case Investigation Team is provided in the
Supplementary Appendix, available at NEJM.org.
Supplementary Material
S upplementary Appendix
hops://www.nejl~n.ol-g/doi/full/10.1056/NEJMoa2001191
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Qisclo~~~re Forms
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~`los~ Rcfer~~ncer
v
Citing Articles
'~
!#::`:
Letters
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OutL~r~eak
-WSJ
Investigating
PneLu~~onia
Scientists
New Virus
Discovered
WORLD ~ ASIA ~ CHINA
New Vitus Discovered by Chinese
Scientists Investigating Pneumonia
Outbreak
Latest tally of people sickened in Wuhan is 59, with seven in critical
condition
By Natasha Khan
Updated Jan. 8, 2020 8:3o pm ET
HONG KONG—Chinese scientists investigating a mystery illness that has sickened
dozens in central China have discovered a new strain of coronavirus, a development that
will test the country's upgraded capabilities for dealing with unfamiliar infectious
diseases.
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Coi~onavirus(COVID-19)frequently asked c~uest~ons ~ CDC
~~ ~ ~~
~~~ ~
38
Centers for Disease Control and Prevention
~~/j,~~~ CDC 24/7: Saving Lives, Protecting PeopleT"^
Coronavirus Disease 2019(COVID-19)
Frequently Asked Questions
U pdated May 24, 2020
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Other Frequently Asked Questions and Answers About:
Travel
Personal Protective Equipment
Water Transmission
K-12 Schools and Child Care Program Administrators
Healthcare Professionals
Community events: for administrators and individuals
Healthcare Infection
Retirement Communities and Independent Living
Facilities
Laboratory Viral Panels
Correctional and Detention Facilities
Laboratory Biosafety
Event Organizers &Individuals
General Business
Cloth Face Coverings
Help control the spread of rumors and be aware of fraud schemes.
• Coronavirus Rumor Control [~ (FEMA)
• COVID-19 Fraud Alert C~ (Office of the Inspector General)
Coronavirus Disease 2019 Basics
W hat is a novel coronavirus?
A novel coronavirus is a new coronavirus that has not been previously identified. The virus causing coronavirus
disease 2019 (COVID-19), is not the same as the coronaviruses that commonly circulate among humans and cause
m ild illness, like the common cold.
A diagnosis with coronavirus 229E, NL63, OC43, or HKU1 is not the same as a COVID-19 diagnosis. Patients with
COVID-19 will be evaluated and cared for differently than patients with common coronavirus diagnosis.
W hy is the disease being called coronavirus disease 2019, COVID-19?
~
On February 11, 2020 the World Health Organization announced an official name for the disease that is causing the
2019 novel coronavirus outbreak, first identified in Wuhan China. The new name of this disease is coronavirus disease
2019, abbreviated as COVID-19. In COVID-19,'CO'stands for'corona,"VI'for'virus,' and 'D'for disease. Formerly, this
disease was referred to as "2019 novel coronavirus" or "2019-nCoV".
https://www.cdc.gov/coronavirus/2019-ncov/fac~.html
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Coronav~rus(COVID-~9) fi-~quently asked questions ~ CDC
~z ~
Tk~~ere are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract
illnesses. COVID-19 is a new disease, caused be a novel (or new)coronavirus that has not previously been seen in
h umans. The name of this disease was selected following the World Health Organization(WHO) best practice[~ for
naming of new human infectious diseases.
W hy might someone blame or avoid individuals and groups (create stigma) because of COVID-19?
People in the U.S. may be worried or anxious about friends and relatives who are living in or visiting areas where
COVID-19 is spreading. Some people are worried about getting the disease from these people. Fear and anxiety can
lead to social stigma,for example, toward people who live in certain parts of the world, people who have traveled
i nternationally, people who were in quarantine, or healthcare professionals.
Stigma is discrimination against an identifiable group of people, a place, or a nation. Stigma is associated with a lack of
knowledge about how COVID-19 spreads, a need to blame someone,fears about disease and death, and gossip that
spreads rumors and myths.
Stigma hurts everyone by creating more fear or anger toward ordinary people instead of focusing on the disease that
is causing the problem.
How can people help stop stigma related to COVID-19?
People can fight stigma by providing social support in situations where you notice this is occurring. Stigma affects the
emotional or mental health of stigmatized groups and the communities they live in. Stopping stigma is important to
m aking communities and community members resilient. See resources on mental health and coping during COVID-19.
Everyone can help stop stigma related to COVID-19 by knowing the facts and sharing them with others in your
community.
Why do some state's COVID-19 case numbers sometimes differ from what is posted on CDC's website?
CDC's overall case numbers are validated through a confirmation process with jurisdictions. The process used for
finding and confirming cases displayed by different places may differ.
How do CDC's COVID-19 case numbers compare with those provided by the World Health Organization
(WHO)orJohns Hopkins?
CDC's COVID-19 case numbers include many publicly reported numbers, including information from state, local,
territorial, international and external partners.
W hy do the number of cases for previous days increase?
Delays in reporting can cause the number of COVID-19 cases reported on previous days to increase.(Sometimes this
effect is described as "backfill.") State, local, and territorial health departments report the number of cases that have
been confirmed and share these data with CDC. Since it takes time to conduct laboratory testing, cases from a
previous day may be added to the daily counts a few days late.
COVID-19 and Hypertension
Are people with high blood pressure(hypertension)at higher risk from COVID- 79?
https://www.cdc.gov/coronavil~us/2019-ncov/fac~.html
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Coronavirus(COVID-19)frequently asked questions ~ CDC
~~~~
At this time, we do not think that people with high blood pressure and no other underlying health conditions are more
like{y than others to get severely iil from COVID-19. Although many people who have gotten severely iil from COVID-19
have high blood pressure, they are often older or have other medical conditions like obesity, diabetes, and serious
heart conditions that place them at higher risk of severe illness from COVID-19.
If you have high blood pressure, it's critically important that you keep your blood pressure under control to lower your
risk for heart disease and strokes. Take your blood pressure medications as directed, keep a log of your blood
pressure every day if you are able to take your blood pressure at home, and work with your healthcare team to make
sure your blood pressure is well controlled. Any changes to your medications should be made in consultation witf~
your healthcare team.
Should /continue to take my blood pressure medication?
Yes. Continue to take your blood pressure medications exactly as prescribed and make lifestyle modifications agreed
u pon in your treatment plan. Continue all your regular medications, including angiotensin-converting enzyme
i nhibitors(ACE-Is) or angiotensin receptor blockers (ARBs), as prescribed by your healthcare team. This is
recommended by current clinical guidelines from the American Heart Association, the Heart Failure Society of
A merica, and the American College of Cardiology
HoW COVID-19 Spreads
What is the source of the virus?
COVID-19 is caused by a coronavirus called SARS-CoV-2. Coronaviruses are a large family of viruses that are common
i n people and many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses
can infect people and then spread between people. This occurred with MERS-CoV and SARS-CoV, and now with the
virus that causes COVID-19. The SARS-CoV-2 virus is a betacoronavirus, like MERS-CoV and SARS-CoV. All three of these
viruses have their origins in bats. The sequences from U.S. patients are similar to the one that China initially posted,
suggesting a likely single, recent emergence of this virus from an animal reservoir. However, the exact source of this
virus is unknown.
M ore information about the source and spread of COVID-19 is available on the Situation Summary: Source and Spread
of the Virus.
How does the virus spread?
The virus that causes COVID-19 is thought to spread mainly from person to person, mainly through respiratory
d roplets 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. Spread is more likely when people are in close contact
with one another (within about 6 feet).
COVID-19 seems to be spreading easily and sustainably in the community("community spread") in many affected
geographic areas. Community spread means people have been infected with the virus in an area, including some who
a re not sure how or where they became infected.
Learn what is known about the spread of newly emerged coronaviruses.
W hy are we seeing a rise in cases?
https://www.cdc.gov/coi•onavirus/2019-ncov/faq.html
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Col-onavirus(COVID-19)frequently asked c~uest~ons ~ CDC
The number' of cases of COVID-1 a being reported in the United States is rising due to increased laboratory testing and
reporting across the country. The growing number of cases in part reflects the rapid spread of COVID-19 as many U.S.
states and territories experience community spread. More detailed and accurate data will allow us to better
u nderstand and track the size and scope of the outbreak and strengthen prevention and response efforts.
Can someone who has had COVID-19 spread the illness to others?
The virus that causes COVID-19 is spreading from person-to-person. People are thought to be most contagious when
they are symptomatic (the sickest). That is why CDC recommends that these patients be isolated either in the hospital
or at home (depending on how sick they are) until they are better and no longer pose a risk of infecting others. More
recently the virus has also been detected in asymptomatic persons.
How long someone is actively sick can vary so the decision on when to release someone from isolation is made using
a test-based or non-test-based strategy (i.e. time since illness started and time since recovery) in consultation with
state and local public health officials. The decision involves considering the specifics of each situation, including
disease severity, illness signs and symptoms, and the results of laboratory testing for that patient.
Learn more about CDC's guidance on when to release someone from isolation and discharge hospitalized patients
with COVID-19. For information on when someone who has been sick with COVID-19 is able to stop home isolation
see Interim Guidance for Discontinuation of In-Home Isolation for Patients with COVID-19.
Someone who has been released from isolation is not considered to pose a risk of infection to others.
Can someone who has been quarantined for COVID-19 spread the illness to others?
Quarantine means separating a person or group of people who have been exposed to a contagious disease but have
not developed illness (symptoms)from others who have not been exposed, in order to prevent the possible spread of
that disease. Quarantine is usually established for the incubation period of the communicable disease, which is the
span of time during which people have developed illness after exposure. For COVID-19, the period of quarantine is 14
days from the last date of exposure because the incubation period for this virus is 2 to 14 days. Someone who has
been released from COVID-19 quarantine is not considered a risk for spreading the virus to others because they have
not developed illness during the incubation period.
Can the virus that causes COVID-19 be spread through food, including restaurant take out, refrigerated or
frozen packaged food?
Coronaviruses are generally thought to be spread from person to person through respiratory droplets. Currently,
there is no evidence to support transmission of COVID-19 associated with food. Before preparing or eating food it is
i mportant to always wash your hands with soap and water for at least 20 seconds for general food safety. Throughout
the day use a tissue to cover your coughing or sneezing, and wash your hands after blowing your nose, coughing or
sneezing, or going to the bathroom.
It may be possible that a person can get COVID-19 by touching a surface or object, like a packaging container, 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.
I n general, because of poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from
food products or packaging.
Learn what is known about the spread of COVID-19.
https://ww~~.cdc.gov/coronavil-us/2019-ncov/faq.htl~11
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Can I get sick with COVID-19 if it is on food?
Based ors information about this novel coronavirus thus far, it seems unlikely that COVID-19 can be transmitted
through food -additional investigation is needed.
Will warm weather stop the outbreak of COVID-19?
It is not yet known whether weather and temperature affect the spread of COVID-19. Some other viruses, like those
that cause the common cold and flu, spread more during cold weather months but that does not mean it is
i mpossible to become sick with these viruses during other months. There is much more to learn about the
transmissibility, severity, and other features associated with COVID-19 and investigations are ongoing.
W hat is community spread?
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.
What temperature kills the virus that causes COVID-19?
Generally coronaviruses survive for shorter periods at higher temperatures and higher humidity than in cooler or
d ryer environments. However, we don't have direct data for this virus, nor do we have direct data fora temperaturebased cutoff for inactivation at this point. The necessary temperature would also be based on the materials of the
surface, the environment, etc. Regardless of temperature please follow CDC's guidance for cleaning and disinfection.
Can mosquitoes or ticks spread the virus that causes COVID-19?
At this time, CDC has no data to suggest that this new coronavirus or other similar coronaviruses are spread by
mosquitoes or ticks. The main way that COVID-19 spreads is from person to person. See How Caronavirus Spreads for
more information.
HoW to Protect Yourself
A m I at risk for COVID-19 in the United States?
~-
This is a rapidly evolving situation and the risk assessment may change daily. The latest updates are available on CDC's
Coronavirus Disease 2019(COVID-19) website.
How many cases have been reported in the United States?
~-
COVID-19 case counts for the United States are updated regularly online. See the current U.S. case taunt of COVID-19.
How can I help protect myself?
Visit the COVID-19 Prevention and Treatment page to learn about how to protect yourself from respiratory i llnesses,
l ike COVID-19.
W hat should I do if I have had close contact with someone who has COVID-19?
https://www.cdc.gov/coi-onavirus/2019-ncov/fac~.html
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There is information for people who f~ave had close contact with a persor confirmed to have, or being evaluated for,
COVID-19 available online.
Does CDC recommend the use of facemask or face coverings to prevent COVID-19?
I n light of data about how COVID-19 spreads, along with evidence of widespread COVID-19 illness in communities
across the country, CDC recommends that people wear a cloth face covering to cover their nose and mouth in the
community setting. This is an additional public health measure people should take to reduce the spread of COVID-19
i n addition to (not instead of) social distancing, frequent hand cleaning and other everyday preventive actions. A cloth
face covering is not intended to protect the wearer, but may prevent the spread of virus from the wearer to others.
This would be especially important in the event that someone is infected but does not have symptoms. A cloth face
covering should be worn whenever people must go into public settings (grocery stores, for example). Medical masks
a nd N-95 respirators are reserved for healthcare workers and other first responders, as recommended by current
CDC guidance.
Is it safe to get care for my other medical conditions during this time?
• It is important to continue taking care of your health and wellness. If you have a chronic health problem, you
may be at higher risk for severe illness from COVID-19. Below are some things you canto do to take care of your
health during this time.
• Continue your medications, and do not change your treatment plan without talking to your healthcare provider.
• Continue to manage your disease the way your healthcare provider has told you.
• Have at least a 2-week supply of all prescription and non-prescription medications. Talk to your healthcare
provider, insurer, and pharmacist about getting an extra supply of prescription medications, if possible, to reduce
trips to the pharmacy.
• Talk to your healthcare provider about whether your vaccinations are up-to-date. People aged 65 years or older,
a nd those with some underlying medical conditions, are recommended to receive vaccinations against influenza
a nd pneumococcal disease as soon as your provider tells you that can.
• Call your healthcare provider
if you have any concerns about your medical conditions, or if you get sick.
to find out about different ways you can connect with your healthcare provider for chronic disease
management or other conditions. Ask about phone calls, video appointments, use of the patient portal,
emails and mailings. Learn more about telef~ealth here [~
• Do not delay getting emergency care for your health problems or anyhealth condition that requires immediate
attention.
If you need emergency help, call 911.
E mergency departments have infection prevention plans to protect you from getting COVID-19 if you need
care for your medical condition.
• Continue to practice everyday prevention: wash your hands often, keep space between yourself and others, cover
your mouth and nose with a cloth face cover when around other people, cover coughs and sneezes, and clean and
disinfect frequently touched surfaces often.
A m I at risk for COVID-19 from mail, packages, or products?
hops://www.cdc.gov/col-onavirus/2019-ncov/fac~.ht1111
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There is still a lot that is unknown about COVID-19 and how it spreads. Coronaviruses are thought to be spread most
often by respiratory droplets. Although the virus can survive for a short period on some surfaces, it is unlikely to be
spread from domestic or international mail, products or packaging. However, it may be possible that people 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.
Learn more about safe handling of deliveries and mail.
Is it okay for me to donate blood?
I n healthcare settings across the United States, donated blood is a lifesaving, essential part of caring for patients. The
need for donated blood is constant, and blood centers are open and in urgent need of donations. CDC encourages
people who are well to continue to donate blood if they are able, even if they are practicing social distancing because
of COVID-19. CDC is supporting blood centers by providing recommendations that will keep donors and staff safe.
Examples of these recommendations include spacing donor chairs 6 feet apart, thoroughly adhering to environmental
cleaning practices, and encouraging donors to make donation appointments ahead of time.
Should contact lens wearers take special precautions to prevent COVID-19?
• Currently there is no evidence to suggest contact lens wearers are more at risk for acquiring COVID-19 than
eyeglass wearers.
• Contact lens wearers should continue to practice safe contact lens wear and care hygiene habits to help prevent
against transmission of any contact lens-related infections, such as always washing hands with soap and water
before handling lenses.
• People who are healthy can continue to wear and care for their contact lenses as prescribed by their eye care
professional.
Find more information about how coronavirus spreads and how to protect yourself.
Visit CDC's contact lens website for more information on healthy contact lens wear and care.
Is contact lens disinfecting solution effective against COVID-19?
• Hydrogen peroxide-based systems for cleaning, disinfecting, and storing contact lenses should be effective against
the virus that causes COVID-19.
For other disinfection methods, such as multipurpose solution and ultrasonic cleaners, there is currently not
enough scientific evidence to determine efficacy against the virus.
• Always use solution to disinfect your contact lenses and case to kill germs that may be present.
• Handle your lenses over a surface that has been cleaned and disinfected.
Find more information about how coronavir us spreads and how to protect yourself.
Visit CDC's contact lens website for more information on healthy contact lens wear and care.
COVID-19 and Children
https://www.cdc.gov/col-onavirus/?019-ncov/fac~.html
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W hat is the risk of my child becoming sick with COVID-19?
Based on available evidence, children do not appear to be at higher risk for COV4D-19 than adults. While some
children and infants have been sick with COVID-19, adults makeup most of the known cases to date. You can learn
m ore about who is at higher risk for severe illness from COVID-19 at People who are at higher risk for severe illness.
How can I protect my child from COVID-19 infection?
You can encourage your child to help stop the spread of COVID-19 by teaching them to do the same things everyone
should do to stay healthy.
• Avoid close contact with people who are sick.
• Stay home when you are sick, except to get medical care.
• Cover your coughs and sneezes with a tissue and throw the tissue in the trash.
• Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing,
or sneezing; going to the bathroom; and before eating or preparing food.
• If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60%alcohol. Always
wash hands with soap and water if hands are visibly dirty.
• Clean and disinfect frequently touched surfaces and objects (e.g., tables, countertops, light switches, doorknobs,
a nd cabinet handles).
• Launder items, including washable plush toys, as appropriate and in accordance with the manufacturer's
i nstructions. If possible, launder items using the warmest appropriate water setting for the items and dry items
completely. Dirty laundry from an ill person can be washed with other people's items.
You can find additional information on preventing COVID-19 at Prevention for 2019 Novel Coronavirus and
at Preventing COVID-19 Spread in Communities. Additional information on how COVID-19 is spread is available at How
COVID-19 Spreads.
M ore information on Children and Coronavirus Disease 2019(COVID-19) is available online.
Are the symptoms of COVID-19 different in children than in adults?
No. The symptoms of COVID-19 are similar in children and adults. However, children with confirmed COVID-19 have
generally presented with mild symptoms. Reported symptoms in children include cold-like symptoms, such as fever,
runny nose, and cough. Vomiting and diarrhea have also been reported. It's not known yet whether some children
may be at higher risk for severe illness, for example, children with underlying medical conditions and special
healthcare needs. There is much more to be learned about how the disease impacts children.
Should children wear masks?
CDC recommends that everyone 2 years and older wear a cloth face covering that covers their nose and mouth when
they are out in the community. Cloth face coverings should NOT be put on babies or children younger than 2 because
of the danger of suffocation. Children younger than 2 years of age are l isted as an exception as well as anyone who
has trouble breathing or is unconscious, incapacitated, or otherwise unable to remove the face covering without
assistance.
Wearing cloth face coverings is a public health measure people should take to reduce the spread of COVID-19 in
addition to (not instead of) social distancing, frequent hand cleaning ,and other everyday preventive actions. A cloth
face covering is not intended to protect the wearer but may prevent the spread of virus from the wearer to others.
https://www.cdc.gov/coronavirus/2019-ncov/fac~.html
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~i~
r
This would be especially important if someone is infected but does not have symptoms. Medical dace masks and N95
respirators are still reserved for healthcare personnel and other first responders, as recommended by current CDC
guidance.
How do I prepare my children in case of COVID-19 outbreak in our community?
Outbreaks can be stressful for adults and children. Talk with your children about the outbreak, try to stay calm, and
reassure them that they are safe. If appropriate, explain to them that most illness from COVID-19 seems to be
m ild. Children respond differently to stressful situations than adults. CDC offers resources to help talk with children
a bout COVID-19.
W hat steps should parents take to protect children during a community outbreak?
This is a new virus and we are still learning about it, but so far, there does not seem to be a lot of illness in children.
M ost illness, including serious illness, is happening in adults of working age and older adults. However, children do get
the virus and become ill. Many schools across the country have announced dismissals for temporary periods. 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.
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.
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.
W hat is multisystem inflammatory syndrome in children (MIS-C) and who is at risk?
CDC is working with state and local health departments to investigate reports of multisystem inflammatory syndrome
i n children (MIS-C) associated with COVID-19 and gather more information as quickly as possible about how common
it is and who is at risk. As new information becomes available, we will continue to provide information for parents and
caregivers as well as healthcare and public health professionals. MIS-C has been described as inflammation (swelling)
across multiple body systems, potentially including the heart, lungs, kidneys, brain, skin, eyes, and gastrointestinal
organs. Signs and symptoms of MIS-C include fever and various symptoms such as abdominal pain, vomiting,
diarrhea, neck pain, rash, and feeling tired.
If your child has any of these symptoms, other symptoms of COVID-19, or other concerning signs, contact your
pediatrician. If your child is showing any emergency warning signs including trouble breathing, persistent pain or
pressure in the chest, new confusion, inability to wake or stay awake, bluish lips or face, severe abdominal pain, or
other concerning signs, seek emergency care right away.
School Dismissals and Children
W hile school's out, can my child hang out with their friends?
https://www.cdc.gov/col-onavil-us/2019-ncov/faq.html
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• The key to slowing the spread of COVID-19 is to practice social distancing. While school is out, children should not
have in-person playdates with children from other households. If children are playing outside their own homes, it
is essential that they remain 6 feet from anyone who is not in their own household.
• To help children maintain social connections while social distancing, help your children have supervised phone
calls or video chats with their friends.
• Make sure children practice everyday preventive behaviors, such as washing their hands often with soap and
water. Remember, if children meet outside of school in groups, it can put everyone at risk.
Revise spring break plans if they included non-essential travel.
• Information about COVID-19 in children is somewhat limited, but current data suggest children with COVID-19 may
have only mild symptoms. However, they can still pass this virus onto others who may be at higher risk,
i ncluding older adults and people who have serious underlying medical conditions.
While school's out, how can I help my child continue learning?
• Stay in touch with your child's school.
Many schools are offering lessons online (virtual learning). Review assignments from the school, and help
your child establish a reasonable pace for completing the work. You may need to assist your child with turning
on devices, reading instructions, and typing answers.
Communicate challenges to your school. If you face technology or connectivity issues, or if your child is having
a hard time completing assignments, let the school know.
• Create a schedule and routine for learning at home, but remain flexible.
Have consistent bedtimes, and get up at the same time, Monday through Friday.
Structure the day for learning, free time, healthy meals and snacks, and physical activity.
Allow flexibility in the schedule—it's okay to adapt based on your day.
• Consider the needs and adjustment required for your child's age group.
The transition to being at home will be different for preschoolers, K-5, middle school students, and high
school students. Talk to your child about expectations and how they are adjusting to being at home versus at
school.
Consider ways your child can stay connected with their friends without spending time in person.
• Look for ways to make learning fun.
Have hands-on activities, like puzzles, painting, drawing, and making things.
I ndependent play can also be used in place of structured learning. Encourage children to build a fort from
sheets or practice counting by stacking blocks.
Practice handwriting and grammar by writing letters to family members. This is a great way to connect and
limit face-to-face contact.
Start a journal with your child to document this time and discuss the shared experience.
Use audiobooks or see if your local library is hosting virtual orlive-streamed reading events.
While school's out, will kids have access to meals?
Check with your school on plans to continue meal services during the school dismissal. Many schools are keeping
school facilities open to allow families to pickup meals or are providing grab-and-go meals at a central location.
While school's out, how can I keep my family healthy?
https://www.cdc.gov/coronavirus/2019-ncov/faq.html
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• Watch your child for any signs of illness.
If you see any sign of illness consistent with symptoms of COVID-19, particularly fever, cough, or shortness of
breath, call your healthcare provider and keep your child at home and away from others as much as possible.
Follow CDC's guidance on "What to do if you are sick."
• Watch for signs of stress in your child.
Some common changes to watch for include excessive worry or sadness, unhealthy eating or sleeping habits,
a nd difficulty with attention and concentration. For more information, see the "For Parents" section on CDC's
website, Manage Anxiety and Stress.
Take time to talk with your child or teen about the COVID-19 outbreak. Answer questions and share
facts about COVID-19 in a way that your child or teen can understand.
Go to CDC's Helping Children Cope with Emergencies or Talking with Children About COVID-19 for more
i nformation.
• Teach and reinforce everyday preventive actions.
Parents and caretakers play an important role in teaching children to wash their hands. Explain that hand
washing can keep them healthy and stop the virus from spreading to others.
Be a good role model—if you wash your hands often, they're more likely to do the same.
Make ha ndwashing a family activity.
• Help your child stay active.
Encourage your child to play outdoors—it's great for physical and mental health. Take a walk with your child
or go on a bike ride.
Use indoor activity breaks (stretch breaks, dance breaks) throughout the day to help your child stay healthy
a nd focused.
• Help your child stay socially connected.
Reach out to friends and family via phone or video chats.
Write cards or letters to family members they may not be able to visit.
Some schools and non-profits, such as the Collaborative for Academic, Social, and Emotional Learning C~
and The Yale Center for Emotional Intelligence C'~ ,have resources for social and emotional learning. Check
to see if your school has tips and guidelines to help support social and emotional needs of your child.
W hile school's out, limit time with older adults, including relatives, and people with chronic medical
conditions.
~
Older adults and people who have serious underlying medical conditions are at highest risk of getting sick from
COVID-19.
• If others in your home are at particularly high risk for severe illness from COVID-19, consider extra precautions to
separate your child from those people.
• If you are unable to stay home with your child during school dismissals, carefully consider who might, be best
positioned to provide childcare. If someone at higher risk for COVID-19 will be providing care (older adult, such as a
grandparent or someone with a serious underlying medical condition), limit your children's contact with other
people.
• Consider postponing visits or trip to see older family members and grandparents. Connect virtually or by writing
letters and sending via mail.
hops://www.cdc.gov/col-onavil~us/2019-ncov/faq.hti~nl
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•
Children and Youth with Special Healthcare Needs
Is my child with an underlying medical condition or special healthcare need at higher risk for severe illness
from COVID-19?
Children with complex, chronic medical conditions, including children with physical, developmental, behavioral, or
emotional differences, can have special healthcare needs. It's not known yet whether all of these children are at higher
risk for severe illness from COVID-19.
Although most COVID-19 cases in children are not severe, serious illness that needs to be treated at the hospital still
happens. Some data on children reported that the majority who needed hospitalization for COVID-19 had at least one
u nderlying medical condition. The most common underlying conditions reported among children with COVID-19
i nclude chronic lung disease (including asthma), heart disease, and conditions that weaken the immune system. This
i nformation suggests that children with these underlying medical conditions may be at risk for more severe illness
from COVID-19.
M ore data are needed to learn which underlying or complex medical conditions may put children at increased risk.
CDC is monitoring new information as it becomes available and will provide updates as needed.
Learn more about caring for children with special health care needs during a disaster and people who are at higher
risk for severe illness from COVID-19.
W hat additional steps should families that have a child with an underlying medical condition or special health
care need take?
~
I n addition to following the recommendations to prevent getting sick and running essential errands, families should
take extra steps recommended for persons with higher risk of severe COVID-19 illness and steps outlined for those
with potential COVID-19 exposure or confirmed illness.
• Identify potential alternative caregivers, if you or other regular caregivers become sick and are unable to care for
your child. If possible, these alternative caregivers would not be at higher risk of severe i llness from COVID-19
themselves.
• Try to have at least one month of medication and medical supplies on hand. Some health plans allow fora 90-day
supply of prescription medications. Consider discussing this option with your child's healthcare provider.
• Review any care plans for your child, such as an asthma action plan, and make sure caregivers and backup
caregivers are familiar with these plans.
• If you do not have care plans oi~ an emergency notebook, try to make them. They typically include important
i nformation about your child's medical conditions, how to manage those conditions, how to get in touch with your
child's doctors, allergies, information on medications(names, dosages, and administration instructions),
preferences (food and other) or special needs, daily routines and activities, friends, and details about routines that
a re important to support behavioral and emotional health.
• Learn if your child's healthcare providers, including doctors and therapists, have new ways to be contacted or new
ways of providing appointments. If they offer telemedicine visits, find out how those are arranged and any
additional information you need.
• If your child receives any support care services in the home that need to be continued, make plans for what you
wi ll do if those direct care providers get sick, or if persons in your household are sick.
hops://www.cdc.gov/coronavirus/2019-ncov/fac~.html
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• Discuss with the support care agencies and the providers ways to minimize risk for exposure to the virus that
causes COVID-19.
If your child or other persons in your household are sick with COVID-19 and are able to recover at home,
i nform your direct care providers and consider postponing or rescheduling services until the criteria for
discontinuing home isolation have been met.
Ask service providers if they are experiencing any symptoms ~f COVID-19, or if they have been in contact with
someone who has COVID-19.
Tell the service provider to:
■ Wear a cloth face covering if they will be close (less than 6 feet) to you or persons in your household.
Their cloth face covering helps protect you if they are infected but do not have symptoms.
■ Ask them to wash their hands with soap and water or, if unavailable, use hand sanitizer with at least 60%
alcohol when they enter your home, before and after helping your child (dressing, bathing/showering,
transferring, toileting and/or diapering, feeding), after handling tissues, and after changing linens or
doing laundry. Learn more about proper handwashing.
Service providers and families should:
Routinely clean and disinfect frequently touched objects and surfaces (counters, tabletops, doorknobs,
bathroom fixtures, toilets, phones, keyboards, tablets, bedside tables), and equipment such as
wheelchairs, scooters, walkers, oxygen tanks and tubing, communication boards, and other assistive
devices. Refer to CDC's recommendations for Cleaning and Disinfecting Your Home.
What can I do if my child has difficulties adjusting to new routines and following recommendations?
Helping children understand and follow recommendations, like social distancing and wearing cloth face coverings, can
be challenging if your child has intellectual disabilities, sensory issues, or other special healthcare needs.
• Keeping children at home and sheltering in place can lower stress created by social distancing and cloth face
covering recommendations. Reach out to others for help in running essential errands.
• Behavioral techniques can be used to address behavioral challenges and to develop new routines. These include
social stories, video modeling, picture schedules, and visual cues. Try rewarding your child in small ways with his or
her favorite non-food treat or activities to help switch routines and to follow recommendations.
• Many of the organizations you turn to for information and support around your child's complex, chronic medical
condition may have information on their websites to help families address issues related to COVID-19.
• Your child's therapists) and/or teachers may also have resources to help successfully introduce new routines to
your child.
Additional information on caring for children and on child development specific conditions are available.
How can my family cope with the added stress?
Supporting children with special healthcare needs can put additional demands and stress on families, especially
d uring emergency situations. You have likely found ways to manage the stress and challenges unique to your family's
situation. It is important to continue your family's coping methods, including reaching out to other family members,
friends, support groups, and organizations that have been helpful in the past.
hops://www.cdc.gov/coronavirus/2019-ncov/faq.html
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See information on ways to cape with stress (such as visiting parks, trails, or open spaces) and making your family
stronger.
If you, or someone you care about, are feeling overwhelmed with emotions like sadness, depression, or anxiety, or
feel like you want to harm yourself or others:
• CaEI 91 1
• Visit the Disaster Distress Helpline [~ ,call 1-500-985-5990, or text TalkWithUs to 66746
• Visit the National Domestic i~'iolence Hotline ~ or call 1-800-799-7233 and TTY 1-800-787-3224
What if my child or someone else in the home is sick with symptoms of COVID-19?
If your child with special healthcare needs becomes sick with symptoms of COVID-19, contact your child's healthcare
provider. If your child has new or worsening emergency warning signs, such as trouble breathing, pain or pressure in
the chest, confusion or inability to wake them up, or bluish lips or face, call 911. If you think your child may have
COVID-19, notify the operator so that first responders may be appropriately prepared to protect themselves and
others.
Notify your child's healthcare provider if someone else in your house becomes sick with COVID-19, so they can provide
a ny advice specific for your child.
See additional information if someone in the home is sick with COVID-19 or suspected of having COVID-19.
What if my child's symptoms of their underlying medical condition or complex, chronic medical condition get
worse?
• Call your child's healthcare provider if you have any concerns about your child's medical conditions. If you need
emergency help, call 911.
E mergency departments have infection prevention plans to protect you and your child from getting COVID-19 if
your child needs care for medical conditions not related to COVID-19. Do not delay getting emergency care for your
child's underlying condition or complex medical condition because you are afraid of getting exposed to COVID-19
when visiting the healthcare setting.
W hat if my child needs to go to the hospital?
If your child's healthcare provider tells you to go to the hospital for any health problem, including COVID-19:
• Ask the healthcare provider to let the hospital know you are coming and to share the important information the
hospital will need to know to care for your child.
Visiting policies may have changed due to COVID-19. If your child's hospital policy does not allow an adult to stay
with a child, ask your child's healthcare provider for a statement explaining your child's need for a familiar adult to
be present.
• Bring your care plans/emergency notebook with you along with paper and pen to write down questions you have
d uring your time at the hospital.
hops://www.cdc.gov/coronavirus/?019-ncov/faq.html
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Preparing Your Home and Family for COVID-19
How can my family and I prepare for COVID-19?
Create a household plan of action to help protect your health and the health of those you care about in the event of
a n outbreak of COVID-19 in your community:
• Talk with the people who need to be included in your plan, and discuss what to do if a COVID-19 outbreak occurs in
your community.
• Plan ways to care for those who might be at greater risk for serious complications, particularly older adults and
those with severe chronic medical conditions like heart, lung or kidney disease.
Make sure they have access to several weeks of medications and supplies in case you need to stay home for
prolonged periods of time.
• Get to know your neighbors and find out if your neighborhood has a website or social media page to stay
connected.
• Create a list of local organizations that you and your household can contact in the event you need access to
i nformation, healthcare services, support, and resources.
• Create an emergency contact list of family, friends, neighbors, carpool drivers, health care providers, teachers,
e mployers, the local public health department, and other community resources.
~.
What steps can my family take to reduce our risk of getting COVID-19?
Practice everyday preventive actions to help reduce your risk of getting sick and remind everyone in your home to do
the same. These actions are especially important for older adults and people who have severe chronic medical
conditions:
• Avoid close contact with people who are sick.
• Stay home when you are sick, except to get medical care.
• Cover your coughs and sneezes with a tissue and throw the tissue in the trash.
• Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing,
or sneezing; going to the bathroom; and before eating or preparing food.
• If soap and water are not readily available, use analcohol-based hand sanitizer with at least 60%alcohol. Always
wash hands with soap and water if hands are visibly dirty.
• Clean and disinfect frequently touched surfaces and objects (e.g., tables, countertops, light switches, doorknobs,
a nd cabinet handles).
• Launder items, including washable plush toys, as appropriate and in accordance with the manufacturer's
i nstructions. If possible, launder items using the warmest appropriate water setting for the items and dry items
completely. Dirty laundry from an ill person can be washed with other people's items.
W hat should I do if someone in my house gets sick with COVID-19?
M ost people who get COVID-19 will be able to recover at home. CDC has directions for people who are recovering at
home and their caregivers, including:
https://www.cdc.gov/coronavir'US~ZO 19-I1COV~f1C1.~1t1111
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• Stay home when you are sick, except to get medical care.
When to Seek Emergency Medical Attention
Look for emergency warning signs* for COVID-19. If someone is showing any of these signs, seek emergency
medical care immediately
• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake or stay awake
• Bluish lips or face
*This list is not all possible symptoms. Please call your medical provider for any other symptoms that are severe
or concerning to you.
Call 911 or call ahead to your local emergency facility: Notify the operator that you are seeking care for
someone who has or may have COVID-19.
• Use a separate room and bathroom for sick household members (if possible).
• Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing,
or sneezing; going to the bathroom; and before eating or preparing food.
• If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60%alcohol. Always
wash hands with soap and water if hands are visibly dirty.
• Provide your sick household member with clean disposable facemasks to wear at home, if available, to help
prevent spreading COVID-19 to others.
• Clean the sick room and bathroom, as needed, to avoid unnecessary contact with the sick person.
• Avoid sharing personal items like utensils, food, and drinks.
+-
How can I prepare in case my child's school, child care facility, or university is dismissed?
Talk to the school or facility about their emergency operations plan. Understand the plan for continuing education
a nd social services (such as student meal programs) during school dismissals. If your child attends a college or
u niversity, encourage them to learn about the school's plan for a COVID-19 outbreak.
L
How can I prepare for COVID-19 at work?
Plan for potential changes at your workplace. Talk to your employer about their emergency operations plan, including
sick-leave policies and telework options. Learn how businesses and employers can plan for and respond to COVID-19.
Should I use soap and water or a hand sanitizer to protect against COVID-19?
Handwashing is one of the best ways to protect yourself and your family from getting sick. Wash your hands often
with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing; going to the
bathroom; and before eating or preparing food. If soap and water are not readily available, use analcohol-based hand
sanitizer with at least 60%alcohol.
W hat cleaning products should I use to protect against COVID-19?
hops://www.cdc.gov/coronavirus/?019-ncov/fac~.html
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Clean and disinfect frequently touched surfaces such as tables, doorknobs, light switches, countertops, hanales,
desks, phones, keyboards, toilets, faucets, and sinks. If surfaces are dirty, clean them using detergent or soap and
water prior to disinfection. To disinfect, most common EPA-registered household disinfectants will work. See CDC's
recommendations for household clearing and disinfection.
Should I make my own hand sanitizer if I can't find it in the stores?
CDC recommends handwashing with soap and water for at least 20 seconds or, using alcohol-based hand sanitizer
with at least 60%alcohol when soap and water are not available. These actions are part of everyday preventive
actions individuals can take to slow the spread of respiratory diseases like COVID-19.
• When washing hands, you can use plain soap or antibacterial soap. Plain soap is as effective as antibacterial soap
at removing germs.
• If soap and water are not readily available, you can use an FDA-approved alcohol-based hand sanitizer that
contains at least 60%alcohol. You can tell if the sanitizer contains at least 60%alcohol by looking at the product
label.
CDC does not encourage the production and use of homemade hand sanitizer products because of concerns over the
correct use of the ingredients ~ and the need to work under sterile conditions to make the product. Local industries
that are looking into producing hand sanitizer to fill in for commercial shortages can refer to the World Health
Organization guidance D C~ .Organizations should revert to the use of commercially produced, FDA-approved
product once such supplies again become available.
• To be effective against killing some types of germs, hand sanitizers need to have a strength of at least 60%
alcohol and be used when hands are not visibly dirty or greasy.
• Do not rely on "Do It Yourself' or "DIY" recipes based solely on essential oils or formulated without correct
compounding practices.
• Do not use hand sanitizer to disinfect frequently touched surfaces and objects. See CDC's information for
cleaning and sanitizing your home.
See FAQs about hand hygiene for healthcare personnel responding to COVID-2019.
In Case of an Outbreak in Your Community
W hat should I do if there is an outbreak in my community?
During an outbreak, stay calm and put your preparedness plan to work. Follow the steps below:
Protect yourself and others.
• Stay home if you are sick. Keep away from people who are sick. Limit close contact with others as much as possible
(about 6 feet).
P ut your household plan into action.
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• Stay informed about the local COVID-19 situation. Be aware of temporary school dismissals in your area, as this
may affect your household's daily routine.
• Continue practicing everyday preventive actions. Cover coughs and sneezes with a tissue and wash your hands
often with soap and water for at least 20 seconds. If soap and water are not available, use a hand sanitizer that
contains 60%alcohol. Clean frequently touched surfaces and objects daily using a regular household detergent
a nd water.
• Notify your workplace as soon as possible if your regular work 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. Learn how businesses and employers can plan for and respond to COVID-19.
• Stay in touch with others by phone or email. 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,
especially those at increased risk of developing severe illness, such as older adults and people with severe chronic
medical conditions.
Will schools be dismissed if there is an outbreak in my community?
Depending on the situation, public health officials may recommend community actions to reduce exposures to COVID19, such as school dismissals. Read or watch local media sources that report school dismissals or and watch for
communication from your child's school. If schools are dismissed temporarily, discourage students and staff from
gathering or socializing anywhere, like at a friend's house, a favorite restaurant, or the local shopping mall.
Should I go to work if there is an outbreak in my community?
Follow the advice of your local health officials. Stay home if you can. Talk to your employer to discuss working from
home,taking leave if you or someone in your household gets sick with COVID-19 symptoms, or if your child's school is
dismissed temporarily. Employers should be aware that more employees may need to stay at home to care for sick
children or other sick family members than is usual in case of a community outbreak.
Will businesses and schools close or stay closed in my community and for how long? Will there be a "stay at
home" or "shelter in place" order in my community?
CDC makes recommendations, shares information, and provides guidance to help slow down the spread of COVID-19
i n the U.S. including guidance for schools and businesses. CDC regularly shares information and provides assistance
to state, local, territorial, and tribal health authorities. These local authorities are responsible for making decisions
i ncluding "stay at home" or "shelter in place." What is included in these orders and how they are implemented are
also decided by local authorities. These decisions may also depend on many factors such as how the virus is spreading
i n a certain community.
Please contact your local health department to find out more.
Can CDC tell me or my employer when it is safe for me to go back to work/school after recovering from or
being exposed to COVID-19?
CDC cannot address the policies of any business or organization. CDC shares recommendations based on the best
available science to help people make decisions that improve their health and safety. Employers, schools, and
organizations may decide to visibly screen for symptoms or perform on-site symptom checks.
https://www.cdc.gov/coronavirus/?019-ncov/fac~.html
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If your employer, school, or organization requires you to present documentation regarding COVID-19 before returning
to work or school (for example, proof of a negative COVID-19 lab test, if a test was performed, contact your healthcare
provider to ask if he or she would be able to provide a form of documentation for you. Documentation of self-isolation
a nd self-quarantine may not be possible.
CDC has guidance for when and how people with COVID-19 can discontinue home isolation:
h ops://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html.
CDC also has guidance for what people should do if they think they have been exposed or feel sick:
h ops://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html.
I n all cases, follow the guidance of your healthcare provider and local health department. Local decisions depend
on local circumstances.
Symptoms &Testing
~
W hat are the symptoms and complications that COVID-19 can cause?
People with COVID-19 have had a wide range of symptoms reported -ranging from mild symptoms to severe illness.
Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:
• Cough
• Shortness of breath or difficulty breathing
• Fever
• Chills
• Muscle pain
• Sore throat
• New loss of taste or smell
Children have similar symptoms to adults and generally have mild illness.
This list is not all inclusive. Other less common symptoms have been reported, including gastrointestinal symptoms
like nausea, vomiting, or diarrhea.
Read about COVID-19 Symptoms.
~-
Is it possible to have the flu and COVID-19 at the same time?
Yes. It is possible to test positive for flu (as well as other respiratory infections) and COVID-19 at the same time.
~-
Should I be tested for COVID-19?
Maybe; not everyone needs to be tested for COVID-19.
If you have symptoms of COVID-19 and want to get tested, call your healthcare provider first.
You can also visit your state or local health department's website to look for the latest local information on testing. See
https://www.cdc.gov/coronavil-us/2019-ncov/fac~.html
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Test for Past Infection for more information.
How can I get tested for COVID-19?
Two kinds of tests are available for C~VID-19: viral tests and antibody tests. A viral test checks for a current infection.
An antibody test checks for a previous infection.
If you think you need a viral test, call your healthcare provider or state or local C'i health department and tell them
a bout your symptoms and how you think you may have been exposed to the virus. Your healthcare provider can let
you know if they offer viral tests at their office. Your state or local health department can provide local information on
w here testing is available. See Testing for Current Infection for more information.
If you want an antibody test, call your healthcare provider to see if they offer antibody tests and whether you should
get one. You can also visit your state or local health department's website for local information on antibody testing.
Can someone test negative and later test positive on a viral test for COVID-19?
Yes, it is possible. You may test negative if the sample was collected early in your infection and test positive later
d uring this illness. You could also be exposed to COVID-19 after the test and get infected then. Even if you test
negative, you still should take steps to protect yourself and others. See Testing for Current Infection for more
i nformation.
W hat kind of tests are being used to diagnose COVID-19?
Viral tests are used to diagnose COVID-19. These tests tell you if you currently have an infection with the virus that
causes COVID-19. There are many viral tests available. All of the viral tests identify the virus in respiratory samples,
such as from swabs from the inside of your nose.
Some tests are conducted at the testing site you visit, and results are available to you within minutes. Other tests must
be sent to a laboratory to analyze, a process that takes 1-2 days once the laboratory receives your samples. Two tests
allow you to collect your sample at home - either a swab from the inside of your nose or a saliva sample -but you will
still need to send the sample to a laboratory for processing.
Locations and types of testing sites vary depending on where you live (see question: Where can I get tested). Check
with your testing site to learn which test it uses. You can find a patient information sheet about each test on FDA's
website ~ .
W hat is antibody testing? And can I be tested using this method?
Antibody testing checks a sample of a person's blood to look for antibodies to the virus that causes COVID-19. When
someone gets COVID-19, their body usually makes antibodies. However, it typically takes one to three weeks to
develop these antibodies. Some people may take even longer to develop antibodies, and some people may not
develop antibodies. A positive result from this test may mean that person was previously infected with the virus. Talk
to your healthcare provider about what your antibody test result means.
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38
Antibody tests should not be used to diagnose CQVID-19. To see if you are currently infected, you need a viral test.
Viral tests identify the virus in respiratory samples, such as swabs from the inside of your nose.
We do not know yet if having antibodies to the virus that causes COVID-19 can protect someone from getting infected
again or, if they do, how long this protection might last. Scientists are conducting research to answer those questions.
If I have recovered from COVID-19, will I be immune to it?
We do not know yet if people who recover from COVID-19 can get infected again. CDC and partners are investigating
to determine if a person can get sick with COVID-19 more than once. Until we know more, continue to take steps to
protect yourself and others.
Higher Risk
Who is at higher risk for serious illness from COVID-19?
COVID-19 is a new disease and there is limited information regarding risk factors for severe disease. Based on
currently available information and clinical expertise, older adults and people of any age who have serious
u nderlying medical conditions might be at higher risk for severe illness from COVID-19.
Based on what we know now, those at high-risk for severe illness from COVID-19 are:
• People aged 65 years and older
• People who live in a nursing home or long-term care facility
People of all ages with underlying medical conditions, particularly if not well controlled, including:
• People with chronic lung disease or moderate to severe asthma
• People who have serious heart conditions
• People who are immunocompromised
Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone
marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of
corticosteroids cnd other immune weakening medications
• People with severe obesity (body mass index [BMI] >_40)
• People with diabetes
• People with chronic kidney disease undergoing dialysis
• People with liver disease
W hat should people at higher risk of serious illness with COVID-19 do?
If you are at higher risk of getting very sick from COVID-19, you should:
• Stock up on supplies
hops://www.cdc.gov/col-onavirus/2019-ncov/faq.html
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• Take everyday precautions to keep space between yourself and others
• Wher you go out in public, keep away from others who are sick
• Limit close contact and wash your hands often
• Avoid crowds, cruise travel, and non-essential travel
If there is an outbreak in your community, stay home as much as possible. Watch for symptoms and emergency signs.
If you get sick, stay home and call your doctor. More information on how to prepare, what to do if you get sick, and
how communities and caregivers can support those at higher risk is available on People at Risk for Serious Illness
from COVID-19.
How were the underlying conditions for people considered higher risk of serious illness with COVID-19
selected?
This list is based on:
• What we are learning from the outbreak in other countries and in the United States.
• What we know about risk from other respiratory infections, like flu.
As CDC gets more information about COVID-19 cases here in the United States, we will update this list as needed.
Are there any medications I should avoid taking if I have COVID-19?
Currently, there is no evidence to show that taking ibuprofen or naproxen can lead to a more severe infection of
COVID-19.
People with high blood pressure should take their blood pressure medications, as directed, and work with their
healthcare provider to make sure that their blood pressure is as well controlled as possible. Any changes to your
medications should only be made by your healthcare provider.
What about underlying medical conditions that are not included on this list?
Based on available information, adults aged 65 years and older and people of any age with underlying medical
conditions included on this list are at higher risk for severe illness and poorer outcomes from COVID-19. CDC is
collecting and analyzing data regularly and will update the list when we learn more. People with underlying medical
conditions not on the list might also be at higher risk and should consult with their healthcare provider if they are
concerned.
We encourage all people, regardless of risk, to:
• Take steps to protect yourself and others.
• Call your healthcare provider if you are sick with a fever, cough, or shortness of breath.
• Follow CDC travel guidelines and the recommendations of your state and local health officials.
W hat does awell-controlled health condition mean?
hops://www.cdc.gov/coronavirus/2019-ncov/fac~.html
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~8
Ger~erall~r, welt-controlled means that your condition is stable, not life-threateninb, and laboratory assessments and
ocher findings are as similar as possible to those without the health condition. You should talk with your healthcare
provider if you have a question about your health or how your health condition is being managed.
W hat does more severe illness mean?
Severity typically means how much impact the illness or condition has on your body's function. You should talk with
your healthcare provider if you have a question about your health ar how your health condition is being managed.
Are people with disabilities at higher risk?
M ost people with disabilities are not inherently at higher risk for becoming infected with or having severe illness from
COVID-19. Some people with physical limitations or other disabilities might be at a higher risk of infection because of
their underlying medical condition.
People with certain disabilities might experience higher rates of chronic health conditions that put them at higher
risk of serious illness and poorer outcomes from COVID-19. Adults with disabilities are three times more likely to
have heart disease, stroke, diabetes, or cancer than adults without disabilities.
You should talk with your healthcare provider if you have a question about your health or how your health condition
is being managed.
COVID-19 and H~rpertension
Are people with high blood pressure (hypertension) at higher risk from COVID-19?
At this time, we do not think that people with high blood pressure and no other underlying health conditions are more
likely than others to get severely ill from COVID-19. Although many people who have gotten severely ill from COVID-19
have high blood pressure, they are often older or have other medical conditions like obesity, diabetes, and serious
heart conditions that place them at higher risk of severe illness from COVID-19.
If you have high blood pressure, it's critically important that you keep your blood pressure under control to lower your
risk for heart disease and strokes. Take your blood pressure medications as directed, keep a log of your blood
pressure every day if you are able to take your blood pressure at home, and work with your healthcare team to make
sure your blood pressure is well controlled. Any changes to your medications should be made in consultation with
your healthcare team.
Should I continue to take my blood pressure medication?
Yes. Continue to take your blood pressure medications exactly as prescribed and make l ifestyle modifications agreed
u pon in your treatment plan. Continue all your regular medications, including angiotensin-converting enzyme
i nhibitors (ACE-Is) or angiotensin receptor blockers (ARBs), as prescribed by your healthcare team. This is
recommended by current clinical guidelines from the American Heart Association, the Heart Failure Society of
A merica, and the American College of Cardiology.
hops://www.cdc.gov/coronavirus/?019-ncov/faq.htinl
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Az ;
Healthcare Professionals and Health Departments
What should hea{thcare professionals and health departments do?
For recommendations and- guidance on persons under investigation; infection control, including personal protective
equipment guidance; home care and isolation; and case investigation, see Information for Healthcare Professionals.
For information on specimen collection and shipment, see Information for Laboratories. For information for public
health professional on COVID-19, see Information for Public Health Professionals.
See also: FAQs for Healthcare Professionals
COVID-19 and Funerals
A m I at risk if I go to a funeral or visitation service for someone who died of COVID-19?
There is currently no known risk associated with being in the same room at a funeral or visitation service with the
body of someone who died of COVID-19.
Am I at risk if I touch someone who died of COVID-19 after they have passed away?
COVID-19 is a new disease and we are still learning how it spreads. The virus that causes COVID-19 is thought to
m ainly spread from close contact (i.e., within about 6 feet) with a person who is currently sick with COVID-19. The virus
likely spreads primarily through respiratory droplets produced when an infected person coughs or sneezes, similar to
how influenza and other respiratory infections spread. These droplets can land in the mouths or noses of people who
a re nearby or possibly be inhaled into the lungs. This type of spread is not a concern after death.
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.
People should consider not touching the body of someone who has died of COVID-19. Older people and people of all
ages with severe underlying health conditions are at higher risk of developing serious COVID-19 illness. There may be
less of a chance of the virus spreading from certain types of touching, such as holding the hand or hugging after the
body has been prepared for viewing. Other activities, such as kissing, washing, and shrouding should be avoided
before, during, and after the body has been prepared, if possible. If washing the body or shrouding are important
religious or cultural practices, families are encouraged to work with their community's cultural and religious leaders
a nd funeral home staff on how to reduce their exposure as much as possible. At a minimum, people conducting these
activities should wear disposable gloves. If splashing of fluids is expected, additional personal protective equipment
(PPE) may be required (such as disposable gown,faceshield or goggles and N-95 respirator).
Cleaning should be conducted in accordance with manufacturer's instructions for all cleaning and disinfection
products (e.g., concentration, application method and contact time). Products witf~ EPA-approved emerging viral
pathogens claims ~, are expected to be effective against COVID-19 based on data for harder to kill viruses. After
removal of PPE, perform hand hy~.iene by washing hands with soap and water for at least 20 seconds or using an
alcohol-based hand sanitizer that contains at least 60%alcohol if soap and water are not available. Soap and water
should be used if the hands are visibly soiled.
W hat do funeral home workers need to know about handling decedents who had COVID-19?
hops://www.cdc.gov/coronavirus/2019-ncov/fac~.html
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A funeral or visitation service can be held for a person who has died of COVID-19. Funeral home workers should follow
their routine infection prevention and control precautions when handling a decedent who died of COVID-19. If it is
necessary to transfer a body to a bag, follow Standard Precautions, including additional personal protective
equipment(PPE) if splashing of fluids is expected. For transporting a body after the body has been bagged, disinfect
the outside of the bag with a pE~aduct with EPA-approved emerging viral pathogens claims C'~ expected to be effective
against COVID-19 based on data for harder to kill viruses. Follow the manufacturer's instructions for all cleaning and
disinfection products (e.g., concentration, application method and contact time, etc.). Wear disposable nitrite gloves
w hen handling the body bag.
E mbalming can be conducted. During embalming,follow Standard Precautions including the use of additional PPE if
splashing is expected (e.g. disposable gown,faceshield or goggles and N95 respirator). Wear appropriate respiratory
protection if any procedures will generate aerosols or if required for chemicals used in accordance with the
manufacturer's label. Wear heavy-duty gloves over nitrite disposable gloves if there is a risk of cuts, puncture wounds,
or other injuries that break the skin. Additional information on how to safely conduct aerosol-generating procedures
is in the CDC's Postmortem Guidance. Cleaning should be conducted in accordance with manufacturer's instructions.
Products with EPA-approved emerging viral pathogens claims[~ are expected to be effective against COVID-19 based
on data for harder to kill viruses. Follow the manufacturer's instructions for all cleaning and disinfection products (e.g.,
concentration, application method and contact time).
After cleaning and removal of PPE, perform hand hygiene by washing hands with soap and water for at least 20
seconds or using an alcohol-based hand sanitizer that contains at least 60%alcohol if soap and water is not available.
Soap and water should be used if the hands are visibly soiled.
Decedents with COVID-19 can be buried or cremated, but check for any additional state and local requirements that
may dictate the handling and disposition of the remains of individuals who have died of certain infectious diseases.
How can loved ones safely handle belongings of someone who died from COVID-19?
The belongings of someone who has died of suspected or confirmed COVID-19 outside their home (for example, in a
hospital setting) may be returned to family members along with instructions for cleaning and disinfection. Depending
on local rules and regulations, family members may retrieve these belongings at the funeral home or the healthcare
facility.
Family members should use gloves and practice good hand hygiene when handling these items. Depending on the
belongings received, family members should also follow the household item-specific cleaning and disinfection
guidelines for personal items, such as electronics.
W hat should I do if my family member died from COVID-19 while overseas?
W hen a US citizen dies outside the United States, the deceased person's next of kin or legal representative should
notify US consular officials at the Department of State. Consular personnel are available 24 hours a day, 7 days a
week, to provide assistance to US citizens for overseas emergencies. If a family member, domestic partner, or legal
representative is in a different country from the deceased person, he or she should call the Department of State's
Office of Overseas Citizens Services in Washington, DC,from 8 am to S pm Eastern time, Monday through Friday, at
888-407-4747 (toll-free) or 202-501-4444. For emergency assistance after working hours or on weekends and holidays,
call the Department of State switchboard at 202-647-4000 and ask to speak with the Overseas Citizens Services duty
officer. In addition, the US embassy ~ closest to or in the country where the US citizen died can provide assistance.
https://www.cdc.gov/col-onavirus/2019-ncov/faq.html
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M y family member died from COVID-19 while overseas. What are the requirements for returning the body to
the United States?
CDC does not require an autopsy before the remains of a person who died overseas are returned to the United
States. Depending on the circumstances surrounding the death, some countries may require an autopsy. Sources of
support to the family include the local consulate or embassy, travel insurance provider, tour operator, faith-based and
aid organizations, and the deceased's employer. There likely will need to be an official identification of the body and
official documents issued by the consular office.
CDC requirements for importing human remains depend upon if the body has been embalmed, cremated, or if the
person died from a quarantinable communicable disease.
At this time, COVID-19 is a quarantinable communicable disease in the United States and the remains must meet the
standards for importation found in 42 Code of Federal Regulations Part 71.55 and may be cleared, released, and
a uthorized for entry into the United States only under the following conditions:
• The remains are cremated; OR
• The remains are properly embalmed and placed in a hermetically sealed casket; OR
The remains are accompanied by a permit issued by the CDC Director. The CDC permit (if applicable) must
accompany the human remains at all times during shipment.
Permits for the importation of the remains of a person known or suspected to have died from a
q uarantinable communicable disease may be obtained through the CDC Division of Global Migration and
Quarantine by calling the CDC Emergency Operations Center at 770-488-7100 or
emailing dgmgpolicyoffice@cdc.gov.
Please see CDC's guidance for additional information.
V~That CDC is Doing
What is CDC doing about COVID-19?
CDC is working with other federal partners in awhole-of-government response. This is an emerging, rapidly evolving
situation and CDC will continue to provide updated information as it becomes available. CDC works 24/7 to protect
people's health. More information about CDC's response to COVID-19 is available online.
Cleaning and Disinfection
W hat is the difference between cleaning and disinfecting?
C/eaningwith soap and water removes germs, dirt, and impurities from surfaces. It lowers the risk of spreading
i nfection. Disinfectingkills germs on surfaces. By killing germs on a surface after cleaning, it can further lower the risk
of spreading infection.
Is it safe to vacuum in a school, business, or community facility after someone with suspected or confirmed
COVID-19 has been present?
https://www.cdc.gov/coronavil~us/2019-ncov/faq.ht~nl
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The risk of transmitting or spreading SARS-CoV-2, the virus that causes COVID-19, during vacuuming is unknown. At
this time, there are no reported cases of COVID-19 associated with vacuuming. If vacuuming is necessary or required
i n a school, business, or community facility that was used by a person with suspected or confirmed COVID-19, first
follow the CDC recommendations for Clearing and Disir;fectior~ f~r~ Community Facilities that apply, which includes a
wait time of 24 hours, or as long as practical.
After cleaning and disinfection, the following recommendations may help reduce the risk to workers and other
i ndividuals when vacuuming:
• Consider removing smaller rugs or carpets from the area completely, so there is less that needs to be vacuumed.
• Use a vacuum equipped with ahigh-efficiency particulate air(HEPA)filter, if available.
• Do not vacuum a room or space that has people in it. Wait until the room or space is empty to vacuum, such as at
night, for common spaces, or during the day for private rooms.
• Consider temporarily turning off room fans and the central HVAC system that services the room or space, so that
particles that escape from vacuuming will not circulate throughout the facility.
What is routine cleaning? How frequently should facilities be cleaned to reduce the potential spread of
COVID-19?
Routine cleaning is the everyday cleaning practices that businesses and communities normally use to maintain a
healthy environment. Surfaces frequently touched by multiple people, such as door handles, bathroom surfaces, and
handrails, should be cleaned with soap and water or another detergent at least daily when facilities are in use. More
frequent cleaning and disinfection may be required based on level of use. For example, certain surfaces and objects in
public spaces, such as shopping carts and point of sale keypads, should be cleaned and disinfected before each use.
Cleaning removesdirt and impurities, including germs,from surfaces. Cleaning alone does not kill germs, but it
reduces the number of germs on a surface.
Is cleaning alone effective against the virus that causes COVID-19?
Cleaning does not kill germs, but by removing them, it lowers their numbers and the risk of spreading infection. If a
surface may have gotten the virus on it from a person with or suspected to have COVID-19, the surface should be
cleaned and disinfected. Disinfecting kills germs on surfaces.
Who should clean and disinfect community spaces?
Regular cleaning staff can clean and disinfect community spaces. Cleaning staff should be trained on appropriate use
of cleaning and disinfection chemicals and provided with the personal protective equipment(PPE) required for the
chemicals used.
How long do companies need to close for disinfection after an exposure? How long before other workers can
come back to work?
Companies do not necessarily need to close after a person with confirmed or suspected COVID-19 has been in a
company facility. The areas) used or visited by the i ll person should be closed for 24 hours or as long as possible.
O pen outside doors and windows as much as possible ensuring that doing so does not pose a safety risk to children
using the facility (i.e. make sure that children are not able to enter the closed off area through any windows or doors).
a nd use ventilating fans to increase air circulation in the area. Once the area has been appropriately disinfected, it can
be opened for use. Workers without close contact with the person with confirmed or suspected COVID-19 can return
to work immediately after disinfection is completed.
https://www.cdc.gov/col-onavirus/2019-ncov/fac~.html
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How effective are alternative disinfection methods, such as ultrasonic waves., high intensity UV radiation, aid
LED blue light?
L
The efficacy of these disinfection methods against the virus that causes COVID-19 is not known. EPA only recommends
use of the surface disinfectants identified ors List N C'~ against the virus that causes COVID-19. EPA does not routinely
review the safety or efficacy of pesticidal devices, such as UV lights, LED lights, or ultrasonic devices. Therefore, EPA
cannot confirm whether, or under what circumstances, such products might be effective against the spread of COVID19.
Should outdoor playgrounds, like those at schools or in parks, be cleaned and disinfected to prevent COVID19?
Outdoor areas generally require normal routine cleaning and do not require disinfection. Spraying disinfectant on
outdoor playgrounds is not an efficient use of disinfectant supplies and has not been proven to reduce the risk of
COVID-19 to the public. You should maintain existing cleaning and hygiene practices for outdoor areas. If practical,
high touch surfaces made of plastic or metal, such as grab bars and railings, should be cleaned routinely. Cleaning and
disinfection of wooden surfaces (e.g., play structures, benches, tables) or groundcovers (e.g., mulch, sand) is not
recommended.
Can sanitizing tunnels be used at building entrances or exits to prevent the spread of COVID-19?
CDC does not recommend the use of sanitizing tunnels. There is no evidence that they are effective in reducing the
spread of COVID-19. Chemicals used in sanitizing tunnels could cause skin, eye, or respiratory irritation or damage.
Should sidewalks and roads be disinfected to prevent COVID-19?
CDC does not recommend disinfection of sidewalks or roads. Spraying disinfectant on sidewalks and roads is not an
efficient use of disinfectant supplies and has not been proven to reduce the risk of COVID-19 to the public. The risk of
spreading the virus that causes COVID-19 from these surfaces is very low and disinfection is not effective on these
surfaces.
COVID-19 and Animals
Can I get COVID-19 from my pets or other animals?
At this time, there is no evidence that animals play a significant role in spreading the virus that causes COVID-19.
Based on the limited information available to date, the risk of animals spreading COVID-19 to people is considered to
be low. A small number of pets have been reported to be infected with the virus that causes COVID-19, mostly after
contact with people with COVID-19.
Pets have other types of coronaviruses that can make them sick, like canine and feline coronaviruses. These other
coronaviruses cannot infect people and are not related to the current COVID-19 outbreak.
However, since animals can spread other diseases to people, it's always a good idea to practice heUlthy habits around
pets and other animals, such as washing your hands and maintaining good hygiene. For more information on the
many benefits of pet ownership, as well as staying safe and healthy around animals including pets, livestock, and
w ildlife, visit CDC's Healthy Pets, Healthy People website.
https://www.cdc.gov/coronavirus/2019-ncov/faq.html
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Do I need to get my pet tested for COVID-19?
N o. At this time, routine testing of animals for COVID-19 is nit recommended.
Can animals carry the virus that causes COVID-19 on their skin or fur?
Although we know certain bacteria and fungi can be carried on fur and hair, there is na evidence that viruses,
i ncluding the virus that causes COVID-19, can spread to people from the skin, fur, or hair of pets.
However, because animals can sometimes carry other germs that can make people sick, it's alwa;rs a good idea to
practice healthy habits around pets and other animals, including washing hands before and after interacting with
them.
Should I avoid contact with pets or other animals if I am sick with COVID-19?
We are still learning about this virus, but it appears that it can spread from people to animals in some situations. Until
we learn more about this new coronavirus, you should restrict contact with pets and other animals while you are sick
with COVID-19,just like you would with people. When possible, have another member of your household care for your
a nimals while you are sick. If you are sick with COVID-19, avoid contact with your pet, including
• Petting
• Snuggling
• Being kissed or licked
• Sharing food or bedding
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 cloth face covering.
What animals can get COVID-19?
We don't know for sure which animals can be infected with the virus that causes COVID-19. CDC is aware of a small
n umber of pets, including dogs and cats, reported to be infected with the virus that causes COVID-19, mostly after
close contact with people with COVID-19. A tiger at a zoo in New York has also tested positive for the virus.
Recent research shows that ferrets, cats, and golden Syrian hamsters can be experimentally infected with the virus
a nd can spread the infection to other animals of the same species in laboratory settings. Pigs, chickens, and ducks did
not become infected or spread the infection based on results from these studies. Data from one study suggested dogs
are not as likely to become infected with the virus as cats and ferrets. These findings were based on a small number of
a nimals, and do not show whether animals can spread infection to people.
At this time, there is no evidence that animals play a significant role in spreading the virus that causes COVID-19.
Based on the limited information available to date, the risk of animals spreading COVID-19 to people is considered to
be low. Further studies are needed to understand if and how different animals could be affected by the virus that
causes COVID-19 and the role animals may play in the spread of COVID-19.
Should I worry about my pet cat?
https://www.cdc.gov/col-onavirus/2019-ncov/fac~.html
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We are still learning about this virus and how it spreads, but it appears it can spread from humans to animals in some
situations. CDC is aware of a smal~ number of pets, including cats, reported to be infected with the virus that causes
COVID-19, mostly after close contact with people with COVID-19. Most of these animals had contact with a person with
COVID-19. A tiger at a New York zoo has also tested positive for the virus that causes COVID-19.
At this time, there is no evidence that animals play a significant role in spreading the virus that causes COVID-19.
Based on the limited data available, the risk of animals spreading COVID-19 to people is considered to be low. The
virus that causes COVID-19 spreads mainly from person to person, typically through respiratory droplets from
coughing, sneezing, or talking.
People sick with COVID-19 should isolate themselves from other people and animals, including pets, during their
i{Iness until we know more about how this virus affects animals. If you must care for your pet or be around animals
w hile you are sick, wear a cloth face covering and wash your hands before and after you interact with pets.
Can I walk my dog?
Walking a dog is important for both animal and human health and well-being. Walk dogs on a leash, maintaining at
least 6 feet(2 meters)from other people and animals, do not gather in groups, and stay out of crowded places and
avoid mass gatherings. Do not go to dog parks or public places where a large number of people and dogs gather. To
help maintain social distancing, do not let other people pet your dog when you are out for a walk.
Can I take my dog to daycare or a groomer?
U ntil we know more about how this virus affects animals, CDC encourages pet owners to treat pets as you would
other human family members to protect them from possible infection. This means limiting contact between pets and
people or animals outside the household as much as possible and avoiding places where large numbers of animals
a nd people gather.
Some areas are allowing groomers and boarding facilities such as dog daycares to open. If you must take your pet to a
groomer or boarding facility, follow any protocols put into place at the facility, such as wearing a cloth face
covering and maintaining at least 6 feet of space between yourself and others if possible.
Limit pet items brought from home to the groomer or boarding facility, and disinfect any objects that are taken into a
facility and returned home (such as leashes, bowls, and toys). Use an EPA-registered disinfectant[~ to clean items and
rinse thoroughly with clean water afterwards. Do not wipe or bathe your pet with chemical disinfectants, alcohol,
hydrogen peroxide, or any other products not approved for animal use.
Do not put face coverings on pets, and do not take a sick pet to a groomer or boarding facility. Signs of sickness in
a nimals may include:
• Fever
• Coughing
• Difficulty breathing or shortness of breath
• Lethargy
• Sneezing
• Nasal/ocular discharge
• Vomiting
• Diarrhea
hops://www.cdc.gov/col-onavirus/2019-ncov/fac~.ht1~11
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~i~
If you think your pet is sick, call your veterinarian. Scme veterinarians may offer telemedicine consultations or other
plans for seeing sick pets. Your veterinarian can evaluate your pet and determine the next steps for your pet's
treatment and care.
See more infor~matian on pets and COVID-19 and recommendations for how to help keep your pet safe.
What should I do if my pet gets sick and I think it's COVID-19?
There is a small number of animals around the world reported to be infected with the virus that causes COVID-19,
m ostly after having contact with a person with COVID-19. Talk to your veterinarian about any health concerns you
have about your pets.
If your pet gets sick after contact with a person with COVID-19, do not take your pet to the veterinary clinic yourself.
Call your veterinarian and let them know the pet was around a person with COVID-19. Some veterinarians may offer
telemedicine consultations or other plans for seeing sick pets. Your veterinarian can evaluate your pet and determine
the next steps for your pet's treatment and care.
Why are animals being tested when many people can't get tested?
Animals are only being tested in very rare circumstances. Routine testing of animals is not recommended at this time,
a nd any tests done on animals are done on a case by case basis. For example, if the pet of a COVID-19 patient has a
new, concerning illness with symptoms similar to those of COVID-19, the animal's veterinarian might consult with
public health and animal health officials to determine if testing is needed.
Are pets from a shelter safe to adopt?
Based on the limited information available to date, the risk of animals spreading COVID-19 to people is considered to
be low. There is no reason to think that any animals, including shelter pets, play a significant role in spreading the
virus that causes COVID-19.
W hat about imported animals or animal products?
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questions
y asked
(COVID-l9)
Col~onavi~-us
CDC does not have any evidence to suggest that imported animals or animal products pose a risk for spreading
COViD-19 in the United States. This is a rapidly evolving situation and information will be updated as it becomes
available. CDC, the U. S. Department of Agriculture (USDA), and the U.S. Fish and Wildlife Service(FWS) play distinct
b ut complementary roles in regulating the importation of Live animals and animal products into the United States.
• CDC regulates animals and animal products that pose a threat to human health,
• USDA regulate ~ animals and animal products that pose a threat to agriculture; and
• FWS regulates C~ importation of endangered species and wildlife that can harm the health and welfare of
h umans, the interests of agriculture, horticulture, or forestry, and the welfare and survival of wildlife resources.
Can I travel to the United States with dogs or import dogs into the United States during the COVID-19
outbreak?
Please refer to CDC's requirements for bringing a dog to the United States. The current requirements for rabies
vaccination apply to dogs imported from high-risk countries for rabies.
What precautions should be taken for animals that have recently been imported from outside the United
States (for example, by shelters, rescues, or as personal pets)?
I mported animals wil
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