FREQUENTLY ASKED QUESTIONS
Human coronaviruses are common throughout the world. The name corona refers to a crown because these viruses have crown-like spikes on their surface when viewed under an electron microscope. There are many different coronaviruses identified in animals but only a small number of these can cause disease in humans. Some coronaviruses such as 229E, NL63, OC43 and HKU1 are common causes of illness, including respiratory illness, in humans throughout the world. Sometimes coronaviruses infecting animals can evolve to cause disease in humans and become a new (novel) coronavirus for humans. Examples of this are the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), first reported from Saudi Arabia in 2012, and the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), first recognized in China in 2002.
On 7 January 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed as the causative agent of coronavirus disease 2019 (COVID-19). The majority of the case-patients initially identified were dealers and vendors at a seafood, poultry and live wildlife market (Huanan Seafood Wholesale Market) in Jianghan District of Hubei Province. This suggests that the novel coronavirus has a possible zoonotic origin. The specific source of the virus is not yet known.
As there is community transmission of SARS-CoV-2 in South Africa, all South Africans are at risk of infection with SARS-CoV-2 (illness called COVID-19). There are areas of the country where local transmission of the virus may be occurring at higher rates than other areas. Daily updates are available on nicd.ac.za and www.health.gov.za.
People who have been in contact with a confirmed case of COVID-19 are at an increased risk of infection and disease. In addition, healthcare workers have an increased risk of acquiring infection in the workplace. The elderly and individuals with co-morbidities, such as heart disease (including high blood pressure), chronic respiratory diseases, cancer patients, endocrine diseases (such as diabetes), have been found to be at a higher risk of severe illness and mortality associated with COVID-19.
The following categories of people should be tested in both the public and private health sectors
- Hospitalised patients
a. Symptomatic patients must be prioritised, and test results should be received within 24 hrs
b. All other patients should be tested on admission
- Any person with symptoms where COVID-19 infection is considered to be a possible cause
a. Persons at high-risk for infection or poor outcomes, eg. health care workers, those older than 60 years, those with comorbidities, pregnant women, should be prioritised.
- Individuals who are close contacts of confirmed cases, including asymptomatic contacts. Whilst a close contact is generally defined as contact with one metre of a COVID-19 confirmed cases for more than 15 minutes without PPE (no face cover/eye cover), alternative definitions should be used in some high-risk settings (eg: clusters/outbreaks).
- Post-mortem testing should be conducted in line with current guidelines
The following individuals or groups should not be tested (unless they fall into one of the priority groups):
- Asymptomatic people including employees/learners for purposes of returning to work/school
- Selected groups eg. sportspersons
- Patients meeting de-isolation criteria as per National Department of Health clinical guidelines should not be tested
COVID-19 is diagnosed by a laboratory test, polymerase chain reaction (PCR) molecular test, on a respiratory tract sample (e.g. sample from nose, throat or chest). This test detects the SARS-CoV-2 genetic material.
Symptoms include ANY of the following respiratory symptoms: cough, sore throat, shortness of breath, anosmia (loss of sense of smell), dysgeusia (alteration of the sense of taste) with or without other symptoms (which may include fever, weakness, myalgia, or diarrhoea)
The severity of illness can range from people who are infected without any illness (asymptomatic infection) to mild respiratory illness, to severe illness requiring admission to hospital or death. The majority of patients (approximately 80%) will have mild respiratory illness.
If you test positive for COVID-19 and your symptoms are mild, you need to isolate at home and if possible, in a separate room away from your loved ones. If your condition worsens, please seek medical help as soon as possible.
Please keep in contact with your health care provider telephonically to monitor your progress.
Treatment is supportive (e.g. provide oxygen for patients with shortness of breath or treatment for fever). Antibiotics do not treat viral infections. However, antibiotics may be required if a bacterial secondary infection develops. There are several studies in progress using different medications that may have some effectiveness against the virus. Remdesivir is a repurposed antiviral drug. Data are conflicting as to the clinical benefits of this agent and more data are awaited.
Having oneself vaccinated against COVID-19 is a persons best defense against developing severed disease and hospitalisation. Adopting the following preventative measures can help provide protection against infection:
- Practice physical distancing, this means keeping a physical distance of at least 1.5 metres from all people you interact with, specifically when out in public. This keeps you safe from respiratory droplets.
- Practice social distancing, this means not interacting with people outside of your household unless necessary.
- The use of a cloth mask (not medical mask as these are need for health care workers) may help protect you and people around you. Please look at the recommendation for these masks.
- Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer (at least 70% alcohol).
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Cover your cough or sneeze with a flexed elbow or a tissue, then throw the tissue in the bin.
- Avoid close contact with people who are sick.
- Stay at home when you are sick and try and keep distance from others at home.
Clean and disinfect frequently touched objects and surfaces.
A close contact is defined as a person having had face-to-face contact (less than 1 metre) or having been in a closed space with a confirmed COVID-19 case for at least 15 minutes. This includes, amongst others:
- All persons living in the same household as a COVID-19 case, and people working closely in the same environment as a case.
- Healthcare workers or other people providing direct care for a COVID-19 case while not
wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, N95 respirator, eye protection).
- A contact in an aircraft sitting within two seats (in any direction) of the case, travel
companions or persons providing care, and crew members serving in the section of the aircraft where the case was seated.
It is important to note that there is a difference between being fully recovered and being ready to come out of isolation.
The following criteria are specified for de-isolation of a person who tests positive for COVID-19:
- Symptomatic patients with mild disease (not requiring hospitalisation for Covid-19) can be de-isolated 10 days after the onset of their symptoms, provided their fever has resolved and their other symptoms are improving.
- Hospitalised patients with moderate-severe disease (who require hospitalisation due to COVID-19) can be de-isolated 10 days after achievement of clinical stability (i.e. from when they are not requiring supplemental oxygen and are otherwise clinically stable).
- Asymptomatic patients can be de-isolated 10 days after their test.
- Repeat PCR testing is NOT required in order to de-isolate a patient and is not recommended.
It is common for patients to continue to have symptoms for longer than the above time periods. Full recovery may take several weeks for some patients, especially for symptoms such as fatigue, cough and anosmia (loss of sense of smell). Patients who are still symptomatic at the end of their isolation period can be de-isolated provided that their fever has resolved and their other symptoms have shown improvement. Patients admitted to hospital can continue their isolation period at home or at an isolation facility once clinical stability has been achieved.
Employees can return to work:
1. 10 days after symptom onset for cases of mild disease
2. 10 days after clinical stability (e.g. after oxygen stopped) for cases of severe disease
Note: PCR testing is not required for return to work (exception: if a person remains asymptomatic in quarantine after a high-risk exposure to a confirmed COVID-19 case, a PCR test should be done when assessing the employee for early return to work on day 8 post-exposure).
Distinction between isolation period and returning to work
The recommended isolation time is the period during which a patient is still considered infectious. This should be distinguished from the point at which a patient is medically well enough to return to work. Some patients, especially those who have had severe disease, may require to be booked off sick for longer than the above isolation periods.
The main test used to diagnose COVID-19 is a polymerase chain reaction (PCR) test, which detects the genetic material (RNA) of SARS-CoV-2, the virus which causes COVID-19.
If you test positive then it means that genetic material of the virus was detected in your sample, which is normally a sample collected from your nose or throat and confirms a diagnosis of SARS-CoV-2 infection. A negative test does not exclude an infection with SARS-CoV-2, as your test result depends on when your sample was collected and the quality of the sample that was collected.
The amount of virus in your body (called the viral load) changes during the course of an infection, starting from low levels which increase over a few days and then start to decrease towards the later stages of infection. How long you have the virus for (called viral shedding) depends on many factors such as your age, whether you have an underlying condition and how severe your disease is. Viral shedding is generally detectable around 2-3 days before the onset of symptoms and tends to decrease after about 7 days from the onset of symptoms.
Although the PCR test is a very sensitive test, there is no test that is 100% sensitive and so if you are tested very early in your infection, and the viral loads in your body are low then the test may not detect the virus. However, if tested later in infection, when viral loads are higher, your test may change to positive. Similarly, if you are tested towards the end of the infection, your test result may change to negative.
The test result is also affected by the type and quality of the sample that is collected. If a poorly collected sample is tested, then it is possible that not enough clinical material was collected from you and your test result will be negative when you are infected. If your clinician suspects a false-negative result, they will request that a repeat sample is collected to be re-tested.
If your COVID-19 test result changes on repeat samples, it does not mean that a laboratory error was made but could reflect that the viral load has gone down or could be due to poor sample collection.
The aim of the lockdown is to flatten the infection rate curve. This means spreading infection rate over a longer period of time rather than a large number in a shorter period of time. This is to give healthcare facilities a chance to treat people needing treatment.
Other strategies to minimise the impact of COVID-19 on South Africa includes actively testing as many people with symptoms as possible. The National Department of Health is also doing community based screening in certain areas where there are potentially large number of infected people. Both these strategies help to identify and isolate infected people, protecting their families and the community.
For medical/clinical related queries by health care professionals only, contact the NICD hotline at 0800 111131. The NICD General Public Hotline number is 0800 029 999. All lines operate 24 hours a day.
The government has a number of helplines and call centres through which you can get information about services and programmes. These are available here;