Coronavirus disease (COVID-19)
1. What is COVID-19?
COVID-19 is the disease caused by a new coronavirus called SARS-CoV-2. WHO first learned of this new virus on 31 December 2019, following a report of a cluster of cases of ‘viral pneumonia’ in Wuhan, People’s Republic of China.
2. What are the symptoms of COVID-19?
The most common symptoms of COVID-19 are
Other symptoms that are less common and may affect some patients include:
Loss of taste or smell,
Conjunctivitis (also known as red eyes)
Muscle or joint pain,
Different types of skin rash,
Nausea or vomiting,
Chills or dizziness.
Symptoms of severe COVID‐19 disease include:
Shortness of breath,
Loss of appetite,
Persistent pain or pressure in the chest,
High temperature (above 38 °C).
Other less common symptoms are:
Reduced consciousness (sometimes associated with seizures),
More severe and rare neurological complications such as strokes, brain inflammation, delirium and nerve damage.
People of all ages who experience fever and/or cough associated with difficulty breathing or shortness of breath, chest pain or pressure, or loss of speech or movement should seek medical care immediately. If possible, call your health care provider, hotline or health facility first, so you can be directed to the right clinic.
3. What happens to people who get COVID-19?
Among those who develop symptoms, most (about 80%) recover from the disease without needing hospital treatment. About 15% become seriously ill and require oxygen and 5% become critically ill and need intensive care.
Complications leading to death may include respiratory failure, acute respiratory distress syndrome (ARDS), sepsis and septic shock, thromboembolism, and/or multiorgan failure, including injury of the heart, liver or kidneys.
In rare situations, children can develop a severe inflammatory syndrome a few weeks after infection.
4. Who is most at risk of severe illness from COVID-19?
People aged 60 years and over, and those with underlying medical problems like high blood pressure, heart and lung problems, diabetes, obesity or cancer, are at higher risk of developing serious illness.
However, anyone can get sick with COVID-19 and become seriously ill or die at any age.
5. Are there long-term effects of COVID-19?
Some people who have had COVID-19, whether they have needed hospitalization or not, continue to experience symptoms, including fatigue, respiratory and neurological symptoms.
WHO is working with our Global Technical Network for Clinical Management of COVID-19, researchers and patient groups around the world to design and carry out studies of patients beyond the initial acute course of illness to understand the proportion of patients who have long term effects, how long they persist, and why they occur. These studies will be used to develop further guidance for patient care.
6. How can we protect others and ourselves if we don't know who is infected?
Stay safe by taking some simple precautions, such as physical distancing, wearing a mask, especially when distancing cannot be maintained, keeping rooms well ventilated, avoiding crowds and close contact, regularly cleaning your hands, and coughing into a bent elbow or tissue. Check local advice where you live and work. Do it all!
Read our public advice page for more information.
7. When should I get a test for COVID-19?
Anyone with symptoms should be tested, wherever possible. People who do not have symptoms but have had close contact with someone who is, or may be, infected may also consider testing – contact your local health guidelines and follow their guidance.
While a person is waiting for test results, they should remain isolated from others. Where testing capacity is limited, tests should first be done for those at higher risk of infection, such as health workers, and those at higher risk of severe illness such as older people, especially those living in seniors’ residences or long-term care facilities.
8. What test should I get to see if I have COVID-19?
In most situations, a molecular test is used to detect SARS-CoV-2 and confirm infection. Polymerase chain reaction (PCR) is the most commonly used molecular test. Samples are collected from the nose and/or throat with a swab. Molecular tests detect virus in the sample by amplifying viral genetic material to detectable levels. For this reason, a molecular test is used to confirm an active infection, usually within a few days of exposure and around the time that symptoms may begin.
Learn more about what kind of COVID-19 tests are available
9. What about rapid tests?
Rapid antigen tests (sometimes known as a rapid diagnostic test – RDT) detect viral proteins (known as antigens). Samples are collected from the nose and/or throat with a swab. These tests are cheaper than PCR and will offer results more quickly, although they are generally less accurate. These tests perform best when there is more virus circulating in the community and when sampled from an individual during the time they are most infectious.
- Learn more about rapid diagnostic test
10. I want to find out if I had COVID-19 in the past, what test could I take?
Antibody tests can tell us whether someone has had an infection in the past, even if they have not had symptoms. Also known as serological tests and usually done on a blood sample, these tests detect antibodies produced in response to an infection. In most people, antibodies start to develop after days to weeks and can indicate if a person has had past infection. Antibody tests cannot be used to diagnose COVID-19 in the early stages of infection or disease but can indicate whether or not someone has had the disease in the past.
11. What is the difference between isolation and quarantine?
Both isolation and quarantine are methods of preventing the spread of COVID-19.
Quarantine is used for anyone who is a contact of someone infected with the SARS-CoV-2 virus, which causes COVID-19, whether the infected person has symptoms or not. Quarantine means that you remain separated from others because you have been exposed to the virus and you may be infected and can take place in a designated facility or at home. For COVID-19, this means staying in the facility or at home for 14 days.
Isolation is used for people with COVID-19 symptoms or who have tested positive for the virus. Being in isolation means being separated from other people, ideally in a medically facility where you can receive clinical care. If isolation in a medical facility is not possible and you are not in a high risk group of developing severe disease, isolation can take place at home. If you have symptoms, you should remain in isolation for at least 10 days plus an additional 3 days without symptoms. If you are infected and do not develop symptoms, you should remain in isolation for 10 days from the time you test positive.
12. What should I do if I have been exposed to someone who has COVID-19?
If you have been exposed to someone with COVID-19, you may become infected, even if you feel well.
After exposure to someone who has COVID-19, do the following:
Call your health care provider or COVID-19 hotline to find out where and when to get a test.
Cooperate with contact-tracing procedures to stop the spread of the virus.
If testing is not available, stay home and away from others for 14 days.
While you are in quarantine, do not go to work, to school or to public places. Ask someone to bring you supplies.
Keep at least a 1-metre distance from others, even from your family members.
Wear a medical mask to protect others, including if/when you need to seek medical care.
Clean your hands frequently.
Stay in a separate room from other family members, and if not possible, wear a medical mask.
Keep the room well-ventilated.
If you share a room, place beds at least 1 metre apart.
Monitor yourself for any symptoms for 14 days.
Stay positive by keeping in touch with loved ones by phone or online, and by exercising at home.
If you live in an area with malaria or dengue fever, seek medical help if you have a fever. While travelling to and from the health facility and during medical care, wear a mask, keep at least a 1-metre distance from other people and avoid touching surfaces with your hands. This applies to adults and children. Read our malaria and COVID-19 Q&A for more information.
13. How long does it take to develop symptoms?
The time from exposure to COVID-19 to the moment when symptoms begin is, on average, 5-6 days and can range from 1-14 days. This is why people who have been exposed to the virus are advised to remain at home and stay away from others, for 14 days, in order to prevent the spread of the virus, especially where testing is not easily available.
14. Is there a vaccine for COVID-19?
Yes. The first mass vaccination programme started in early December 2020 and the number of vaccination doses administered is updated on a daily basis here. At least 13 different vaccines (across 4 platforms) have been administered. Campaigns have started in 206 economies.
The Pfizer/BioNtech Comirnaty vaccine was listed for WHO Emergency Use Listing (EUL) on 31 December 2020. The SII/Covishield and AstraZeneca/AZD1222 vaccines (developed by AstraZeneca/Oxford and manufactured by the Serum Institute of India and SK Bio respectively) were given EUL on 16 February. The Janssen/Ad26.COV 2.S developed by Johnson & Johnson, was listed for EUL on 12 March 2021. The Moderna COVID-19 vaccine (mRNA 1273) was listed for EUL on 30 April 2021 and the Sinopharm COVID-19 vaccine was listed for EUL on 7 May 2021. The Sinopharm vaccine is produced by Beijing Bio-Institute of Biological Products Co Ltd, subsidiary of China National Biotec Group (CNBG).
For further information, see here.
Once vaccines are demonstrated to be safe and efficacious, they must be approved by national regulators, manufactured to exacting standards, and distributed. WHO is working with partners around the world to help coordinate key steps in this process, including to facilitate equitable access to safe and effective COVID-19 vaccines for the billions of people who will need them. More information about COVID-19 vaccine development is available here.
15. What should I do if I have COVID-19 symptoms?
If you have any symptoms suggestive of COVID-19, call your health care provider or COVID-19 hotline for instructions and find out when and where to get a test, stay at home for 14 days away from others and monitor your health.
If you have shortness of breath or pain or pressure in the chest, seek medical attention at a health facility immediately. Call your health care provider or hotline in advance for direction to the right health facility.
If you live in an area with malaria or dengue fever, seek medical care if you have a fever.
If local guidance recommends visiting a medical centre for testing, assessment or isolation, wear a medical mask while travelling to and from the facility and during medical care. Also keep at least a 1-metre distance from other people and avoid touching surfaces with your hands. This applies to adults and children.
16. Are there treatments for COVID-19?
Scientists around the world are working to find and develop treatments for COVID-19.
Optimal supportive care includes oxygen for severely ill patients and those who are at risk for severe disease and more advanced respiratory support such as ventilation for patients who are critically ill.
Dexamethasone is a corticosteroid that can help reduce the length of time on a ventilator and save lives of patients with severe and critical illness. Read our dexamethasone Q&A for more information.
Results from the WHO’s Solidarity Trial indicated that remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon regimens appear to have little or no effect on 28-day mortality or the in-hospital course of COVID-19 among hospitalized patients.
Hydroxychloroquine has not been shown to offer any benefit for treatment of COVID-19. Read our hydroxychloroquine Q&A for more information.
WHO does not recommend self-medication with any medicines, including antibiotics, as a prevention or cure for COVID-19. WHO is coordinating efforts to develop treatments for COVID-19 and will continue to provide new information as it becomes available.
17. Are antibiotics effective in preventing or treating COVID-19?
Antibiotics do not work against viruses; they only work on bacterial infections. COVID-19 is caused by a virus, so antibiotics do not work. Antibiotics should not be used as a means of prevention or treatment of COVID-19.
In hospitals, physicians will sometimes use antibiotics to prevent or treat secondary bacterial infections which can be a complication of COVID-19 in severely ill patients. They should only be used as directed by a physician to treat a bacterial infection.
2. Coronavirus disease (COVID-19): Adolescents and youth
1. Can adolescents catch COVID-19?
Yes. All age groups can catch COVID-19.
While we are still learning about how COVID-19 affects people, so far, data suggests that children under the age of 18 years have few deaths compared to other age groups and usually mild disease. However, cases of critical illness have been reported. As with adults, pre-existing medical problems like high blood pressure, heart and lung problems, asthma, diabetes, obesity, cancer and neurological and developmental conditions are risk factors for severe disease and intensive care admission in children.
Read our Q&A on Coronavirus disease (COVID-19) on who is most at risk of severe illness from COVID-19
2. Can adolescents spread COVID-19 to other people even if they have mild or no symptoms?
Yes. Infected people in all age groups – including adolescents - can transmit the virus to other people, even if they have mild symptoms or do not feel ill.
The virus is spread from person to person through liquid particles such as aerosols (smaller) and droplets (larger) from the nose or mouth which are spread when a person with COVID-19 coughs, sneezes or speaks. People can catch COVID-19 if they breathe in these droplets from an adolescent infected with the virus. Therefore, it is important to stay at least 1 meter away from others. These droplets can land on objects and surfaces. People can then become infected by touching these objects or surfaces, and then touching their eyes, nose or mouth.
Further resources: Read our Q&A on Coronavirus disease (COVID-19): How is it transmitted? for more information on how COVID-19 spreads between people
3. Since there are few known cases of adolescents getting seriously ill with COVID-19, should I go to a health facility if I develop symptoms of the disease?
If you have any symptoms suggestive of COVID-19, contact your health care provider or COVID-19 hotline for instructions and find out what to do. If you have minor symptoms, such as a slight cough or a mild fever, and no risk factors for severe disease there is generally no need to go to a health care facility. Your health provider will assess the situation and give instructions when and where to get a test, stay at home for 14 days away from others and monitor your health.
Seek medical care immediately if your health gets worse, or if there is no one in your family that can take care of you at home. If possible, call your health care provider, hotline or health facility first, so you can be directed to the right clinic. It is important that you follow the procedures put in place by your country. Ask a family member or another trusted adult how you can find out what these procedures are where you live.
Find out more on our main public advice page.
Read our Q&A on Coronavirus disease (COVID-19) for more information on what to do if you have COVID-19 symptoms
Read our Q&A on Coronavirus disease (COVID-19): Home care for families and caregivers on when someone who has tested positive for COVID-19 can be cared for at home
4. What should I do if someone in my family gets really ill with COVID-19?
Immediately seek medical care if a member of your family gets seriously ill, for example develops difficulty breathing or feels pain or pressure in the chest. If possible, either you or an adult should contact your health care provider or COVID-19 hotline for instructions and find out where and how you could get care. If your family member is confirmed as having COVID-19, you must be prepared that you and other known contacts will need to isolate for 14 days and monitor symptoms, even if you feel healthy.
Find out more on our main public advice page.
Read our Q&A on Coronavirus disease (COVID-19): Home care for families and caregivers on when someone who has tested positive for COVID-19 can be cared for at home
WHO has developed the guidance on Considerations in the investigation of cases and clusters of COVID-19 that offers guidance to local, regional, or national health authorities what to do if a person is suspected or confirmed of having COVID-19
5. I was due to get vaccinated for HPV, meningitis or tetanus, but immunization services have been disrupted. Should I be concerned?
WHO recommends that countries continue routine immunization services wherever feasible. For example, school-based vaccination initiatives should continue only if infection prevention and control measures are implemented to avoid increased risk of transmission of the COVID-19 virus among the students, school personnel and health care providers. However, vaccines provided to adolescents have sufficiently flexible schedules to make sure you can get the vaccine in time when vaccination services start again. For example, the HPV vaccine that requires two doses can be started any time between 9 and 14 years of age and the interval between the two doses can be longer. The minimum interval between doses is 6 months, but it can be 12 or 15 months and, if necessary, even longer. It is most important that you receive the second dose at some point in time to be fully protected.
Decisions to continue routine vaccination services are made by each country. Ask a family member or another trusted adult how you can get information about vaccination services where you live. It is important you get the vaccines you are supposed to get, even if they have to be delayed due to the COVID-19 pandemic.
Read our Q&A on Vaccines and immunization: What is vaccination? to find out more why is vaccination important and how does a vaccine work
Read our Frequently Asked Questions on Immunization in the context of COVID-19 pandemic
WHO has developed the guidance that provides Guiding principles for immunization activities during the COVID-19 pandemic
6. I am on medication for a chronic health condition. Should I change anything?
For people with chronic conditions such as such as asthma, diabetes, TB and HIV the most important thing is to continue your medication as prescribed, attend recommended check-ups and seek medical help if you have new symptoms.
Check with your health authorities and health provider if your regular check-ups should be done differently during the COVID-19 pandemic. Some services, such as counselling, may be available remotely. For treatment of clinically stable adolescents with HIV and adolescents with TB and/or other chronic conditions, your health provider should consider multi-month prescriptions and dispensing which will reduce the frequency of your visits to the clinic and ensure continuity of treatment, if movements are disrupted during the pandemic. Seek advice from your health authorities and health care provider on how to be protected from COVID-19 and continue your treatment as prescribed.
Find out more on our main public advice page.
Read our Q&A on Coronavirus disease (COVID-19): HIV and antiretrovirals on whether people living with HIV are at increased risk of being infected with the virus that causes COVID-19
Read our Q&A on Coronavirus disease (COVID-19): Tuberculosis to find out if people with tuberculosis are likely to be at increased risk of COVID-19 infection and severe illness
7. I am bored having to spend so much time at home. Since I am very unlikely to get severely ill even if I was to get COVID-19, why is it important that I follow the guidelines to prevent transmission such as keeping physical distance from other people?
Spending more time at home is difficult and can get boring, but it may help to do something you enjoy. This could be reading a book, playing games or listening to music. Try to stay connected with friends and family every day either by communicating with them by phone or internet if you can, or, if you live close to them and the local rules allow you to, by talking in-person while keeping your distance. You can also get involved with your community to help fight the transmission of the virus.
At the same time, it is still really important that you reduce your chances of being infected or spreading COVID-19 by washing your hands with soap and water or alcohol-based hand rub as often as possible, keeping at least 1 metre (3 feet) from other people, and avoiding crowded places. Even if adolescents with COVID-19 usually do not have symptoms and have mild disease, you might be one of the unlucky adolescents who does get severely ill from COVID-19, or you could spread it to others and be responsible for them getting really ill or even dying. You have the power to make choices that could save lives and together young people can play an important part in fighting COVID-19.
Find out more on our main public advice page.
Read about 10 Ways Young People are Leading the Way Against COVID-19
8. Some of my friends are not sticking to the rules about physical distancing. What should I do?
Explain to your friends why it is important to protect themselves and others by washing their hands, avoiding touching their face, always coughing or sneezing into their elbow, sleeve, or a tissue, and cooperating with physical distancing measures and movement restrictions when called on to do so. Maybe you can share ideas for fun virtual activities that your friends can participate in, and you can encourage them to do them together with you or with other friends. For example, you can encourage them to join YouthAgainstCOVID19 campaign that aims to help teach young people around the world about COVID-19 and what they can do to keep their friends, families and communities safe. This way you are giving them alternatives rather than just telling them to stay at home.
But, remember that you do not have control over other peoples’ actions so do not get into an argument or a fight to try to change their minds.
9. I know there is a risk of getting COVID-19, but can I still play sports?
Yes. You can play sports that are in line with the physical distancing measures and movement restrictions that are in place in your country. If you are able to go for a bicycle ride, or if you go to a park or public open space to walk, run or exercise always practice physical distancing and wash your hands with water and soap before you leave, when you get to where you are going, and as soon as you get home. If water and soap are not immediately available, use alcohol-based hand rub.
Being physically active is good for your health, both physical and mental. Set up a regular routine to practice activities or sports that do not require close contact with others every day for 1 hour. You can do individual sports, like jogging, walking, dancing or yoga. There are many options to try. You can set up playground games indoors, such as jump rope and hop-scotch, play with your brothers and sisters, and practice some strength training activities, using improvised weights like bottles full of water or sand. If you have access to the internet, you can also join in online active games or fitness classes, or set up your own online physical exercises with your friends or classmates. Find an activity that is fun, can be done within the restrictions that are in place in your country, and makes you feel good.
Do not exercise if you have a fever, cough and difficulty breathing. Stay home and rest, seek medical attention and follow the directions of your local health authority.
Read our Q&A on How to be active during COVID-19
10. COVID-19 makes me really anxious. I feel worried and at times have difficulty coping with stress. What should I do?
In situations like a pandemic it is very normal to feel anxious and powerless, and that is ok. Here are a few suggestions on things that could help you proactively manage your anxiety:
TIP 1: DO THINGS THAT ARE GOOD FOR YOUR BODY AND MIND
Your body and mind are connected. Here are some things you can do to keep them healthy:
• Stay active! Being physically active is good for your body and can help your mind feel better too. If you can go outside, try a walk, run, bike ride, or any other sport. If indoors, try dancing, stretching, or any other movement you can do. Find what works for you – and do it!
• Eat well! Try to make healthy choices about what you eat if you can.
• Take notice of yourself and the world around you. This means becoming more aware of your breathing, your body and your surroundings. Try to BE PRESENT in the moment!
• Sleep! Try to get the right balance of sleep each night. This will help you grow well, stay healthy, and keep clear thoughts.
• Find things that make you happy and do those things more! Listening to music, reading, playing games, chatting with friends, growing plants, cooking, drawing, playing sports…there are many possibilities! Perhaps even try something new! Just make sure that during these activities you respect physical distancing and other protection measures that are in place in your country.
TIP 2: STAY CONNECTED TO LOVED ONES
Keep in touch with your family and friends however you can. Use social media, email, phone calls, write a letter! Be creative. And if you can’t connect, then think about a memory of a shared time together.
TIP 3: RECOGNISE HOW YOU ARE FEELING
Understanding how you feel is important. Don’t ignore it. Sometimes writing your feelings down can help you to describe it. It might sound easy or simple, but try this “I feel ....... right now”.
TIP 4: BE KIND TO YOURSELF
It is okay to feel however it is that you’re feeling. Putting pressure on yourself to always ‘be happy’ or ‘stay positive’ or ‘stay productive’ can sometimes make you feel worse. Instead, if you notice you are experiencing difficult emotions, try telling yourself: “I feel worried and scared, but that does not mean I am not coping.” “It’s been a tough time, it’s okay to be upset.” “I am feeling [insert how you are feeling] and that is okay.” “These are difficult times, it’s normal to feel upset.”
Or think of something to tell yourself that works for you
TIP 5: LISTEN TO YOUR BODY
Our body experiences and reacts to how we feel. Do you often get headaches? Do your shoulders, chest, or stomach sometimes feel tense? Try closing your eyes, and listening to your own breathing. Notice how you feel in each part of your body, starting from your head down to your toes. Notice if you are feeling any tightness, pain, or pressure in your body. Being aware of where you are feeling tension can help you release it.
TIP 6: TRY USING YOUR BREATH TO CALM YOURSELF
Slow breathing is one of the quickest ways of calming down the body when we experience feelings such as fear, worry or anger. Close your eyes and think of a calm place. Imagine yourself there, feeling relaxed.
• Focus on breathing slowly.
• Breathe in for a slow count of 3 and out for a slow count of 3.
• Practice this for a few minutes.
How do you feel after?
TIP 7: AVOID UNHEALTHY WAYS OF COPING WITH STRESS
When you are experiencing difficult feelings, it is important to find healthy ways to take care of yourself.
Find out more on our #HealthyAtHome - Mental health page.
Read our guide “Doing What Matters in Times of Stress: An Illustrated Guide”
Read more from Voices of Youth on how to take care of yourself and your relationships in stressful times
Read about Coping with stress during the 2019-nCoV outbreak
Your parents or legal guardians may access this resources on Helping children cope with stress during the 2019-nCoV outbreak
The #CopingWithCOVID is a webinar series that provides young people with a platform for genuine connection amid uncertainty, encouraging them to field their questions to the experts from UNICEF and WHO, and generate mental health awareness among young people. If you missed any of the sessions, you can watch them still!
Teamup at home: support for children during the coronavirus pandemic is a resource specifically developed for children aged 6 to 11 but can be enjoyed by people of all ages – it provides a simple, safe and above all fun way to play and exercise in pairs or individually.
11. COVID-19 is everywhere in the news, and I am finding it difficult to know what is true and what is false. What should I do?
A near-constant stream of news, sometimes contradictory, can cause anyone to feel lost and distressed. Make sure to use reliable sources such as UNICEF and WHO’s sites to get information, or to check any information you might be getting through less reliable channels.
If you have a phone, you can use the WHO Health Alert on WhatsApp to get the latest information about the pandemic. This is a new service, which is free to use, designed to give prompt, reliable and official information 24 hours a day, worldwide. Start by clicking the WHO Health Alert, then simply text the word ‘Hi’ in a WhatsApp message to get started. Many countries have similar initiatives to provide context-specific information and updates. Keep in mind that overloading yourself with information about the COVID-19 pandemic can also be stressful, so seek information updates and practical guidance at specific times during the day and avoid listening to or following rumours that make you feel uncomfortable.
Find out more on our Mythbusters page
Find out more on our #HealthyAtHome - Mental health page.
Read about Coping with stress during the 2019-nCoV outbreak
12. Schools are reopening in some areas of my country. Is it safe to go back to school?
A decision to reopen schools in every country and area is made based on careful assessment of the situation, with consensus among all the key parties involved, including the health and education policy-makers, teachers and other school staff, parents and health and community workers. In addition, reopening of schools is carefully planned and prepared, with all necessary measures in place to protect the safety and health of everyone in the school community.
Therefore, if your school reopens, you should feel assured it is safe for you to go back to school – provided that you strictly follow the guidelines and rules that will be provided by your school.
Of course, if you have any concerns with going back to school, do not hesitate to speak out to your teachers and parents or guardians.
Read what WHO recommends for safe schools reopening in Considerations for school-related public health measures in the context of COVID-19
Read our Q&A on Schools and Covid-19
13. What should I do if I missed out on my education due to the COVID-19 pandemic?
Your school or place where you are studying are likely to make arrangements for you to catch up on what you have missed when your school was closed. Many schools have put in place accelerated learning modalities to help pupils catch up on learning loss.
If your school is still closed, and you cannot attend classes in person, follow the procedures that your school has put in place to give you access to educational materials and technologies (internet, texting radio, radio, or television). If you have access to the internet, you can also consult your teachers and other trusted adults to identify and access reliable online learning opportunities and resources, including those included in the distance learning solutions recommended by UNESCO, the United Nations agency that helps countries improve their education systems. In addition, UNESCO is collecting stories from students, teachers and parents about how they are coping and continuing to learn during school closures. Access those stories, they might inspire you. You can also contact UNESCO and share your story! Find out how to share it here.
In places where internet connectivity is a problem, many governments have started to broadcast educational programmes on TV and radio channels during school closures. If you live in such a place, look out for educational programmes on your local TV and radio channels.
Studying at home due to coronavirus? This is how young people around the world are keeping their mood up
14. Should I wear a mask at school or when playing sports?
You should not wear a mask when playing sports or doing physical activities, such as running, jumping or playing on the playground, so that it doesn’t compromise your breathing. However, remember to maintain at least a 1-metre distance from others, limit the number of friends playing together, and respect hand hygiene.
Regarding wearing masks in schools and other public places, WHO advises that people always consult and abide by local authorities on recommended practices in their area. In countries or areas where there is intense community transmission of the virus and in settings where physical distancing cannot be achieved, WHO and UNICEF advise decision makers to apply the following criteria for use of masks in schools (either in classes, corridors or communal areas) when developing national policies:
• Children aged 5 years and under should not be required to wear masks.
• For children between six and 11 years of age, the decision to use a mask will vary from place to place, and will depend on several factors, such as the intensity of transmission in the area where the child lives, local norms that influence social interactions, the child’s capacity to comply with the appropriate use of masks and availability of appropriate adult supervision, and other factors.
• Children and adolescents 12 years or older should follow the national mask guidelines for adults.
Watch our ‘How to wear a fabric mask’ video for a demonstration.
Watch our ‘WHO’s recommended fabric mask materials and composition’ video for more information.
Read our Q&A on children and masks related to COVID-19 for more information on precautions for younger age groups.
Watch our animation on medical and fabric masks, explaining who wears what, when and where.
Read more in our guidance Considerations for school-related public health measures in the context of COVID-19 what are the considerations in schools for wearing masks
15. I am spending much more time online in social media, playing games and studying. Should I be worried about this?
COVID-19 has abruptly pushed many people’s daily lives online, and you may be spending even more hours online than before. While online solutions provide huge opportunities for continuing your learning, socializing and playing, you should try to limit the amount of screen time that is not related to your studies or physical activity. This is because you need to be physically active to keep healthy and a positive attitude. In addition, some people are sensitive to flickering lights and may get headaches, nausea, and dizziness, and even seizures if they spend too much time in front of a screen. Therefore, it is important to replace some of the recreational screen time with non-screen activities, like listening to music, reading, playing board games, and physical activity, like going for a walk or jog. Excessive gaming can lead to “gaming disorder” that leads to reduced sleep or day-night reversal, loss of appetite, aggression, headaches, and attention problems. If you experience these symptoms, seek help from your parents or a trusted adult.
Read our brief on Addictive behaviours: Gaming disorder
Find out more about COVID-19 and its implications for protecting children online
16. I heard I can be hurt by online contacts. What are my risks and how I can protect myself online.
Since you might be spending even more time online than before, it is wise to be aware of some of the risks. First, be careful what content you share online. Risky behaviour, such as sexting or sharing of sexualized content, can expose you to risks of blackmail, harassment and humiliation. Second, spending more time online may increase the chances that you could come into contact with online predators who seek to sexually exploit young people. When in front of webcams wear appropriate clothing and avoid using private instant messaging services in your communication with teachers. In addition, it’s important to note that some adolescents – for example those with disabilities and those perceived to be different or at greater risk of catching or spreading COVID-19 - may be at increased risk of cyberbullying and discrimination. Hurtful, discriminatory or inappropriate online contact is never okay. If in doubt, or if you feel uncomfortable or distressed about some interactions you have online, tell a parent or another trusted adult immediately.
Find out more about COVID-19 and its implications for protecting children online
17. Since my parents stopped going out to work, they have been arguing with each other much more, and in some instances, I have seen one parent harm or hurt the other either verbally or physically. I don’t feel safe at home. What should I do?
This is a difficult time. Many people – including perhaps your parents - are worrying about security, health, and money. When people are in cramped and confined living conditions, these tensions and stress can become even greater. It is normal to have disagreements. However, if the disagreements become verbal or physical, then it is right to take action.
If you are worried about what is happening in your home, or don’t feel safe, talk to a trusted adult about what worries you, and seek their advice. During an argument or a fight, try not to draw attention to yourself so that you don’t end up getting hurt. It might be useful to have a safety plan in case the violence escalates. This includes preparing a bag with essential items, like clothing, documents and electric charger, and having a neighbour, friend, relative, or shelter identified to go to should you need to leave the house immediately for safety reasons. Arrange with the trusted adult to help you alert the relevant authorities who can help you stay safe, including the police, emergency health services and social services.
In many of the countries that have been most affected by COVID-19, essential services are still available, including shelters or protection services. If there are no trusted adults for you to share your concerns with, your country may have helplines, including text services so that you can communicate with someone who can help you or give you advice.
Read more in the COVID-19 and Ending Violence Against Women and Girls brief
Find out more how COVID-19 can exacerbate risks of violence for women
in this brief COVID-19 and violence against women
Read our Guidelines for the health sector response to child maltreatment
18. Is it safe to have sex at this time?
There is no evidence that COVID-19 is transmitted through semen or vaginal fluids. However, having sex with someone means that you are very close to them. This puts one person at risk if the other person has COVID-19. Masturbation does not involve another person and carries no risk of COVID-19. Depending on the government guideline, there might be restrictions in place to meet people outside your household, so it is important you follow these guidelines. Your risk of COVID-19 is not increased if you already live in the same household as your sexual partner and you are both taking steps to protect yourself from the virus. Make sure to use condoms and contraception to avoid sexually transmitted infections and unintended pregnancy.
Read our Q&A on Coronavirus disease (COVID-19): Contraception and family planning
Find out more about contraceptive counselling and services for young people during COVID-19 in this brief Not in Pause. Responding to the Sexual and Reproductive Health Needs of Adolescents During the COVID-19 Crisis
19. I don’t like the way someone touches me at home and we are both at home all the time because of the pandemic. What should I do?
It is wrong for anyone to do this. And it is not your fault in any way. If you are staying in the same house as the person and/or are dependent on him (it will usually be a man), that may make some of the things that you could do difficult, especially during stay-at-home restrictions due to COVID-19. Here are some things that you can consider doing to improve your safety while in the house.
You could tell him politely but firmly that you do not want him to touch you and ask him to please stop.
You could inform your parents or other caregivers or trusted adult in the house about what is happening.
You could inform a trusted adult outside your home such as a neighbour or a teacher or family friend or relative.
If you have access to a phone, you could call or text for help and support. This includes calling hotlines/helplines for children and women who are in need of help or feeling distressed or subjected to abuse, or calling a child protection service in your area. Be careful not to leave your phone calls or text messages where anyone else could access them.
If you need to leave the house immediately because he is hurting or harming you, think of discretely (without him overhearing) pre-arranging with a neighbour or trusted relative or family friend to help you leave the house and stay with them until it is safe for you to return home.
If you have been sexually abused or raped and need urgent medical help or care, go as soon as possible to the nearest hospital or clinic to ask for medical care.
Find out more what can you do if you feel home is not a safe place in our Q&A Coronavirus disease (COVID-19): Violence against women
Find out more how COVID-19 can exacerbate risks of violence for women in this brief COVID-19 and violence against women
20. When will this pandemic end so things can go back to normal?
We don’t know when the pandemic will end, but we know it depends on every person’s contribution in helping stop the spread of the virus. The sacrifices you have made by not seeing your friends and by not going to school for a while, and other activities, are your contributions to fighting the pandemic. By putting societies and economies on hold, we have reduced the ability of the virus to spread through our communities. These defensive measures have helped to limit the damage the virus can cause, and bought us time to learn more about the virus and find solutions so that we can get back to a more familiar way of living. This is why it was possible to reopen schools and businesses in many places. It is important that you continue to practice the recommended measures and encourage your friends to do the same to prevent the situation from getting worse.
Find out more on our main public advice page.
Read more about COVID-19 vaccine development.
21. I feel like my future has been affected. I am not able to apply for the jobs I wanted, and now that I have a new job I find it hard to be noticed when remote working
The anonymity of working from home is really taking a toll on people and it is normal if you are feeling a bit forgotten and lost. It can feel difficult to get the attention you deserve and get your work noticed, especially if this is a new job and you do not yet know your manager and other colleagues well. If you have a comfortable relationship with your supervisor it may be helpful to discuss whether adjustments to your workload, work schedule or other work-related matters can be made. This conversation could also be held with the person responsible for human resources at work.
There are many things you can do to feel more comfortable in the new job while working remotely. Ask your supervisor to access a training on remote working and personal effectiveness skills. Using your time to access learning and training opportunities can not only help you develop skills for your current role but also prepare you for future roles you may desire. Agree with your manager to have regular check-in calls where you can keep your supervisor aware of accomplishments with an informative summary. If you have regular team meetings use this as an opportunity to flag your key successes, and let your co-workers to know you better. Invite your colleagues with whom you haven’t connected yet to virtual coffee dates. Don’t be shy to volunteer for new projects, and offer help to your colleagues when you can.
When solutions to problems are hard to find, it can help to talk through with people who you trust, who may be able to help or can be a person to discuss ideas with - ranging from friends, to our work colleagues or supervisors or HR or to external advisors such as career guidance and job-seeking support. Many public employment offices have moved their services online and can offer you great insights about the labour market, vacancies and training opportunities.
If you feel your mental health is taking a big toll and its affecting you much more than expected (such as affecting how well you work) then consider the following 1) engaging in stress management techniques – as reduced stress can help to improve our problem solving thinking (see Doing What Matters in Times of Stress and Managing work-related psychosocial risks during the COVID-19 pandemic); 2) if you are still in work, consider reaching out to your staff health or human resources services who may be able to help you find to mental health and psychosocial support at work or through your local health services including online support.
Read Tips for teens to learn about 5 ways to stay safe at work
Access this resource for young people who are about to enter, or have recently entered, the labour market to know more about Rights@work for youth. It has hands-on examples on workplace situations and tips how to manage them.
Watch these videos on Positive wellbeing in the workplace during COVID-19 pandemic
Read this piece on how human factors/ergonomic considerations can improve your teleworking experience
Read and get inspired by the stories of young people volunteering and leading collective action to mitigate the impacts of the pandemic.
22. What can we do so that other diseases like COVID-19 do not affect us in future?
COVID-19 is a zoonotic disease which means that it existed naturally in animals before it spilled over to humans. Most new or emerging infectious diseases —whether in wildlife, domestic animals, plants or people — are driven by human activities that lead to environmental degradation. Human pressures, from deforestation, to intensive and polluting agricultural practices, to unsafe management and consumption of wildlife, increase the risk of new or emerging infectious diseases. This is why the number of emerging infectious disease outbreaks has increased steadily since 1980.
To prevent the disastrous effects of emerging infectious diseases, we have to recognize that human health is intimately connected to the health of animals and our shared environment, and take action. Millions of young people have already mobilized to demand action not only on climate and biodiversity - but also for the right to breathe clean air, and for their future on a liveable planet. You can join them to add your voice and talents to this global movement:
Read and disseminate the WHO Manifesto for a healthy recovery from COVID-19 by disseminating it and taking personal steps
Support actions in your country to implement the 6 prescriptions of the WHO Manifesto for a healthy recovery from COVID-19.
Find out more about in these Q&A about Biodiversity and infectious diseases
Read our Manifesto for a healthy recovery from COVID-19
Find out what actions can be taken for a healthy, green recovery from COVID-19
3. Coronavirus disease (COVID-19): Breastfeeding
1. Can COVID-19 be passed through breastfeeding?
Transmission of active COVID-19 (virus that can cause infection) through breast milk and breastfeeding has not been detected to date. There is no reason to avoid or stop breastfeeding.
2. In communities where COVID-19 is prevalent, should mothers breastfeed?
Yes. In all socio-economic settings, breastfeeding improves survival and provides lifelong health and development advantages to newborns and infants. Breastfeeding also improves the health of mothers.
3. Following delivery, should a baby still be immediately placed skin-to-skin and breastfed if the mother is confirmed or suspected to have COVID-19?
Yes. Immediate and continued skin-to-skin care, including kangaroo mother care, improves the temperature control of newborns and is associated with improved survival among newborn babies. Placing the newborn close to the mother also enables early initiation of breastfeeding which also reduces mortality.
The numerous benefits of skin-to-skin contact and breastfeeding substantially outweigh the potential risks of transmission and illness associated with COVID-19.
4. Can women with confirmed or suspected COVID-19 breastfeed?
Yes. Women with confirmed or suspected COVID-19 can breastfeed if they wish to do so. They should:
Wash hands frequently with soap and water or use alcohol-based hand rub and especially before touching the baby;
Wear a medical mask during any contact with the baby, including while feeding;
Sneeze or cough into a tissue. Then dispose of it immediately and wash hands again;
Routinely clean and disinfect surfaces that mothers have touched.
It is important to replace medical masks as soon as they become damp and dispose of them immediately. Masks should not be reused or touched in the front.
5. If a mother confirmed or suspected to have COVID-19 does not have a medical face mask should she still breastfeed?
Yes. Breastfeeding unquestionably reduces mortality in newborns and infants and provides numerous lifelong health and brain development advantages to the child.
Mothers with symptoms of COVID-19 are advised to wear a medical mask, but even if this is not possible, breastfeeding should be continued. Mothers should follow other infection prevention measures, such as washing hands, cleaning surfaces, sneezing or coughing into a tissue.
Non-medical masks (e.g. home-made or cloth masks) have not been evaluated. At this time, it is not possible to make a recommendation for or against their use.
6. I have confirmed or suspected COVID-19 and am too unwell to breastfeed my baby directly. What can I do?
If you are too unwell to breastfeed your baby due to COVID-19 or other complications, you should be supported to safely provide your baby with breast milk in a way possible, available, and acceptable to you. This could include:
Donor human milk.
If expressing breast milk or donor human milk are not feasible then consider wet nursing (another woman breastfeeds the child) or infant formula milk with measures to ensure that it is feasible, correctly prepared, safe and sustainable.
7. I had confirmed or suspected COVID-19 and was unable to breastfeed, when can I start to breastfeed again?
You can start to breastfeed when you feel well enough to do so. There is no fixed time interval to wait after confirmed or suspected COVID-19. There is no evidence that breastfeeding changes the clinical course of COVID-19 in a mother. Health workers or breastfeeding counsellors should support you to relactate.
8. I have confirmed or suspected COVID-19, is it safer to give my baby infant formula milk?
No. There are always risks associated with giving infant formula milk to newborns and infants in all settings. The risks associated with giving infant formula milk are increased whenever home and community conditions are compromised, such as reduced access to health services if a baby becomes unwell, reduced access to clean water and/or access to supplies of infant formula milk are difficult or not guaranteed, affordable and sustainable.
The numerous benefits of breastfeeding substantially outweigh the potential risks of transmission and illness associated with the COVID-19 virus.
9. Can a breastfeeding woman get vaccinated against COVID-19?
Yes, women who are breastfeeding can take the vaccine when it becomes available to them.
None of the currently approved vaccines use the live virus, so there is no risk of passing the virus to the baby through breastmilk.
There is also some evidence that, after vaccination, antibodies are found in breastmilk, which may help protect the baby against COVID-19.
4. Coronavirus disease (COVID-19): Casirivimab and Imdevimab - monoclonal antibody therapy
1. I have COVID-19, should I be prescribed this monoclonal antibody therapy?
A combination of casirivimab and imdevimab, a monoclonal antibody cocktail developed by Regeneron, is recommended for:
Patients with confirmed non-severe COVID-19 at highest risk for hospitalization.
Those at highest risk are typically individuals older than 60, have a chronic disease, are immunocompromised, or are not vaccinated.
Patients with severe or critical COVID-19* who do not have antibodies to the COVID-19 virus (i.e., those who are seronegative).
This drug should be administered by a healthcare worker in a monitored clinical setting along with the current standard of care for COVID-19 which may include oxygen and other medications.
*A patient has severe COVID-19 when they have signs of pneumonia, severe respiratory distress, and their blood oxygen level is low. A patient has critical COVID-19 when they need life sustaining treatment, have acute respiratory distress syndrome, or have septic shock (evidence of injury to other organs ).
2. How is this monoclonal antibody therapy administered and what is the dosage?
Casirivimab and imdevimab should be administered by a healthcare worker in a monitored clinical setting intravenously through an infusion (drip). In some instances, the medication may be given subcutaneously through an injection.
The dosage of the medication will be determined by the healthcare provider.
For patients with non-severe COVID-19 the total dose of casirivimab and imdevimab is 1200 – 2400 mg given once intravenously. Alternatively, a patient may receive a total one-time dose of 1200 mg subcutaneously.
For patients with severe or critical COVID-19 the total dose of casirivimab and imdevimab is 2400 – 8000 mg given once intravenously.
3. Is this monoclonal antibody therapy suitable for anyone with COVID-19?
There is limited data regarding the use of casirivimab and imdevimab in patients who are pregnant or breastfeeding. If you are pregnant or breastfeeding discuss the risks and benefits of this drug with your healthcare provider first.
4. How does this monoclonal antibody therapy act?
These drugs (casirivimab and imdevimab) are antibodies like the ones produced by our bodies when they are faced with the COVID-19 virus. They act by blocking the ability of the virus to infect our body’s cells.
Casirivimab and imdevimab are a combination of two recombinant human antibodies that targets a different part of the spike protein, the part of the coronavirus responsible for infecting human cells.
5. Are there any side effects? Interactions with other drugs?
In rare instances, patients receiving casirivimab and imdevimab can develop severe allergic reactions. If this occurs, appropriate medical therapy should be initiated immediately. This is why it is important for patients to receive this medication in the presence of a healthcare professional in a monitored clinical setting.
Infusion-related reactions are rare and may occur while receiving the infusion or up to 24 hours after completion. If during the infusion a severe or life-threatening reaction occurs, the infusion may be given more slowly or stopped. Signs of an infusion-related reaction include fever, difficulty breathing, reduced oxygenation, chills, fatigue, irregular heartbeat, chest pain or discomfort, weakness, nausea, headache, angioedema (swelling of the lips), throat irritation, hypertension (high blood pressure), hypotension (low blood pressure), throat irritation, rash, tching, muscle aches, feeling faint, passing out, dizziness, and diaphoresis (sweating).
6. Do patients receiving the monoclonal antibody therapy need monitoring?
It is important for patients to receive this medication in the presence of a healthcare professional in a monitored clinical setting in the event of rare severe allergic reactions.
7. How expensive is this drug? Is it widely available?
There is currently a shortage of casirivimab and imdevimab globally and these medications are expensive.
WHO and partners are working with the manufacturer of this therapeutic, Roche Pharmaceutical, to see how the medication can be developed and obtained at a lower price. It is important that we improve access to this life saving medication in low- and middle-income countries .
WHO has launched a call to manufacturers to submit biosimilar versions of this drug for approval or prequalification. This would allow global production to be ramped up so that more people can access the drugs.
5. Coronavirus disease (COVID-19): Children and masks
1. Should my child wear a mask?
Decisions about mask use in children should be driven by what is in the best interest of the child. Mask use should be flexible, so that children can continue play, education and everyday activities. These activities are an important part of child development and health. No child should be denied access to school or activities because of lack of a mask.
Some countries and regions may have specific policies or recommendations in place. As always, follow the guidance provided by your country or local health department or ministry.
WHO and UNICEF recommend the following:
Children aged 5 years and under do not need to wear a mask because in this age group, they may not be able to properly wear a mask without help or supervision.
In areas where SARS-CoV-2 is spreading, children ages 6-11 years are recommended to wear a well-fitted mask in indoor settings where ventilation is poor or unknown, even if physical distancing of at least 1 meter can be maintained; and in indoor settings that have adequate ventilation when physical distancing of at least 1 meter cannot be maintained.
Adolescents 12 years or older should follow the same WHO recommendations for mask use as adults:A well-fitted mask that covers the nose and mouth should be worn in settings where SARS CoV-2 is spreading, regardless of vaccination status or history of prior infection, when interacting with individuals who are not members of their household:in indoor settings where ventilation is known to be poor or cannot be assessed, or the ventilation system is not properly maintained, regardless of whether physical distancing of at least 1 meter can be maintained in indoor settings that have adequate ventilation if physical distancing of at least 1 meter cannot be maintained; or in outdoor settings where physical distancing of at least 1 meter cannot be maintained. As much as possible, it is important that children of all ages keep their hands clean when putting on and taking off their mask.A safe environment should be created for children who are not able to tolerate a mask, including requirements for caregivers, teachers or other adults interacting with the child to wear a mask and to be vaccinated against COVID-19 according to national vaccination policies.
2. My child is under 5 years old. Should they wear a mask?
In general, children aged 5 years and under do not need to wear masks. However, there may be times when caregivers will choose to put a mask on a child – for example, if the child has contact with a person who is at a high risk of developing severe disease or is around someone who is ill. Children of this age should not wear masks for a long duration or without supervision.
3. My child has disabilities. Should they wear a mask?
Children with cognitive or respiratory impairments, developmental disorders, disabilities or other specific health conditions who experience difficulties wearing a mask should not be required to do so.
The individual decision for a child to wear a mask should be discussed in consultation with the child's medical provider where possible.
A safe environment should be created for children who are not able to tolerate a mask, including requirements for caregivers, teachers or other adults interacting with the child to wear a mask and to be vaccinated against COVID-19 according to national vaccination policies
4. My child has a medical condition that compromises their immune system. Should they wear a mask?
The use of a medical mask is recommended for children with a higher risk of severe complications from COVID-19. This includes children with underlying noncommunicable diseases such as diabetes, cardiac disease, chronic lung disease, chronic kidney disease, immunosuppression, HIV, obesity, mental disorders and cancer.
5. What type of mask should my child wear?
Children should wear a well-fitted mask that overs the nose, mouth and chin.
There are three types of masks that WHO recommends for the public*:
reusable non-medical masks that comply with standards disposable medical masks other types of reusable non-medical masks, including homemade multi-layered (fabric) masks are acceptable when other options are not available.
*More on the types of masks, how to choose them, and how to wear them is available here: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks
6. How should children wear a mask?
Adults and children should follow the same principles for safe mask wearing. Some children may not be able to properly wear a mask without help or supervision. Parents or caregivers who help children with masks should be prepared to talk about mask safety and help children understand how to wear masks properly. If you are helping a child to put on or take off a mask, be sure to follow the same steps when you put on and take off your own mask.
Children should be encouraged to clean their hands before putting on their mask and after taking it off and to wear a well-fitted mask that covers the nose, mouth and chin. It is important to not share masks with others.
More information, including videos on how to put on, take off and care for a mask, can be found here:
7. Should my child wear a mask at home?
Your child’s health is a priority, and there may be times when wearing a mask at home is the safest thing to do.
If you have visitors, outdoor gatherings are safer than indoor gatherings. If visitors come into your home, it may be best for everyone to wear a mask if ventilation is poor or if physical distancing of at least 1 metre cannot be maintained.
Children who have symptoms of COVID-19 should wear a medical mask at home when they are in shared spaces, as long as they can tolerate it. Family members/caregivers who come within 1 metre of the sick child at home should also wear a medical mask.
For more information refer to the Coronavirus disease (COVID-19): Home care for families and caregivers
8. Should teachers or other adults interacting with children wear a mask?
In areas where SARS-CoV-2 is spreading, adults under the age of 60 interacting with children should wear a well-fitted mask that covers the nose and mouth when they are:
in indoor settings where ventilation is known to be poor or cannot be assessed, or the ventilation system is not properly maintained, regardless of whether or not physical distancing of at least 1 meter can be maintained; or
in indoor settings that have adequate ventilation if physical distancing of at least 1 meter cannot be maintained.
Adults aged 60 or over, or who have any underlying health conditions, such as heart disease, diabetes or cancer, should wear a medical mask due to their higher risk of getting seriously ill from COVID-19.
9. Should children wear a mask when playing sports or doing physical activities?
Children do not need to wear a mask when playing sports or doing physical activities, such as running, jumping or playing, as it may affect their breathing. When organizing sporting activities for children, it is important to encourage all other public health measures:
Choose outside venues over indoor ones.
If gatherings must be held indoors, open windows to ensure good ventilation.
Maintain at least a 1-metre distance from others and limit the number of children playing together.
Provide access to hand hygiene facilities and encourage children to use them.
10. Are there alternatives to fabric masks such as face shields?
In the context of COVID-19, some children may not be able to wear a mask due to disabilities or specific situations such as speech classes where the teacher needs to see their mouths. In these cases, face shields may be considered an alternative to masks, but they do not provide the equivalent protection in keeping the virus from being transmitted to others.
If a decision is made to use a face shield, it should cover the entire face, wrap around the sides of the face and extend to below the chin. Caution should be taken while wearing one to avoid injuries that could break it and harm the eyes or face.
6. Coronavirus disease (COVID-19): Cleaning and disinfecting surfaces in non-health care settings
1. What areas should be prioritized for disinfection in non-health care settings?
Disinfection practices are important to reduce the potential for COVID-19 virus contamination in non-healthcare settings, such as in the home, office, schools, gyms, publicly accessible buildings, faith-based community centres, markets, transportation and business settings or restaurants. High-touch surfaces in these non-health care settings should be identified for priority disinfection such as door and window handles, kitchen and food preparation areas, counter tops, bathroom surfaces, toilets and taps, touchscreen personal devices, personal computer keyboards, and work surfaces.
2. Which surface disinfectants are effective against COVID-19 in non-health care setting environments?
In non-health care settings, sodium hypochlorite (bleach / chlorine) may be used at a recommended concentration of 0.1% or 1,000ppm (1 part of 5% strength household bleach to 49 parts of water). Alcohol at 70-90% can also be used for surface disinfection. Surfaces must be cleaned with water and soap or a detergent first to remove dirt, followed by disinfection. Cleaning should always start from the least soiled (cleanest) area to the most soiled (dirtiest) area in order to not spread the dirty to areas that are less soiled.
All disinfectant solutions should be stored in opaque containers, in a well-ventilated, covered area that is not exposed to direct sunlight and ideally should be freshly prepared every day.
In indoor spaces, routine application of disinfectants to surfaces via spraying is not recommended for COVID-19. If disinfectants are to be applied, these should be via a cloth or wipe which is soaked in the disinfectant.
3. What protection measures should people take when using disinfectants?
It is important to reduce your risk when using disinfectants:
The disinfectant and its concentration should be carefully selected to avoid damaging surfaces and to avoid or minimize toxic effects on household members (or users of public spaces).
Avoid combining disinfectants, such as bleach and ammonia, since mixtures can cause respiratory irritation and release potentially fatal gases.
Keep children, pets and other people away during the application of the product until it is dry and there is no odour.
Open windows and use fans to ventilate. Step away from odours if they become too strong. Disinfectant solutions should always be prepared in well-ventilated areas.
Wash your hands after using any disinfectant, including surface wipes.
Keep lids tightly closed when not in use. Spills and accidents are more likely to happen when containers are open.
Do not allow children to use disinfectant wipes. Keep cleaning fluids and disinfectants out of the reach of children and pets.
Throw away disposable items like gloves and masks if they are used during cleaning. Do not clean and re-use.
Do not use disinfectant wipes to clean hands or as baby wipes.
The minimum recommended personal protective equipment when disinfecting in non-health care settings is rubber gloves, waterproof aprons and closed shoes. Eye protection and medical masks may also be needed to protect against chemicals in use or if there is a risk of splashing.
Note: Where cleaning and disinfection are not possible on a regular basis due to resource limitations, frequent hand washing and avoiding touching the face should be the primary prevention approaches to reduce any potential transmission associated with surface contamination.
4. What is the guidance for the disinfection of outdoor spaces such as open markets, roads?
In outdoor spaces, large-scale spraying or fumigation in areas such as streets or open market places for the COVID-19 virus or other pathogens is not recommended. Streets and sidewalks are not considered as routes of infection for COVID-19. Spraying disinfectants, even outdoors, can be noxious for people’s health and cause eye, respiratory or skin irritation or damage.
This practice will be ineffective since the presence of dirt or rubbish for example, inactivates the disinfectant, and manual cleaning to physically remove all matter is not feasible. This is even less effective on porous surfaces such as sidewalks and unpaved walkways. Even in the absence of dirt or rubbish, it is unlikely that chemical spraying would adequately cover surfaces allowing the required contact time to inactivate pathogens.
5. Are public systems for disinfecting individuals such as spraying via tunnel or chambers safe to use?
No. Spraying of individuals with disinfectants (such as in a tunnel, cabinet, or chamber) is not recommended under any circumstances. This practice could be physically and psychologically harmful and would not reduce an infected person’s ability to spread the virus through droplets or contact. Even if someone who is infected with COVID-19 goes through a disinfection tunnel or chamber, as soon as they start speaking, coughing or sneezing they can still spread the virus.
The toxic effect of spraying with chemicals such as chlorine on individuals can lead to eye and skin irritation, bronchospasm due to inhalation, and potentially gastrointestinal effects such as nausea and vomiting. In addition to health safety concerns, the use of chlorine in large-scale spraying practices may prevent this resource from being used for important interventions such as drinking water treatment and environmental disinfection of health care facilities.
6. What are the recommended practices once back home after outdoor activities?
Thorough hand hygiene: washing hands with soap and water or using alcohol-based hand gel, should be performed before touching surfaces, items, pets, and people within the household environment. Please see: https://www.who.int/media/docs/default-source/integrated-health-services-(ihs)/infection-prevention-and-control/hand-hygiene-when-and-how-leaflet.pdf
While outside, people should always follow physical distancing measures, staying at least one metre from another person; perform hand hygiene by washing hands frequently with soap and water or using alcohol-based hand rub; follow good respiratory hygiene by covering your mouth and nose with your bent elbow or tissue when coughing or sneezing; avoid touching your eyes, nose and mouth; and avoid crowded places.
7. Are gloves recommended for the community in public spaces to protect against COVID-19, for example when going to the grocery store supermarket?
No. The use of gloves by the public in public spaces is not a recommended or proven prevention measure. Wearing gloves in public spaces does not replace the need for hand hygiene, nor does it offer any additional measure of protection against the COVID-19 virus than hand hygiene. Gloves do not provide complete protection against hand contamination, as pathogens may gain access to the hands via small defects in gloves or by contamination of the hands during glove removal. People can also transfer pathogens from one surface to another by touching with gloved hands, or even transfer pathogens to the mouth, nose, or eyes if they touch their face with gloved hands.
8. How should I clean food items from the grocery store, for example fruit, vegetables or packaged items?
There is no evidence to date of viruses that cause respiratory illnesses being transmitted via food or food packaging. Coronaviruses cannot multiply in food; they need an animal or human host to multiply.
The COVID-19 virus is generally thought to be spread from person to person through respiratory droplets. Currently, there is no evidence to support transmission of the COVID-19 virus associated with food.
Before preparing or eating food it is important to always wash your hands with soap and water for at least 40-60 seconds. Regular food safety and handling guidance should be followed.
For food service businesses, please see the below guidance on COVID-19 and Food Safety: https://www.who.int/teams/risk-communication/food-and-agriculture-sectors.
7. Coronavirus disease (COVID-19): Climate change
1. Where can I find the latest information on COVID-19?
For the latest information on COVID-19, check regularly on the WHO’s coronavirus pages: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
2. Do weather and climate determine where COVID-19 occurs?
No. There is currently no conclusive evidence that either weather (short term variations in meteorological conditions) or climate (long-term averages) have a strong influence on transmission. The SARS-CoV-2 virus which causes COVID-19 disease has been transmitted in all regions of the world, from cold and dry, to hot and humid climates.
SARS-CoV-2 is thought to be mainly transmitted directly from person-to-person through close contact, or through respiratory droplets produced when an infected person coughs or sneezes. People may be infected by touching exposed surfaces, but this is not thought to be a major transmission route. While temperature and humidity may influence how long the virus survives outside of the human body, this effect is likely to be small compared to the degree of contact between people.
Physical distancing and washing hands are therefore essential to breaking the chain of transmission, and are the most effective way to protect yourself, in all locations and all seasons of the year.
3. Will climate change make COVID-19 worse?
There is no evidence of a direct connection between climate change and the emergence or transmission of COVID-19 disease. As the disease is now well established in the human population, efforts should focus on reducing transmission and treating patients.
However, climate change may indirectly affect the COVID-19 response, as it undermines environmental determinants of health, and places additional stress on health systems. More generally, most emerging infectious diseases, and almost all recent pandemics, originate in wildlife, and there is evidence that increasing human pressure on the natural environment may drive disease emergence. Strengthening health systems, improved surveillance of infectious disease in wildlife, livestock and humans, and greater protection of biodiversity and the natural environment, should reduce the risks of future outbreaks of other new diseases.
4. Have measures to contain COVID-19 reduced air pollution and emissions of greenhouse gases?
Air pollution is a serious health risk. It kills approximately 7 million people every year and is responsible for one third of all deaths from stroke, lung cancer and heart disease. Over 90% of the global population lives in places where the WHO outdoor air quality guideline levels are not met, and about two-thirds of this exposure is caused by burning of fossil fuels, which also drives climate change.
Efforts to control COVID-19 transmission have reduced economic activity and led to temporary improvements in air quality in some areas. In contrast, as carbon dioxide and other greenhouse gases that drive climate change persist for a long time in the atmosphere, temporary emissions reductions only have a limited effect on atmospheric concentrations. Carbon dioxide levels at observing stations around the world in the first months of 2020 have been higher than in 2019.
Environmental improvements resulting from the COVID-19 response may be reversed by a rapid expansion of polluting economic activities once the measures have ended, unless there is a clear focus to promote equity, environmental health, around a just transition to a green economy.
Any short-term environmental benefits as a result of COVID-19 come at an unacceptable human and economic cost, and are no substitute for planned and sustained action on air quality and climate.
5. How does water scarcity affect infectious diseases like COVID-19?
Access to adequate and safe water and sanitation is essential for communities to practice basic hygiene and reduce transmission of COVID-19. Access to these services in health facilities is crucial to preventing infections, reducing the spread of antimicrobial resistance and providing quality care.
One in four health care facilities around the world lacks basic water services, directly impacting over two billion people. Around 80% of the world’s population is already experiencing some level of water scarcity. Climate change further threatens the availability of water for consumption, food production, personal hygiene, and medical care, including for infectious disease.
6. What can the global response to COVID-19 teach us about our response to climate change?
The COVID-19 pandemic is a Public Health Emergency of International Concern (PHEIC), which has claimed lives, and severely disrupted communities. Climate change is a gradually increasing stress that may be the defining public health threat of the 21st century. Nonetheless, common lessons can be drawn:
Ensuring universal health coverage (UHC), through well-resourced, equitable health systems, is essential to protect the public from both short and long-term health threats.
Guaranteeing global health security requires an all-hazards approach to preparedness, from infectious disease outbreaks, to extreme weather events, to climate change.
Ensuring access to the environmental determinants of health, such as clean air, water and sanitation, safe and nutritious food, is an essential protection against all health risks. WHO estimates that avoidable environmental risks cause about a quarter of the global health burden.
Early action saves lives. Delay in responding to clear evidence of threats, whether from pandemics, or from climate change, increases human and socioeconomic costs.
Inequality is a major barrier in ensuring health and wellbeing, especially for the most vulnerable in society. Social and economic inequality manifests in unequal health risks. When faced with public health threats of a global scale, such as COVID-19 or climate change, we are only as strong as our weakest health system.
8. Coronavirus disease (COVID-19): Contact tracing
1. What is contact tracing?
Contact tracing is the process of identifying, assessing, and managing people who have been exposed to someone who has been infected with the COVID-19 virus. Contact tracing and quarantine of contacts identified through contact tracing interrupt transmission between people and are essential public health tools for controlling the virus. Contact tracing can also help people who are at a higher risk of developing severe disease know earlier that they have been exposed so that they can get medical care quicker if they go on to develop symptoms.
2. Can contact tracing help in controlling spread of the virus?
Yes. Contact tracing is an essential public health tool for controlling infectious disease outbreaks, such as those caused bythe COVID-19 virus. Contact tracing can break the chains of transmission through the rapid identification, isolation and clinical care of cases, and providing supported quarantine of contacts, meaning that virus transmission can be stopped.
3. Does contact tracing still work against new variants of the COVID-19 virus ?
Yes, the principles of contact tracing remain the same for newly identified variants of the COVID-19 virus. While some of the variants of the virus are more transmissible, thorough and timely contact tracing and supported quarantine of contacts is even more important to control the spread of the virus.
4. How do I know if I’m a contact? What should I do if I am?
If you think you may be a contact of someone who has recently been infected, you should be contacted by health authorities to determine if you meet the contact definition. You may also be informed directly by someone you were in contact with who later tested positive. If you have downloaded a COVID-19 proximity tracing application, you may also get notified through your mobile phone.
If you are identified as a contact, you should undertake quarantine, which means that you separate yourself from others in your household, stay there and monitor your health for any signs of illness. Some countries have set up dedicated facilities to enable contacts to complete quarantine outside their household. Contact your local health authorities to find out how you can safely quarantine.
WHO recommends that you stay in quarantine for 14 days after you were last in contact with the person infected with the COVID-19 virus, but the duration of quarantine may vary by country. Check with your local or national health authority.
5. How is digital proximity tracing data stored and protected?
The data storage for tracing apps can either be stored and processed on a central server managed by the national public health authority, or stored and processed on the users’ phones. There is a consensus by several data protection authorities that storing data on users’ phones enhances privacy, since users have greater control over the amount of information that they share with health authorities. The collection and use of such data by health authorities can therefore be limited to what is strictly necessary for the operation of a digital tracing system.
Whichever approach is selected, governments and third parties should ensure digital tracing systems follow WHO guidance on ethical considerations on the use of digital proximity tracing for COVID-19 contact tracing. Protecting the personal data and privacy of individuals participating in digital tracing is critical to ensure the protection of human rights and civil liberties as well as the establishment of public trust.
6. What is quarantine? And how is it different from isolation?
Quarantine is the separation of contacts from others after exposure to a probable or confirmed COVID-19 case – you may or may not be infected.
Isolation is the separation of people who are known to be infected with the COVID-19 virusfrom other who are not infected.
Both quarantine and isolation help to stop the spread of the virus.
7. How do I manage quarantine and how do I take care of myself during quarantine?
WHO recommends supported quarantine for 14 days from the last contact with a confirmed case to minimize risk of infecting others. You should remain separated from others in the household for the duration of quarantine. If you cannot be in a separate room, stay at least one metre away from others, the farther the better. Make sure you have enough foodand water, and a way to communicate with others. The quarantine space should be well ventilated. You should minimize your contact with others. If you do have someone visit you during quarantine, you should both wear medical masks, keep windows open if possible and clean your hands before and after being together. Ideally, you should have only one visitor provide food and supplies during the quarantine period and this should be someone at low risk of developing severe COVID-19.
Quarantinemay cause worry or anxiety, and this is normal. Thiscan also be an opportunity to take time to care for yourself. Consider reconnecting with loved ones via telephone or phone apps, watch movies or read books, exercise indoors, make crafts, or catch up on things you haven’t had time for. To help you get groceries, medicine and other necessities, ask family and friends or use delivery services.
8. What can I do as an individual to support contact tracing measures in my community?
Everyone has a part to play to bring COVID-19 under control, and contact tracing begins with informed, engaged and enabled communities. Understand the local public health and social measures and collaborate with health authorities for case and contact investigation. Agree to monitoring, report signs or symptoms of COVID-19 promptly, and be prepared to quarantine or go into isolation if you become a confirmedcase of COVID-19.
In addition, you can, while respecting physical distancing and all other protective measures, provide support to relatives or friends who have to be isolated or undertake quarantine. Check in on them by phone or offer to bring supplies to their house, if needed. Transmission of the COVID-19 virus can only be stopped if we all play our role to protect our family, friends and community.
9. If I’m travelling outside my country, do I need to provide accurate information to contact tracing personnel at the airport or at my destination? What if I’m concerned about how my private information is going to be used?
Yes, providing accurate information when requested is important to successful contact tracing activities. National authorities may ask incoming travelers to report their health status at the time of travel, possible exposures to confirmed or probable COVID-19 cases within the previous two weeks, and to provide their contact details so they can be located for health monitoring or international contact tracing purposes. Authorities may also require arriving passengers to download and use a national COVID-19 digital proximity tracing app on arrival. Please consult national authorities/airline companies to verify details before you travel.
9. Coronavirus disease (COVID-19): Contact tracing for responders
1. How does contact tracing work?
Contact tracing identifies, and monitors people who have been exposed to someone who has been infected with SARS-CoV-2, and involves several steps:
Defining contacts: Contact definitions may vary by country. WHO defines a contact as a person who has been exposed to someone else who has had recent probable or confirmed SARS-CoV-2 infection: 1. face-to-face contact with a probable or confirmed case within 1 meter and for at least 15 minutes; 2. direct physical contact with a probable or confirmed case; 3. direct care for a patient with probable or confirmed COVID-19 disease without the use of recommended PPE; or 4. other situations as indicated by local risk assessments. Exposure is considered any time between 2 days before to at least 13 days after the case started to show symptoms. For asymptomatic cases, a contact is anyone who has been exposed between 2 days before and 10 days after the date on which the sample that led to confirmation of infection was taken.
Identifying contacts: this is usually done through an interview with the person infected with SARS-CoV-2 to find out who they have been in contact with during the period of time described above. There are other ways to identify contacts depending on the setting, for example through membership or attendance lists of places the case visited during the period described above, or through public notices. Digital proximity tracing applications have also been developed to help identify and notify contacts through automated processes.
Informing contacts: each identified contact should be contacted to confirm whether they meet the definition of a contact. This may be done through health authorities and/or via digital tracing proximity applications. Cases may also be encouraged to inform their own contacts. Each person identified as a contact will be informed about the goal of contact tracing, the process (including how their personal data will be protected), how to undertake quarantine and for how long, and who to contact with any concerns or questions. Additional information should be provided on symptoms to monitor throughout the quarantine period, and what to do if a contact returns a positive test or becomes unwell.
Managing and monitoring contacts: contacts should be encouraged and supported during the quarantine period. WHO recommends that the quarantine period ends 14 days after the contact was last exposed to the person who has been infected with SARS-CoV-2. However, the duration of the quarantine period may vary between countries.
Data processes and analysis: The information collected from each contact is stored in a secure database. These processes vary from country to country. See question What should be considered for data protection?
2. Who is defined as a contact?
A contact is currently defined as anyone who had direct contact with, or was within 1 metre for at least 15 minutes, with a person who may be infected or is infected with SARS-CoV-2 while they were infectious or potentially infectious, even if the person with the infection did not have symptoms. National and local public health authorities may have additional considerations to define contacts according to local risk assessments.
Contacts should be supported to quarantine to limit the possibility of exposing other people to infection if they become ill.(The complete definition of a contact can be found here).
3. What is backward contact tracing?
Backward contact tracing refers to the process of trying to understand how the case became infected, also known as case or source investigation. While traditional contact tracing identifies people who were exposed to cases and may become cases themselves, backward contact tracing or source investigation looks back in time to identify settings or events where exposure to the virus may have occurred. This may help public health authorities identify more cases (such as at an event or setting where the case may have been infected) and identify settings that have led to infection. This can inform the development of targeted public health and social measures to reduce the overall number of cases.
4. When should contact tracing be implemented?
Comprehensive contact tracing should be implemented each time cases or clusters (groups of linked cases) are identified. During intense transmission, contact tracing capacities may be overwhelmed, so contact tracing activities may focus on household contacts, healthcare workers contacts, contacts in high-risk closed settings (such as dormitories, institutions, long-term living facilities),and contacts at higher risk of developing severe COVID-19.
It is important to maintain contact tracing and quarantine of contacts even when the number of new cases may be decreasing, and/or public health and social measures may be being relaxed, in order to ensure that transmission continues to reduce.
5. How do you form a contact tracing workforce?
A contact tracing workforce can be drawn from many settings, including individuals connected with local government, civil society, non-governmental organizations, universities and community volunteers. Ideally, a gender-balanced contact tracing team should be recruited from the community and have general literacy, strong communication skills, local language proficiency and an understanding of the local context and culture.
They should be provided with adequate training to ensure efficiency, accuracy and good communication skills when implementing case and contact investigations, and integrated within the wider COVID-19 response team.
Several training materials have been developed by WHO and partners and may be adapted to local needs. Many are available through the Global Outbreak Alert and Response Network (GOARN) knowledge platform, and OpenWHO. Training should include the basics of virus transmission, prevention and control measures; how to monitor signs and symptoms; and standard operating procedures for contact tracing, including interview tips and ethics of public health surveillance and quarantine. Contact tracers should also be briefed on their rights, roles and responsibilities, including for occupational safety and health.
It is important for public health authorities to train the contact tracing workforce when there is no or low transmission, and anticipate ways to be able to scale the size of the trained contact tracing workforce, if transmission increases.
6. What are some of the challenges to effective contact tracing for COVID-19?
Some of the challenges are the availability of a trained contact tracing workforce, availability of resources for contact tracing and community engagement.
Another main challenge is the intensity of the COVID-19 transmission. In situations of intense transmission, public health resources can quickly become overwhelmed and often cannot cope with the workload of identifying contacts and monitoring them. In such situations, WHO recommends focusing on the contacts with highest exposure and those most at risk of developing severe disease.
7. What are some digital tools used to support contact tracing? How can they enhance contact tracing processes?
Classic interview-based contact tracing relies heavily on the presence of a trained workforce to carry out essential activities such as contact elicitation, notification and follow-up. However, this workforce can be quickly overwhelmed in the context of widespread SARS-CoV-2 transmission.
Electronic tools and information technology have been used to enhance the efficiency of contact tracing processes, and are currently being used in the COVID-19 pandemic. So far, no single digital tool addresses all the steps required to monitor end-to-end contact tracing and quarantine of contacts. Oversight from public health workforce is still required. The technical and ethical requirements related to the use of such digital tools should be considered when making decisions as to the use of these tools. Digital tools that support contact tracing processes may be broadly divided into three categories based on their public health function during specific steps of the contact tracing process:
Identifying and notifying contacts: These solutions are intended for use by the general public, health professionals and the contact tracing team. They include digital proximity tracing tools that use systems based on Bluetooth or GPS location signaling, to notify users who have been in close proximity and prolonged contact to individuals who tested positive for COVID-19 and registered their status in the tool. There are also location-based digital contract tracing tools that use quick response (QR) codes that can be scanned by smartphones users when they visit a venue, so that if they later test positive for COVID-19, other application users who attended the same venue, at the same time may be sent an alert, if local public health authorities deem it necessary.
Monitoring contacts: These tools are intended for use by those identified as contacts, health professionals and the contact tracing team. They include symptoms checker tools that can help contacts to self-monitor and report the presence or absence of symptoms to health professionals who may conduct further assessments, health counselling and connect them with the public health authorities for testing and other supportive services. These tools may be particularly helpful in settings where contact tracing workforce personnel may be limited and/or there are physical or security barriers preventing in-person visits by contact tracing teams.
Surveillance data management and analysis: These solutions are used by public health professionals to collect, manage, analyse and visualize data collected by contact tracing teams which link cases and contacts. They include outbreak response tools (such as Go.Data, Commcare, SORMAS, etc.) that can be used for case investigation, listing and monitoring of contacts, and analysis.
It is important to note that these tools cannot substitute a well-trained health and community workforce, qualified supervisors, decentralized operations and good coordination; which are all necessary criteria for successful and effective contract tracing. More information on digital tools for contact tracing can be accessed here and ethical considerations to guide the use of digital proximity tracking technologies is available here.
8. What should be considered for data protection?
The ethics of public health information, data protection, and data privacy must be considered at all levels of contact tracing activities, including training and use of tools. In particular:
Safeguards must be in place to guarantee privacy and data protection in accordance with the legal frameworks of the countries where systems are implemented.
Everyone involved in contact tracing must adhere to the ethical principles of handling personal information, to ensure responsible data management and respect for privacy throughout the process.
How data will be handled, stored, and used needs to be communicated to those concerned in a clear and transparent manner. This is important for buy-in and engagement as well as to avoid misperceptions that could jeopardize the effectiveness of a contact tracing programme.
Digital tools used for contact tracing should be assessed before use to ensure safeguarding data protection according to national regulations.
See WHO’s interim guidance on ethical considerations to guide the use of digital proximity tracking technologies for COVID-19 contact tracing.
10. Coronavirus disease (COVID-19): Contraception and family planning
1. Is contraception/ family planning safe to use during the COVID-19 pandemic?
Yes. All modern methods of contraception are safe to use, including during the COVID-19 pandemic.
If you have had a baby in the last six months or have a health condition, such as diabetes, high blood pressure, or breast cancer – or if you smoke – seek advice from a health care professional to ensure you are using a method of contraception which is suitable and safe for you.
2. I want to avoid getting pregnant during the COVID-19 pandemic. What can I do?
If you do not want to become pregnant, you should start or continue to use your contraceptive method of choice. You may be able to access information and contraceptive services from a healthcare provider by phone or online.
If you cannot access these services you may opt for a method that is available without a prescription (such as condoms, spermicides, diaphragm, pills, or emergency contraceptive pills) from a nearby pharmacy or drug shop.
3. I can’t access my contraceptive method of choice. What do you advise?
If you cannot access your contraceptive method of choice – perhaps because it requires a prescription, or because it can only be given to you by a health worker – consider using condoms, fertility awareness-based methods, lactational amenorrhea (if you are exclusively breastfeeding), or other contraceptive methods that are recommended for self-care in your country.
Depending on the situation in your country, methods recommended for self-care could include the pill or mini-pill, emergency contraception pills, and DMPA-SC (Sayana Press®).
4. What is the best contraceptive method to use during the COVID-19 pandemic?
All modern methods of contraception help to prevent pregnancy. Women and their partners can choose any modern contraceptive method that is acceptable to and safe for them. The best method of contraception is the one that works well for you.
There is a wide variety of modern methods, one of which may suit you best. For more information see here.
Condoms, when they are used consistently and correctly, are the only method of contraception that help to prevent unintended pregnancy and protect against sexually transmitted infections, including HIV. They can be used together with other methods of contraception to protect against both unintended pregnancy and sexually transmitted infections.
Emergency contraceptive pills can prevent up to 95% of pregnancies when taken within 5 days after intercourse, and they can be taken by anyone with or without a health condition.
5. I want to change my contraceptive method – is this possible?
Yes. It may be difficult however, to access all the methods of contraception that are normally available in your country due to restrictions on movement, lack of supply, as well as increased demands on health providers and services. If you are experiencing side effects or desire urgent removal for other reasons, contact a provider to find out what options suit you best, and which are available and feasible.
If you have a pre-existing health condition, consult a provider to find out what options suit you best, and which are available and feasible. Seek advice and information from your health provider and consider using methods that do not have medical restrictions like minipills, condoms, fertility awareness-based methods, diaphragm, spermicides or lactational amenorrhea if you are exclusively breastfeeding.
6. I want to remove or replace my implant or IUD – can I do this during COVID-19 pandemic?
Removal of long acting methods such as implants or IUDs, after the recommended period of use (and routine follow up appointments) may not be prioritized by your country’s health system during this health emergency. Seek advice from your health provider.
If, due to restrictions on movement due to the COVID-19 pandemic you cannot have your long acting method removed straight away, it is important to use another method of contraception to avoid pregnancy at this time.
There are no medical problems caused by delaying removal of long acting methods such as implants or IUDs. Do not try to remove the contraception method yourself; wait until you are able to access health care from a trained provider.
7. Why is providing contraception/ family planning, as well as family planning services and information, important during the COVID-19 pandemic?
Contraception and family planning information and services are life-saving and important at all times. Sexual activity does not cease with the COVID-19 pandemic, it is therefore crucial to ensure that people are able to access rights-based services and information to initiate and / or continue use of contraception.
By preventing unintended pregnancies, contraception helps to protect girls and women from the negative health consequences of unintended pregnancies, which can save their lives. Contraception reduces the need for abortion, meaning that women and girls are less at risk of unsafe abortion, which again can be lifesaving.
Condoms, when used consistently and correctly, help to prevent both unintended pregnancies and sexually transmitted infections (including HIV).
In addition, by preventing the negative health consequences associated with unintended pregnancies, unsafe abortion and sexually transmitted infections (including HIV), contraception can help alleviate unnecessary additional pressure on already-stretched health systems which are working hard to address COVID-19.
8. I am a policy maker. What can I do to make sure people can access contraception and family planning information and services?
Plan and develop innovative strategies to ensure as many eligible people as possible can access information and contraception during this period.
Increase use of mobile phones and digital technologies to help people make decisions about which contraceptive methods to use, and how they can be accessed.
Enable health care workers to provide contraceptive information and services as per national guidelines to the full extent possible. This is particularly important where pregnancy poses a high risk to health.
Expand availability of contraceptive services (including both information and methods) through places other than healthcare facilities, such as pharmacies, drug shops, online platforms and other outlets. This can be with or without prescription depending on national guidelines and contraceptive method.
Relax restrictions on the number of repeat issues of prescription-only hormonal contraceptives that can be issued.
Ensure access to emergency post-coital contraception, including consideration of over the counter provision.
Enable access to contraception for women and girls in the immediate post-partum and post abortion periods when they may access health services.
9. I am a programme manager. What can I do to help people access contraception and family planning information and services?
Increase use of telehealth for counselling and sharing of messages related to safe and effective use of contraception and for selection and initiation of contraceptives.
Ensure adequate inventory to avoid potential stock outs at all levels of the health system.
Prepare advisories for users on how they can access contraceptive information, services and supplies.
Monitor contraceptive consumption in your area to identify any potential pitfall and shortage
Increase availability and access to the contraceptives which can be used by the client without service provider support.
10. I am a healthcare provider. I have heard that persons with COVID-19 may have increased risk of blood clots. How should I advise individuals who are using or want to use combined hormonal contraception?
According to currently available evidence, most women of childbearing age with COVID-19 will likely be asymptomatic or have mild COVID-19 symptoms and should continue to take combined hormonal contraception (CHC). Here are the most common possible scenarios:
Women who are asymptomatic or with mild symptoms of known COVID-19: combined hormonal contraception can be continued and is considered safe in this population. If women are concerned, their provider should explain that there is no evidence of increased risk of thrombosis among combined hormonal contraception users with mild COVID-19 symptoms. If a combined hormonal contraception user wishes to discontinue this method, she can be offered a progestin-only or non-hormonal method, if available and acceptable.
Women with serious symptoms of COVID-19 who are not hospitalized: Discontinuation of combined hormonal contraception should be considered, based on a patient’s clinical symptoms of COVID-19 (e.g. immobilization for more than 7 days, difficulty breathing or shortness of breath, pneumonia). Considerations around stopping combined hormonal contraception should also take into account if the user has other medical conditions that may increase the risk of thrombosis during COVID-19. If combined hormonal contraception is discontinued, progestin-only or non-hormonal methods can be offered, if available and acceptable.
Women hospitalized with severe COVID-19: Combined hormonal contraception should be discontinued during hospitalisation. The risk of thrombosis in this acutely ill population may outweigh the benefits of continuing combined hormonal contraception. Progestin-only and non-hormonal contraceptive methods can be used.
Women resuming contraception: It is important that all women who discontinue contraception during COVID-19 illness are given counselling about when to resume contraception and are provided with the method of their choice. Any new or existing medical conditions need to be considered when choosing a contraceptive method. Combined hormonal contraception can be resumed 2 weeks after any prolonged period of prolonged limited mobility (immobilization). the end of immobilization. Other methods can be started without delay.
 Serious symptoms may include difficulty breathing or shortness of breath, chest pain or pressure, or loss of speech or movement.
Coronavirus. In: World Health Organization/Health topics [website]. Geneva: World Health Organization. (https://www.who.int/health-topics/coronavirus#tab=tab_3, accessed 5 November 2020).
11. Coronavirus disease (COVID-19): COVID-19 vaccines and people living with HIV
1. Are COVID-19 vaccines safe for people living with HIV?
Many of the COVID-19 vaccines studies have included a small number of people living with HIV in their trials. Despite limited data, available information suggests current WHO recommended COVID-19 vaccines ( AstraZeneca/Oxford, Johnson and Johnson, Moderna, Pfizer/BionTech, Sinopharm and Sinovac) are safe for people living with HIV. The currently available vaccine products are not live vaccines, they include genetic material from SARS-CoV-2 which cannot replicate. Therefore, these vaccines are not expected to be less safe in people who are immunocompromised. In addition to this, no pharmacological interactions have been reported between COVID-19 vaccines and antiretroviral medications which people living with HIV should continue to take after vaccination to maintain health.
Recently, a debate in the scientific literature has led to broader concerns about a potential association observed more than a decade ago between adenovirus vector-based vaccines and an increased risk of acquiring HIV infection among men who received this type of vaccine. This unexpected finding was detected in two HIV vaccine trials that used adenovirus vector containing products,. The reason for this observed HIV risk remains uncertain, although several follow-up studies have suggested a possible interference in the HIV specific vaccine response or in the CD4 cell susceptibility to HIV infection induced by this kind of vaccine,. However, a third study using another adenovirus vector-based vaccine, conducted more recently has not reported this finding. Specific studies on this topic with COVID-19 vaccines are needed. Despite these potential concerns, it is important to highlight that the benefits of all authorized COVID-19 vaccines in a pandemic context currently outweigh the potential risks. WHO will continue to monitor the situation as new data become available and SAGE recommendations will be updated accordingly.
2. Do COVID-19 vaccines provide protection for people living with HIV?
It is theoretically possible that people living with HIV with low CD4 cell counts might have a weaker immune response to vaccines. However, in practice this has not been documented for all vaccines and there is no evidence to support a less robust immune response to COVID-19 vaccines among people living with HIV and low CD4 cell counts. WHO is reviewing new evidence as it emerges and will provide updates. More importantly, advocacy is needed so that no one person is left behind and that national COVID-19 vaccination programmes do not exclude people from key and vulnerable populations, at risk of HIV, who may have limited access to health services. It is also important to advocate for the inclusion of people living with HIV, including those with more advanced disease, in COVID-19 vaccine trials to provide information to confirm efficacy.
3. Should people living with HIV get vaccines early in the roll out?
WHO recommends that countries refer to the WHO SAGE Roadmap For Prioritizing Uses Of COVID-19 Vaccines In The Context Of Limited Supply which was created under the assumption that there would not be substantive differences in vaccine efficacy among subgroups (for example, in people with comorbidities that increase the risk of severe COVID-19 such as HIV-positive status). Therefore, countries can make plans for people to receive the vaccine in order of priority based on their age, health, occupation and other factors such as people in living in care or residential homes, or closed settings such as prisons.
Some countries are prioritizing vaccination for all people living with HIV or for those who are immunocompromised (as indicated by having a CD4 cell count <200/mm3) ,. An informal poll of more than 100 countries from all regions revealed at least 40 that have an immunization policy that prioritizes vaccinations for people living with HIV. These policies are supported by recent literature which suggests that people living with HIV at any CD4 cell count appear to be at increased risk for severe outcomes and death due to COVID-19 compared with people without HIV ,,. Independent of immune status, many people living with HIV have one or more comorbidities that may put them at increased risk for a more severe COVID-19.
A new WHO report confirms that HIV infection is a significant independent risk factor for both severe/ critical COVID-19 presentation at hospital admission and in-hospital mortality. Overall, nearly a quarter (23.1%) of all people living with HIV who were hospitalized with COVID-19, died . The report is based on clinical surveillance data from 37 countries regarding the risk of poor COVID-19 outcomes in people living with HIV (PLHIV) admitted to hospital for COVID-19. And found that the risk of developing severe or fatal COVID-19 was 30% greater in PLHIV compared to people without HIV infection. Underlying conditions such as diabetes and hypertension are common among PLHIV. Among male PLHIV over the age of 65 years, diabetes and hypertension were associated with an increased risk of more severe and fatal COVID-19. These conditions are known to put people at increased risk of severe disease and death .
Therefore, all people living with HIV should be prioritized for early vaccination. And people living with HIV with co-morbidities (such as chronic pulmonary disease, diabetes, hypertension, obesity, kidney disease, liver disease, Parkinson’s disease, multiple sclerosis, motor-neuron disease) should be prioritized for early vaccination and management of their co-morbidities. People living with HIV should not be excluded from COVID-19 vaccine access plans regardless of their immune status, and countries should include people living with HIV as a priority group for COVID-19 vaccination according to their epidemiological context.
4. What can WHO and the world do to support people living with HIV to live a healthy life?
While WHO is working with countries to ensure fair and equitable access to safe and effective COVID-19 vaccines, it is important to continue actions to prevent SARS-CoV-2 transmission and to reduce COVID-19 deaths. Alongside the response to COVID-19, it is critical to maintain access to essential health services. This includes:
Supporting people living with HIV to continue taking antiretroviral therapy (ART) and adapting services to make this easier and more efficient during the COVID-19 response.
Continuing to provide HIV prevention and testing services with linkage to ART initiation as a priority.
Ensuring those who start ART can remain on it to reduce health risks and complications during COVID-19, including maintaining viral load suppression. This must be classified as an essential service, together with prevention, diagnosis and treatment of co-morbidities and co-infections.
Monitoring all people living with HIV and SARS-CoV-2 infections, especially those with advanced HIV disease or with co-morbidities.
Although there may be an increase in the risk of developing severe disease from COVID-19 among people living with HIV, making sure that people have access to effective ART and other health care they need will help to minimize this risk.
For further information on COVID-19 vaccines and all WHO guidance related to COVID-19 see https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance.
For community friendly resources please see: https://i-base.info/covid-19/
12. Coronavirus disease (COVID-19): Dexamethasone
1. I have COVID-19, should I be prescribed corticosteroids like dexamethasone?
Corticosteroids are lifesaving medicines recommend for patients with severe or critical COVID-19*. They should be given along with current standard of care for COVID-19 which includes oxygen and other medications .
They should not be given to patients with non-severe* COVID-19, and when given in such cases it could be harmful to patients’ health.
*A patient has severe COVID-19 when they have signs of pneumonia, severe respiratory distress, and their blood oxygen level is low. A patient has critical COVID-19 when they need life sustaining treatment, have acute respiratory distress syndrome, or have septic shock (evidence of injury to other organs). More.
2. What is dexamethasone and does it work against COVID-19?
Dexamethasone is a corticosteroid used in a wide range of conditions for its anti-inflammatory and immunosuppressant effects.
It was tested in hospitalized patients with COVID-19 in the United Kingdom’s national clinical trial RECOVERY and was found to have benefits for critically ill patients.
According to preliminary findings shared with WHO (and now available as a preprint), for patients on ventilators, the treatment was shown to reduce mortality by about one third, and for patients requiring only oxygen, mortality was cut by about one fifth.
3. How are corticosteroids administered and what is the dosage?
Corticosteroids are given as a pill or via injection, depending on formulation
Patients with severe or critical COVID-19 should be given low dose corticosteroids for 7-10 days. The daily dose depends on the corticosteroid being used.
4. Were all patients in RECOVERY given dexamethasone?
Eligible patients were randomly allocated between several treatment arms. Dexamethasone was administered as an oral (liquid or tablets) or intravenous preparation, at a dose of 6 mg once daily for ten days, in one of the arms.
In pregnancy or breastfeeding women, patients were randomized to prednisolone (a milder corticosteroid) 40 mg administered by mouth.
5. Are corticosteroids suitable for anyone with COVID-19?
WHO recommends that patients who have severe or critical COVID-19 receive corticosteroids.
6. How do corticosteroids work?
Patients with severe or critical COVID-19 develop an overstimulation of the immune system, which can be very harmful to their health. Corticosteroids act to suppress this overstimulation.
7. Do corticosteroids have side effects?
When taken for a short period of time, corticosteroids are generally safe and not associated with serious side effects. Corticosteroids can increase blood glucose levels in patients and it is recommended that all individuals have their blood sugar monitored.
Possible complications from corticosteroids include poor wound healing, immunosuppression (which can increase risk for other infections), and elevated blood sugar, which if not monitored can lead to diabetic ketoacidosis or uncontrolled diabetes. When used for a period longer than two weeks, corticosteroids may be associated with adverse events such as the development of glaucoma, cataracts, fluid retention, high blood pressure, weight gain, osteoporosis (weak bones), and mood swings, confusion, or irritation. "
8. Is dexamethasone prequalified by WHO?
Yes, dexamethasone solution for injection 4mg/ml in 1ml ampoules, manufactured by Kern Pharma SL, Spain, has been prequalified for its use in the management of diseases associated with HIV/AIDS, but not for COVID-19.
Another dexamethasone injection product is currently under assessment.
Manufacturers interested in prequalifying their product can contact the Prequalification Team at email@example.com for further information.
9. Do patients receiving corticosteroids need monitoring?
WHO recommends that all patients, even those without diabetes, should have their blood sugar monitored since corticosteroids can increase blood glucose levels.
Certain patients should be monitored closely when receiving corticosteroids since they are at increased risk of developing complications. These include people with diabetes, cancer, open wounds following traumatic injuries, severe burns, or malnourishment. Patients taking immunosuppressants/immunomodulators, with severe immunodeficiencies should also be monitored along with intravenous drug users.
10. What dose was used in the Recovery trial?
Dexamethasone was used in the Recovery Trial in oral (liquid or tablets) or intravenous preparation 6 mg once daily for ten days.
In pregnancy or breastfeeding women, prednisolone 40 mg administered by mouth (or intravenous hydrocortisone 80 mg twice daily) should be used instead of dexamethasone.
Note: It is permitted to switch between the two routes of administration according to clinical circumstances.
Source: Page 9 of 35 RECOVERY [V6.0 2020-05-14] ISRCTN50189673 EudraCT 2020-001113-21
11. How expensive are corticosteroids? Are they widely available?
Corticosteroids are readily available at a low cost globally. WHO has acquired a small stock of corticosteroids for distribution to resource limited settings that may have reduced supply or pipeline.
Corticosteroids are listed in the WHO model list of essential medicines.
12. What are the typical side effects of dexamethasone?
Dexamethasone is generally safe. It presents a favourable benefit-risk profile, particularly in patients with severe forms of pneumonia, while the benefit is less prominent in patients with non-severe pneumonia. As the treatment is short, even at high doses, corticosteroids are not associated with serious side effects. Potentially higher blood glucose levels (hyperglycaemia) are temporary.
Prolonged use (I.e., used for more than two weeks) may be associated with adverse events such as glaucoma, cataract, fluid retention, hypertension, psychological effects (e.g., mood swings, memory issues, confusion or irritation), weight gain, or increased risk of infections and osteoporosis.
To reiterate: All these adverse events are not associated with short term use (with the exception of hyperglycaemia that can worsen diabetes).
13. Can steroids be used in the elderly/children/pregnancy?
They can be used in children and the elderly. In pregnancy, the Recovery trial used prednisolone orally or hydrocortisone by intravenous infusion instead of dexamethasone. Steroids are ubiquitous in terms of geographic use."
14. Is dexamethasone available across the world?
Yes. Dexamethasone is off-patent and has been marketed in different formulations (e.g., tablets, liquid, solution for injection) for many years. It is generally available in most countries. There are several manufacturers of the product. One manufacturer has already been prequalified by WHO (Kern Pharma in Spain) while another is under assessment.
The most common formulations are:
Tablets: 0.5mg, 0.75mg, 1mg, 1.5mg, 2mg, 4mg and 6mg
Oral Solution: 0.5mg/5ml, 20mg/5ml and 1mg/ml (concentrate)
Injectable suspension: 4mg/ml, 20mg/5ml
In recent years there have been occasional reports of shortages of this product. It is important to quickly understand the projected volumes for COVID-19 utilization and manufacturing capacity to help assess the impact for existing indications and the potential need for substitute therapies, to ensure all patients retain access to a safe, effective, quality, affordable product to meet their therapeutic needs.
15. Is dexamethasone affordable/what is the price per treatment?
Dexamethasone is an off-patent, common supportive treatment option and is generally affordable. WHO 2016 and 2019 surveys of different health facilities in low- and middle-income countries indicate that dexamethasone was available to patients at a median price of $0.33 per 4mg/ml injection ampoules (range: US$0.13-$3.5). Major UN procurers may be able to supply dexamethasone for a median price of $0.092 per 4mg/ml injection ampoule.
16. Are there any import restrictions?
There are likely no restrictions, as dexamethasone is authorized worldwide.
17. What are the risks of Substandard or Falsified (SF) products?
There are 21 records of falsified dexamethasone in the WHO Global Surveillance and Monitoring System database with the most recent one received from the Eastern Mediterranean in February 2020.
It is expected that, following the high level of publicity given to the medicines, incidents of substandard and/or falsified dexamethasone products will occur. This is based on experience with reports of falsified chloroquine products when hydroxychloroquine was thought to be a potential treatment for COVID19
Increased vigilance throughout all supply chains and due diligence in any procurement activities are essential. Member States and regulatory authorities are encouraged to promptly report any incidents of substandard or falsified dexamethasone to the WHO global surveillance and monitoring system.
13. Coronavirus disease (COVID-19): Environmental Surveillance
1. Why is environmental surveillance of wastewater important during disease outbreaks?
Testing wastewater has a long history of use in public health. Environmental surveillance is already used to detect poliovirus in high risk settings, monitor antimicrobial resistance and complement surveillance for other public health programmes.
2. How is wastewater testing used for COVID-19?
Wastewater testing can be used to monitor the presence of SARS-CoV-2 virus in untreated sewage. Several countries are monitoring wastewater for SARS-CoV-2 virus, the virus that causes COVID-19, in a range of locations for different purposes. These include:
early warning for COVID-19 cases in a community;
detection of COVID-19 in locations with weak clinical surveillance;
monitoring circulation of the virus during outbreaks; or
to trigger case-finding in locations where there are or may be suspected cases, such as quarantine hotels, university campuses or prisons.
Some countries are also analysing historical wastewater samples for evidence of past SARS-CoV-2 circulation.
3. What does it mean when a wastewater sample tests positive for SARS-CoV-2?
Molecular tests such as polymerase chain reaction (PCR) tests can detect the presence of the SARS-CoV-2 virus via fragments of genetic material (RNA) in wastewater. Finding this RNA in wastewater means that one or more people in the community likely excreted virus through urine, faeces or by coughing or sneezing. The RNA suggests that the virus was in the community at the time it was excreted. However, the wastewater test does not identify who was or is infected or indicate if the persons excreting the virus are still infectious to others.
4. Can I get sick with COVID-19 through contact with urine, faeces or sewage?
While fragments of SARS-CoV-2 genetic material (RNA) have been detected in the urine or faeces of some patients, there have been no reports to date of transmission of COVID-19 through urine or faeces. It remains important to protect yourself with personal protective equipment whenever contact with bodily fluids may occur and to clean your hands frequently
Infectious SARS-CoV-2 has also not been detected in wastewater, suggesting transmission through contact or contamination with sewage is highly unlikely.
Guidance for water, sanitation, hygiene and waste management can be found here.
5. Can I get sick with COVID-19 from swimming in the sea, rivers, lakes or swimming pools?
Available evidence suggests that SARS-CoV-2 does not spread from water. Natural bodies of water and swimming pools do not appear to pose a risk for COVID-19 transmission even if polluted by faeces or wastewater. Pools are usually treated regularly to prevent contamination with a range of pathogens which could be present.
However, crowded beaches or swimming pools do pose a risk of spreading COVID-19 through close contact with infected people or contaminated surfaces. To reduce the risk of this transmission, clean hands frequently, stay at least 1 metre away from others in and out of the water, and wear a mask when this distancing is not possible.
6. Can I get sick with COVID-19 from drinking water?
The risk coronaviruses pose to drinking water is considered to be low and SARS-CoV-2 virus has not been detected in drinking water supplies.
Drinking water treatment methods neutralize infectious pathogens present in the water. SARS-CoV-2 is an enveloped virus, which means it has a fragile fatty envelope that is easily destroyed by the treatment process. Therefore, treated drinking water does not pose a risk for COVID-19.
7. Can wastewater testing be conducted in low-resource settings?
Putting in place wastewater testing requires a good understanding of how environmental surveillance could add value in monitoring the spread of disease. The laboratory capacity needed to test wastewater samples may be limited in some settings. Clinical testing and epidemiological surveillance are higher priority strategies, as they lead directly to public health measures that can reduce transmission. Water, sanitation and hygiene (WASH) activities are also top public health priorities, such as ensuring access to hand washing facilities for all. The cost-benefit of wastewater testing relative to other public health measures should be carefully evaluated.
8. Does WHO recommend environmental surveillance of wastewater for COVID-19?
At present more evidence is needed regarding use of environmental surveillance for COVID-19. Wastewater monitoring may be considered as an optional and complementary approach to COVID-19 surveillance in addition to more standard clinical surveillance. Scientists and public health authorities continue to assess effectiveness and validate testing methods in different settings. WHO encourages efforts to continue to explore potential uses of wastewater testing and recognizes its potential as an emerging tool for improving control of COVID-19.
14. Coronavirus disease (COVID-19): Ethics, resource allocation and priority setting
1. Can I adapt previous frameworks for pandemic influenza to guide resource allocation for COVID-19?
Many ethical frameworks have been produced for resource allocation, some of which have been included in pandemic plans. Those frameworks provide useful guidance in the current scenario. Yet, when applying them, we must take into account the type of health care resource, the context, and the stage of the pandemic. That is, while the ethical principles that apply to resource allocation might be the same in different pandemics, they can lead to different decisions, given contextual circumstances. For example, this pandemic appears to significantly impact older adults (those 60 years of age or older), and such characteristics are relevant to shaping priorities for the allocation of resources during COVID-19. As a result, it may be inappropriate to use critical care triage guidelines that have age cut-offs that deprioritize or exclude those aged over 60 years.
When applying ethical guidelines for resource allocation, we should consider the extent to which resources are overwhelmed in the current context. It would be inappropriate, for instance, to exclude population groups from being allocated a resource (for example, ventilators) at the outset of a pandemic when capacity remains. When resources are scarce, though – when there is an insufficient supply to meet everyone’s needs – resource allocation should be guided by well established, broadly applicable ethical principles, unless there are characteristics of the outbreak that justify different courses of action. Irrelevant characteristics of populations within countries, such as ethnicity, race or creed, should play no role in any resource allocation in any pandemic. This reflects our commitment to treating people with equal respect.
2. Are the ethical considerations the same for all medical countermeasures, including therapeutics, vaccines and personal protective equipment (PPE)?
Generally, the considerations may be different. The allocation of different resources may find ethical justifications in different principles or values. For instance, once a novel vaccine is found to be safe and effective, to prioritize those at highest risk, as well as populations like health care workers who may be more likely to serve as vectors for transmission, is justified.
Within those subgroups, some suggest that a lottery-based (i.e., random) allocation may be justified, given that resources will be limited and we can assume nearly equal benefits will be derived from any recipient within that group. This is not the case, however, for other resources such as ventilators, where some individuals may derive significantly more benefit than others.
3. What is the basis for deciding who should have priority access to scarce resources?
The ethical basis for deciding which individuals or groups might be prioritized, including the principles to be applied, are presented in the below table:
Ethical considerations when deciding who to prioritize
Principle -Description- Practice implication
Each person’s interest should count equally unless there are good reasons that justify the differential prioritization of resources.
Irrelevant characteristics of individuals, such as race, ethnicity, creed, ability or gender, should not serve arbitrarily as the basis for the differential allocation of resources.
This principle can be used to justify the allocation of resources by a lottery – that is, randomly by chance – or by a system of first come, first served.
May be most appropriate to guide the allocation of scarce resources among individuals or populations who can be expected to derive the same benefit from the resource, for example, vaccines among high-risk populations, or ventilators among those with similar clinical indicators for benefit.
Best outcomes (utility)
This principle can be used to justify the allocation of resources according to their capacity to do the most good or minimize the most harm, for example, using available resources to save the most lives possible.
May be most appropriate to guide the allocation of scarce resources that confer substantially different benefits to different individuals, for example, ventilators to those expected to derive the most benefit.
Prioritize the worst off
This principle can be used to justify the allocation of resources to those in greatest medical need or those most at risk.
May be most appropriate to guide the allocation of resources that are designed or intended to protect those at risk, for example, PPE for health care workers, vaccines for those most at risk of infection and severe illness, or those most in need, as in the case of provision of drugs in short supply to those needing them most urgently.
Prioritize those tasked with helping others
This principle can be used to justify the allocation of resources to those who have certain skills or talents that can save many other people, or because something is owed to them on account of their participation in helping others.
May be most appropriate to guide the allocation of resources to health care workers, first responders, etc.
Allocation principles may be relevant or justified at different stages of resource scarcity (from less scarcity to more scarcity). For example, where little scarcity exists, the allocation of resources such as ventilators may be most justified by the principle of first come, first served (which promotes the value of equality). When those resources become increasingly scarce, their allocation may be justified according to a principle that prioritizes those most in need. With even greater scarcity, a principle that aims to maximize benefit from the resource may be most justified. At each stage, allocation should aim to promote equality – that is, first come, first served, or random allocation, when no relevant factors distinguish individuals within a particular scheme of allocation (for example, among those with similar needs, or among those who can be expected to benefit similarly from the resources, or among those that are at similar levels of risk).
In addition, multiple principles may be combined within an allocation scheme. For example, an allocation scheme for PPE might find its justification in a principle prioritizing those most at risk as well as a principle prioritizing those tasked with helping others, which would support priority allocation of PPE to health care workers.
4. How should decision-makers make considered ethical judgements about these matters, given the likelihood that there will not be enough of a resource? Who should be involved in decision-making on scarce resources?
For most decisions, multiple ethical values and principles will be relevant to deliberations about how to allocate resources. This is likely to generate some disagreement, because different people may weigh the values differently. Some may prioritize equality while others might put more emphasis on best outcomes or prioritization of the worst-off. For this reason, it is imperative that the different values be weighed and applied to specific allocation issues using a fair process.
A fair process for allocating scarce resources must promote certain ethical values:
Transparency. In a transparent process, the decisions and their justifications should be made public. This means that the population should be informed about the criteria guiding the decisions.
Inclusiveness. Those affected by allocation decisions – including individuals, communities or countries – should be able to exert at least some influence over the decision-making process as well as the decision itself. This also means that decisions 4 should be open to challenge and potentially revisable, perhaps through an appeal process.
Consistency. Decisions should be consistent so that all persons in the same categories are treated in the same way. This means that favouritism towards one’s own family, religious or political compatriots, or otherwise, is not appropriate. All forms of corruption that are at variance with this principle should be challenged and condemned.
Accountability. Those making decisions about allocation must be accountable for those decisions – that is, they should justify their decisions and be held responsible for them. A fair process means that allocation decisions should not be made by individuals, by individual pharmaceutical companies, or, in the case of allocation between countries, by a single country. Resources such as vaccines and therapies should not be stockpiled outside the system of fair allocation.
The fair allocation of resources is one that is valuable in itself precisely because it is fair. However, it may also be valuable because a fair system engenders solidarity and trust, which are vital to the successful and sustained collective response necessary for dealing effectively with any outbreak.
5. What are the key ethical considerations that governments, vaccine manufacturers and funders should take into account to ensure a fair distribution of vaccines globally?
Countries are equally vulnerable to COVID-19 and have a shared responsibility, grounded in solidarity, to collaborate globally to mitigate the outbreak. Each government has special obligations to its own citizens, but the fair allocation of vaccines globally requires us not to simply appeal to self-interest, claims of resource ownership and the prioritization of compatriots. Vaccines should be allocated in a way that prioritizes those who fall into the categories presented in the below table. (Where individuals or populations fall into multiple categories, they should receive even higher priority.)
Priority populations, and rationale for prioritization
Priority population- Rationale for prioritization
Those at greatest risk of becoming infected and seriously ill
Maximize benefit of vaccine
Those who, if vaccinated, would prevent the greatest spread of the virus
Maximize benefit of vaccine
Those who have volunteered to participate in research aimed at developing the vaccine
Reciprocal obligation to those who were voluntarily put at risk to aid in this effort
Those falling into each category may change over time.
6. What conclusions can we draw about the fair allocation of scarce resources within countries during the COVID-19 outbreak?
Health care workers (caring for patients) and first responders can justifiably be prioritized when allocating some resources because of their contribution to the health and well-being of the community. Their health helps preserve the health of others.
Participants of research aimed at developing vaccines, therapies or other critical resources should receive some priority in receiving those resources because they have also helped save others by their participation. This is not an absolute priority – for example, it should not take precedence over giving priority to those most at risk in the case of resources such as vaccines.
While the principle of first come, first served is often applied when allocating resources in health care settings, it is rarely appropriate in an emergency. In practice, it is very likely to favour certain groups, such as those closest to a distribution centre, those with access to better information, or those who are most well-off.
Younger populations appear to be at lower risk in the COVID-19 context. Consequently, the principle of youngest first should have low priority for vaccine, but perhaps may have more weight if they do become sick and need critical care resources.
The allocation of different resources may find ethical justification in different principles or values. For instance, if a novel vaccine is found to be safe and effective, a lottery-based allocation may be justified among those as highest risk, the old and those with co-morbidities, if they outnumber available vaccines.
Maximizing utility should be balanced with the principle of priority to the worst-off: centralizing the availability of resources in larger centres may extend their benefits to more people, but may exclude isolated populations and challenge our concern for those at highest risk.
15. Coronavirus disease (COVID-19): Food businesses
1. How can food businesses remain safe from virus contamination?
The main priority is to keep the virus out of the food environment. Several key measures are required including upgrading of cleaning and sanitation measures, disinfecting surfaces and high-touch points, educating staff on the virus and how to protect themselves and others, reinforcing protocols such as physical distancing, hand washing, and improved security with people staying in their vehicles/sanitizing hands when handing out documents and other material.
2. Should grocery store workers wear gloves? Masks?
Gloves may be used by food workers but must be changed frequently and hands must be washed between glove changes and when gloves are removed. Gloves must be changed after carrying out non-food related activities such as opening/closing doors by hand, and emptying bins. Food workers should be aware that wearing gloves can allow bacteria to build up on the surface of the hands, so hand washing is extremely important when gloves are removed to avoid subsequent contamination of food. Food workers should not touch their mouth, nose and eyes when wearing gloves.
Disposable gloves can give a false sense of safety and should not be used in the food work environment as a substitute for hand washing. The COVID-19 virus can contaminate disposable gloves in the same way it can get onto workers hands and contact surfaces. Removal of disposable gloves can lead to contamination of hands. Wearing disposable gloves can give you a false sense of security and may result in staff not washing hands as frequently as required.
Handwashing is a greater protective barrier to infection than wearing of disposable gloves. Food businesses need to ensure adequate sanitary facilities are provided and ensure food workers thoroughly and frequently wash their hands. Soap and water is adequate for hand washing. Hand sanitisers can be used as an additional measure but should not replace hand washing.
Wearing of Face Masks
WHO advice on the use of masks in the context of COVID-19 should be followed. Face Masks do not have to be routinely used by food workers to protect against transmission of COVID-19. However, for some food processing activities, such as working in abattoirs or handling cooked, ready-to-eat foods, wearing face masks is a usual practice.
WHO recommends that face masks should be used if a person is sick with symptoms of COVID-19 (especially coughing) or looking after someone with suspected or confirmed COVID-19.
However, a food worker who is sick or who has symptoms of COVID-19 should not be allowed to work in grocery stores or other food businesses and should be excluded from work until free of symptoms or deemed fit for work by a medical doctor.
3. What is the protocol when an employee working in a food business becomes ill with COVID-19?
Staff who are feeling unwell should not report to work and should seek medical advice. However, in the event that a food worker becomes unwell in the workplace with typical symptoms of COVID-19, they should be removed to an area away from other people. If possible, find a room or area where they can be isolated behind a closed door, such as a staff office. If it is possible to open a window, do so for ventilation. Arrangements should be made for the unwell employee to be removed quickly from the food premise.
The employee who is unwell should follow national guidelines for reporting cases/suspect cases of COVID-19. Whilst they wait for medical advice or to be sent home, they should avoid any contact with other employees. They should avoid touching people, surfaces and objects and be advised to cover their mouth and nose with a disposable tissue when they cough or sneeze and put the tissue in a bag or pocket and then dispose of the tissue in a bin. If they do not have any tissues available, they should cough and sneeze into the crook of their elbow. If they need to go to the bathroom whilst waiting for medical assistance, they should use a separate bathroom, if available.
All surfaces that the infected employee has come into contact with must be cleaned. Alcohol based sanitizers/surface disinfectants should be used for cleaning purposes. In general, alcohol-based disinfectants (ethanol, propan-2-ol, propan-1-ol) have been shown to significantly reduce infectivity of enveloped viruses like COVID-19 virus, in concentrations of 70-80%. Common disinfectants with active ingredients based on quaternary ammonium compounds (QUATS) and chlorine would also have virucidal properties. All staff should wash their hands thoroughly for 20 seconds with soap and water after any contact with someone who is unwell with symptoms consistent with coronavirus infection.
If an employee is confirmed as a case of COVID-19 it will be necessary to notify all close contacts of the infected employee so they too can take measures to minimise further risk of spread. WHO definitions of a contact of a COVID-19 case can be found here. Examples of contacts in the food businesses could include any employee who was in face-to-face or physical (i.e., touching) contact; any employee who was within 1 meter with the confirmed case; anyone who has cleaned up any bodily fluids without adequate PPE (e.g. gloves, overalls, protective clothing); employees in the same working team or workgroup as the confirmed case, and any employee living in the same household as a confirmed case.
WHO recommends that contacts be quarantined for 14 days from the last point of exposure to the confirmed case.22 At a minimum, staff who have had close contact with the infected employee should be asked to stay at home for 14 days from the last time they had contact with the confirmed case and practice physical distancing. If they become unwell at any time within their 14-day isolation period and they test positive for COVID-19, they will become a confirmed case, and should be managed as such.
Staff who have not had close contact with the original confirmed case should continue taking the usual precautions and attend work as usual. Organising employees into small teams or workgroups will help to minimise disruption to work processes in the event of an employee reporting sick with symptoms of COVID-19. Closure of the workplace is not recommended.
More detailed information can be found in COVID-19 and food safety: guidance for food businesses.
For more information on contacts of COVID-19 confirmed cases, see WHO guidance on surveillance and case definitions."
4. When can an employee return to work following illness? Are temperature checks appropriate?
A return to work policy for staff who have been infected and recovered from COVID-19 should be in place. WHO recommends that a confirmed patient could be released from isolation once their symptoms resolve and they have two negative PCR tests at least 24 hours apart. If testing is not possible, WHO recommends that a confirmed patient can be released from isolation 14 days after symptoms resolve.
Taking the temperature of food workers is not recommended. Fever is only one of the symptoms of COVID-19 and absence of fever alone is not a reliable indicator of wellness. As part of a food business ‘fitness to work’ guidelines, staff should report to management if they are sick with typical COVID-19 symptoms, particularly fever.
5. What specific precautions do food workers need to take?
Physical distancing, good personal hygiene with frequent hand washing, and application of general food hygiene measures are the most important precautions food workers should adopt. Physical distancing is very important to help slow the spread of coronavirus. This is achieved by minimising contact between potentially infected individuals and healthy individuals. Frequent hand washing with soap and water and use of hand sanitizers are also important in reducing the risk of transmission. All food businesses should follow the physical distancing and hand washing guidance of WHO.
The Codex Alimentarius Commission has adopted several practical guidelines on how to apply and implement best practices to ensure food hygiene (Codex General Principles of Food Hygiene, CXC 1- 1969), handle meats (Codex Code of Hygienic Practice for Meat, CXC 58 – 2005), and control viruses in foods (Guidelines for the Application of General Principles of Food Hygiene to the Control of Viruses in Food (CAC/GL 79-2012). Enhanced food safety practices at this time, such as those recommended in the Codex documents mentioned, will reduce the likelihood of contamination of foods with any pathogen and help lowering the public health burden caused by already established foodborne infections, reducing the stress on an already overburdened public health system.
6. How should employees maintain safe distance from one another during food production and processing?
WHO guidelines are to maintain at least 1 metre (3 feet) between fellow workers. Where the food production environment makes it difficult to do so, employers need to consider what measures to put in place to protect employees. Examples of practical measures to adhere to physical distancing guidance in the food processing environment are to:
stagger workstations on either side of processing lines so that food workers are not facing one another,
provide personal protection equipment (PPE) such as face masks, hair nets, disposable gloves, clean overalls and slip reduction work shoes for staff. The use of PPE would be routine in high risk areas of food premises that produce ready-to-eat and cooked foods. When staff are dressed in PPE it is possible to reduce distance between workers,
space out workstations, which may require reduction in the speed of production lines,
limit the number of staff in a food preparation area at any one time,
organise staff into working groups or teams to facilitate reduced interaction between groups, including during change of work shifts.
7. How should baked goods and fresh produce be displayed in a food market/grocery store?
It is important to maintain good hygiene practices around open food displays, with ready-to-eat food products such as salad bars, fresh produce displays and bakery products. Consumers should always be advised to wash fruits and vegetables with potable water prior to consumption. Both customers and staff should strictly observe good personal hygiene practices at all times around open food areas.
In order to hygienically manage open food displays and to avoid the transmission of COVID-19 through surface contact, food retailers should:
Maintain frequent washing and sanitising of all food contact surfaces and utensils;
Require food service workers to frequently wash hands, and, if using gloves, these must be changed;
Require food service workers to frequently clean and sanitise counters, serving utensils and condiment containers;
Make available hand sanitiser for consumers on their way in and out of the food premises;
Should consider not openly displaying or selling unwrapped bakery products from self-service counters. Bakery products on open, self-service displays in retail stores should be placed in plastic/cellophane or paper packaging. Where loose bakery products are displayed in retail stores, these should be placed in plexiglass display cabinets and placed in bags using tongs when customers are served.
Ready-to-eat salads available in retail for self-serve, should also be placed behind plexiglass display cabinets and serving utensils should be frequently sanitized.
8. How should shopping trolleys or carts be disinfected?
The handles of shopping trolleys or carts should be frequently cleaned using either alcohol-based sanitizers or chlorine-based disinfectants (sodium hypochlorite). Sanitizers, paper towels and trash bins should be placed outside the retail premises close to the trolley park for customers to use.
9. What is the most appropriate sanitizer to use on surfaces in a food production environment?
In general, alcohol-based disinfectants (ethanol, propan-2-ol, propan-1-ol) have been shown to significantly reduce infectivity of enveloped viruses like SARS-CoV-2, in concentrations of 70-80% with one-minute exposure time. Chlorine-based disinfectants (sodium hypochlorite) are effective for surface decontamination, as are disinfectants with active ingredients based on quaternary ammonium compounds (QUATS).
10. Could the virus be transmitted from humans to food animals or vice versa?
Currently, there is no evidence to suggest that food animals could be a possible route for transmission of COVID-19 to humans or that food animals can become infected by humans. Studies are underway to better understand the susceptibility of different animal species to the COVID-19 virus and to assess infection dynamics in susceptible animal species. Additional information can be found on the website of the World Organisation for Animal Health (OIE).
11. What is known about various conditions affecting survivability of the virus?
Very little is known about how the SARS-CoV-2 virus survives outside the human body. Probably the most up-to-date summary of scientific information we have on survival in the environment is from the European Centre for Disease control (ECDC) and the following is extracted from their recent technical report:
Recent publications have evaluated the survival of SARS-CoV-2 on different surfaces. According to van Doremalen et al., the environmental stability of SARS-CoV-2 is up to three hours in the air post-aerosolization, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel, albeit with significantly decreased titres . These findings are comparable with results obtained for environmental stability of SARS-CoV-1. These findings resulted from experiments in a controlled environment and should be interpreted with caution in the real-life environment. Moreover, different levels of environmental contamination have been detected in rooms of COVID-19 patients, ranging from 1 out of 13 to 13 out of 15 samples testing positive for SARS-CoV-2 before cleaning. No air samples were positive in these studies, but one sample from an air exhaust outlet was positive indicating that virus particles may be displaced by air and deposited on surfaces [4,5]. In a study of environmental contamination in a Chinese hospital during the COVID-19 outbreak, SARS-CoV-2 was detected in environmental samples from the COVID-19 dedicated intensive care units (ICU), the COVID-19 dedicated obstetric isolation ward and the COVID-19 dedicated isolation ward. SARS-CoV-2 was also detected on objects such as the self-service printers used by patients to self-print the results of their exams, desktop keyboards and doorknobs. Virus was detected most commonly on gloves (15.4% of samples) and rarely on eye protection (1.7%) . This evidence shows the presence of SARS-CoV-2 in the environment of a COVID-19 patient, therefore reinforcing the belief that fomites play a role in transmission of SARS-CoV-2; however, the relative importance of this route of transmission compared to direct exposure to respiratory droplets is still unclear."
12. What measures should be taken to ensure safe transport of food during this pandemic?
The general guidelines outlined in the Codex Code of Hygienic Practice for the Transport of Food in Bulk and Semi-Packed Food.1 should be followed, in addition to ensuring that employees delivering foods are free from COVID-19, coughing/sneezing etiquette is practiced by all involved in food transport and that frequent hand washing/sanitizing is practiced and staff practice physical distancing.
See also other Codes of Hygienic Practice for various groups of food.
13. What measures should be taken to ensure safe water is used in food production during this pandemic?
There is no evidence that COVID-19 is transmitted by water used in food processing. The WHO guidelines for drinking-water quality should be followed.
14. How should food premises be cleaned/disinfected during this pandemic?
The general guidelines outlined in the General Principles of Food Hygiene for food processing and manufacture premises should be followed. If a suspected or confirmed case of COVID-19 is identified in a food premises then there is a requirement to completely clean the area with a neutral detergent, followed by decontamination of surfaces using a disinfectant effective against viruses. All surfaces that the infected employee has come into contact with must be cleaned, including all surfaces and objects which are visibly contaminated with body fluids/respiratory secretions, and all potentially contaminated high-contact areas such as toilets, door handles, telephones. Alcohol based sanitizers/surface disinfectants should be used for cleaning purposes. In general, alcohol-based disinfectants (ethanol, propan-2-ol, propan-1-ol) have been shown to significantly reduce infectivity of enveloped viruses like SARS-CoV-2, in concentrations of 70-80% with one-minute exposure time. Chlorine-based disinfectants (sodium hypochlorite) are effective for surface decontamination, as are disinfectants with active ingredients based on quaternary ammonium compounds (QUATS).
All staff should wash their hands thoroughly for 20 seconds after any contact with someone who is unwell with symptoms consistent with coronavirus infection. Staff engaged in environmental cleaning should wear PPE when performing cleaning activities, such as overalls or uniform, single-use plastic aprons, gloves and a face mask. Protective clothing (e.g. uniforms, overalls, etc.) should be frequently washed at 60°C or above.
16. Coronavirus disease (COVID-19): Food safety and nutrition
1. Can I get COVID-19 from eating fresh foods, like fruits and vegetables?
There is currently no evidence that people can catch COVID-19 from food, including fruits and vegetables. Fresh fruits and vegetables are part of a healthy diet and their consumption should be encouraged. Read more in the COVID-19 and food safety: guidance for food businesses.
2. How should I wash fruits and vegetables in the time of COVID-19?
Wash fruit and vegetables the same way you would in any other circumstance. Before handling them, wash your hands with soap and water. Then wash fruits and vegetables thoroughly with clean water, especially if you eat them raw.
3. Can the virus that causes COVID-19 live on the surface of food packaging?
Coronaviruses need a live animal or human host to multiply and survive and cannot multiply on the surface of food packages. It is not necessary to disinfect food packaging materials, but hands should be properly washed after handling food packages and before eating (see question 10 of Questions relating to food businesses).
4. Can the virus that causes COVID-19 be transmitted through the consumption of cooked foods, including animal products?
There is currently no evidence that people can catch COVID-19 from food. The virus that causes COVID-19 can be killed at temperatures similar to that of other known viruses and bacteria found in food. Foods such as meat, poultry and eggs should always be thoroughly cooked to at least 70°C. Before cooking, raw animal products should be handled with care to avoid cross-contamination with cooked foods. The WHO 5-Keys to Safer Food provides further information.
5. Is it safe to go to grocery stores and other food markets?
Yes, it is generally safe to go grocery shopping and to markets by following the below prevention measures:
Clean your hands with sanitizer before entering the store.
Cover a cough or sneeze in your bent elbow or tissue.
Maintain at least a 1-metre distance from others, and if you can’t maintain this distance, wear a mask (many stores now require a mask).
Once home, wash your hands thoroughly and also after handling and storing your purchased products.
There is currently no confirmed case of COVID-19 transmitted through food or food packaging.
For more recommendations on how to minimize the risk of transmission of emerging pathogens in traditional food markets, see the WHO recommendations to reduce risk of transmission of emerging pathogens from animals to humans in live animal markets or animal product markets.\
6. Is it safe to have groceries delivered?
Yes, it is safe to have groceries delivered if the provider follows good personal and food hygiene practices. After accepting food/grocery deliveries, hands should be properly washed."
7. What is the best household disinfectant for surfaces?
Regular household cleaning and disinfection products will effectively eliminate the virus from household surfaces. For cleaning and disinfecting households with suspected or confirmed COVID19, surface virucidal disinfectants, such as 0.05% sodium hypochlorite (NaClO) and products based on ethanol (at least 70%), should be used.
8. What foods should be consumed to support the immune system?
The immune system requires the support of many nutrients. It is recommended to consume a variety of foods for a healthy and balanced diet, including whole grains, legumes, vegetables, fruits, nuts and animal source foods. There is no single food that will prevent you from catching COVID-19. For more information on a healthy diet, see the Healthy diet fact sheet.
9. Can micronutrient (vitamin and mineral) supplements prevent COVID-19 in healthy individuals or cure it in those with COVID-19 disease?
No. There is currently no guidance on micronutrient supplementation for the prevention of COVID-19 in healthy individuals or for the treatment of COVID-19. Micronutrients are critical for a well-functioning immune system and play a vital role in promoting health and nutritional well-being. Wherever possible, micronutrient intakes should come from a nutritionally balanced and diverse diet, including from fruits, vegetables and animal source foods.
10. Are vitamin D supplements needed if individuals are not exposed to sunlight due to lockdowns?
Vitamin D can be made in the skin by exposure to sunlight or obtained through the diet from natural sources (e.g. fatty fishes such as salmon, tuna and mackerel, fish liver oils, beef liver, cheese and egg yolks), or from vitamin D-fortified foods or vitamin D-containing supplements.
In situations where individuals’ vitamin D status is already marginal or where foods rich in vitamin D (including vitamin D-fortified foods) are not consumed, and exposure to sunlight is limited, a vitamin D supplement in doses of the recommended nutrient intakes (200-600 IU, depending on age) or according to national guidelines may be considered.
See WHO guidance on Vitamin and mineral requirements in human nutrition.
11. Are there any herbal teas or herbal supplements that may help prevent or cure COVID-19?
No. There is currently no evidence to support the use of herbal teas or herbal supplements to prevent or cure COVID-19.
12. Can probiotics help prevent COVID-19?
No. Probiotics are live microorganisms that are generally added to foods or used as a supplement to the diet to confer a health benefit. However, there is currently no evidence to support the use of probiotics to help prevent or cure COVID-19.
13. Can eating ginger help prevent COVID-19?
No. There is no evidence that eating ginger has protected people from COVID-19. However, ginger is a food that may have some antimicrobial and anti-inflammatory properties.
14. Can eating garlic help prevent COVID-19?
No. There is no evidence that eating garlic has protected people from COVID-19. However, garlic is a food that may have some antimicrobial properties.
15. Can adding pepper to your soup or other meals help prevent or cure COVID-19?
No. There is no evidence that adding hot peppers to your food can prevent or cure COVID-19.
17. Coronavirus disease (COVID-19): Food safety authorities
1. How should imported foods from countries with high prevalence of COVID-19 be treated?
As food has not been implicated in the transmission of COVID-19, imported food should be subjected to the same import controls as before the pandemic. See FAO guidance on risk based imported food control.
2. Do food inspectors need to wear any protective equipment?
In the course of conducting a food inspection, food inspectors routinely wear protective equipment. There is no need for additional protective equipment to be used. The primary focus of the additional hygiene and sanitation measures implemented by food businesses should be on keeping the COVID-19 out of their businesses. COVID-19 virus will only enter business premises when an infected person enters, or contaminated fomites are brought into the premises. Food safety authorities should consider reducing the frequency of food inspections during this pandemic. If food inspectors continue to carry out food inspections, they will need to demonstrate that they are free from infection, they will need to practice physical distancing while in the food premises, changing clothes/shoes between inspections, washing hands before and after entering the food premises and good coughing/sneezing etiquette.
3. What do food inspectors need to consider when reopening a food business when the pandemic is over?
Food inspectors do not need to intervene when restaurants reopen after having closed upon the advice of national governments.
4. What are the lab protocols for identifying the virus in food? On surfaces?
As food has not been implicated in the transmission of COVID-19, testing of food or food surfaces for this virus is not recommended. Frequent cleaning of food contact surfaces with virucidal disinfectants such as 0.05% sodium hypochlorite (NaClO) or products based on ethanol (at least 70%) should be carried out. Alcohol-based disinfectants (ethanol, propan-2-ol, propan-1-ol) have been shown to significantly reduce infectivity of enveloped viruses like SARS-CoV-2, in concentrations of 70-80% with one-minute exposure time. Chlorine-based disinfectants (sodium hypochlorite) are effective for surface decontamination, as are disinfectants with active ingredients based on quaternary ammonium compounds (QUATS).
5. Is quarantine necessary for live animals imported from countries experiencing a large numbers of COVID-19 cases?
No, food animals have not been implicated in the transmission of COVID-19 and the same import controls should apply as before this pandemic. See Q&A from the World Organisation for Animal Health for more about COVID-19 and animals.
6. How do we ensure the food supply chain remains intact to prevent food shortages?
While many businesses have introduced working from home and teleworking, these are not options for food workers who are required to continue to work as normal. Keeping all workers in the food production and supply chains healthy and safe is critical to avoid food shortage. Maintaining the movement of food along the food chain is an essential function of all sectors of the food industry and is extremely important for ensuring consumer confidence in the food supply. In order to ensure that the food supply chain remains intact to prevent food shortages there is an urgent requirement for the industry to introduce additional measures to protect food workers from contracting COVID-19; to prevent the risk of exposure to COVID-19, and to strengthen existing food hygiene and sanitation practices.
18. Coronavirus disease (COVID-19): Food safety for consumers
1. Can I get COVID-19 from food?
There is currently no evidence that people can catch COVID-19 from food or food packaging. COVID-19 is a respiratory illness and the transmission route is through person-to-person contact and through direct contact with respiratory droplets generated when an infected person coughs or sneezes.
2. Can the virus live on the surface of foods (including fruits and vegetables, frozen foods, pre-packaged foods)?
Coronaviruses cannot multiply in food – they need a live animal or human host to multiply and survive ( see question 10 of Questions relating to food businesses)
3. How to wash fruits and vegetables? Just with water, or something else?
Washing fruit and vegetables with potable water is sufficient: it is recommended to follow the WHO Five keys to safer food.
4. Can the virus live on the surface of food packaging? How long? Is it necessary to disinfect?
See question 10 of Questions relating to food businesses. It is not necessary to disinfect food packaging materials, but hands should be properly washed after handling food packages and before eating.
5. How long is it to cook food? To what temperature to kill the virus?
This virus is not more resistant to heat than the usual viruses and bacteria found in food. As recommended for good hygiene practice, foods should be thoroughly cooked to at least 70°C. It is recommended to follow the WHO Five keys to safer food.
6. What precautions should consumers take in grocery stores?
Consumers should maintain a safe physical distance of at least one metre from all other shoppers and staff while queuing before entering the store and while shopping in the store. If a trolley or basket is used while shopping, sanitize the handle before and after use. Hands should be sanitized before entering the store. Practice good coughing/sneezing etiquette while in the store. Avoid touching mouth, nose or eyes during shopping. Minimise direct hand contact with food by using available tongs and serving utensils. Use contactless payment rather than cash/notes (where feasible).
7. Is food/grocery delivery safe?
Yes, if the provider follows good personal and food hygiene practices. After accepting food/grocery deliveries, hands should be washed with soap and water.
8. What is the best household disinfectant for surfaces?
Regular household cleaning and disinfection products will effectively eliminate the virus from household surfaces. For cleaning and disinfecting households with suspected or confirmed COVID19 illnesses - surface virucidal disinfectants, such as 0.05% sodium hypochlorite (NaClO) and products based on ethanol (at least 70%), should be used.
9. Is it still safe to go to food markets? Animal markets? Wet markets?
It should be safe provided it is possible to maintain a safe physical distance of at least one metre from all other shoppers and staff, it is possible to wash/sanitize hands, and that Good Manufacturing Practices and Good Hygienic Practices (GMP/GHP) standards are maintained in the market. For more recommendations on how to minimise the risk of transmission of emerging pathogens in wet markets, see the WHO recommendations to reduce risk of transmission of emerging pathogens from animals to humans in live animal markets or animal product markets.
19. Coronavirus disease (COVID-19): Health and safety in the workplace
1. Can COVID-19 be transmitted at the workplace?
COVID-19 spreads primarily through respiratory droplets or contact with contaminated surfaces. Exposure can occur at the workplace, while travelling to work, during work-related travel to an area with local community transmission, as well as on the way to and from the workplace.
2. What is the risk of contracting COVID-19 in the workplace?
The risk of exposure to COVID-19 in the workplace depends on the likelihood of coming within 1 metre of others, in having frequent physical contact with people who may be infected with COVID-19, and through contact with contaminated surfaces and objects.
3. How can people assess the risk for exposure to COVID-19 in their workplace and plan for preventive measures?
Managers with the support of an occupational health and safety advisor should carry out rapid risk assessments to determine the possibility of exposure risk in order to put in place preventive measures. This should be done for each specific work setting and each job.
Low exposure risk
Jobs or work without frequent, close contact with the general public or others. Workers in this group have minimal occupational contact with the public and other co-workers. Examples of such jobs may include remote workers (i.e., working from home), office workers without frequent close contact with others and workers providing teleservices.
Medium exposure risk
Jobs or tasks with close, frequent contact with the general public or others. This risk level may apply to workers who have frequent and close contact with the people in high-population-density work environments (e.g. food markets, bus stations, public transport, and other work activities where physical distancing of at least 1 metre may be difficult to observe), or tasks that require close and frequent contact between co-workers. This may also include frequent contact with people returning from areas with community transmission. Examples of such jobs may include frontline workers in retail, home deliveries, accommodation, construction, police and security, public transport, and water and sanitation.
High exposure risk
Jobs or tasks with close contact with people who may be more likely to have COVID-19, as well as contact with objects and surfaces possibly contaminated with the virus. Examples include transporting people known or suspected to have COVID-19 without separation between the driver and the passenger, providing domestic services or home care for people with COVID-19, and having contact with the deceased who were known or suspected of having COVID-19 at the time of their death. Jobs that may fall under this category include domestic workers, social care workers, personal transport and home delivery providers and home repair technicians (plumbers, electricians) who have to provide services in the homes of people with COVID-19.
4. Who should carry out the workplace risk assessment?
Employers and managers, in consultation with workers, should carry out and regularly update the risk assessment for work-related exposure to COVID-19, preferably with the support of occupational health services.
5. What are the key considerations for the workplace risk assessment?
For each risk assessment, consider the environment, the task, the threat, resources available, such as personal protective equipment, and the feasibility of protective measures. The risk assessment should also extend to collective accommodation provided by the employer for workers, such as dormitories. Essential public services, such as security and police, food retail, accommodation, public transport, deliveries, water and sanitation, and other frontline workers may be at an increased risk of exposure to occupational hazards for health and safety. Workers who may be at higher risk of developing severe COVID-19 illness because of age or pre-existing medical conditions should be considered in the risk assessment for individuals.
6. How should employers decide when to open, close or re-open workplaces and/or suspend or downscale work activities?
Deciding to close or re-open a workplace or suspend or downscale work activities should rely on the risk assessment, the capacity to put in place protective measures and the level of compliance, and recommendations of national authorities.
7. What key measures to protect against COVID-19 should be undertaken in ALL workplaces?
Measures to prevent transmission of COVID-19 that apply to all workplaces and all people at the workplace include frequent hand-washing or disinfection with alcohol based hand sanitizer, respiratory hygiene such as covering coughs, physical distancing of at least 1 metre or more according to the national recommendations, wearing of masks where distancing is not possible, regular environmental cleaning and disinfection, and limiting unnecessary travel. Clear policies and messages, training, and education for staff and managers to increase awareness of COVID-19 are essential. The management of people with COVID-19 or their contacts is also critical e.g. requiring workers who are unwell or who develop symptoms to stay at home, self isolate and contact a medical professional or the local COVID-19 information line for advice on testing and referral.
8. What additional measures should be taken at workplaces and for jobs at medium risk?
Workplaces for jobs at medium risk require daily cleaning and disinfection at least two times a day of objects and surfaces that are touched regularly, including all shared rooms, surfaces, floors, bathrooms, and changing rooms. Consider suspending any activity where physical distancing of at least 1 metre cannot be implemented in full. If this is not possible, increase ventilation, implement enhanced regular hand hygiene, and require staff to wear appropriate face masks, goggles, gloves and work clothes during cleaning procedures that generate splashes, providing training on their use. Organize changing and washing of work clothes at the workplace, so that workers to do take them home.
9. What additional measures should be taken at workplaces and for jobs at high risk?
In work areas at high risk, assess the possibility of suspending the activity; enhance regular hand hygiene; provide medical masks, disposable gowns, gloves, and eye protection for workers who must work in the homes of people who are suspected or known to have COVID-19; train workers in infection prevention and control practices and use of personal protective equipment; avoid assigning tasks with high risk to workers who have pre-existing medical conditions, are pregnant, or older than 60 years of age.
10. What should be taken into consideration when setting a physical distance at the workplace?
WHO recommends keeping a physical distance of at least 1 metre between each person in all settings, including in workplaces. Because transmission can occur in crowded workplaces, WHO recommends providing sufficient space, at least 10 square meters, for every worker. National recommendations for physical distancing may require greater physical distance and should be complied with.
In order to support compliance with national or local recommendations, implement physical distance guidelines in a way that is practical and feasible in the context of work tasks, and which is acceptable to both workers and employers. Stimulate workers to comply with physical distancing norms also at events outside the workplace, in the community, and in dormitories.
Risk assessment and consultation between employers and workers is very important for setting up and implementing physical distancing measures at the workplace. This may require modification of workstations, changing the use of common spaces and transport vehicles, staggered work shifts, split teams and other measures to reduce social mixing at the workplace.
If physical distancing measures at the workplace are not feasible for specific work tasks, consider whether the work can be suspended, and if this is not possible, apply additional protective measures, such as the use of screens, sneeze guards, face masks, enhanced hand hygiene, ventilation and disinfection.
Physical distancing alone can’t prevent COVID-19 transmission, it is important that it is combined with other public health measures, such as hand and respiratory hygiene, environmental clean-up and disinfection of commonly touched surfaces and objects, ventilation, wearing face masks and a policy of staying at home if unwell.
11. What are the rights, duties and responsibilities of employers?
Employers, workers, and their organizations should collaborate with health authorities to prevent and control COVID-19. Cooperation between management and workers and their representatives is essential for workplace‐related prevention measures. International labour standards on the rights and responsibilities of workers and employers in occupational safety and health should be fully respected.
Employers, in consultation with workers and their representatives, should plan and implement measures to prevent and mitigate COVID-19 at the workplace through engineering and administrative controls, and provide personal protective equipment and clothing according to the risk assessment. Such measures should not involve any expenditure on the part of the workers.
Special measures are needed to protect workers at higher risk of developing severe disease, such as those age 60 and over, or with underlying medical conditions, upon recommendation of the occupational health services. Workers in the informal economy and digital labour platforms, those in small enterprises, domestic and migrant workers should not be left behind in the protection of their health and safety at work and their livelihood.
There should be no social stigma or discrimination at the workplace for any reason, including access to information and protection from COVID-19, occupational health services and mental health and psychosocial support.
If COVID-19 is contracted through occupational exposure, it could be considered an occupational disease and, if so determined, should be reported and compensated according to the international labour standards and the national schemes for employment injury benefits.
12. What are the rights, duties and responsibilities of workers?
Workers are responsible to follow the measures for occupational safety and health and infection prevention and control established for their workplace, and to participate in training provided by the employer. Workers should report to their supervisor any situation which may present an imminent and serious danger to their life or health. Workers have the right to remove themselves from any work situation that they have reasonable justification to believe presents an imminent and serious danger to their life or health, and should be protected from any undue consequences as a result of exercising this right.
13. How can workplaces plan for the prevention and mitigation of COVID-19?
Workplaces should develop action plans to prevent and mitigate COVID-19 as part of the business continuity plan and according to the results of the risk assessments and the epidemiological situation.
The action plan and preventive measures should be regularly monitored and updated. Workers and their representatives should be consulted and should participate in the development, monitoring and updating of the workplace COVID-19. It is very important to monitor the effectiveness of preventive measures, and the compliance of workers, visitors, customers, clients and sub-contractors with the measures. The plans should be updated when someone with known or suspected COVID-19 is at the workplace.
14. Can the return to the workplace be immediate after public measures are lifted?
The return to work premises should be carefully planned ahead, with preventive measures put in place according to the risk assessment of the different jobs and work tasks. All possible risks for safety and health should be assessed, such as risks resulting from reduced maintenance of machines and facilities during the closure period. If a return to work is rushed and not done in a phased and cautious manner, it puts lives at risk, and threatens to undermine efforts to restore social and economic activity.
15. Does WHO recommend thermal testing of people entering a workplace?
Temperature screening cannot detect all cases of COVID-19, since infected individuals may not have fever early in the course of infection or illness, such as during the incubation period or just before other symptoms begin, even though they may already be infectious. Some people may reduce fever with a fever-reducing medication if they are concerned about the possible consequences of not coming to work. Relying on temperature screening alone will not stop the spread of COVID-19 at work.
Thermal screening at the workplace can be considered part of a package of measures to prevent and control COVID-19 at the workplace. Workers should be encouraged to self-monitor their health, possibly with the use of questionnaires, and take their own temperature regularly at home. Workplaces should adopt “stay at home if unwell” and flexible sick leave policies to discourage workers with symptoms consistent with COVID-19 from coming to the workplaces.
16. Does WHO recommend workers wear masks at the workplace (office or others)? If yes, what type of masks?
Wearing masks depends on the risk assessment. For jobs and tasks that carry a medium or high risk, for people aged 60 and older, and for those with underlying health conditions, a medical mask and other personal protective equipment should be provided. Fabric masks or face coverings are currently recommended for younger people and those with no symptoms where physical distancing is not achievable. This prevents the spread of virus from the wearer (who could have COVID-19 but no symptoms) to others. The policy on wearing a mask or face covering in low risk workplaces should be in line with national or local guidelines. Masks may carry some risks if not used properly.
17. Are there any directives on office ventilation and air conditioning use?
There should be fresh, clean air in all workplaces. For jobs and work tasks at medium or high risk of exposure, WHO recommends an increased ventilation rate through natural aeration or artificial ventilation, preferably without re-circulation of the air. In case of air recirculation, filters should be cleaned regularly.
18. What mental health and psychosocial support should be provided to workers during COVID-19?
COVID-19 is associated with a range of concerns, such as fear of falling ill and dying, of being socially excluded, placed in quarantine, or losing a livelihood. Symptoms of anxiety and depression are common reactions for people in the context of COVID-19. Mental health and psychosocial support should be made available to all workers. Comprehensive risk assessments can help identify and mitigate related occupational hazards for mental health
Full Guideline Document Considerations for public health and social measures in the workplace in the context of COVID-19 is accessible at: https://www.who.int/publications/i/item/considerations-for-public-health-and-social-measures-in-the-workplace-in-the-context-of-covid-19
20. Coronavirus disease (COVID-19): Herd immunity, lockdowns and COVID-19
1. What is ‘herd immunity’?
Herd immunity', also known as 'population immunity', is the indirect protection from an infectious disease that happens when a population is immune either through vaccination or immunity developed through previous infection. WHO supports achieving 'herd immunity' through vaccination, not by allowing a disease to spread through any segment of the population, as this would result in unnecessary cases and deaths.
Herd immunity against COVID-19 should be achieved by protecting people through vaccination, not by exposing them to the pathogen that causes the disease. Read the Director-General’s 12 October media briefing speech for more detail.
Vaccines train our immune systems to create proteins that fight disease, known as ‘antibodies’, just as would happen when we are exposed to a disease but – crucially – vaccines work without making us sick. Vaccinated people are protected from getting the disease in question and passing on the pathogen, breaking any chains of transmission. Visit our webpage on COVID-19 and vaccines for more detail.
To safely achieve herd immunity against COVID-19, a substantial proportion of a population would need to be vaccinated, lowering the overall amount of virus able to spread in the whole population. One of the aims with working towards herd immunity is to keep vulnerable groups who cannot get vaccinated (e.g. due to health conditions like allergic reactions to the vaccine) safe and protected from the disease. Read our Q&A on vaccines and immunization for more information.
The percentage of people who need to be immune in order to achieve herd immunity varies with each disease. For example, herd immunity against measles requires about 95% of a population to be vaccinated. The remaining 5% will be protected by the fact that measles will not spread among those who are vaccinated. For polio, the threshold is about 80%. The proportion of the population that must be vaccinated against COVID-19 to begin inducing herd immunity is not known. This is an important area of research and will likely vary according to the community, the vaccine, the populations prioritized for vaccination, and other factors.
Achieving herd immunity with safe and effective vaccines makes diseases rarer and saves lives.
Find out more about the science behind herd immunity by watching or reading this interview with WHO’s Chief Scientist, Dr Soumya Swaminathan.
2. What is WHO’s position on ‘herd immunity’ as a way of fighting COVID-19?
Attempts to reach ‘herd immunity’ through exposing people to a virus are scientifically problematic and unethical. Letting COVID-19 spread through populations, of any age or health status will lead to unnecessary infections, suffering and death.
The vast majority of people in most countries remain susceptible to this virus. Seroprevalence surveys suggest that in most countries, less than 10% of the population have been infected with COVID-19.
We are still learning about immunity to COVID-19. Most people who are infected with COVID-19 develop an immune response within the first few weeks, but we don’t know how strong or lasting that immune response is, or how it differs for different people. There have also been reports of people infected with COVID-19 for a second time.
Until we better understand COVID-19 immunity, it will not be possible to know how much of a population is immune and how long that immunity last for, let alone make future predictions. These challenges should preclude any plans that try to increase immunity within a population by allowing people to get infected.
Although older people and those with underlying conditions are most at risk of severe disease and death, they are not the only ones at risk.
Finally, while most infected people get mild or moderate forms of COVID-19 and some experience no disease, many become seriously ill and must be admitted into hospital. We are only beginning to understand the long-term health impacts among people who have had COVID-19, including what is being described as ‘Long COVID.’ WHO is working with clinicians and patient groups to better understand the long term effects of COVID-19.
Read the Director-General’s opening remarks at the 12 October COVID-19 briefing for a summary of WHO’s position.
3. What do we know about immunity from COVID-19?
Most people who are infected with COVID-19 develop an immune response within the first few weeks after infection.
Research is still ongoing into how strong that protection is and how long it lasts. WHO is also looking into whether the strength and length of immune response depends on the type of infection a person has: without symptoms (‘asymptomatic’), mild or severe. Even people without symptoms seem to develop an immune response.
Globally, data from seroprevalence studies suggests that less 10% of those studied have been infected, meaning that the vast majority of the world’s population remains susceptible to this virus.
For other coronaviruses – such as the common cold, SARS-CoV-1 and Middle East Respiratory Syndrome (MERS) – immunity declines over time, as is the case with other diseases. While people infected with the SARS-CoV-2 virus develop antibodies and immunity, we do not yet know how long it lasts.
Watch this conversation with Dr Mike Ryan and Dr Maria Van Kerkhove for more information on immunity.
4. What is WHO’s position on ‘lockdowns’ as a way of fighting COVID-19?
Large scale physical distancing measures and movement restrictions, often referred to as ‘lockdowns’, can slow COVID‑19 transmission by limiting contact between people.
However, these measures can have a profound negative impact on individuals, communities, and societies by bringing social and economic life to a near stop. Such measures disproportionately affect disadvantaged groups, including people in poverty, migrants, internally displaced people and refugees, who most often live in overcrowded and under resourced settings, and depend on daily labour for subsistence.
WHO recognizes that at certain points, some countries have had no choice but to issue stay-at-home orders and other measures, to buy time.
Governments must make the most of the extra time granted by ‘lockdown’ measures by doing all they can to build their capacities to detect, isolate, test and care for all cases; trace and quarantine all contacts; engage, empower and enable populations to drive the societal response and more.
WHO is hopeful that countries will use targeted interventions where and when needed, based on the local situation.
21. Coronavirus disease (COVID-19): HIV and antiretrovirals
1. Are people living with HIV at increased risk of being infected with the virus that causes COVID-19?
People living with HIV (PLHIV) who are not taking antiretroviral treatment (ART) and have a low CD4 cell count, particularly those with advanced HIV disease, are at increased risk of opportunistic infections and AIDS related complications. However, there is evolving and conflicting evidence whether people living with HIV have an increased risk of acquisition of SARS-CoV-2 infection and/or COVID-19 clinical complications in PLHIV compared to the general population.
PLHIV can have a greater prevalence of the known risk factors for COVID-19 acquisition and complications, such as heart disease, kidney disease, diabetes, chronic pulmonary disease, obesity, as well as, other comorbidities and co-infections, like tuberculosis.
Several case report series and small cohort studies among hospitalized PLHIV with COVID-19 have shown comparable clinical outcomes and similar risk of SARS CoV2 infection when compared with general population, particularly in those with well controlled HIV infection (on ART and with a CD4 count > 200 cells/mm3 and suppressed viral load). These limited clinical data suggest the mortality risk in PLHIV is associated with known COVID-19 factors such as older age and presence of comorbidities including cardiovascular disease, diabetes, chronic respiratory disease and obesity [1-3].
There have been several systematic and non-systematic reviews that evaluated COVID-19 outcomes among PLHIV; most have found comparable outcomes of mortality and morbidity when compared with HIV negative patients [4-8]. Methods did not always include assessment of outcomes while controlling for known COVID-19 risk factors . There is also limited data in patients with advanced HIV disease (i.e. low CD4 cell count).
One systematic review, notably published as a pre-print, found of 144,795 hospitalized COVID-19 patients in North America, Europe, and Asia the pooled prevalence of HIV in COVID-19 patients was 1.22% [95% (CI): 0.61%-2.43%)] translating to a 2-fold increase compared to the respective local-level pooled HIV prevalence in the general population of 0.65% (95% CI: 0.48%-0.89%) – which hinted at a potential susceptibility among PLHIV .
Additional data on this topic come from several cohort studies from South Africa, the USA and the UK [10-12] have reported a moderate increased risk of death directly attributed to HIV infection after adjustments for age, sex, ethnicity and presence of comorbidities; an unpublished meta-analysis including these studies found that the risk of death was almost double that of HIV-negative patients; however, confounding by comorbidities associated with increased risk of severe COVID-19 cannot be ruled out .
Protecting people living with HIV during the COVID-19 pandemic, and ensuring they can maintain treatment, is critical. Researchers are currently investigating whether people with HIV have an increased risk of poor outcomes with COVID-19. Preliminary evidence of moderate increased vulnerability of people with HIV makes it even more urgent that people with HIV have access to ARVs and treatments for co-morbidities – such as treatment for hypertension, cardiovascular disease, chronic pulmonary disease, diabetes, tuberculosis, and maintenance of a healthy body weight.
A larger dataset from a broader geographical representation is required to expand understanding of how SARS-CoV-2 co-infection with HIV impacts the severity of illness, disease progression and outcomes from hospitalization with COVID-19. For this purpose, WHO has established a Global COVID-19 Clinical Platform. As of 4 November 2020, WHO has received clinical data from 79 000 patients hospitalised with confirmed or suspected COVID-19, including from 5 291 hospitalised patients living with HIV, from over 30 countries around the world. The platform is open to all Member States and health facilities to contribute data and inclusion will help inform future guidance on how best to ensure PLHIV are well protected during the COVID-19 pandemic.
PLHIV are advised to take the same COVID-19 precautions as recommended for the general population [14-15]: wash hands often; practice cough etiquette; ensure physical distancing; wear masks when appropriate and according to local regulations; seek medical care if symptomatic; self-isolate if one develops symptoms or has contact with a positive COVID-19 case; and other actions per the local and government response.
It is important to ensure that PLHIV have access to antiretroviral drugs for longer periods (3-6 month supply); and that programmes practice multi-month dispensing (MMD) of ARVs, as well as, other necessary medications, such as, opiate substitution therapy (OST), TB preventative therapy (TPT) and treatments for comorbidities. It is also important to ensure that some vaccinations are up to date (influenza and pneumococcal vaccines) and there is access to adequate supplies of medicines to treat or prevent co-infections and comorbidities.
2. Can antiretrovirals or direct-acting antivirals against hepatitis C virus be used to treat COVID-19?
Antiretrovirals drugs were initially considered for use in the treatment of COVID-19 based on virtual screening and in vitro studies. Published data indicate that most of patients infected with the virus causing COVID-19 have mild to moderate symptoms, have good clinical outcomes and do not require hospitalization. In some cases, patients admitted to the hospital were given an antiretroviral drug, most often lopinavir boosted with ritonavir (LPV/r) or, less frequently, darunavir boosted with ritonavir (DRV/r). Studies assessing the potential benefit of an antiretroviral drug on COVID-19 were mostly carried out in HIV-negative individuals.
A systematic review on use of antiretrovirals in patients with coronaviruses, conducted in March 2020 identified two randomized trials and 21 observational studies provided clinical outcome data on the use of LPV/r for the treatment of COVID‐19, SARS and MERS . The randomized trials showed no clinical benefit, the observational studies were inconclusive, and the certainty of the body of evidence across all important outcomes was low or very low quality. A living systematic review and network meta-analysis on the efficacy and safety of drug treatments for COVID-19 published in September 2020 did not find any convincing evidence that antiretrovirals drugs such as lopinavir/ritonavir reduced the mortality or increased the rate of viral clearance .
More recently, two additional randomized studies confirmed these findings and didn't support the use of LPV/r for treatment of hospitalized patients with COVID-19.
A recently published clinical trial showed that in patients admitted to hospital with COVID-19, LPV/r was not associated with reductions in mortality, duration of hospital stay, or risk of progressing to invasive mechanical ventilation or death . Similarly, in the WHO-coordinated Solidarity Trial recently published, LPV/r appears to have little or no effect on hospitalized COVID-19 patients, as indicated by overall mortality, initiation of ventilation and duration of hospital stay. .
Based on available evidence, the use of LPV/r and other antiretrovirals are not likely to improve clinical outcomes in hospitalized individuals with COVID-19.
Several randomized and nonrandomized studies have evaluated anti-hepatitis C drugs including sofosbuvir and daclatasvir for treating of SARS-CoV-2 and while these preliminary results suggested benefit in terms of clinical recovery, this evidence is insufficient (small sample size, inclusion of a nonrandomized study) to be able to recommend using these antivirals for treating SARS-CoV-2. 
3. Can antiretrovirals be used to prevent COVID-19 infection?
A number of small studies have assessed whether antiretrovirals can be used to prevent infection from SARS-CoV2, often with discordant results.
A recent study suggests that people living with HIV who were using tenofovir disoproxil fumarate (TDF) were less likely to contract SARS-CoV-2. However, other studies indicate that tenofovir-based HIV pre-exposure prophylaxis (PrEP) does not provide protection against infection with the new coronavirus, nor does it ameliorate the course of COVID-19 disease . In this study, prevalence of SARS-CoV-2 was actually higher among people taking PrEP compared to individuals who were not.
Taken together, the available literature does not provide conclusive evidence that antiretrovirals could protect individuals from SARS-CoV-2 infection or from becoming seriously ill with the virus. However, the certainty of the evidence is very low due to small sample size, and uncertainty regarding intensity of exposure.
People taking PrEP or who are taking ARVs with the hopes of preventing COVID-19 need to adopt the same COVID-19 prevention measures as recommended for people in the general population.
4. What is WHO’s position on the use of antiretrovirals for the treatment or prevention of COVID-19?
WHO does not currently recommend the use of antiretrovirals as treatment or prevention of COVID-19, outside of the context of clinical trials. Existing published literature on antiretrovirals is mostly observational in nature, with few clinical trials; and does not provide good quality evidence in favour of these agents for these purposes. The current body of evidence does not show benefit of using LPV/r and other antiretrovirals reduce the risk of new coronavirus infection or improve clinical outcomes in symptomatic disease among patients with COVID‐19.
More recently, two additional randomized studies confirmed these findings and didn't support the use of LPV/r for treatment of hospitalized patients with COVID-19. The Recovery trial showed that LPV/r was not associated with reduction in mortality, time of hospitalisation stay and risk of progressing to invasive mechanical ventilation or death.  The interim results of the WHO multicounty adaptative trial (Solidarity trial) also found that LPV/r had little or no effect on overall mortality, initiation of ventilation and duration of hospital stay in hospitalized patients with COVID-19 .
5. How do we ensure human rights and reduce stigma and discrimination?
As the world scales up public health responses to the COVID19 pandemic, countries are being urged to take decisive action to control the epidemic. WHO has urged all countries to ensure an appropriate balance between protecting health, preventing economic and social disruption, and respecting human rights.
WHO is working with partners including the UNAIDS Joint Programme and the Global Network of People Living with HIV to ensure that human rights are not eroded in the response to COVID-19 and to ensure that people living with, or affected by, HIV are offered the same access to services as others and to ensure HIV-related services continue without disruption.
To mitigate potential prison outbreaks of COVID-19 and reduce morbidity and mortality among people in prisons and other closed settings, it is crucial that prisons and immigration detention centres are embedded within the broader public health response. This requires close collaboration between health and justice ministries and includes protocols for entry screening, personal protection measures, physical distancing, environmental cleaning and disinfection, and restriction of movement, including limitation of transfers and access for non-essential staff and visitors. In the current context it is of critical importance that countries work toward developing non-custodial strategies to prevent overcrowding in closed settings . Governance of prison health by a ministry of health, rather than a ministry of justice or similar, is likely to facilitate this approach .
6. How can programmes assure continued access to HIV services?
Continuous access to essential HIV prevention, testing and treatment services must be assured, including in settings where measurements of confinement are implemented within the public health response to the COVID-19 pandemic. Adapted and evidence-based measures to reduce possible transmission should be considered and implemented. These include :
Applying standard precautions for all patients (including ensuring that all patients cover their nose and mouth with a tissue or elbow when coughing or sneezing, offering a medical mask to patients with suspected COVID-19 infection while they are in waiting in the service, perform hand hygiene etc.)
Health care and outreach workers, as well as peer educators and clients should apply hand hygiene and other protective measures
Ensuring triage, early recognition, and source control (isolating patients with suspected COVID-19 infection)
Ensure there is adequate ventilation in all areas in the healthcare facility
Spatial distance between 1 and 2 meters should ideally be maintained between all patients within all types of services
Cleaning and disinfection procedures should be followed consistently and correctly
Dispensing medicines (for treatment of HIV, TB and other chronic conditions such as opioid dependence) for longer periods allowing reduced frequency of patient visits
Consider reduction of services to the most critical ones (provision of essential treatment and prevention services; services such as counselling sessions may be reduced or adapted)
Many countries have developed virtual ways of delivering services and supporting people to reduce clinic attendance.
Countries have also increased self-care options, for example HIV self-testing, often in combination with virtual support to keep services going.
There are many examples of innovations being used to support the continuation of PrEP services including virtual support, community and home distribution and using HIVST for monitoring during periods when clinic services have been suspended. Learning from these may help guide future implementation in the post-COVID-9 era.
Generally, vulnerable populations, including members of key populations (men who have sex with men, sex workers, people who use drugs, transgender people and people in prisons) as well as homeless and/or displaced people may be at increased risk of infection – because of additional comorbidities impacting on their immune system, reduced ability to apply measures of confinement and social distancing, as well as generally limited access to health services. It is critical that services that reach these populations such as community-based services, drop-in centres and outreach services can continue providing life-saving HIV prevention (distribution of condoms, PrEP, needles and syringes), testing and treatment while securing safety of staff and clients. Services can be adapted according to above considerations where applicable. Some prevention services, such as voluntary medical male circumcision (VMMC), which require clinic attendance, were initially suspended in the early phases of the response to the COVID-19 epidemic. Some countries, following assessing the covid situation, have adjusted their responses and are restating VMMC services with additional COVID-19 prevention measures.
7. What is the role of multi-month prescriptions and dispensing for antiretrovirals and other medicines?
All PLHIV doing well on ART can benefit from simplified antiretroviral therapy delivery models which include multi-month prescriptions and dispensing (3-6 month supply) which will reduce the frequency of visits to clinical settings and ensures continuity of treatment during possible disruption of movements during the coronavirus outbreak. Similar consideration should be given to providing people who are clinically stable on methadone or buprenorphine substitution therapy with an increased possibility for take-home medications to reduce additional burden on the health sector. Many countries have now implemented the provision of take-home dosages for stable patients on opioid substitution therapy as recommended by WHO .
As is common practice, experienced preexposure prophylaxis (PrEP) users may be given multi-month prescriptions according to national guidance which may include regular STI testing. Individuals initiating PrEP should continue to return for a 1-month follow-up HIV testing and clinic visit before receiving multi-month prescriptions. This is to rule out acute HIV infection, assess adverse effects and determine intention to continue PrEP use. However, flexibility for the 1-month visit can be considered for motivated clients who have not had a recent (in the past 3 weeks) potential exposure to HIV. These decisions could be made on a case-by-case basis between providers and clients initiating PrEP for the first time. Telehealth and community dispensing can be considered for follow up. Quality-assured HIV self-testing can be considered for maintenance.
8. Can pregnant or postpartum women living with HIV transmit the COVID-19 virus to their unborn child or infant?
There are few data on the clinical presentation of COVID-19 in specific populations, such as children, pregnant and breastfeeding women  but findings from a small published study suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy, nor are data sufficient to conclude vertical transmission through breastfeeding . Although no vertical transmission has been documented, transmission after birth via contact with infectious respiratory secretions is a concern. Infants born to mothers with suspected, probable, or confirmed COVID-19 should be fed according to standard infant feeding guidelines , while applying necessary precautions for infection prevention and control (IPC). As with all confirmed or suspected COVID-19 cases, symptomatic mothers who are breastfeeding or practicing skin-to-skin contact or kangaroo mother care should practice respiratory hygiene, including during feeding (for example, use of a medical mask when near a child if the mother has respiratory symptoms), perform hand hygiene before and after contact with the child, and routinely clean and disinfect surfaces with which the symptomatic mother has been in contact .
9. Should pregnant and breastfeeding women living with HIV with COVID-19 and their newborns be managed differently?
There is currently no well-established difference between the clinical manifestations of COVID-19 or risk of severe illness or foetal compromise for pregnant and non-pregnant women with HIV. However, a recent large database study conducted by US-CDC suggested that pregnant women with COVID-19 are more likely to need intensive care due an increased relative risk of developing severe disease . Pregnant women with suspected or confirmed COVID-19 should be treated with supportive and management therapies, considering the immunologic and physiologic adaptations during and after pregnancy which may overlap with COVID-19 symptoms. Data are limited but, until the evidence base provides clearer information, special consideration should be given to pregnant women with concomitant medical illnesses who could be infected with COVID-19. There are no reported deaths in pregnant women at time of publishing this information . However, COVID-19 testing of symptomatic pregnant women may need to be prioritized to enable access to specialized care. All recently pregnant women with COVID-19 or who have recovered from COVID-19 should be provided with information and counselling on safe infant feeding and appropriate IPC measures to prevent COVID-19 virus transmission .
With confirmed disease or under investigation, management is similar to non-pregnant women, with appropriate isolation of confirmed or under investigation. Obstetric facilities must be notified and prepared, noting that each infant born to any mother with confirmed COVID-19 should be considered a ‘person under investigation’ and should be isolated according to the IPC guidance. Currently, it is unknown whether newborns with COVID-19 are at increased risk for severe complications.
22. Coronavirus disease (COVID-19): Home care for families and caregivers?
1. Someone in my household tested positive for COVID-19. Is it safe to care for them at home?
People at high risk for severe illness and death from COVID-19 may require care that cannot be provided at home. Contact your healthcare provider for advice. People at high risk include:
people who are pregnant;
people of any age with chronic medical conditions (such as chronic cardiac, pulmonary, renal, metabolic, neurologic, liver or hematologic diseases); and
people with immunosuppressive conditions (such as HIV/AIDS, patients receiving chemotherapy or steroids, and people with cancer.)
If you have recently tested positive for COVID-19 infection, have mild symptoms AND are at high risk of severe disease, contact your health provider. There may be effective treatments available to you.
If someone in your home is not at high risk for severe disease, tests positive for COVID-19, and has no symptoms or mild symptoms, they can usually be cared for safely at home. A quick guide to home care for people with COVID-19 infection can be found here. As you take care of others, don’t forget to take care of yourself too. Wear a medical mask when sharing a space with someone with COVID-19 and follow prevention measures:
Stay at least 1 metre away from the sick person;
Open windows to bring fresh air into the sick person’s room;
Cough or sneeze into a bent elbow;
Clean your hands frequently; and
Get vaccinated as soon as it is your turn.
Monitor the person with COVID-19 infection’s symptoms regularly, and call your healthcare provider immediately if you see any of these danger signs:
Loss of speech or mobility
2. Someone in my household tested positive for COVID-19. They have very mild symptoms, and our doctor says it is safe for me to care for them at home. What should I do to keep myself and others in the household healthy?
It’s hard when someone close to you is unwell. Even though you may want to provide comfort and company to your ill relative, it is important to reduce the likelihood that you or other family members catch COVID-19. For people with mild or moderate symptoms, the best thing you can do is provide the care they need while also keeping a safe distance.
First of all – protect the health of others in the household
People with COVID-19 infection should be isolated in a separate room, away from others in the home. If possible, close the door to stop air from moving from the sick person’s room into the rest of the home. If it’s safe, open windows and turn on a fan in the sick person’s room. No other visitors should be allowed in the home when someone in the household has COVID-19 infection. Follow national guidelines for whether close contacts need to isolate at home.
If you have to share space in your home with someone with COVID-19, open windows to bring in fresh air if it’s safe to do so. COVID-19 spreads easily in places that are poorly ventilated. Learn more about ventilation.
Secondly - protect the health of the person caring for the person with COVID-19 infection
The spread of the COVID-19 virus occurs most often when an infected person is in close or direct contact with another person. If possible, there should be only one person in the household providing care to the person who is sick
If possible, choose someone to be the caregiver who is healthy with no underlying medical conditions. Caregivers should wash their hands before AND after any interaction with the sick person. Both the caregiver and the person who is sick should wear a well-fitted medical mask whenever they share a space with each other. If possible, open windows when the caregiver is in the room with the person with COVID-19 infection.
Monitor how you feel.
Caregivers and others in a home with a person with COVID-19 infection should pay close attention to how they feel (even if they are vaccinated or are being careful). On average, if takes 5-6 days from when someone is infected for symptoms to show. However, it can take up to 14 days.
Monitor yourself and others in your home for any symptoms of COVID-19 -- including fever, dry cough or tiredness. Get tested if you have any of these symptoms.
Seek immediate medical care if you have any of these severe symptoms of COVID-19:
Loss of speech or mobility
If you think you may have COVID-19 infection and are waiting for test results, avoid contact with other people if possible until you know whether or not you are infected.
Watch for warning signs.
Pay attention to any changes in the signs and symptoms a person with COVID-19 infection in your care. Some symptoms may be signals that more urgent medical care is needed. Depending on the age of the person in your care, their symptoms may look different. Adults may look dehydrated, have shortness of breath or chest pains. They may also complain of light-headedness. Children may suddenly appear confused or refuse to eat. Their face or lips may turn blue. Babies may be unable to breastfeed. These symptoms are warning signs that urgent care is needed.
If the person with COVID-19 infection under your care shows any of these signs, contact your healthcare provider immediately.
Keep things clean.
Any surfaces and household items touched by the person with COVID-19 infection should be cleaned and disinfected at least once a day. Household items include dishes, cups and flatware.
COVID-19 can spread from an infected person’s mouth or nose in small liquid particles when they cough, sneeze, speak, sing or breathe. These particles range from larger respiratory droplets to smaller aerosols.
Current evidence suggests that the virus spreads mainly between people who are in close contact with each other, typically within 1 metre. A person can be infected when aerosols or droplets containing the virus are inhaled or come directly into contact with the eyes, nose, or mouth.
The virus can also spread in poorly ventilated and/or crowded indoor settings, where people tend to spend longer periods of time. This is because aerosols remain suspended in the air or travel farther than 1 metre.
People may also become infected by touching surfaces that have been contaminated with the virus and then touching their eyes, nose or mouth without cleaning their hands.
Continue to practice prevention measures.
Keep a distance of at least 1 metre from others;
Wear a well-fitted mask over your mouth and nose;
Cough or sneeze into a bent elbow;
Clean your hands frequently; and
Get vaccinated when it is your turn.
3. Our healthcare provider has recommended that I use a pulse oximeter as part of the care I am providing at home to a COVID-19 patient. What is a pulse oximeter and what does it do?
A pulse oximeter is a small medical device used to measure the level of oxygen in the blood. People with COVID-19 may have low oxygen levels, which can be life-threatening.
To measure the level of oxygen in the blood, a pulse oximeter is usually placed on the finger or toe of the person who is sick. Using a pulse oximeter is painless and only takes a few minutes. If your healthcare provider recommends the use of a pulse oximeter, be sure to get instructions about how to use it and how to read and understand the results, and report them to your healthcare provider. Accurate measurements and readings from a pulse oximeter are important signs in determining if and when a COVID-19 patient at home may need urgent care at a healthcare facility. As a general rule, a decline below 90%, or a progressive downwards trend, can be an early warning of need for further medical assessment.
Most COVID-19 patients being cared for at home will not require a pulse oximeter. Learn more about medical oxygen and pulse oximeters.
4. What should I do if the symptoms of the person with COVID-19 infection in my care seem to be getting worse?
If symptoms worsen, contact your healthcare provider immediately.
Some symptoms may be signals that more urgent medical care is needed. Depending on the age of the person in your care, their symptoms may look different. Adults may look dehydrated, have shortness of breath or chest pains. They may also complain of light-headedness. Children may suddenly appear confused or refuse to eat. Their face or lips may turn blue. Babies may be unable to breastfeed. These symptoms are warning signs that urgent care is needed.
5. How long does the person with COVID-19 infection need to stay in isolation?
People with symptoms should stay isolated for a minimum of 10 days after the first day they developed symptoms, plus another 3 days after the end of symptoms – when they are without fever and without respiratory symptoms.
People without symptoms should stay isolated for a minimum of 10 days after testing positive.
Monitor the person with COVID-19 infection’s symptoms regularly, and call your healthcare provider immediately if you see any of these danger signs:
Loss of speech or mobility
6. Someone in my household has COVID-19. Do other people in the household need to isolate?
WHO recommends that people who have been in contact with a person with COVID-19 infection should quarantine themselves if they have had face-to-face or direct physical contact with someone who has COVID-19 infection or is suspected to have COVID-19 infection. People who have not used medical masks or appropriate personal protective equipment in caring for someone with COVID-19 infection should also quarantine, if possible.
Many countries and regions have their own policies about isolation and quarantine for people who have been in contact with people who have COVID-19 infection. Follow the guidance from your health department or ministry.
7. If I have been vaccinated against COVID-19, can I safely care for someone with COVID-19 infection without risk?
No. Even if you have been vaccinated, it is important to continue practicing all other prevention measures too. Vaccination does not fully protect you against infection, and you may still spread the virus to others if you are infected. WHO recommends that you should still wear a medical mask and follow prevention measures when you are caring for someone with COVID-19 infection, even if you are vaccinated.
Even though the COVID-19 vaccines are highly effective against serious disease and death, some people will still get infected or ill after they have been vaccinated. There is still a chance you could be infected with the virus and pass it on to other people around you who have not been vaccinated.
23. Coronavirus disease (COVID-19): Home care for health workers and administrators
1. When should a patient with COVID-19 be cared for at home?
Ideally, all patients with COVID-19 are cared for in a healthcare facility. However, there may be some circumstances where patients may not require hospitalization or inpatient care is unavailable or unsafe, such as when capacity is insufficient to meet the demand for healthcare services. Patients should be assessed on a case-by-case basis by the health worker to determine where their care needs can best be met.
2. What factors determine whether a COVID-19 patient can be cared for at home?
Patients with mild or moderate disease can be considered for home care if the home setting is suitable for the isolation and care of a COVID-19 patient, and if the patient is under the age of 60, does not smoke, is not obese, and does not have other diseases such as cardiovascular disease, diabetes mellitus, chronic lung disease, cancer, chronic kidney disease, immunosuppression. An assessment about home care for each patient should be based on the following factors:
Clinical evaluation of the patient.
Evaluation of the patient’s home setting according to infection prevention and control (IPC) criteria (e.g., ability to carry out hand and respiratory hygiene, environmental cleaning, adequate ventilation, limitations on movement around or from the house).
Presence of vulnerable people at higher risk of COVID-19 in the home.
Ability of a caregiver to provide care and closely monitor the evolution of the patient’s health, at least once per day, and to recognize signs and symptoms of any worsening of the health status.
Availability of trained health workers to support the patient and caregiver (home-based, phone, telemedicine, trained community workers or outreach teams).
If adequate isolation from others in the home and infection prevention control measures cannot be ensured, then isolation in designated community facilities or a health facility may need to be arranged, with consent from the patient and in agreement with the caregiver and household members.
It is important to note that in areas with other endemic infections that cause fever, such as influenza, malaria, dengue, etc., febrile patients should seek medical care, be tested and treated for those endemic infections per routine protocols, irrespective of the presence of respiratory signs and symptoms.
Home care does not replace healthcare by professionals. Those patients who receive homecare should be regularly monitored by health workers.
3. What additional factors should be taken into consideration when assessing the home setting to determine if it is safe for patients and families to remain at home?
There are a number of environmental and social factors to consider for patients to safely remain at home with their families or household members. An overall needs assessment of the patient and family that includes the availability of trained health workers for support should be conducted. A detailed description is available in the Appendix, Box 2, of the guidance.
4. What precautions should health workers take when providing care to patients in home settings?
Health workers should take the following precautions:
Perform a risk assessment to select the use of appropriate personal protective equipment (PPE), such as a medical mask, eye protection, gloves and gown when caring for the patient.
Implement infection prevention and control measures, including hand hygiene.
Ensure the room where the patient is cared for is well ventilated, opening windows if necessary.
Provide instructions to caregivers and household members on cleaning and disinfection in the home, and on management of waste, laundry and utensils related to the patient.
Request the patient to wear a medical mask when providing care or within a 1-metre distance.
Request limiting the number of household members during visits and maintaining at least a 1-metre distance.
Remove PPE and discard what is disposable, then perform hand hygiene before leaving the home.
Make sure that the waste generated from providing care to the patient be placed in strong bags or safety boxes as appropriate, closed completely, disposed as infectious waste and removed from the home.
5. Could pregnant women be cared for at home if they have COVID-19?
Pregnant women with mild or moderate disease can be considered for home care if the home setting is suitable for the isolation and care of a COVID-19 patient, if they do not smoke, are not obese, and do not have other diseases such as cardiovascular disease, diabetes mellitus, chronic lung disease, cancer, chronic kidney disease, immunosuppression. An assessment about home care for each patient should be based on the following factors:
Clinical evaluation of the patient.
Evaluation of the patient’s home setting according to IPC criteria (e.g., ability to carry out hand and respiratory hygiene, environmental cleaning, limitations on movement around or from the house).
Presence of vulnerable people at higher risk of COVID-19 in the home.
Ability of a caregiver to provide care and closely monitor the evolution of the patient’s health, at least once per day, and to recognize signs and symptoms of any worsening of the health status.
Availability of trained health workers to support the patient and caregiver (home-based, phone, telemedicine, trained community workers or outreach teams).
6. Can children be cared for at home if they have COVID-19?
Children should be kept together with their parents or caregivers wherever possible. Children with mild or moderate disease can be considered for home care if the home setting is suitable for the isolation and care of a COVID-19 patient, if they are not obese, do not smoke, and do not have other conditions such as cardiovascular disease, diabetes mellitus, chronic lung disease, cancer, chronic kidney disease, or immunosuppression.
Caregivers of children with COVID-19 should monitor for signs and symptoms of clinical deterioration requiring urgent re-evaluation. These include difficulty breathing/fast or shallow breathing (for infants: grunting, inability to breastfeed), blue lips or face, chest pain or pressure, new confusion, inability to awaken/not interacting when awake, inability to drink or keep down any liquids.
If caregivers are suspected or have confirmed COVID-19 infection, medical and non-medical factors must be taken into account due to the negative and possible long-term consequences of even a short period of family separation.
Community protection focal points and caseworkers should help families plan–in advance–agreements for the care of children in case the caregiver becomes ill. Children living with primary caregivers who are elderly, disabled or have underlying health conditions should be prioritized.
24. Coronavirus disease (COVID-19): How is it transmitted?
1. How does COVID-19 spread between people?
We know that the disease is caused by the SARS-CoV-2 virus, which spreads between people in several different ways.
Current evidence suggests that the virus spreads mainly between people who are in close contact with each other, for example at a conversational distance. The virus can spread from an infected person’s mouth or nose in small liquid particles when they cough, sneeze, speak, sing or breathe. Another person can then contract the virus when infectious particles that pass through the air are inhaled at short range (this is often called short-range aerosol or short-range airborne transmission) or if infectious particles come into direct contact with the eyes, nose, or mouth (droplet transmission).
The virus can also spread in poorly ventilated and/or crowded indoor settings, where people tend to spend longer periods of time. This is because aerosols can remain suspended in the air or travel farther than conversational distance (this is often called long-range aerosol or long-range airborne transmission).
People may also become infected when touching their eyes, nose or mouth after touching surfaces or objects that have been contaminated by the virus.
Further research is ongoing to better understand the spread of the virus and which settings are most risky and why. Research is also under way to study virus variants that are emerging and why some are more transmissible. For updated information on SARS-CoV-2 variants, please read the weekly epidemiologic updates.
2. When do infected people transmit the virus?
Whether or not they have symptoms, infected people can be contagious and the virus can spread from them to other people.
Laboratory data suggests that infected people appear to be most infectious just before they develop symptoms (namely 2 days before they develop symptoms) and early in their illness. People who develop severe disease can be infectious for longer.
While someone who never develops symptoms can pass the virus to others, it is still not clear how frequently this occurs and more research is needed in this area.
3. What is the difference between people who are asymptomatic or pre-symptomatic? Don’t they both mean someone without symptoms?
Both terms refer to people who do not have symptoms. The difference is that ‘asymptomatic’ refers to people who are infected but never develop any symptoms, while ‘pre-symptomatic’ refers to infected people who have not yet developed symptoms but go on to develop symptoms later.
4. Are there certain settings where COVID-19 can spread more easily?
Yes, any situation in which people are in close proximity to one another for long periods of time increases the risk of transmission. Indoor locations, especially settings where there is poor ventilation, are riskier than outdoor locations. Activities where more particles are expelled from the mouth, such as singing or breathing heavily during exercise, also increase the risk of transmission.
The “Three C’s” are a useful way to think about this. They describe settings where transmission of the COVID-19 virus spreads more easily:
Close-contact settings, especially where people have conversations very near each other;
Confined and enclosed spaces with poor ventilation.
The risk of COVID-19 spreading is especially high in places where these “3Cs” overlap.
In health facilities where people are receiving treatment for COVID-19, there is an increased risk of infection during medical procedures called aerosol generating procedures. These can produce very small droplets that can stay suspended in the air for longer periods of time and spread beyond conversational distances (typically 1 meter). This is why health workers performing these procedures or in settings where these procedures are performed should take specific airborne protection measures, including using appropriate personal protective equipment such as respirators. This is also why visitors are not permitted in areas where these procedures are being performed.
5. How can I reduce my risk of getting COVID-19?
There are many things you can do to keep yourself and your loved ones safe from COVID-19. Know your risks to lower risks. Follow these basic precautions:
Follow local guidance: Check to see what national, regional and local authorities are advising so you have the most relevant information for where you are.
Keep your distance: Stay at least 1 metre away from others, even if they don’t appear to be sick, since people can have the virus without having symptoms.
Wear a mask: Wear a well-fitting three-layer mask, especially when you can’t physically distance, or if you’re indoors. Clean your hands before putting on and taking off a mask.
Read our Masks and COVID-19 Q&A and watch our videos on how to wear and make masks.
Avoid crowded places, poorly ventilated, indoor locations and avoid prolonged contact with others. Spend more time outdoors than indoors.
Ventilation is important: Open windows when indoors to increase the amount of outdoor air.
Avoid touching surfaces, especially in public settings or health facilities, in case people infected with COVID-19 have touched them. Clean surfaces regularly with standard disinfectants.
Frequently clean your hands with soap and water, or an alcohol-based hand rub. If you can, carry alcohol-based rub with you and use it often.
Cover your coughs and sneezes with a bent elbow or tissue, throwing used tissues into a closed bin right away. Then wash your hands or use an alcohol-based hand rub.
Get vaccinated: When it’s your turn, get vaccinated. Follow local guidance and recommendations about vaccination.
25. Coronavirus disease (COVID-19): Hydroxychloroquine
1. Does WHO recommend hydroxychloroquine to prevent COVID-19?
WHO does not recommend hydroxychloroquine to prevent COVID-19. This recommendation is based on six trials with more than 6000 participants who did not have COVID-19 and received hydroxychloroquine. Using hydroxychloroquine for prevention had little or no effect on preventing illness, hospitalization or death from COVID-19. Taking hydroxychloroquine to prevent COVID-19 may increase the risk of diarrhea, nausea, abdominal pain, drowsiness and headache. More information can be found here.
However, hydroxychloroquine and chloroquine are safe for use in patients with autoimmune diseases or malaria (not COVID-19).
2. Does WHO recommend hydroxychloroquine as a treatment for COVID-19?
WHO does not recommend hydroxychloroquine as a treatment for COVID-19. This recommendation is based on 30 trials with more than 10 000 COVID-19 patients. Hydroxychloroquine did not reduce mortality, the need for or duration of mechanical ventilation. Taking hydroxychloroquine to treat COVID-19 may increase the risk of heart rhythm problems, blood and lymph disorders, kidney injury, liver problems and failure.
More information can be found here.
However, hydroxychloroquine and chloroquine are safe for use in patients with autoimmune diseases or malaria (not COVID-19).
3. Why did WHO stop clinical trials on hydroxychloroquine as a treatment for COVID-19?
The Solidarity trial, the UK's Recovery trial, and a Cochrane review of other evidence on hydroxychloroquine conclusively showed that hydroxychloroquine did not reduce deaths among hospitalized COVID-19 patients. Based on this evidence, WHO dropped the hydroxychloroquine arm of the Solidarity Trial in June of 2020. More information can be found here.
26. Coronavirus disease (COVID-19): Malaria and COVID-19
1. How many malaria-affected countries have reported cases of COVID-19?
Malaria-endemic countries in all WHO have regions have reported cases of COVID-19. In the WHO African Region, which carries more than 90% of the global malaria burden, there have been more than 1 million confirmed cases of COVID-19 since the beginning of the pandemic. The latest situation reports on the COVID-19 pandemic are available on the WHO website.
2. Should core malaria vector control interventions be maintained in view of the rapid global spread of COVID-19?
As of March 2020, there have been reports of the suspension of insecticide-treated net (ITN) and indoor residual spraying (IRS) campaigns in several African countries due to concerns around exposure to COVID-19. Suspending such campaigns will leave many vulnerable populations at greater risk of malaria, particularly young children and pregnant women.
WHO strongly encourages countries not to suspend the planning for – or implementation of – vector control activities, including ITN and IRS campaigns, while ensuring these services are delivered using best practices to protect health workers and communities from COVID-19 infection. Modifications of planned distribution strategies may be needed to minimize exposure to the coronavirus.
WHO commends the leaders of Benin, Chad, the Central African Republic, the Democratic Republic of the Congo, Mali, Niger, Sierra Leone and Uganda for committing to move forward with ITN campaigns during the pandemic. Other countries are adapting their net distribution strategies to ensure households receive the nets as quickly and safely as possible.
Together with partners, WHO has developed guidance to ensure that those suffering from malaria can safely receive the care they need in COVID-19 settings. Tailoring malaria interventions in the COVID-19 response includes guidance on the prevention of infection through vector control and chemoprevention, testing, treatment of cases, clinical services, supply chain and laboratory activities. The document is consistent with broader WHO guidance on how to maintain essential health services during the pandemic.
3. Should WHO-recommended preventive therapies be maintained in sub-Saharan Africa?
Yes, delivery of intermittent preventive treatment in pregnancy (IPTp), seasonal malaria chemoprevention (SMC), and intermittent preventive treatment in infants (IPTi) should be maintained provided that best practices for protecting health workers – and other front-line workers – from COVID-19 are followed. Ensuring access to these and other core malaria prevention tools saves lives and is an important strategy for reducing the strain on health systems in the context of the COVID-19 response.
Tailoring malaria interventions in the COVID-19 response, developed by WHO and partners, includes guidance on how to deliver preventive therapies for pregnant women and young children in ways that protect health workers and communities against potential COVID-19 transmission.
4. Are there any changes to WHO guidance with respect to malaria diagnosis and treatment?
WHO guidance remains the same. Countries should not scale back efforts to detect and treat malaria; doing so would seriously undermine the health and well-being of millions of people infected with a potentially life-threatening disease.
As signs and symptoms of malaria and COVID-19 can overlap (such as a fever), public health messages will need to be adapted in malaria-endemic settings so that people who have a fever are encouraged to seek immediate treatment rather than stay at home; without prompt treatment, a mild case of malaria can rapidly progress to severe illness and death.
5. What additional special measures may be needed in the context of COVID-19?
In addition to routine approaches to malaria control, there may be a case for special measures in the context of the COVID-19 pandemic – such as a temporary return to presumptive malaria treatment, or the use of mass drug administration – which have proved useful in some previous emergencies.
Presumptive malaria treatment refers to treatment of a suspected malaria case without the benefit of diagnostic confirmation (e.g. through a rapid diagnostic test). This approach is typically reserved for extreme circumstances, such as disease in settings where prompt diagnosis is no longer possible.
Mass drug administration (MDA) is a WHO-recommended approach for rapidly reducing malaria mortality and morbidity during epidemics and in complex emergency settings. Through MDA, all individuals in a targeted population are given antimalarial medicines – often at repeated intervals – regardless of whether or not they show symptoms of the disease.
Such special measures should only be adopted after careful consideration of 2 key aims: lowering malaria-related mortality and keeping health workers and communities safe. WHO is exploring concrete proposals for when and how to activate such measures; guidance will be published in due course.
6. What are the key considerations for countries that are working to eliminate malaria or prevent re-establishment of transmission?
All of the considerations described above apply to malaria-eliminating countries and those preventing re-establishment of the disease: efforts must be sustained to prevent, detect and treat malaria cases while preventing the spread of COVID-19 and ensuring the safety of those who deliver the services. Countries that are nearing malaria elimination must protect their important gains and avoid malaria resurgences. Countries that have eliminated malaria must remain vigilant for any imported cases of malaria that may be occurring to prevent reintroduction of the disease.
7. Why is WHO particularly concerned about the spread of COVID-19 in malaria-affected areas?
Experience from previous disease outbreaks has shown the disruptive effect on health service delivery and the consequences for diseases such as malaria. The 2014-2016 Ebola outbreak in Guinea, Liberia and Sierra Leone, for example, undermined malaria control efforts and led to a massive increase in malaria-related illness and death in the 3 countries.
A modelling analysis from WHO and partners, published on 23 April, found that the number of malaria deaths in sub-Saharan Africa could double this year alone if there are severe disruptions in access to insecticide-treated nets and antimalarial medicines due to COVID-19. These projections reinforce the critical importance of sustaining efforts to prevent, detect and treat malaria during the pandemic.
In all regions, protective measures should be utilized to minimize the risk of COVID-19 transmission between patients, communities and health providers. WHO and partners have developed guidance on how to safely maintain malaria prevention and treatment services in COVID-19 settings.
8. Have there been disruptions in the global supply of key malaria-related commodities as a result of the COVID-19 pandemic?
Yes. Since the early days of the pandemic, there have been reports of disruptions in the supply chains of essential malaria commodities – such as long-lasting insecticidal nets, rapid diagnostic tests and antimalarial medicines – resulting from lockdowns and from a suspension of the importation and exportation of goods in response to COVID-19. WHO and partners are working together to ensure the availability of key malaria control tools, particularly in countries with a high burden of the disease, and that efforts to limit the spread of COVID-19 do not compromise access to malaria prevention, diagnosis and treatment services.
9. What is WHO’s position on the use of chloroquine and hydroxychloroquine in the context of the COVID-19 response?
WHO is actively following the ongoing clinical trials that are being conducted in response to COVID-19, including the more than 80 studies looking at the use of chloroquine and its derivative, hydroxychloroquine, for treatment and/or prevention.
To date, 3 large randomized controlled trials, including the WHO Solidarity trial, have failed to show that the use of hydroxychloroquine among hospitalized patients infected with COVID-19 can prevent death or disease progression. Additionally, 3 trials of patients with mild or moderate disease failed to show a significant benefit in prevention of respiratory failure through the use of hydroxychloroquine. Thus, there is now growing evidence that hydroxychloroquine is not an effective treatment for COVID-19. This evidence will inform the next update of WHO guidance on therapeutics.
Studies on the use of chloroquine or hydroxychloroquine to prevent individuals, particularly those at high risk such as health care workers, from contracting COVID-19 are ongoing. Currently, there is insufficient evidence to assess the protective efficacy of either of these medicines for the prevention of COVID-19 infection or disease.
WHO cautions physicians against administering these unproven treatments to patients with COVID-19 outside the context of a clinical trial. Individuals are also advised against self-medicating with these drugs.
For public health emergencies, WHO has a systematic and transparent process for research and development (R&D), including for clinical trials of drugs. The WHO R&D Blueprint for COVID-19, initiated on 7 January 2020, aims to fast-track the availability of effective tests, vaccines and medicines that can be used to save lives and avert large-scale crises.
10. What is WHO’s position on the use of Artemisia plant material for the prevention or treatment of malaria and/or COVID-19?
The most widely used antimalarial treatments, artemisinin-based combination therapies (ACTs), are produced using the pure artemisinin compound extracted from the plant Artemisia annua. There have been reports that products or extracts (e.g. herbal teas or tablets) made from Artemisia plant material may have a preventive or curative effect on COVID-19.
However, available in vitro data suggests that purified artemisinin compounds or A. annua plant product or extracts do not have an appreciable effect against COVID-19 at concentrations that could be safely achieved in humans. As such, current evidence does not support the use of artemisinins or A. annua products or extracts as an antiviral for COVID-19.
WHO urges extreme caution over reports touting the efficacy of such products. As explained in a WHO position statement, there is no scientific evidence base to support the use of non-pharmaceutical forms of Artemisia for the prevention or treatment of malaria. There is also no evidence to suggest that COVID-19 can be prevented or treated with products made from Artemisia-based plant material.
11. What is WHO doing to support malaria-affected countries in the context of COVID-19?
The WHO Global Malaria Programme is leading a cross-partner effort to mitigate the negative impact of the coronavirus in malaria-affected countries and, where possible, contribute towards a successful COVID-19 response. The work is being carried out in close collaboration with colleagues based at WHO headquarters, regional offices and country level.
In March 2020, before the pandemic had secured a strong footing in Africa, WHO sounded an urgent call for maintaining core malaria prevention and treatment services while protecting health workers and communities against COVID-19 transmission. The findings of a modelling analysis from WHO and partners, published in April, reinforced the WHO call for continuity of malaria services during then pandemic.
In collaboration with partners, WHO developed technical guidance for countries on how to safely maintain malaria prevention and treatment in COVID-19 settings. Tailoring malaria interventions in the COVID-19 response is consistent with broader WHO guidance on how to maintain essential health services during the pandemic.
27. Coronavirus disease (COVID-19): Masks
1. Why should people wear masks?
Masks are a key measure to reduce transmission and save lives.
Wearing well-fitted masks should be used as part of a comprehensive ‘Do it all!’ approach including maintaining physical distancing, avoiding crowded, closed and close-contact settings, ensuring good ventilation of indoor spaces, cleaning hands regularly, and covering sneezes and coughs with a tissue of bent elbow.
Depending on the type, masks can be used for either protection of healthy persons or to prevent onward transmission, or both.
2. What kind of mask should the public wear?
There are three types of masks that WHO recommend for the public:
Reusable non-medical masks which comply with the ASTM F3502 standard or CEN Working Agreement 17553, or a non-medical mask meeting WHO essential parameters;
Disposable medical masks which comply with medical mask standards EN 14683 Type I, ASTM F2100 Level 1, YY/T 0969, YY 0469 (or equivalent);
Other types of well-fitting non-medical masks, including homemade multi-layered masks are an acceptable option, when other options are not available.
Disposable medical masks are also recommended for the following groups, because if infected, they are at a higher risk of becoming seriously ill with COVID-19 and dying:
People aged 60 or over.
People of any age with underlying health conditions, including chronic respiratory disease, cardiovascular disease, cancer, obesity, immunocompromised patients and diabetes mellitus.
Disposable medical masks are also recommended for:
Anyone who is feeling unwell, including people with mild symptoms, such as muscle aches, slight cough, sore throat or fatigue.
Anyone awaiting COVID-19 test results or who has recently tested positive.
A respirator or a medical mask should be worn by to caregivers at any setting where care is provided to patients with suspected or confirmed COVID-19, including home care, long-term care facilities and community care settings
3. When should masks be worn by the public?
In settings where there is community or cluster transmission of SARS-CoV-2, irrespective of vaccination status or history of prior infection, wearing a well-fitting mask that covers the nose and mouth is recommended for the public when interacting with individuals who are not members of their household:
in indoor settings where ventilation is known to be poor or cannot be assessed, or the ventilation system is not properly maintained, regardless of whether physical distancing of at least 1 metre can be maintained;
in indoor settings that have adequate ventilation if physical distancing of at least 1 metre cannot be maintained; or
in outdoor settings where physical distancing of at least 1 metre cannot be maintained.
It’s not always easy to determine the quality of ventilation. If you have any doubts, it’s safer to simply wear a mask. While wearing a mask, you should continue to maintain physical distance from others as much as possible. Wearing a mask does not mean you can have close contact with people.
4. When should health workers wear a respirator in the context of COVID-19?
A respirator or a medical mask should be worn by health workers along with other personal protective equipment (PPE) – a gown, gloves and eye protection – before entering a room where there is a patient with suspected or confirmed COVID-19, including home care, long-term care facilities and community care settings.
Respirators should be worn in the following situations:
in care settings where ventilation is known to be poor* or cannot be assessed or the ventilation system is not properly maintained
based on health workers’ values and preferences and on their perception of what offers the highest protection possible to prevent SARS-CoV-2 infection.
A respirator should always be worn along with other PPE (gown, gloves and eye protection) by health workers performing aerosol-generating procedures (AGPs) and by health workers on duty in settings where AGPs are regularly performed on patients with suspected or confirmed COVID-19, such as intensive care units, semi-intensive care units or emergency departments.
5. What is the difference between medical masks and respirators, like N95s?
Medical masks (also known as surgical masks) are:
composed of 3 layers of synthetic nonwoven materials
configured to have filtration layers sandwiched in the middle
available in different thicknesses
have various levels of fluid-resistance and filtration
Respirators (also known as filtering facepiece respirators – FFP) are available at different performance levels such as FFP2, FFP3, N95, N99, N100.
Medical masks and respirator masks are similar in their filtration value. However, respirators also have a tight fit around the wearer face as the model and size of the respirator is specific to the wearer to ensure an adequate seal. Respirator masks are designed to protect health workers who provide care to COVID-19 patients in settings and areas where aerosol generating procedures are undertaken. They are also recommended for health workers providing care to suspected or confirmed COVID-19 patients in settings where ventilation is known to be poor or cannot be assessed or the ventilation system is not properly maintained
Health workers should be fit tested before using a respirator to ensure that they are wearing the correct size. Wearing a loose-fitting respirator will not offer the same level of protection to the wearer as it may allow small particles to get inside the mask where there are gaps, for example through the side.
6. How do I choose what fabric mask to buy, or ideal fit and fabrics if I make my own?
Filtration, breathability and fit are all important.
If you purchase a non-medical mask, check the labels to make sure it complies with the ASTM F3502 standard or CEN Working Agreement 17553.
If you choose to make your own mask, it should be made of three layers of fabric:
Inner layer of absorbent material, such as cotton.
Middle layer of non-woven non-absorbent material, such as polypropylene.
Outer layer of non-absorbent material, such as polyester or polyester blend.
Watch the video on WHO’s recommended fabric mask materials and composition for more information.
For either type of mask, you should choose the one that fits your face well - cover your nose, cheeks and chin without leaving gaps on the sides. Masks with vents or exhalation valves are not advised because they allow unfiltered breath to escape the mask.
7. When should health workers wear a mask in the context of COVID-19?
Health workers are the most likely to be exposed to COVID-19 because they are in close contact with patients with suspected, probable or confirmed COVID-19.
In areas of community or cluster transmission, health workers, caregivers and visitors should wear a mask at all times when in the health facility, even if physical distancing can be maintained. Masks should be worn throughout their shifts, apart from when eating, drinking or needing to change the mask for specific reasons:
Health workers and caregivers include: doctors, nurses, midwives, medical attendants, cleaners, community health workers, and any others working in clinical areas.
Health workers must remember to combine hand hygiene with any time they touch their mask or face, before and after putting on and removing their masks, as well as before they touch them to readjust them.
In settings where there is community or cluster transmission of SARS-CoV-2, health workers in clinical areas should wear medical masks throughout their shift apart from when eating, drinking or needing to change the mask for specific reasons.
Health workers should continue to physically distance and avoid unnecessary close contact with colleagues and others in the facility when not providing patient care.
Healthcare workers can complete our OpenWHO course on how to put on and remove personal protective equipment.
Read our guidance on ‘Infection prevention and control during health care when coronavirus disease (COVID-19) is suspected or confirmed’.
8. How should I wear and clean a fabric mask?
How to put on and wear a fabric mask:
Before touching the mask, clean your hands with an alcohol-based hand rub or soap and water.
Inspect the mask for tears or holes, do not use a mask that is damaged.
Adjust the mask to cover your mouth, nose, and chin, leaving no gaps on the sides.
Place the straps behind your head or ears. Do not cross the straps because this can cause gaps on the side of your face.
Avoid touching the mask while wearing it. If you touch it, clean your hands.
Change your mask if it gets dirty or wet.
How to take off and store a fabric mask:
Clean your hands before taking off the mask.
Take off the mask by removing it from the ear loops, without touching the front of the mask.
If your fabric mask is not dirty or wet and you plan to reuse it, put it in a clean resealable bag. If you need to use it again, hold the mask at the elastic loops when removing it from the bag. Clean your mask once a day.
Clean your hands after removing the mask.
How to clean a fabric mask:
Wash fabric masks in soap or detergent and preferably hot water (at least 60 degrees Centigrade/140 degrees Fahrenheit) at least once a day.
If it is not possible to wash the mask in hot water, then wash it in soap/detergent and room temperature water, followed by boiling the mask for 1 minute.
Watch our ‘How to wear a fabric mask’ video for a demonstration.
9. How should I put on, wear and take off a medical mask?
How to put on and take off a medical mask:
Before touching the mask, clean your hands with an alcohol-based hand rub or soap and water.
Inspect the mask for tears or holes; do not use a mask that has previously been worn or is damaged.
Verify which side is the top – this is usually where the metal strip is.
Then, identify the inside of the mask, which is usually the white side.
Place the mask on your face covering your nose, mouth and chin, making sure that there are no gaps between your face and the mask. Place the straps behind your head or ears. Do not cross the straps because this can cause gaps on the side of the mask.
Pinch the metal strip so it moulds to the shape of your nose.
Remember, do not touch the front of the mask while using it to avoid contamination; if you accidentally touch it, clean your hands.
How to take off a medical mask:
Before touching the mask, clean your hands with an alcohol-based hand rub or soap and water.
Remove the straps from behind the head or ears, without touching the front of the mask.
As you remove the mask, lean forward and pull the mask away from your face.
Medical masks are for single use only; discard the mask immediately, preferably into a closed bin.
Clean your hands after touching the mask.
Be aware of the condition of the mask; replace it if it gets soiled or damp.
10. Should I wear a mask while exercising?
Even when you’re in an area of COVID-19 transmission, masks should not be worn during vigorous physical activity because of the risk of reducing your breathing capacity. No matter how intensely you exercise, keep at least 1 metre away from others, and if you’re indoors, make sure there is adequate ventilation.
28. Coronavirus disease (COVID-19): Mass gatherings
1. How large does a meeting or event need to be in order to be a “mass gathering”?
High profile international sporting events such as the Olympics or World Cups as well as international religious events such as the Hajj count as mass gatherings. However, lower profile conferences and events can also meet WHO’s definition of a mass gathering. An event counts as a “mass gatherings” if the number of people it brings together is so large that it has the potential to strain the planning and response resources of the health system in the community where it takes place. You need to consider the location and duration of the event as well as the number of participants. For example, if the event takes place over several days in a small island state where the capacity of the health system is quite limited then even an event with just a few thousand participants could place a big strain on the health system and then be considered a “mass gathering” event. Conversely, if the event is held in a big city in a country with a large, well-resourced health system and lasts just a few hours, the event may not constitute a “mass gathering” event.
2. Does WHO recommend that all international mass gatherings be cancelled because of COVID-19?
No. As each international mass gathering is different, the factors to consider when determining if the event should be cancelled may also differ. Any decision to change a planned international gathering should be based on a careful assessment of the risks and how they can be managed, and the level of event planning. The assessment should involve all stakeholders in the event, and in particular the health authorities in the country or community where the event is due to take place. These authorities and stakeholders are in the best position to assess the level of stress the event might place on the local health system and emergency services – and whether this level of stress is acceptable in the current situation.
It is WHO’s view that all countries with community transmission should seriously consider postponing or reducing mass gatherings that bring people together and have the potential to amplify disease and support the recommended best practice of physical distancing. Any decision will be supported through the use of WHO tools, in particular the Risk Assessment for Mass Gatherings during COVID-19.
If movement restrictions and further national measures have been established in the country, the WHO RA does not apply. However, when the process of re-opening/conducting mass gatherings is being considered post movement restrictions, it will be key to ensure any decisions are based on a risk assessment, such as the WHO Mass gatherings COVID-19 risk assessment
3. What factors should organizers and health authorities look at when assessing whether the risks are acceptable or not?
For countries not currently known to be experiencing community transmission of COVID-19, the priority consideration will be whether the planned mass gathering event substantially increases the risk of the virus entering the country and becoming established, as well as the risk for participants to importing infection back to their home country and further increasing global spread. In making this assessment, the organizers and their national or local health authorities should recognize that the risk of imported cases of COVID-19 is naturally linked to international travel. They should also recognize that it is neither realistic or desirable to aim for zero risk. When organizers and health authorities are determining whether to hold a mass gathering, they should determine what is an acceptable risk and what additional measures should be implemented to mitigate the risks.
For countries where COVID-19 has already started to spread in the community, key consideration will be:
aiming at containing or at least slowing down the spread of the virus in the local community/country.
preventing participants from other countries being infected with COVID-19
In each case the risk should be considered in the context of the known features of COVID-19, its severity, its transmissibility and the effectiveness of measures to prevent or reduce transmission. The strain already placed on the local health system in responding to COVID-19 outbreak(s), and the additional strain the mass gathering might place on the system also need to be taken into account.
You can find more advice on what to look at in the WHO document Key planning recommendations for Mass Gatherings in the context of the current COVID-19 outbreak of 14 February 2020. See: https://www.who.int/publications-detail/key-planning-recommendations-for-mass-gatherings-in-the-context-of-the-current-covid-19-outbreak
4. What if my organization does not have the expertise to assess the risks COVID-19 poses for our planned mass gathering?
The national and local public health authorities in the country where you plan to hold the mass gathering will most likely know how to conduct a health risk assessment. If there is a WHO Country Office there they may also be able to provide some expert support. So too might the WHO Regional Office in your part of the world. You can find the names and contact details of the WHO Regional Offices at https://www.who.int/about/who-we-are/regional-offices
5. If we go ahead with an international mass gathering, what can we do to reduce the risk of participants catching COVID-19?
Promote hand washing, respiratory hygiene and social distancing at the event. Make sure you have emergency contact details for all participants, including where they are staying during the event. You should make it clear to them that this information will be shared with the local public health authorities to enable rapid contact tracing if a participant at the event becomes ill with COVID-19. The event organisers need to have an agreed preparedness plan in case one or more participants become ill with COVID-19 symptoms. This should include rapid isolation of the ill person and their safe transfer to a local health facility. You should consider whether the number of participants at the event could be reduced, making available participation by video or teleconference and possibly screening participants for COVID-19 symptoms (cough, fever, malaise) at points of entry to the venue. You can find advice on how individual participants can protect themselves and their loved ones from COVID-19 at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
6. Where can I find more advice on assessing and managing health risks around international mass gatherings?
WHO has produced guidance and also a training course on how to plan for a mass gathering. The guidance and the course both look at how to conduct a risk assessment, plan for and manage health risks in partnership with the local authorities: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/points-of-entry-and-mass-gatherings You can find advice to give individual participants on how to protect themselves and their loved ones from COVID-19 at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
7. What should be the criteria for excluding an athlete or other accredited participant from competing?
Agreed health criteria are needed for the exclusion of athletes from competing and for allowing them to return to competition wherever appropriate. These should be consistent with public health guidelines for the general population, with risk profiles based on recent travel to high-risk community transmission zones, recent contact with individuals diagnosed with or suspected of having COVID-19, current symptomatology, etc. Athletes who are feeling unwell should not participate in events.
If testing of athletes has been agreed with the local public health service there is a need to consider test availability, time taken for receipt of test results and host-country health services capacity.
Criteria for exclusion of officials/judges from competition and for allowing them to return to competition where appropriate should follow guidance and criteria for the workplace.
Requirements for the attendance of all athletes and other accredited participants should be put in place:
– health check: travel declaration and temperature screening
– contact tracing protocols ready (with all details of those present)
– allowing extra spacing (physical distancing)
– following all hygiene precautions.
Isolation procedures for athletes and other accredited participants (e.g. field-of-play staff, medical teams, officials who have close contact with the athletes) who feel unwell or become symptomatic should be clear and documented and rehearsed prior to holding the event, especially for higher risk sports, e.g. contact sports.
8. Should event organizers arrange screening at venues beyond national government requirements for point of entry (PoE)?
Temperature screening alone, at exit or entry, is not an effective way to stop international spread, since infected individuals may be in incubation period, may not express apparent symptoms early on in the course of the disease, or may dissimulate fever through the use of antipyretics; in addition, such measures require substantial investments for what may bear little benefits. It is more effective to provide prevention recommendation messages to travellers and to collect health declarations at arrival, with travellers’ contact details, to allow for a proper risk assessment and a possible contact tracing of incoming travellers.
Event organizers should also consider the capacity to undertake this and the management of suspected cases. However, sporting organizations may have criteria for participation that are stricter than government requirements for Ports of Entry into the country that are based on event risk assessment, including organizers' healthcare capacity.
Any additional screening questionnaires for participation in events need to be aligned with public health agencies in the jurisdiction. There is a need to consider how to manage different groups – athletes, officials and spectators, and the large numbers of individuals likely to arrive at a sporting event from many oversea countries – and to follow both host country and WHO travel advice and to assess whether there is difficulty in obtaining accurate information about the travel history of those individuals.
9. Should event organizers provide COVID-19 testing?
No, testing should be conducted in accordance with local health providers and national guidance. Anyone unwell or symptomatic should not be allowed to participate in the event. Establish close collaboration with local public health authorities well before the event, to facilitate testing for athletes, officials or spectators who meet pre-agreed suspect cases definitions.
Consider host-country health service capacity to manage any COVID-19 activity, and other public health issues happening at the event over and above its own national pandemic response.
10. Are there additional safeguards event organizers can implement or recommend to athletes/officials/visitors in the context of COVID-19?
Follow standard preventative advice to the general public, including physical distancing, in the athletes’ village.
signage, digital messaging to all participants and their entourages about COVID-19 and how to prevent infection
regular disinfection and cleaning of surfaces, in venues and in personal spaces
non-sharing of equipment and cleaning of equipment after each user.
Organizers are recommended to develop a checklist (include hand gels stations, hygiene facilities, etc.). See the event mitigation recommendations checklist for event organizers above.
11. What are the risks arising from public transport to the venue(s)?
The extra risk from participants and spectators travelling on public transport in a major city may not be significant compared to the ongoing risk to the local population using the transport all the time if physical distancing is not possible on public transport.
29. Coronavirus disease (COVID-19): Post COVID-19 condition
1. What is post COVID-19 condition?
Post COVID-19 condition, also known as “long COVID,” refers collectively to the constellation of long-term symptoms that some people experience after they have had COVID-19. People who experience post COVID-19 condition sometimes refer to themselves as “long-haulers.”
While most people who develop COVID-19 fully recover, some people develop a variety of mid- and long-term effects like fatigue, breathlessness and cognitive dysfunction (for example, confusion, forgetfulness, or a lack of mental focus and clarity). Some people also experience psychological effects as part of post COVID-19 condition.
These symptoms might persist from their initial illness or develop after their recovery. They can come and go or relapse over time.
Post COVID-19 condition can affect a person’s ability to perform daily activities such as work or household chores.
2. How is post COVID-19 condition defined?
Post COVID-19 condition is defined as the illness that occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; usually within three months from the onset of COVID-19, with symptoms and effects that last for at least two months. The symptoms and effects of post COVID-19 condition cannot be explained by an alternative diagnosis.
Read the clinical case definition
3. What are common symptoms of post COVID-19 condition (AKA long COVID)?
The most common symptoms of post COVID-19 condition include:
Shortness of breath or difficulty breathing
Memory, concentration or sleep problems
Loss of smell or taste
Depression or anxiety
People with post COVID-19 condition, also known as “long COVID”, may have difficulty functioning in everyday life. Their condition may affect their ability to perform daily activities such as work or household chores.
4. What should I do if I had COVID-19 and am experiencing symptoms and effects like those described as post COVID-19 condition?
If you think you may have developed post COVID-19 condition, consult and seek care from your healthcare provider. They will help you to determine whether this is the case, and to provide you with the care you need to manage your symptoms.
At present, there is no specific medication therapy for people with post COVID-19 condition. However, there is data suggesting that holistic care, including rehabilitation, can be helpful. We are continuing to learn why some people develop this condition, the mechanisms behind the development of post COVID-19 condition and how to best manage it.
5. Who is most at risk of developing post COVID-19 condition?
Anyone who becomes ill with COVID-19 can develop post COVID-19 condition. Post COVID-19 condition is being studied by many experts around the world and our knowledge and understanding of post COVID-19 condition is growing. Current research shows that approximately 10%-20% of COVID-19 patients go on to develop prolonged symptoms that may be post COVID-19 condition.
There does not appear to be a relationship between the initial severity of COVID-19 infection and the likelihood of developing post COVID-19 condition.
6. When do symptoms of post COVID-19 condition occur?
Symptoms of post COVID-19 condition can persist from the initial illness, or begin after recovery. Symptoms may come and go or relapse over time.
Post COVID-19 condition is usually diagnosed three months after COVID-19. This allows the healthcare provider to rule out the normal recovery process after illness. The symptoms and effects last for at least two months. We are still learning about COVID-19 and post COVID-19 condition.
7. If I had a confirmed case of COVID-19 and I’m still experiencing symptoms, how long would it take before I could be diagnosed with post COVID-19 condition?
At present, the minimum time before a person is diagnosed with post COVID-19 condition is usually three months after they first developed symptoms of COVID-19. The three-month time period rules out the normal recovery process after illness.
8. How long does post COVID-19 condition last?
It is difficult to predict how long post COVID-19 condition will last for any given patient. There is much to learn about post COVID-19 condition, but current research shows that patients can experience lingering symptoms for weeks to months following COVID-19. The research also shows that patients can improve with time.
9. What can I do to protect myself against post COVID-19 condition?
The best way you can protect yourself against post COVID-19 condition is by doing everything you can to avoid getting infected with the COVID-19 virus. This includes getting vaccinated and following the many public health and social measures that can reduce your chances of getting infected and spreading the COVID-19 virus. The best way to protect yourself against COVID-19 is to do a combination of actions, and as WHO commonly says "Do it all!", including:
Keep physical distance of at least 1 metre from others
Wear a well-fitted mask over your nose and mouth
Cough or sneeze into your elbow
Clean your hands frequently
Get vaccinated as soon as it is your turn
10. Does getting vaccinated prevent post COVID-19 condition?
Research is ongoing. A vaccine’s ability to prevent post COVID-19 condition depends on its ability to prevent COVID-19 in the first place. The vaccines we use today are aimed at preventing severe disease and death from COVID-19. However, some people may still get infected with COVID-19 even after they are vaccinated.
11. If I have post COVID-19 condition, can I give it to others?
No, post COVID-19 condition cannot be passed to others, Post COVID-19 condition is a long-term condition following infection with the virus that causes COVID-19.
30. Coronavirus disease (COVID-19): Pregnancy and childbirth
1. Are pregnant women at higher risk from COVID-19?
Pregnant women do not seem to be at higher risk of getting SARS-CoV-2, the virus that causes COVID-19. However, studies have shown an increased risk of developing severe COVID-19 if they are infected, compared with non-pregnant women of a similar age. COVID-19 during pregnancy has also been associated with an increased likelihood of preterm birth.
Pregnant women who are older, overweight, or have pre-existing medical conditions such as hypertension (high blood pressure) and diabetes are at particular risk of serious outcomes of COVID-19.
It is important that pregnant women - and those around them - take precautions to protect themselves against COVID-19. If they become unwell (including with fever, cough or difficulty breathing), they should seek urgent medical advice from a health worker.
2. I’m pregnant. How can I protect myself against COVID-19?
Pregnant women should take the same precautions to avoid COVID-19 infection as other people. Measures to protect yourself - and those around you - include:
Getting vaccinated, if you wish to do so, after consultation with your healthcare provider
Keeping space between yourself and other people, and avoiding crowded spaces
Keeping rooms well ventilated
Wearing a mask where it is not possible to keep sufficient physical distance from others
Washing your hands frequently with an alcohol-based hand rub or soap and water.
Practicing respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.
If you have fever, cough or difficulty breathing, seek medical care early. Call before going to a health facility, and follow the directions of your local health authority.
Pregnant women and women who have recently delivered should attend their routine care appointments, according to local policies and following adapted measures to reduce possible transmission of the virus.
3. Should pregnant women be tested for COVID-19?
Testing protocols and eligibility during pregnancy vary depending on where you live.
However, WHO recommendations are that pregnant women with symptoms of COVID-19 should be prioritized for testing. If they have COVID-19, they may need specialized care.
4. Can COVID-19 be passed from a woman to her unborn or newborn baby?
We still do not know if a pregnant woman with COVID-19 can pass the virus to her fetus or baby during pregnancy or delivery. To date, the active virus has not been found in samples of fluid around the baby in the womb or breastmilk.
5. What care should be available during pregnancy and childbirth?
All pregnant women and their newborns, including those with confirmed or suspected COVID-19 infections, have the right to high quality care before, during and after childbirth, including mental health care.
A safe and positive childbirth experience includes:
Being treated with respect and dignity;
Having a companion of choice present during delivery;
Clear communication by maternity staff;
Appropriate pain relief strategies:
Mobility in labour where possible, and birth position of choice.
If COVID-19 is suspected or confirmed, health workers should take all appropriate precautions to reduce risks of infection to themselves and others, including hand hygiene, and appropriate use of protective clothing like gloves, gown and medical mask.
6. Do pregnant women with suspected or confirmed COVID-19 need to give birth by caesarean section?
No. WHO advice is that caesarean sections should only be performed when medically justified.
The mode of birth should be individualized and based on a woman’s preferences alongside obstetric indications.
7. Can I touch and hold my newborn baby if I have COVID-19?
Yes. Close contact and early, exclusive breastfeeding helps a baby to thrive. You should be supported to
Breastfeed safely, with good respiratory hygiene;
Hold your newborn skin-to-skin, and
Share a room with your baby
You should wash your hands before and after touching your baby, and keep all surfaces clean. Mothers with symptoms of COVID-19 are advised to wear a medical mask, during any contact with the baby.
8. Can pregnant women get vaccinated against COVID-19?
Yes, pregnant women can be vaccinated against COVID-19, in consultation with their healthcare provider.
Limited data are currently available to assess the safety of COVID-19 vaccines in pregnancy. However, based on what we know about the kinds of vaccines being used, there is no specific reason for concern. None of the COVID-19 vaccines authorized to date use live viruses, which are more likely to pose risks during pregnancy.
Before getting vaccinated, pregnant women should discuss with their healthcare provider whether the benefits of vaccination outweigh the potential risks.
The benefits may be greatest for pregnant women at highest risk from COVID-19, such as frontline health workers, people living in areas of high transmission, and those with health conditions like hypertension (high blood pressure) and diabetes that add to their risk of severe disease.