School-Wide Project

Good afternoon everyone! I realize this is a bit "different" from what you have been receiving online and in your packets from school. However, as all of you now know, the COVID-19 virus is a major event. Quite honestly, other than 9/11, this is the biggest event of my entire life as well. As I look back on 9/11,

. ' we did take quite a bit of time within the school to watch what was happening around the world. As an adult, I still remember that event and the weeks that followed. That being said, I wanted to do something here that will help you remember this time and also the far-reaching effects of this outbreak. In some way or form, COVID-19 has a place in every subject within our school. I am including all of the information you will need to complete this project. However, you are more than welcome to look up your own

• information as well. Be very careful with the resources you choose. This is a wonderful chance for you to pay close attention to resources that are slanted by political beliefs. You will see stories on both sides of the coin.

What is required for successful completion? Read - Research - Watch - Respond

We will expect to see one of two things with regard to the response.

1. A paper answering all of the questions given below. This can be typed or handwritten. A MAXIMUM of 4 pages. OR

2. A PowerPoint or Prezi answering all of the questions listed below.

Questions for you to answer: 1. What is COVID-19, and why is it dangerous? 2. Based on the graphs I gave you from Mississippi and the US with regard to cases at that time, what do you think was happening? Explain your answer based on interpretation of the graphs given. Follow up: In one of the articles, it mentions "flattening the curve". What do you think that means with regard to the graphs I gave you? How does the US and Mississippi "response" accomplish this goal? 3. I included a year-long graph of the DOW Jones Industrial Average and the S&P 500. Tell me what you see in that graph with regard to the economy? Did it go down? Up? When? Why? Where are we now? Do you think this affects retirement accounts? Savings accounts? Investment accounts? A quick watch of the news can give you some of these answers. 4. OPINION - How has this affected you as a student? How has this affected you as a family? 5. OPINION - Has our response as a nation and a state been appropriate? Explain. 6. OPINION - Have you seen any or DO you see any positives that will ultimately come out of this event? Explain your answer. 7. OPINION - What has been your biggest challenge and/or struggle during the "Shelter in Place" order? Explain. 8. OPINION - How do you think this will affect you in the future? Explain.

Last, we will take all of these projects and rate them. The TOP project, as voted on by staff, will receive a BIG prize. You ALL know me. When I say big, I mean BIG!

Stay Safe! I miss you all!

Mr. Chism

COVID-19 Worldwide: The Pandemic's Impact On The Economy And Markets Brian MenickellaContributor Personal Finance Brian Menickella, co-founder of The Beacon Group of Companies

At the start of the year, most investors expected the I I-year bull market to continue in 2020, only to be shockingly

disabused of that notion by the spread of COVID- I 9. As a result, the Dow fell from record highs to bear-market

territory in a matter of weeks.

Investors need a way to price in risk, and as of April 2020, there are simply too many unknowns surrounding

COVID-19 for investors to predict the economic impact, leading to fear and extreme volatility.

COVID-19 Goes Global

COVID-19 has officially been designated a pandemic by the World Health Organization (WHO). It has gone global

with cases in over 150 countries.

As of April I, 2020, almost 900,000 COVTD-19 cases have been reported worldwide with a death toll of over

44,000. Note that over 185,000 of the infected patients have recovered, and almost 3,000 fatalities have already

occurred in the U.S.

China's unprecedented quarantine of approximately 600 million people in their homes or hospitals has slowed the

progression of the outbreak. At the epidemic's peak in late-January and early-February, China frequently

experienced over a thousand new COVID-19 cases per day, along with I 00 fatalities.

Although still a relatively high amount of new cases emerged, this is drastically lessened compared to prior months.

This is part of a long-term downward trend that gives rise to hopes that China nearly has the virus under control.

However, the spread in the United States, Europe and other regions continues to rapidly evolve. How long the

epidemic will last and its economic impact is difficult to predict. As a result, the stock and bond markets have

I

entered a period of extreme volatility, leaving investors to wonder: What does COVID-19 mean for the global

markets and economy?

Impact Thus Far

The government, Wall Street and the American people want to see the virus contained. Until it is, risk assets remain

vulnerable to additional selloffs. However, there are some bright spots. The outbreak has increased the demand for

medical products, especially face masks and test kits in an effort to avoid spreading and/or catching the virus.

The news across other risk assets points to earnings weakness in the first quarter of 2020. For example, Nike relies

heavily on China for its production, igniting fears of an earnings dip due to supply-chain disruption. Starbucks also

had to shutter half of its 4,292 stores in China, and Apple has begun a search for alternative suppliers who can make

up any production losses.

However, with China hitting its peak with new COVID-19 cases, the country continues to steadily decline its

infected count. Apple CEO Tim Cook expressed optimism that the company's Chinese supply chain is rebounding.

Starbucks has reopened most of its locations.

While people all over the world remain quarantined, the number of those infected still continues to aggressively ,

increase. Collectively worldwide, experts are steadily working on finding a vaccine. Unfortunately, we can expect

more economic pain in the U.S. and abroad as virus containment measures continue to decrease economic activity.

For example, trade shows and business conferences are canceling events around the world, such as the giant The

Inspired Home Show in Chicago, which draws more than 60,000 attendees worldwide. Many businesspeople are

canceling travel and concerned vacationers are rescheduling trips . As a result, United Airlines has taken the

unprecedented step of canceling I 0% of its upcoming domestic flights and 20% of its international flights.

Further, cautionary action has been taken on the federal , state and city level to ensure as many Americans as

possible remain safe and uninfected. To slow down the spread of COVID-19, everyone is highly encouraged to

practice social distancing for the foreseeable future .

The Future Of The Markets Amid COVID-19

With market angst so high, what does this mean for investors?

It means adopting strategies that benefit from volatility. The market has gone from a record high to correction

territory in a week and then shot up 4.2% in a day as the focus shifted to Joe Biden's resurgence in the Democratic

primary.

The effect of COVID-19 remains uncertain. In a case such as this, when continued volatility can be expected, it is

wise to employ strategies that enhance returns, whether the market shifts violently up or down.

Further, it' s wise to consult with a trusted financial partner to ensure you don't panic sell or buy based on FOMO

(Fear Of Missing Out) or FOLE (Fear Of Losing Everything). It is important to remain patient and make sound

decisions not based on emotion.

Volatility can provide an opportunity for market-beating returns. The key is employing a strategy that allows you to

make money in volatile markets regardless of which direction they tum.

Economists have lowered their estimates for global growth due to the outbreak. Predictions include that China's

economy will reach low growth levels that haven't been seen since the 2008 financial crisis and may exper-ience

$800 billion in new bad loans.

The effect in the U.S. remains unknown, but economists expe£_t a hard hit to the economy, and the timing of the

subsequent recovery remains uncertain. The volatile conditions create an opportunity to protect against downside

risk and increase income. COVID-19 will continue to effect the markets, but we should all collectively remain

vigilant as we navigate through this period of uncertainty together.

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What has happened to the US Economy since COVID-19 made it to the US? Interpret the stock market graphs listed below. Pay close attention to the dates.

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The Effect ofCOVID-19 on the U.S. Economv Author: Chris Miller www.fpri.org (Foreign Policy Research Institute)

As the novel coronavirus (COVID-19) rips through America's biggest cities, its effect is being felt

far beyond the over 140,000 Americans who are confirmed infected. The quarantines and

lockdowns that are needed to fight the virus's spread are freezing the economy, too, with

unprecedented force and speed. The stock market has sunk a quarter from its peak last month,

wiping out three years of gains. Last week, meanwhile, brought news that a record 3.28

mill ion Americans applied for unemployment benefits, the highest number ever recorded.

Unemployment is shooting up far faster than it did during the 2008 recession, a sign the economy

is headed toward recession. How long is the COVID-19 slump likely to last?

To understand COVID-19's hit on the economy, consider its effect on different industries.

Consumption makes up 70% of America's gross domestic product (GDP), but consumption has

slumped as businesses close and as households hold off on major purchases as they worry about

their finances and their jobs. Investment makes up 20% of GDP, but businesses are putting off

investment as they wait for clarity on the full cost of COVID-19. Arts, entertainment, recreation,

and restaurants constitute 4.2% of GDP. With restaurants and movie theaters closed, this figure

will now be closer to zero until the quarantines are lifted. Manufacturing makes up 11 % of U.S.

GDP, but much of this will be disrupted, too, because global supply chains have been obstructed

by factory closures and because companies are shutting down factories in anticipation of reduced

demand. Ford and GM, for example, have announced temporary closures of car factories.

As businesses rack up losses due to closures, layoffs have already followed. Small businesses will

especially struggle to keep staff on the payroll as their revenue slumps. Countries such as Germany

are taking steps to help businesses avoid layoffs, and the United States would be wise to do so as

well. The U.S. Congress has passed a massive stimulus bill that provides for hundreds of billions

in new spending, expanding unemployment insurance and providing a cash handout to low and

middle-income Americans, which should help laid off workers make ends meet until the economy

begins to recover. The legislation also provides for $350 billion in "loans" for businesses, targeted

at firms with fewer than 500 employees. These loans will be forgiven if firms don't cut wages or

lay off employees-so they function de facto like grants to businesses.

How far off is economic recovery? That depends, in part, on when the virus's spread can be slowed

and businesses can be reopened. President Donald Trump has suggested that the economy will be

"raring to go" by mid-April. This looks unlikely. Judging by the progressjon of the virus in places

like Italy, places in full lockdown such as New York are still at least two weeks away from when

I

the COVID-19 deaths will peak. Yet, it is na'ive to think that this is the point that life will return to

normal. If businesses and restaurants are immediately reopened, then the virus will start spreading

again. And some parts of the United States have not yet adopted the lockdowns needed to

substantially slow the infection rate. Two months of lockdown looks more likely than two weeks.

Most projections by public health experts suggest something similar is necessary to substantially

reduce the virus' spread rate. Italy, the European county that has suffered worst from COVID, has

taken a month to reduce the death rate from infections, despite strict quarantines.

The best-case scenario is that the lockdowns bring down the COVID-19 infection rate and that

testing capacity continues to expand. Suppose that America's big cities emerge from their

lockdowns later this spring. If so, will the economy pick up where it left off? That is far from

guaranteed. Some purchases that were deferred during the quarantine will be made once stores are

reopened. Yet, others will never happen.

One key risk is the number of businesses that are forced to close during the lockdowns. The more

business closures-and the more layoffs that result-the higher the cost of the crisis will be.

Unemployment will increase, and the higher it goes, the less likely consumption is to immediately

recover after the lockdowns end.

The other major risk to the economy is that the health crisis is accompanied by a financial crisis.

The immediate negative effect of COVID-19 on GDP is likely to be far more substantial than was

the 2008 subprime crisis. The length of time that the COVID-19 crisis hangs over the economy

will be determined by its financial effects. The 2008 crisis caused many years of slow growth

because of the huge financial disruptions that resulted, as banks suffered losses and cut back

lending-usually a key driver of growth-as a result.

It is easy to imagine ways that the COVID-19 crisis could have a similar financial effect.

Businesses and consumers alike will default on loans. Financial markets are expecting the default

rate of large corporations to increase, too. America's banks are better capitalized today than they

were in 2008-so they have more of a cushion to take losses. Yet, as losses pile up, government

support may be needed to backstop credit markets again. The lesson of 2008, and of the Great

Depression, is that the only thing worse than a bank bailout is a bank run, the costs of which are

born not only by banks but by their customers. The Federal Reserve has already stepped in to offer

additional liquidity to financial markets, but it may have to do more to keep credit available to

companies and individuals.

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It is possible to imagine scenarios in which the · COVID-19 quarantines are followed by a swift

economic recovery. The economy was growing steadily before the virus struck, so there are no

other factors pushing. But the longer the shutdowns last, the less likely this becomes. More •

worrisome is that some state and local governments are only just beginning to take the risk

seriously-thereby increasing the likelihood that the coronavirus spreads further, and requires

longer shutdowns to bring it under control.

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What is a novel coronavirus?

Coronavirus Disease 2019 Basics Source: Center for Disease Control

A novel coronavirhs is a new coronavirus that has not been previously identified. The virus causing coronavirus qisease 2019 (COVID-19), is not the same as the coronaviruses that commonly circulate among hwnans and cause mild illness, like the common cold.

A diagnosis with coronavirus 229E, NL63, OC43, or HKUI is not the same as a COVID-19 diagnosis. Patients with COVID-19 will be evaluated and cared for differently than patients with common coronavirus diagnosis.

Why is the disease being called corona virus disease 2019, COVID-19? On February 11, 2020 the World Health Organization announced an official name for the disease that is causing the 2019 novel corona virus outbreak, first identified in Wuhan China. The new name of this disease is coronavirus disease 2019, abbreviated as COVID-19. In COVID-19, 'CO' stands for 'corona,' 'VI' for 'virus,' and 'D' for disease. Formerly, this disease was referred to as "2019 novel coronavirus" or "2019-nCoV".

There are many types of human coronaviruses including some that commonly cause mild upper­respiratory tract illnesses. COVID-19 is a new disease, caused be a novel ( or new) coronavirus that has not previously been seen in humans. The name of this disease was selected following the World Health Organization (WHO) best practiceextemal iconexternal icon for naming of new human infectious diseases.

Why do some state's COVID-19 case numbers sometimes differ from what is posted on CDC's website? CDC's overall case numbers are validated through a confirmation process with jurisdictions. The process used for finding and confirming-cases displayed by different places may differ.

How do CDC's COVID-19 case numbers compare with those provided by the World Health Organization (WHO) or Johns Hopkins? CDC's COVID-19 case numbers include many publicly reported numbers, including information from state, local, territorial, international and external partners.

Why do the number of cases for previous days increase? Delays in reporting can cause the number of COVID-19 cases reported on previous days to increase. (Sometimes this effect is described as "backfill.") State, local, and territorial health departments report the number of cases that have been confirmed and share these data with CDC. Since it takes time to conduct laboratory testing, cases from a previous day may be added to the daily counts a few days late.

How COVID-19 Spread What is the source of the virus?

I

COVID-19 is caused by a coronavirus called SARS-Co V-2. Coronaviruses are a large family of viruses that are common in people and may different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people. This occurred with MERS-CoV and SARS-CoV, and now with the virus that causes COVID-19 . More information about the source and spread of COVID-19 is available on the Situation Summary: Source and Spread of the Virus.

How does the virus spread?

•

The virus that causes COVID-19 is thought to spread mainly from person to person, mainly through respiratory droplets produced when an infected person coughs or sne~zes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Spread is more likely when people are in close contact with one another (within about 6 feet).

COVID-19 seems to be spreading easily and sustainably in the community ("community spread") in many affected geographic areas. Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.

Why are we seeing a rise in cases?

The number of cases of COVID-19 being reported in the United States is rising due to increased laboratory testing and reporting across the country. The growing number of cases in part reflects the rapid spread of COVID-19 as many U.S. states and territories experience community spread. More detailed and accurate data will allow us to better understand and track the size and scope of the outbreak and strengthen prevention and response efforts.

Can someone who has had COVID-19 spread the illness to others? The virus that causes COVID-19 is spreading from person-to-person. People are thought to be most contagious when they are symptomatic (the sickest). That is why CDC recommends that these patients be isolated either in the hospital or at home ( depending on how sick they are) until they are better and no longer pose a risk of infecting others. More recently the virus has also been detected in asymptomatic persons.

How long someone is actively sick can vary so the decision on when to release someone from isolation is made using a test-based or non-test-based strategy (i.e. time since illness started and time since recovery) in consultation with state and local public health officials. The decision involves considering the specifics of each situation, including disease severity, illness signs and symptoms, and the results of laboratory testing for that patient.

Someone who has been released from isolation is not considered to pose a risk of infection to others.

Can someone who has been quarantined for COVID-19 spread the illness to others? Quarantine means separating a person or group of people who have been exposed to a contagious disease but have not developed illness (symptoms) from others who have not been exposed, in order to prevent the possible spread of that disease. Quarantine is usually established for the incubation period of the communicable disease, which is the span of time during which people

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have developed illness after exposure. For COVID-19, the period of quarantine is 14 days from the last date of exposure because the incubation period for this virus is 2 to 14 days. Someone who has been released from COVID-19 quarantine is not considered a risk for spreading the virus to others because they have not developed illness during the incubation period.

Can the virus that causes COVID-19 be spread through food, including restaurant take out, refrigerated or frozen packaged food? Coronaviruses are generally thought to be spread from person to person through respiratory droplets. Currently, there is no evidence to support transmission of COVID-19 associated with food. Before preparing or eating food it is important to always wash your hands with soap and water for at least 20 seconds for general food safety. Throughout the day use a tissue to cover your coughing or sneezing, and wash your hands after blowing your nose, coughing or sneezing, or going to the bathroom.

It may be possible that a person can get COVID-19 by touching a surface or object, like a packaging container, that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

In general, because of poor survivability of these corona viruses on surfaces, there is likely very low risk of spread from food products or packaging.

Can I get sick with COVID-19 if it is on food?Based on information about this novel coronavirus thus far, it seems unlikely that COVID-19 can be transmitted through food - additional investigation is needed.

Will warm weather stop the outbreak of COVID-19?

It is not yet known whether weather and temperature affect the spread of COVID-19. Some other viruses, like those that cause the common cold and flu, spread more during cold weather months but that does not mean it is impossible to become sick with these viruses during other months. There is much more to learn about the transmissibility, severity, and other features associated with COVID-19 and investigations are ongoing.

What is community spread? Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.

What temperature kills the virus that causes COVID-19? Generally, coronaviruses survive for shorter periods at higher temperatures and higher humidity than in cooler or dryer environments. However, we don't have direct data for this virus, nor do we have direct data for a temperature-based cutoff for inactivation at this point. The necessary temperature would also be based on the materials of the surface, the environment, etc. Regardless of temperature please follow CDC s guidance for cleaning and disinfection.

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Svmptoms & Testing What are the symptoms and complications that COVID-19 can cause?

Current symptoms reported for patients with COVID-19 have included mild to severe respiratory illness with feverl, cough, and difficulty breathing. Read about COVID-19 Symptoms.

Should I be tested for COVID-19? Not everyone needs to be tested for COVID-19. For information about testing, see Testing for COVID-19.

Where can I get tested for COVID-19? The process and locations for testing vary from place to place. Contact your state, local, tribal, or territorial department for more information, or reach out to a medical provider. State and local public health departments have received tests from CDC while medical providers are getting tests developed by commercial manufacturers. While supplies of these tests are increasing, it may still be difficult to find someplace to get tested. See Testing for COVID-19 for more information.

Can a person test negative and later test positive for COVID-19? Using the CDC-developed diagnostic test, a negative result means that the virus that causes COVID-19 was not found in the person's sample. In the early stages of infection, it is possible the virus will not be detected.

For COVID-19, a negative test result for a sample collected while a person has symptoms likely means that the COVID-19 virus is not causing their current illness.

Higher Risk Who is at higher ri'sk for serious illness from COVID-19?

COVID-19 is a new disease and there is limited information regarding risk factors for severe disease; Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.

Based on what we know now, those at high-risk for severe illness from COVID-19 are:

• People aged 65 years and older • People who live in a nursing home or long-term care facility

People of all ages with underlying medical conditions, particularly if not well controlled, including:

• People with chronic lung disease or moderate to severe asthma • People who have serious heart conditions • People who are immunocompromised

o Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications

• People with severe obesity (body mass index [BMI] ~40) • People with diabetes • People with chronic kidney disease undergoing dialysis • People with liver disease

HOW TO PROTECT YOURSELF - Know How it Spreads

• There is currently no vaccine to prevent coronavirus disease 2019 (COVID-19). • The best way to prevent illness is to avoid being exposed to this virus. • The virus is thought to spread mainly from person-to-person.

o Between people who are in close contact with one another (within about 6 feet). o Through respiratory droplets produced when an infected person coughs, sneezes or

talks. o These droplets can land in the mouths or noses of people who are nearby or possibly

be inhaled into the lungs. o Some recent studies have suggested that COVID-19 may be spread by people who

are not showing symptoms.

Everyone Should

Clean your hands often

• Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.

• If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.

• A void touching your eyes, nose, and mouth with unwashed hands.

A void close contact

• Avoid close contact with people who are sick • Stay home as much as possible.pdf iconexternal icon I [Espafiolpdf iconexternal icon] • Put distance between yourself and other people .

• o Remember that some people without symptoms may be able to spread virus .

• o Keeping distance from others is especially important for people who are at higher

risk of getting very sick.

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Cover your mouth and nose with a cloth face cover when around others

• You could spread COVID-19 to others even if you do not feel sick. • Everyone should wear a cloth face cover when they have to go out in public, for example to

the grocery store or to pick up other necessities. • o Cloth face coverings should not be placed on young children under age 2, anyone

who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.

• The cloth face cover is meant to prot~ct other people in case you are infected. • Do NOT use a facemask meant for a healthcare worker. • Continue to keep about 6 feet between yourself and others. The cloth face cover is not a

substitute for social distancing.

Cover coughs and sneezes

• If you are in a private setting and do not have on your cloth face covering, remember to always cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow.

• Throw used tissues in the trash. • Immediately wash your hands with soap and water for at least 20 seconds. If soap and

water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol.

Clean and disinfect

• Clean AND disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.

• If surfaces are dirty, clean them. Use detergent or soap and water prior to disinfection. • Then, use a household disinfectant. Most common EPA-registered household

disinfectantexternal icon will work.

COVID-19 Cases in MISSISSIPPI First 17 days since the first case was identified

COVID-19 Cases in the US First 35 days since the 100th case

5 Things Everyone Should Know About the Coronavirus Outbreak By KATHY KATELLAAPRIL 15, 2020

[Originally published: January 23, 2020. Updated: April 15, 2020.J

COVID-19 is changing daily life in the United States as SARS-Co V-2, the new virus responsible for spreading the disease, continues to sweep across the country. The U.S., which declared a national emergency in mid-March, now has the most detected cases in the world. Americans are still adjusting to strict guidelines urging them to stay home, avoid unnecessary travel, and stay 6 feet away from other people.

In early March, the World Health Organization (WHO) declared COVID-19 a pandemic-a disease outbreak occurring over a wide geographic area and affecting an exceptionally high proportion of the population. According to the WHO, there are almost 2 million confirmed cases of people with COVID-19 and almost 125,000 people have died from the disease-a death toll that has far surpassed that of the severe acute respiratory syndrome (SARS) epidemic that occurred in 2002 and 2003. (While some news sources report different numbers, the WHO provides official counts of confirmed cases once a day.)

In the U.S., the numbers are multiplying, as different parts of the country experience different levels of COVID-19 activity. All 50 states have reported community spread (meaning the source of infection is unknown), and there have been large clusters in certain areas of the country. The Centers for Disease Control and Prevention (CDC) currently provides a rough picture of the outbreak in the U.S. here, currently putting the total confirmed and presumptive cases at more than 600,000, with almost 25,000 deaths," but dafa provided by state publfo health departments should be considered the most up to date, according to the agency.

SARS-Co V-2 is a virus that scientists haven't seen before. Like other viruses, it is believed to have started in animals and spread to humans. Animal-to-person spread was suspected after the initial outbreak in December among people who had a link to a large seafood and live animal market in Wuhan, China.

Scientists and public health officials are working as quickly as possible to find answers to key questions about the severity of the disease and its transmission. They are investigating treatments and a potential vaccine for the disease.

Below is a list of five things you should know about the coronavirus outbreak.

1. What we know about COVID-19 is changing rapidly

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What we do know about coronaviruses is that they cause respiratory tract illnesses that range from the common cold to such potentially deadly illnesses as SARS, a global epidemic that killed almost 800 people. COVID-19 is the first pandemic known to be caused by the emergence of a new coronavirus-novel influenza viruses caused four pandemics in the last century (which is why the response to the new disease is being adapted from existing guidance developed in anticipation of an influenza pandemic).

According to the CDC, reported COVID-19 illnesses have ranged from very mild (with no reported symptoms in some cases) to severe, including illness resulting in death. People ages 65 and older, those who living in a nursing home or long-term care facility, and people of all ages with underlying health conditions seem to be at higher risk of developing serious illness. But doctors are still working to develop a complete clinical picture of COVID-19, as evidenced by a recent CDC report noting that 20% of those who have been hospitalized for the disease in the U.S. are younger adults (between 20 and 44 years old).

"I think there are two main questions," says Richard Martinello, MD, a Yale Medicine infectious diseases specialist and medical director of infection prevention at Yale New Haven Health. "First, we need to know how this virus is transmitted between people so we can be more precise in our efforts to stop its spread. Data is needed not only to better understand when those who become ill shed the virus, but also which body fluids contain the virus and how those may contaminate surfaces and even the air surrounding them," says Dr. Martinello. "Second, there needs to be a better understanding of the pathogenesis of the infection and resulting inflammatory response, so that knowledge can drive the development of therapeutic and preventive medications."

More information is becoming available. The American Academy of Otolaryngology has called for adding anosmia (loss of smell) to a list of screening tools for COVID-19, and while evidence is still preliminary, the WHO says it is probing a possible link between the disease and the symptom.

Meanwhile, a letter to the editor published in The New England Journal of Medicine in mid­March showed the virus that causes COVID-19 may be stable for several hours in aerosols and for several hours to days on surfaces. Scientists from National Institutes of Health (NIH), CDC, UCLA, and Princeton University who participated in the analysis found SARS-Co V-2 was detectable in aerosols for up to three hours, copper up to four hours, cardboard up to 24 hours, and plastic and stainless steel up to two to three days. While there is much to learn, scientists involved in the analysis observed that emerging evidence suggests people who are infected might be spreading the virus without recognizing, or prior to recognizing, symptoms, according to the NIH.

But Yale Medicine Infectious Diseases specialist Jaimie Meyer, MD, MS, notes, "A lot of times people will make basic science observations in the research lab, but it takes time for us to figure out how clinically relevant it is. So, we don't know yet know what this study means for transmissibility. Until we understand more about the granular details of how SARS-Co V-2 passes from person to person, public health dictates that people maintain social distancing, wash hands, and frequently disinfect high-touch surfaces."

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2. Strict measures are critical for slowing the disease

While no one knows for sure how the situation will progress around COVID-19, studies of influenza have shown that pandemics begin with an "investigation" phase, followed by • "recognition," "initiation," and "acceleration" phases, according to the CDC. The peak of illnesses occurs at the end of the acceleration phase (the U.S. is currently in an acceleration phase), and that is followed by deceleration, during which there is a decrease in illnesses. Finally, there is a "preparation" phase, where the pandemic has subsided, and public health officials.monitor virus activity and prepare for possible additional waves of infection. Different parts of the country can be in different phases of the pandemic, and the length of each phase can vary depending, in part, on the public health response.

Efforts right now are aimed at "flattening the curve." If you map the number of COVID-19 cases over time, the expectation is that it will peak at some point-on a graph this peak would mirror a surge in patients (which could overwhelm hospitals and health care providers, affecting the ability to care for all patients). Flattening the curve would mean there would be fewer patients during that period, and hospitals would be better able to manage the demands of patients who are sick with COVID-19 and other illnesses.

State and local authorities are working to flatten the curve by decreasing chances of exposure for as many people as possible, which means responding with strict measures in some cases, including recommendations to shelter-in-place, avoid travel, and social distancing, which means maintaining a 6-foot physical distance from other people. Guidelines from the White House call for "15 Days to Slow the Spread," a plan that has been extended through the month of April that stresses avoiding social gatherings of more than 10 people; using drive-thru, pick-up, or delivery options instead of eating in restaurants; avoiding discretionary travel or shopping; and staying away from nursing homes and long-term care facilities (as the elderly are at especially high risk for serious complications if they get the virus).

People may be at higher risk of exposure if they visit an area that is experiencing community spread of COVID-19, and those coming from a hard-hit area may contribute to spreading the disease when th~y travel.

Anyone who must travel should first check the CDC's latest travel advisories, which include advice on precautions for domestic in addition to international travel, as well as any state and local recommendations.

3. Infection prevention is key

There are many things you can do to protect yourself and the people you interact with. As with a cold, a flu vaccine won't protect people from developing COVID-19. "The best thing you can do at this point is take care of yourself the way you would to prevent yourself from getting the flu," says Yale Medicine infectious diseases specialist Joseph Vinetz, MD. "You know you can get the flu when people sneeze and cough on you, or when you touch a doorknob. Washing hands-especially before eating and touching your face, and after going to the bathroom-and avoiding other people who have flu-like symptoms are the best strategies at this point."

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The CDC also recommends the following preventive actions:

• Wash hands with soap and water for at least 20 seconds. Dry them thoroughly with an air dryer or clean towel. If soap isn't available, use a hand sanitizer with at least 60% alcohol.

• Stay home if you' re sick.

• A void touching nose, eyes, and mouth. Use a tissue to cover a cough or sneeze, then dispose of it in the trash.

• Use a household wipe or spray to disinfect doorknobs, light switches, desks, keyboards, sinks, toilets, cell phones, and other objects and surfaces that are frequently touched.

• It may also be important to create a household plan of action. You should talk with people who need to be included in your plan, plan ways to care for those who might be at greater risk for serious complications, get to know your neighbors, and make sure you and your family have a household plan that includes ways to care for loved ones if they get sick. This includes planning a way to separate a family member who gets sick from those who are healthy, if the need arises.

• The CDC recommends that people voluntarily wear cloth face masks in public settings where other social distancing measures are difficult to maintain, including grocery stores and pharmacies, especially if they live in an area of significant community-based transmission. It should be noted that the cloth mask is not meant to protect the wearer from infection. It is instead meant to slow the spread of the virus (if people who have the virus and do not know it wear masks, they help prevent transmitting it unknowingly to others). The CDC advises making face coverings at home from simple materials, and reserving surgical masks and N95 respirators for health care workers and other medical first responders.

While everyone should take precautions, measures may be critical for adults over 65 years old (the risk seems to gradually increase with age starting at age 40, according to the WHO) and those with chronic conditions (such as diabetes, heart disease, and lung disease). People in these categories especially should stock up on household items, groceries, medications, and other supplies in case they need to stay home for an extended period.

4. Experts are working rapidly to find solutions

In the U.S., widely available testing will be important in understanding how the disease is transmitted and the true infection and mortality rates. In addition to COVID-19 testing being done by the CDC, state and local public health labs in all 50 states and the District of Columbia are currently using the CDC's COVID-19 diagnostic tests, although the number of available tests is still limited. Until there can be comprehensive testing for COVID-19, it's difficult to know how many cases have not been identified. "Testing is still very limited in Connecticut," says Yale Medicine infectious disease specialist Manisha Juthani, MD. "This will hopefully change, but testing will have to be prioritized for those that are the sickest."

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Meanwhile, scientists are studying the virus closely. "With the new virus in a culture dish, they are looking at the biology and working to make drugs to treat it," says Dr. Vinetz. There is also a great deal of effort underway to assess drugs in development (and some medications currently available) to determine if they are beneficial for treating patients infected with COVID-19, adds Dr. Martinello. •

While no pharmaceutical products have yet been shown to be safe and effective for COVID-19, a number of existing medicines have been suggested as potential investigational therapies. An important effort is a clinical trial evaluating different potential therapeutics at the University of Nebraska Medical Center in Omaha, the first of which is Remdesivir, says Dr. Juthani. Remdesivir is an antiviral treatment that, according to the National Institutes of Health, was previously tested in humans with Ebola virus disease and has shown promise in animal models for treating SARS and Middle Eastern Respiratory Syndrome (MERS), a deadly virus that was first reported in Saudi Arabia in 2012.

In mid-March, the National Institute of Allergy and Infectious Diseases (NIAID) announced the first testing in humans of an experimental vaccine called mRNA-1273 developed by NIAID scientists and their collaborators at the biotechnology company Moderna, Inc. But it could take at least a year before such a vaccine is available. The first trial is testing the vaccine on 45 healthy adult volunteers, ages 18 to 55, over approximately 6 weeks. But it could take at least a year before all the necessary phases of the investigation can be completed to ensure the vaccine is safe and effective enough to make publicly available.

5. If you feel ill, here's what you should do

So far, information shows the severity of COVID-19 infection ranges from very mild (sometimes with no reported symptoms at all) to severe to the point of requiring hospitalization. Symptoms can appear anywhere between 2 to 14 days after exposure, and may include:

• Fever

• Cough

• Difficulty breathing

You should call your medical provider for advice if you experience these symptoms, especially if you have been in close contact with a person known to have COVID-19 or live in an area with ongoing spread of the disease.

Most people will have a mild illness and can recover at home without medical care. Seek medical attention immediately if you are at home and experience emergency warning signs, including difficulty breathing or shortness of breath, persistent pain or pressure in the chest, new confusion or ability to arouse, or bluish lips or face. This list is not inclusive, so consult your medical provider if you notice other concerning symptoms.

Patients and members of the community can call the Yale Medicine/Yale New Haven Health Call Center at COVID-19 hotline of Yale New Haven Health at 203-688-1700 (toll-free, 833-484-1200) if they have questions.

Be aware of the information and resources that are available to you

Because knowledge about the new virus is evolving rapidly, you can expect information and recommendations to change frequently. Threats like COVID-19 can lead to the circulation of misinformation, so it's important to trust information only from reputable health organizations and government sources such as the CDC and the WHO. "The public health infrastructure in the U.S. is a critical resource for leading the federal, state, and local response," Dr. Martinello says.

Yale M~dicine doctors are advising anyone who has concerns about COVID-19 exposure or symptoms to call their primary care doctor for instructions. Doctors at Yale Medicine and Yale New Haven Health also are encouraging all patients to sign up for MyChart, a secure online portal that allows patients to manage and receive information about their health, and enables telehealth visits (by phone or video), which is how Yale Medicine specialists currently are delivering most care not related to COVID-19.

SOURCES

Articles

www.cdc.gov Coronavirus Disease 2019 Basics

www.forbes.com COVID-19 Worldwide: The Pandemic's Impact on the Economy and Markets

www.fpri.org The Effect ofCOVID-19 on the US Economy

www.yalemedicine.org 5 Things Everyone Should Know About the Coronavirus Outbreak

Graphs and Charts

www.robinhood.com (DOW & S&P)

www.worldometers.info (I made the charts in Excel. This is the data source.)