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Illinois COVID-19 questions answered: Should people wear 2 masks? Will everyone be able to get a vaccine by April? Will more mass vaccination sites be opening?

Wednesday, February 17, 2021
Chicago Tribune
by Alison Bowen, Christen A. Johnson Darcel Rockett

Should people wear two masks to lower the risk of spreading coronavirus? Will vaccines be available to everyone by the end of April? Will more mass vaccination sites be opening? Is there an entity keeping track of the COVID-19 variants? These are some of the many questions readers have sent us that we’ve put to health and science experts. This resource will be updated as more questions arrive, so check back often. Have your own pandemic question? Send it to the Tribune here. Get the latest Chicago COVID-19 information and updates from Chicago Tribune reporters and editors on our COVID-19 Facebook page.

Should people wear 2 masks to lower the risk of spreading the coronavirus?

Researchers found that two masks are better than one in slowing coronavirus spread.

The Centers for Disease Control and Prevention reported on Feb. 16 the results of a lab experiment that spaced two artificial heads 6 feet from each other and checked to see how many coronavirus-size particles spewed by one were inhaled by the other.

The researchers found that wearing one mask — surgical or cloth — blocked about 40% of the particles coming toward the head that was breathing in. When a cloth mask was worn on top of a surgical mask, about 80% were blocked.

When both heads were double-masked, more than 95% of the particles were blocked, according to the CDC’s Dr. John Brooks. However, health officials stopped short of recommending that everyone double up on masking.

— Darcel Rockett

Will vaccines be available to everyone by the end of April?

In a “CBS This Morning” interview Feb. 17, U.S. infectious disease chief Dr. Anthony Fauci said the plan to have vaccines available to “everybody and anybody” who wants to take them (beyond those eligible under 1a, 1b and 1c guidelines) by the end of April has shifted. Johnson & Johnson’s one-dose vaccine will likely not be available for “another couple of months after that,” he said. However, Fauci said he’s pretty confident that J&J’s doses will be in the pipeline by the end of June or the beginning of July.

“I’m sure we’ll get them by that time,” he said. He knows uniformity and consistency with vaccination dissemination has been difficult so far. “Right now the demand far exceeds the supply. As we get into the later months, April, May, June and July, those kind of difficulties and discrepancies will disappear.”

— Darcel Rockett

Will more mass vaccination sites be opening in Illinois?

Gov. J.B. Pritzker launched three additional state-supported mass vaccination sites — two in Carbondale and another in Springfield. The Springfield site (opened Feb. 17) and the combined Carbondale sites (opening Feb. 19) will each launch with an allocation of 4,000 doses per week with plans to ramp up to the full capacity of 2,700 doses daily, pending increases in federal vaccine shipments.

The new sites build upon the state-supported mass vaccination infrastructure at the Tinley Park Convention Center in Cook County and the Belle-Clair Fairgrounds and Expo Center in St. Clair County.

— Darcel Rockett

As news of COVID-19 variants spreading continues, is there an entity keeping track of their development?

Cases of COVID-19 mutations of the coronavirus have been popping up in Illinois.

Last week, 22 cases of the B.1.1.7 variant were identified in Illinois, according to public health officials. And a case of variant B.1.351 was reported in Rock Island.

Rush University Medical Center will launch an advanced molecular laboratory in March to study and monitor the spread of coronavirus strains in Chicago, determining which strains are transmitting quickest and tracking them as they spread, according to university officials.

White House coronavirus coordinator Jeffrey Zients has called U.S. tracking of virus mutations “totally unacceptable,” saying the nation ranks 43rd in the world.

Currently, there is legislation advancing in Congress that would provide $1.75 billion for genomic sequencing or mapping the DNA of coronavirus mutations. Sequencing could take COVID-19 precautions to the next level, according to U.S. Sen. Tammy Baldwin of Wisconsin.

“Variants represent a growing threat. At the start of the COVID-19 pandemic, increasing our testing capacity was essential to our ability to track and slow the spread of the virus — the same is true for finding and tracking these variants,” she said.

— Angie Leventis Lourgos and Associated Press

Will community health centers directly receive more vaccines from the federal government?

On Feb. 9, President Joe Biden announced the Federally Qualified Health Center program, which will directly provide more vaccines to community health clinics.

According to the White House, starting Feb. 15, federally qualified community health centers will begin directly receiving vaccines. The initial phase will include at least one community health center in each state.

Gov. J.B. Pritzker noted the program Jan. 10 and said it would ramp up over the coming weeks.

When will pregnant women be eligible to get a COVID-19 vaccine?

In Illinois, pregnant women will be eligible when phase 1b expands to include medical conditions such as pregnancy on Feb. 25.

Pregnant women are commonly excluded from research, and were not included in initial clinical trials for the coronavirus vaccine, despite groups like the American College of Obstetricians and Gynecologists calling for their inclusion. This is an issue, said Dr. Kathleen Neuzil, co-director of the National Institutes of Health’s COVID-19 Prevention Network, because many in the health care field are women.

A Society for Maternal-Fetal Medicine statement recommended that health care workers be offered the vaccine if pregnant, and that in general, pregnant women should have access to vaccines in future vaccine campaigns.

Dr. Emily Miller, assistant professor in the Division of Maternal-Fetal Medicine at Northwestern Medicine’s Feinberg School of Medicine, said unknowns have to be “balanced against the risk of not getting the vaccine, which is the risk of acquisition of (COVID-19), which has concrete and well-documented risks. ... Through that lens, if we can remember that there is no zero-risk option, then the balance at this point favors receiving the vaccine.”

Should breastfeeding moms receive a vaccine?

The Centers for Disease Control and Prevention, along with American College of Obstetricians and Gynecologists guidance, says lactating women should be offered the vaccine.

Because breastfeeding and lactating women were not included in initial trials, data is limited about how the COVID-19 vaccines might impact them. The Academy of Breastfeeding Medicine noted the limited data but also noted that vaccines generally do not affect the safety of breastfeeding.

Despite the CDC guidance that women should be able to speak with their provider and make their own decisions regarding the vaccine, some localities might exclude them. Last week, Kane County reversed a decision that had denied vaccines to pregnant and breastfeeding women even if they were otherwise eligible.

I completed my doses of the Pfizer vaccine. Days later, I was prescribed a steroid and antibiotic. I am concerned this might blunt or diminish the vaccine. How can I determine if the vaccine will still be effective? Should I get an antibody test to determine efficacy?

Dr. Michael Lin, a Rush University Medical Center infectious disease specialist, said that right now, antibody testing is not recommended to assess immunity to COVID-19 after vaccination, partly because reliable tests are not commercially available.

Many of the antibody tests are not designed to test for the vaccine-generated antibody, he said, so these tests would be expected to have negative results, which could lead to false anxiety.

As far as medications, Lin said that, in general, medications will not interfere with COVID-19 vaccines. “A potential exception would be medications designed to suppress the immune system, such as steroids,” he said. “At this time, data are not available to establish vaccine safety and efficacy in people who are taking immune-suppressive medications.”

But he added that he agrees with the Centers for Disease Control and Prevention statement that people with immunocompromising conditions might be at increased risk for severe COVID-19, and that they may receive the vaccine if “they have no contraindications to vaccination.”

CDC guidance adds, “However, they should be counseled about the unknown vaccine safety profile and effectiveness in immunocompromised populations, as well as the potential for reduced immune responses and the need to continue to follow all current guidance to protect themselves against COVID-19.”

It’s hard scheduling a vaccination appointment. Is there a site that makes it easier?

The hunt for COVID-19 vaccines has seemed like a part-time job for some, and stories of people venturing to other neighborhoods to get them are plentiful. Starting Feb. 2, Chicago began promoting use of Zocdoc, a national website that allows people to find and schedule COVID-19 vaccination appointments from some local vaccination sites, including those operated by AMITA Health, Erie Family Health, Innovative Express Care and Rush University Medical Center.

Don’t be worried if appointments for February are already full, said public health Commissioner Dr. Allison Arwady. The process is going as expected, Arwady said, and residents should register their emails for notifications about future availability. Zocdoc will allow people to sign up to be notified when new appointments are available.

Suburban Cook County residents can make appointments through the Cook County Public Health site. Illinoisans can go through the Illinois Department of Health and enter their ZIP code to find vaccination locations and get appointment information.

— Gregory Pratt, Alice Yin

What if I get one dose of the vaccine but don’t follow up for the second?

According to the Journal of the American Medical Association (JAMA), it is not known what will happen if a person gets only one dose — partial immunity and a higher risk of susceptibility to a variant that causes COVID-19 are two possibilities. There is no evidence that people who get only one dose have adequate long-term protection against COVID-19 infection.

The Centers for Disease Control and Prevention (CDC) recommends the second dose of the COVID-19 vaccine be given within three weeks of the first dose for the Pfizer vaccine and within four weeks for the Moderna vaccine. No more than six weeks should lapse between doses.

If the second dose is not given during these time frames, it can be given without the need to repeat the first dose. Earlier doses of the second shot are not recommended, but if a person needs to get a second dose earlier, giving the second dose up to four days ahead of schedule is allowed.

Should people wear 2 masks to lower the risk of spreading the coronavirus?

U.S. infectious disease chief Dr. Anthony Fauci says using two masks instead of one is a common sense move and one recommended as more-contagious virus variants continue to spread in our country.

According to Fauci in a ”Today” show interview Jan. 25, adding a second barrier against the virus is likely to prevent droplets and the virus from getting in.

“If you have a physical covering with one layer, you put another layer on — it just makes common sense that it likely would be more effective. And that’s the reason why you see people either double-masking or doing a version of an N95 (mask),” Fauci said.

“A mask is like an obstacle course for particles to get through,” said Linsey Marr, an expert in virus transmission and a professor of civil and environmental engineering at Virginia Tech.

“Adding a second mask adds another obstacle course, increasing the chance that the particle will be trapped before it gets through to the other side,” she told AARP.

According to Dr. John Brooks, chief medical officer for the Centers for Disease Control and Prevention COVID-19 response team, the CDC doesn’t yet have data about double-masking, but scientists are studying it.

By using “a cloth mask with a very high thread count over a medical mask ... the medical mask acts as a filter, and the cloth mask over it adds to that filtration but also ensures a better fit to the contour of one’s face,” Brooks said in an Infectious Diseases Society of America Zoom briefing Jan. 29.

— Molly Bilinski, Morning Call

Is anyone studying how vaping affects a COVID-19 outcome?

Dr. Nora Volkow, director of the National Institute on Drug Abuse (part of the National Institutes of Health), says there is research/data being collected from the vaping population. While relatively new, there are published reports that look at the association between vaping and the risk of getting infected with coronavirus and/or developing symptoms. A national online survey conducted in May 2020 of people aged 13-24 revealed those with a history of e-cigarettes and vaping showed a significant increased risk of being infected with COVID-19, five times higher.

“Vaping poses inflammatory changes in the pulmonary airway,” Volkow said. “And if you have an inflammation, you are much more vulnerable to being infected with viruses or bacteria.

You have two conditions – vaping and COVID-19, both of them harming the pulmonary epithelium, and you can see why it is very likely that in this case, if you are vaping you are at higher risk of not just infection but worse, the outcome. The recommendation across the world of pulmonary specialists is try to avoid smoking, vaping or putting anything in your lungs, that can harm them.”

How can I schedule my second shot?

The second dose of the Moderna shot is supposed to be given 28 days after the first, and the second dose of the Pfizer shot is supposed to be given 21 days after the first.

Many pharmacies and health systems are scheduling second shots, on-site, right after people receive their first ones. University of Chicago Medicine is typically scheduling people for their second shots when they get first doses, and if they don’t schedule at that time, they get electronic reminders to do so. At Rush University Medical Center, the clinician who gives a person a shot also books that person for their second one, Quick said.

Some people reported trouble scheduling a second shot at Walgreens, but the Walgreens website has been updated to allow people to schedule first and second doses at the same time, said spokesman Phil Caruso. People who already got a first shot at Walgreens without being able to schedule a second one will be contacted with steps to make their second dose appointments, he said.

Mariano’s, Jewel-Osco and Walmart are scheduling second shots when people get their first shots.

— Lisa Schencker

What if I can’t get my shot 21 days or 28 days after the first?

People shouldn’t panic if they can’t get their second doses on day 21 or 28, said Dr. Michelle Prickett, an associate professor of medicine in pulmonary and critical care at Northwestern University’s Feinberg School of Medicine.

Those are the recommended times for the second doses, but there is wiggle room. Those second doses may also be given, if necessary, up to four days earlier than the recommended time or as late as within six weeks of the first dose, according to the Centers for Disease Control and Prevention.

As long as people receive their second doses within that six-week time frame, “It should be effective,” Prickett said.

— Lisa Schencker

Do all Cook County ZIP codes work for the county’s vaccination program?

Yes. Despite a technological snafu Jan. 27, all Cook County ZIP codes should work on the website for the Cook County Community Vaccination Program, where people can sign up for vaccine updates, distribution locations and notification of when vaccine administration is open to your phase.

Put in your ZIP code for more information here: https://vaccine.cookcountyil.gov. People should get an email with their phase and a confirmation number.

Do I have to prove I’m 65 or older or an essential worker to get a shot?

In some places, yes, and in other places, no. Loyola, for example, is asking older patients to bring an ID with date of birth, and essential workers to bring proof of their employment, such as a letter from their employer, a pay stub, a work ID or a uniform to their vaccination appointments, Gupta said. Loyola is turning away people who cannot prove they’re eligible.

Cook County Health asks for proof from essential workers when they check in at the county’s mass vaccination sites, such as staff IDs, professional license numbers or certificates, pay stubs, signed letters from employers or a uniform.

Others, however, are taking a different approach. Rush is asking people to bring a photo ID, but otherwise is not asking essential workers for proof of employment, Quick said.

Walgreens’ website says people should bring work IDs or other documents showing proof of employment to their vaccination appointments if they’re front-line, essential workers.

— Lisa Schencker

What kinds of side effects might I experience from the vaccine?

The most common side effects are pain at the injection site, fatigue, headache and muscle pain, though people may also have chills, nausea and/or vomiting. Most side effects go away within a few days. Side effects are mostly mild to moderate, according to the CDC.

— Lisa Schencker

Is it true that side effects are more common with the second dose than the first?

Yes, said Prickett. The side effects typically only last for a day or two but most commonly include fatigue, headache and/or muscle pain. With the second dose of each vaccine, higher percentages of people in clinical trials experienced fatigue, headache or muscle pain than with the first dose, according to the CDC.

“It’s essentially restimulating your immune system to think it’s trying to fight the virus again,” Prickett said. “Most people who are vaccinated are having an immune response, and it’s just an indicator their immune system is trying to make antibodies to the virus.”

— Lisa Schencker

When should someone seek medical attention because of side effects?

Severe reactions, such as an allergic response, are rare, and typically occur within 15 minutes of receiving the shot, which is why patients are generally being observed for 15 minutes after being vaccinated, Prickett said. People, however, should seek medical attention if they’re experiencing high fevers after a shot, altered mental states, gastrointestinal issues with dehydration, or if they pass out, she said.

— Lisa Schencker

Will we see 100 million doses of the vaccine delivered in the next 100 days?

As this week marks the one-year anniversary of the Centers for Disease Control and Prevention’s first confirmed coronavirus case in the United States, the CDC has a new director, Dr. Rochelle Walensky. She spoke to the Journal of the American Medical Association’s network Jan. 19 about President Joe Biden’s goal of delivering 100 million doses of COVID-19 vaccine within the first 100 days of his presidency. This was on the heels of the announcement of four new Cook County vaccination locations (available for health care workers who are part of phase 1a before opening to those eligible for phase 1b on Jan. 25).

“I don’t think the (president) would have suggested 100 million doses for the next 100 days if he, his team, and we didn’t have a vision about supply,” Walensky said.

“There are four prongs to this that Biden and the team is working on:

  • One is community vaccination centers, be it stadiums, gymnasiums, things like that.
  • Another is mobile units, making sure we can do the outreach to get to those communities who otherwise wouldn’t be reached.
  • Another is for federally qualified health centers. Some of that is happening, but not as much as could be happening across the States.
  • And finally, a pharmacy program — working closely with the States and the pharmacies to make sure we can do outreach at the pharmacy level.”

Will the distribution of the vaccine be fair?

“The vision of that four-pronged approach to places is really founded in equity,” Walensky said. We want to make sure that we can deliver volume, but also volume to the people in places that might be harder to reach, and then this collaboration of the federal level to make sure that with the entire support and resources available at the federal level to work with states in order to do that distribution.”

Robert Wachter of UCSF School of Medicine and Paul Offit of The Children’s Hospital of Philadelphia spoke about vaccine doses in another virtual conversation with the JAMA Network. Wachter said the rollout has been sluggish.

“I think what we had was a lot of well-meaning groups try to parse this around to which groups should be prioritized using ethical principles and redressing health care disparities,” he said. “All correct, but I don’t believe there was a whole lot of discussion about the practical implications, someone saying, ‘How the hell is this going to work?’

“The more complex a system is, the less equitable it is likely to be. Who is going to be able to figure out their way around the system? It’s going to be the well-to-do, it’s going to be the privileged — exhibit A is the tax code. And so, what our fear was in a perfectly well-meaning effort to get the ethics right, we have created a monster — an absolutely, unworkable mess of a system that was going to be confusing. And ultimately, inequitable, even though the goal was equity,” Wachter said.

“Our recommendation: We go back to the drawing board and start with the groups that we started with: health care workers and people in nursing homes, and then go to age,” he said. “The advantage of age is it’s completely knowable, stores know how to card people, everybody has identification that shows their age. When you’re done with 55 and above, you go to a lottery. And the lottery this week, the number we pulled is a No. 3. If the last number in the year of your birth is the number three, it is your week. Congratulations. You go and get your shot.”

How effective will the vaccines be on COVID-19 variants?

“I think with regard to the variants,” Walensky said, “we worry about four things: increased transmissibility, increased morbidity and mortality, and then, how robust our vaccines and our therapies are in tackling them when they arise. We will probably be doing most of the detection and the surveillance at the CDC level,” she said.

“I think the good news with regard to the variants is that the efficacy of the vaccine is so good and so high that we have a little bit of a cushion. So that even in the lab some of these variants don’t appear as robust as the initial strain that we’ll probably still end up with quite a good vaccine.

“I just want to remind people almost no vaccine we have is 95% effective. So, before we panic and say, ‘Well, should I really get the vaccine if it’s not going to work against the variant?’ It’s going to work against the variant. Will it be 95%? Maybe. Will it be 70%? Maybe. But our flu vaccines aren’t 70% effective every year, and we’ve still got them. So, so I’m really optimistic about how these variants are going to go.”

How can Chicagoans get information on when a vaccine might be available to them?

Although public registration to get in line for a vaccine is not yet available, Chicagoans can find vaccine updates at chicago.gov/COVIDvax. As the rollout progresses, the Chicago Department of Public Health will update the website with registration and clinic information.

The city is expanding its network of vaccination sites, called Points of Dispensing, or PODs, in preparation for vaccine rollout to the general public. By next week, the city will have six PODs, Mayor Lori Lightfoot said Jan. 14.

The city-run sites, similar to the city’s COVID-19 testing sites, will be in addition to several thousand established providers — doctors’ offices, pharmacies and federally qualified health centers — ready to vaccinate Chicagoans when more doses of the vaccines become available, Lightfoot said.

Health care workers, who are already eligible under the current phase 1a, can make an appointment to receive a vaccine at a POD site. A representative from their health care facility must complete the Staff Vaccination Inquiry Survey, which is available here.

Why does COVID-19 pneumonia last longer and cause more damage than typical pneumonia?

Northwestern Medicine researchers sought to answer this question in a study published in the journal Nature on Jan. 11. They found that COVID-19 spreads across the lungs in a way unlike other types of pneumonia. Instead of rapidly infecting large regions of the lungs, the virus causing COVID-19 plants itself in multiple small areas across the lung, researchers said. It uses the lungs’ own immune cells to spread in a way that researchers described as like multiple wildfires spreading across a forest. This drives the disease over a slower and longer course than what doctors see with influenza.

Northwestern will be testing an experimental drug that targets COVID-19 pneumonia.

When will vaccines be available for children? What is the approach for them?

Initial vaccine trials excluded children. But experts have called for COVID-19 vaccination trials for young children to begin, reported the Tribune’s Madeline Buckley.

It will still be at least months before vaccines could become available for children, because these trials need to be replicated with children as test subjects. Doctors, including American Academy of Pediatrics president Dr. Sally Goza, have called for children to be included; officials will need to understand both whether vaccines are safe and effective in children, as well as proper dosing.

A Pfizer spokesperson told Buckley that the company is “working actively with regulators on a potential pediatric study plan.”

According to CNBC, Moderna has begun a study testing the vaccine in adolescents as young as 12, which might be done by fall, but said study data for younger children will take much longer, likely until 2022.

When might teachers receive vaccines?

Chicago Public Schools resumed some in-person schooling Jan. 4, but half of teachers did not show up, amid concerns about risks.

“It is absolutely possible for schools to be open, not driving community infection,” Dr. Allison Arwady, commissioner of the Chicago Department of Public Health, said Jan. 5.

Arwady said educators will be included in phase 1b. According to the Centers for Disease Control and Prevention, teachers and support staff members and child care workers should be vaccinated under phase 1b.

Educator access to vaccines has been part of the conversation as Chicago Public Schools considers its reopening plans.

Arwady said guidance from the Centers for Disease Control and Prevention allows moving onto future stages when several things happen: when demand seems to be met for those vaccinating under the current stage, and when the supply of vaccine increases. “We need more vaccine,” she said.

“We do intend to make vaccine available for anyone who is in public-facing settings,” she said.

She added that this means all kinds of educators, including those private and parochial schools as well as day care workers.

Does Chicago have enough vaccine?

Mayor Lori Lightfoot said Jan. 5 that with the level of vaccine the city has received so far, administering at least 33,607 doses of vaccine, it would take a year and a half to vaccinate everyone.

The city has distributed 95% of the vaccine that officials have received, Lightfoot said. But she added, “We do not have enough vaccine.” She has asked both the outgoing and incoming federal administrations for an increase in the amount of the vaccine to the city.

“If you want to have us bend this curve, and give people confidence that they can resume their normal lives, there must be an exponential increase in the amount of vaccine that’s available to cities and towns all over the country,” Lightfoot said.

I am in the high-risk category for COVID-19. I’m an Illinois resident but out of state for the next six months. Am I eligible to receive the vaccine in the state I am visiting?

According to Dr. Kevin Most,a board-certified physician in family medicine and chief medical officer and senior vice president for medical affairs at Northwestern Medicine Central DuPage Hospital, the issue is going to hinge on whether the reader has a physician who will identify her as being high risk.

“We’re getting to this 1B, 1C rollout, where we’re starting to take care of people over the age of 75 — that’s easily done with a driver’s license,” he said. “Those between the ages of 16 and 64 in that 2B (rollout) with complications or vulnerabilities — that certainly is going to take a physician to identify you as having diabetes or COPD. We’re making sure we vaccinate people in the right stratification regardless of where they’re at. I can’t speak for whatever state she’s in, but you would hope that if she has proof that she falls into what would be the 1C category, that they would honor that. When she’s back here, the vaccine should be out to the general public.”

I am a nurse who tested positive with coronavirus in November. I had mild symptoms and recovered. What are the findings related to people with past histories of virus exposure and the vaccine?

“We’re asking any health care workers who know that they have tested positive for COVID-19, and done well, to hold off getting the vaccine for 90 days,” Most said. “We don’t have enough vaccine to get to all the front-line workers, and we know that these individuals who had COVID-19 have some natural immunity. That being said, individuals who had COVID-19, we certainly will vaccinate them.

You’ve had influenza before, do we give you another influenza shot? Absolutely ... it’s essentially a booster. With this illness, it’s very clear we have many people who are asymptomatic, but yet had the illness. We’re not sure exactly how strong their immune system is, so the ability to give them a booster with the vaccine is going to be one of the ways that we’re really going to fight and control the spread.”

When will vaccine testing on those 16 and younger begin?

“I think you’ll start to see clinical trials right now for pediatric patients, probably 10 and above or 12 and above,” Most said. “They were excluded from all the clinical trials, which is not something that’s that surprising. This illness obviously was hitting seniors and older individuals with co-morbidities. For them to say we’re going to focus on this population — we’re going to exclude children, we’re going to exclude women who are pregnant — made total sense because it allowed them to get to the finish line with a safe vaccine quicker. So, I think you will start to see, now, rollouts of clinical trials with children, just after the 1st of the year.”

I agreed to watching a friend’s pets while she is out of town. I will not be in direct contact with her, however I am nervous about the apartment. How long before the danger of inhaling the virus is gone?

“If they’re going to be gone for two months or three weeks, cleaning the house once is perfect,” Most said. “Be careful of any surfaces you touch. We know that the virus can survive on surfaces for a while. As long as you are wearing a mask and don’t touch the surface and then your mouth or your face very quickly, you’ll be fine. Someone who is going to take care of a dog in a house, If they wait for 24 to 48 hours, after walking the dog a couple of times and they’re going to do it the next week, you don’t have to wash the surfaces every day.

“Now, if you have a neighbor who can’t get out to walk their dog, and you’re going to go walk the dog for that individual, you’ve got to be a little bit more careful. Wash your hands prior to going in, make sure you wear a mask, wear gloves. Walk the dog. When you bring the dog back and hand the dog off again, wash your hands. The goal is to not be around somebody for more than 15 minutes who potentially could have the illness that you don’t know about. For the long-term care of a home when someone’s gone, don’t be concerned.”

Should Americans be concerned about the highly contagious new variant of the coronavirus circulating in England?

British officials recently have expressed alarm about a highly contagious coronavirus mutation circulating in England. According to University of Chicago Medicine’s Dr. Allison Bartlett, who specializes in the medical management of acute and chronic infectious diseases, it is important that Americans be aware that this variant has been detected. But because scientists actively have been looking for potential variants throughout the pandemic, news of mutations lets us know that the process is working.

“This variant has multiple mutations, several of which are in the spike protein, which is important for attaching to host (human) cells and which is the target for the currently available vaccines,” she said. “There are many parameters that influence transmission of SARS-CoV-2 (COVID-19). The structure of the virus is one important parameter, but the behavior and environment of the population is critical as well. Mask use, physical distancing, ventilation, hand-washing all impact the risk of transmission, and will remain effective and essential components of controlling the pandemic.”

Bartlett says the mutation news does not have an impact on vaccination plans in the United States because there is no evidence to suggest that the spike protein in the variant is distinct enough that the current vaccines will not be effective.

“The virus (as with all viruses) is constantly mutating. Many mutations lead to dead ends; some lead to virus that can be spread from person to person,” Bartlett added. “Our hope is that when millions of people are vaccinated, there will be less virus circulating in the community and, therefore, fewer opportunities for mutations to develop. However, if a mutant virus develops that is not susceptible to the vaccine-derived immune response, that strain could spread from person to person if people have let down their guard and are not masking, physically distancing, etc.”

How can the medical field ease COVID-19 vaccine hesitancy in communities of color?

While the pandemic has affected all of our lives, it has disproportionately affected Black and brown communities. Over one-third of Black adults in a June survey said they knew someone firsthand who’d died after contracting COVID-19. And yet, in a recent poll, fewer than half of Black Americans said they would take the coronavirus vaccine. Drs. Brandi Jackson and Brittani James discussed COVID-19 and the Black community in a Chicago Tribune Facebook Live. James, a family practitioner with the University of Illinois health system and assistant professor in the Department of Family and Community Medicine, offered some suggestions on how to alleviate vaccine concerns for those in the Black community:

“Think of the people who will be trusted by the Black community, who are already trusted by the Black community,” she said. “I’m talking about Black church leaders. We turn to local community centers, we turn to local activists, nonprofits. Those are the people and the institutions, really, that the Black community trusts. So, any intervention that is serious about getting their buy-in, you have to go through these authorities in the local community, Black and brown communities, to spread that message (to take the vaccine). From everything that I can evaluate, this is safe, not just for white people, for all people.”

Jackson, director of Integrative Behavioral Health at Howard Brown Health Center and an adjunct professor of psychiatry at Rush University Medical College, agreed and suggested that Black and brown communities read the vaccine research and data, and then make an informed decision.

“When you’re making your assessment, don’t fall into the trap of only attending to the potential side effects,” she said. “The question people need to be asking is: How does that compare to what happens if I don’t get the vaccine? How does that compare to my risk of contracting and passing away from coronavirus? That number is so far from zero, that risk is not negligible, particularly if you’re in the Black community. We know that being a Black person in America right now, your risk is higher than a white person of contracting and dying from COVID-19. So, you should think about that.”

How long does it take before the vaccine is effective in the body?

The vaccine starts to work right away within the body, said University of Chicago Medicine infectious diseases expert Dr. Emily Landon. In a Chicago Tribune Facebook Live, Landon explained how it signals our immune system: “We create molecules that have our body make the proteins that basically act like a wanted poster for your immune system. They say, ‘This is what you’re looking for. When you find this, kill it.’”

Although the vaccine starts to work right away, how long it takes until you’re immune or able to fight off the disease is hard to say. Landon said with the Pfizer vaccine, about half of the time, data showed people had antibodies a few weeks after getting the vaccine. Researchers are still learning about how long this might protect people.

According to the Centers for Disease Control and Prevention, it typically takes a few weeks for the body to provide protection, so it is possible that a person could be infected and become sick with COVID-19 just before or just after vaccination.

What will distribution of the vaccine look like?

The first thing to understand, Landon said, is “it’s not a single-file line.” Rather, when the vaccine is released to approved populations, it will be groups of people that are first priority, second priority, third priority.

“It’s not like Southwest boarding, it’s more like United boarding,” Landon said.

Groups of people will be able to get vaccines all at the same time. And this is important to understand because there might not be enough vaccines for everyone in those groups on the first day a group is able to be vaccinated. So there might be some waiting, but, Landon added, “It doesn’t matter too much in the grand scheme of things if you get vaccinated this Wednesday or next Wednesday.”

She added that you don’t have to go when your group is called. You can wait until the next group, if you still have some concerns about some aspects of the vaccine. For example, some people who are pregnant are assessing whether to get a vaccine. Landon won’t wait. “I am raring to go. I am signing up right away for my first time.”

Given the speed with which these vaccines were developed and tested, what long-term safety concerns, if any, do you have?

Landon emphasized that there aren’t long-term consequences of other vaccines we already know more about. And for any issues that vaccines can cause, “They start upfront. They don’t start 10 years later.” So with the data we already have, we should have a good sense of what to expect.

“The short-term problems are all mild,” she said. “They may not feel awesome to you, because you have a pretty bad headache and you may feel really tired afterwards. But that is way better than having COVID.”

Headaches can be expected after the vaccine, she said, but with most people it goes away with Tylenol and within 24 hours, she said.

What should people with allergies know about the Pfizer vaccine, now that British regulators are investigating 2 possible allergic reactions?

First, don’t panic, says Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center and former board member at the Infectious Diseases Society of America. The recent news of possible allergic reactions is “a bit of a surprise,” he said, as this did not occur during Pfizer’s clinical trials. But varying things can happen after a person is vaccinated — we are, after all, giving them to many different people.

The system is working as it should, he said. Experts have detected this issue, and British officials are going to investigate further. “And they’ve said in the meantime, all you folks who have had allergies to other things, stand aside for the moment, and we’ll call you when we’re comfortable with this,” Schaffner said.

If someone has already had COVID-19, could they still get the vaccine?

Yes, Schaffner said. In fact, experts hope the vaccine will offer even more robust protection than whatever protection someone gets from the infection itself. “If you’ve had COVID before, that’s OK,” he said. “You’re not going to have a more severe reaction to the vaccine or anything like that.”

How long will the vaccine give people protection from COVID-19?

It’s hard to say, Schaffner said, and he knows this might be an unsatisfactory response. He, too, is eager to find out. “Just as soon as we start vaccinating a large number of people that will be assessed, and we’ll just have to stay tuned for further information down the road,” he said. He would not offer any estimate, saying this is a new vaccine and a distinctive virus, and more data is needed.

Does alcohol compromise the immune system? If so, should people limit or stop drinking during the pandemic?

The Zoom happy hours have added up. With Thanksgiving in our rearview mirror and more holidays on the horizon, opportunities for drinking are all around us.

The full impact of COVID-19 on alcohol use is not yet known, but rates of alcohol usage have been rising during the pandemic. According to the World Health Organization, alcohol compromises the body’s immune system and increases the risk of adverse health outcomes. The organization suggests people minimize their alcohol consumption — particularly during the pandemic. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has issued communications warning people to avoid excessive drinking.

According to NIAAA Director George Koob, people who choose to consume alcohol should follow the U.S. Dietary Guidelines.

“A person’s pattern of alcohol consumption can have an impact on health,” he said. “The current 2015-2020 guidelines suggest limiting drinks to up to one drink per day for women or two drinks per day for men. Having one drink per day is not the same as having seven drinks all at once in a single day. It’s best to spread them out as recommended in the guidelines.”

Need to get tested for COVID-19? Here’s how to find the most convenient and affordable options.

To get the most convenient, affordable and reliable COVID-19 test possible:

Start with your primary care doctor; many doctors offer in-office testing. If you don’t have a doctor who does testing, then rapid testing, in-home testing or drive-thru testing are options. If an option is not affordable enough or closed to you due to restrictions, try crowdsourcing information to get up-to-date information about local testing sites, appointment availability, cost and wait times.

Looking for a rapid test with same-day results? Those tests are best for people who actually have COVID-19 symptoms, said Heather Keirnan, a nurse and vice president of operations for Northwestern Medicine Immediate Care. If you don’t have symptoms, the PCR test, which can detect very small amounts of the coronavirus, is a better choice, she said.

Northwestern and other local hospitals and state drive-up testing sites offers PCR tests. Northwestern offers drive-up testing for those with Northwestern doctors’ referrals in Wheaton, Aurora, St. Charles, Bartlett, Glenview, Vernon Hills, Sycamore, McHenry and Huntley, and both drive-up and walk-up testing at Northwestern Memorial Hospital in downtown Chicago.

For free tests, your options include state drive-up sites in Arlington Heights, Harwood Heights and South Holland. Tests are free for those without insurance; if you have insurance, bring your information, and the state will submit a claim.

The city of Chicago and Cook County also offer free testing.

For those who care more about convenience than cost, private clinics offer shorter waits. Many require upfront payments of $175 to $300. If you want to submit a claim to your insurance company, check the rules for coverage. Your insurer may require that you are referred for testing by a doctor.

Is it OK to travel if you’re in good health?

In a Nov. 19 “What The Health?” podcast from Kaiser Health News, Dr. Anthony Fauci said traveling “depends on your individual circumstances,” and that, “If you’re a 25-year-old person who has absolutely no underlying conditions, that’s much different than a 75-year-old person, a woman who’s on chemotherapy for breast cancer.”

Is it OK to travel if you don’t have any co-morbidities, and is it possible to do so safely? The short answer is no, according to Dr. Gregory Poland, professor of medicine and infectious diseases at the Mayo Clinic.

“It’s not a good idea,” said Poland, who is also director of the Mayo Vaccine Research Group. “What (Dr. Fauci) meant when he said that was your individual risk. But that’s only one side of the coin.

“The other side of the coin is the more times you bring more people together, the greater the risk for super spreader and transmissibility,” he continued. “So that healthy 22-year-old may have an upper respiratory mild symptom, or no symptoms at all, and yet can spread the virus to the people he walks by, or sits next to, or in that airplane with him. So it actually does add risk.”

Poland predicts that there’s going to be a “continued exponential increase” in COVID-19 cases, followed by increases in hospitalizations and deaths, he said. “So it makes absolutely no sense to be traveling right now — unless you have no possible alternative.”

What about driving, instead of taking a train or plane?

To some degree, that does cut down on exposure, as it decreases the number of people you’ll encounter and who will encounter you, Poland said. Yet, the current surge stems from small gatherings, he said.

“Here’s what’s driving a lot of this current surge: It is this seemingly deceptively safe family gatherings and small group gatherings,” Poland said. “So when your relatives drive a day or two to come and see you, now both of you are trading whomever you’ve been in contact with at school, work, church (or) whatever it might be, and so you’re just giving more and more opportunity.”

Suppose everyone quarantines for two weeks before driving?

“The real question is: What could we do to be absolutely sure we’re not going to get infected or infect other people?” proposed Poland.

He set up a hypothetical scenario in which driving and quarantining could work, but acknowledged it’s a situation most people wouldn’t adhere to.

“You would drive, you would quarantine — as you say — the two weeks before,” he said. “You might even get a test to be sure that even though you’re asymptomatic, that you’re not infected. You would then drive without staying in a hotel or going to restaurants. You’d have a procedure for how you’d get gas and go to the bathroom.”

Once you arrived, you’d ideally not stay in the same house as other family members, or at least sleep on different floors, he said. When sharing common areas, everyone would wear masks and maintain their distance. Meals would have be to eaten in separate rooms.

“So do you really want to do all that?” Poland asked. “Or do you want to say, like our family is saying, ‘We’re really thankful that everybody’s in good health, and we want everybody to stay healthy’?”

I tested positive. I isolated. Now what?

Once all symptoms are gone, people can return to work and be with others 10 days after testing positive, said Mercedes Carnethon, vice chair of preventive medicine at Northwestern University Feinberg School of Medicine. A negative test isn’t needed, unless someone’s workplace or school requires it.

If people test positive, they should isolate themselves immediately, said Robert Citronberg, Advocate Aurora Health’s executive medical director of infectious disease and prevention. Isolate for 10 days from the onset of symptoms. If someone tested positive but never had symptoms, they should isolate 10 days from the date of the positive test.

Here’s the good news: those who test positive can still go outside. “Truthfully, if you’re cooped up inside your house for 10 days you may go a little stir crazy,” Citronberg said. They should wear a mask and avoid being close to people, but it’s OK to get some fresh air.

What can college students do to best protect themselves and their families when they come home?

No matter what students do, it won’t be without risk, Citronberg said. If any family members at home are high risk, students should be especially cautious. He recommends two layers of testing — one test before leaving campus and another three days after returning home.

Here’s what he acknowledged will be the tough part: Until you have passed the 14-day incubation period, everyone should remain masked inside the home except while eating. Families should try to eat separately. He recommends remaining masked until 14 days after the student last had other social contact.

“This is awkward,” he said. “It’s not something people are used to when kids come home.”

Most importantly, college students should be limiting their social gatherings now. “Every day you do that will decrease your chances of having infection,” he said.

I isolated for 14 days before seeing family. Is that enough?

Citronberg said if people isolate themselves for 14 days and do not experience symptoms, that should be fine, even without a test.

Northwestern Medicine pulmonologist and critical care physician John Coleman said people often plan to isolate for two weeks in order to feel secure in visiting loved ones.

“But in my experience, this degree of caution doesn’t happen,” he said. “The minute you leave the house, even just for a coffee or gas, that invalidates the quarantine.”

Should a vaccine be mandated?

Chicago’s health commissioner Allison Arwady recently said there likely won’t be enough doses of the vaccine to go around when it first becomes available.

But eventually, should a vaccine be mandated?

It might be mandated for people at high risk, but likely not for the general population, said Tina Tan, pediatric infectious disease physician at the Feinberg School of Medicine. She noted there is not enough information about how these vaccines might impact children or pregnant women, for example, who have not been included in trials.

“The vaccines can be strongly recommended but (it) probably would not be a good idea to mandate their use,” she said.

Lori Post, director of Northwestern’s Buehler Center for Health Policy and Economics, said vaccines can sicken people with some autoimmune disorders, and there is little information on adverse effects at this point.

“Better strategies than a blanket vaccine mandate would be to prohibit children from attending schools or universities, employees from presenting to the office or block people from group events who are unvaccinated,” she said.

Pfizer says its COVID-19 vaccine may be 90% effective. The vaccine uses genetic code that trains the immune system to recognize the spiked protein on the surface of the virus. How does it work?

Pfizer Inc.’s Nov. 9 announcement comes on the heels of the pandemic having killed almost a quarter-million people in the United States, according to The Associated Press. Dr. Anthony Fauci, the U.S. government’s top infectious-disease expert, said the results suggesting 90% effectiveness are “extraordinary.”

Pfizer, which is developing the vaccine with its German partner BioNTech, is among four candidates already in huge studies in the U.S., with still more being tested in other countries. Another U.S. company, Moderna Inc., also hopes to file an application with the U.S. Food and Drug Administration this month. Neither company’s shot is made with the coronavirus itself.

Instead, the vaccine contains a piece of genetic code that trains the immune system to recognize the spiked protein on the surface of the virus. It’s called a messenger RNA vaccine. (A refresher on basic biology: DNA is transcribed, or copied, into RNA, which then makes proteins that carry out the actual work of living cells. Molecules called messenger RNA are couriers that carry instructions from DNA to proteins.)

Chemist and biochemist Chuan He, the John T. Wilson Distinguished Service Professor in the Department of Chemistry and Department of Biochemistry and Molecular Biology at the University of Chicago, says what Pfizer has done has taken advantage of the basic knowledge about messenger RNA generated in the last several decades.

“mRNA therapy in the vaccine field supplies proteins that mimic viral proteins to induce an immune response,” he said. “mRNA comes in, will express the encoded protein for a period of time to elicit an immune response, then the immune cells will keep this memory. The RNA is gone and your body goes back to its normal state, but your immune cells have been trained by the presence of this foreign protein produced from the delivered mRNA.”

Pfizer’s news, however, doesn’t mean a vaccine will be here soon. Pfizer’s study is continuing, and the company cautioned that the protection rate might change as more COVID-19 cases are added to the calculations. Scientists have warned for months that any COVID-19 shot may be only as good as flu vaccines, which are about 50% effective and require yearly immunizations. Earlier this year, Fauci said he would be happy with a COVID-19 vaccine that was 60% effective.

Many questions still need to be answered, including how long the vaccine’s effects last and whether it protects older people as well as younger ones.

Confirmed COVID-19 infections in the U.S. eclipsed 10 million on Nov. 9, the highest in the world.

Can you explain the new colors and the changes in Chicago’s quarantine travel list?

Chicago’s travel quarantine list moved Nov. 10 from a list of states under travel quarantine orders to a color-coded list comparing the rate of infection here with other states. Under the original version of the emergency travel order, states were added to the list when they had an infection rate higher than 15 cases per 100,000 residents and were removed once the daily case average remained below that rate for two consecutive weeks. The city’s new color-coded list will be updated every two weeks.

Here’s what you need to know:

  • Yellow states are those with a rolling seven-day average below 15 cases per day per 100,000 residents. Travelers returning from these states don’t have to quarantine.
  • Orange states are those with a rolling seven-day average between 15 cases per day per 100,000 residents and Chicago’s rolling seven-day average. People traveling from these states must either quarantine for 14 days or show they had a negative COVID-19 test no more than 72 hours before arrival in Chicago.
  • Red states are those with a rolling seven-day average above Chicago’s. Anyone traveling from these states has to quarantine for 14 days.

Visitors of red states will face fines of $100 to $500 per day if they don’t quarantine, according to the city. Those who visit orange-listed states are subject to the same fines if they don’t have a negative COVID-19 test or quarantine.

There are exceptions based on how long travelers spend in the listed states. People who commute across the Indiana or Wisconsin state line to or from Chicago to work or go to school will be exempt from the quarantine rule. But workers in Chicago from Indiana will be expected to avoid restaurants, bars and other public spaces in the city. Read on for the rolling list of states on Chicago’s orange and red lists.

— Katherine Rosenberg-Douglas

Should you get tested for COVID-19 before a gathering?

The Illinois Department of Public Health encourages people to get tested before and after any gatherings and to curb activities outside their homes before getting together. The Centers for Disease Control and Prevention says the lowest risk plans include celebrating only with those who already live in your home, or a virtual dinner with friends and family.

Dr. Michael Lin, an infectious disease specialist at Rush University System for Health, said he doesn’t recommend testing as a prelude to holiday gatherings.

“Testing, in general, only applies to the day of your test. It tells you something about your status,” Lin said.

Tests can have false negatives, but if they’re combined with 14 days of quarantining, they might help families get together more safely, said Dr. Rachel Rubin, co-lead for the Cook County Department of Public Health.

Dr. Robert Murphy, executive director of the Institute for Global Health at Northwestern University’s Feinberg School of Medicine, recommends people who choose to get tested do so as close to the event as possible — keeping in mind that some tests return results in 15 minutes and others take days.

“That’s not a perfect solution, but if you test everybody, that does give you some measure of protection,” Murphy said. “Nothing is 100% protective. There’s no right or wrong answer. It’s how much risk you’re willing to take.”

People who want to get tested for COVID-19 before the holidays are looking at two basic types of tests. One is an antigen test, which looks for specific proteins on the surface of the virus and often returns results within 15 minutes. However, it is not considered as accurate as the other type of test, a molecular test, such as a PCR test. Molecular tests detect the virus’s genetic material. It can take a day to a week for results, depending on the testing facility.

Sites like the 11 run by the Illinois Department of Public Health offer tests to everyone, regardless of symptoms. People can also take at-home, PCR COVID-19 tests, such as those sold through Osco Drug and Costco’s website.

— Lisa Schencker and Hall Dardick

Is a person likely to catch COVID-19 a second time? Is immunity real? If so, how long does it last?

“There have been proven cases of repeat infection (or ‘re-infection’) with COVID-19, although it remains rare,” wrote Dr. Mai Tuyet Pho, an infectious diseases specialist at University of Chicago Medicine, in an email.

Like other viruses, immunity is real, explained Pho, but the question is how long it lasts. In the case of COVID-19, it’s unclear.

“At this time the CDC estimates that on average immunity to COVID-19 lasts about 3 months, making re-infection before that time unlikely,” wrote Pho. “Chances go up the more someone is exposed to the virus.”

Is there any way to safely have an indoor gathering with a small group of family, around six people? Should we quarantine for two weeks prior or get tested before the gathering?

“Unfortunately, there is no risk-free gathering,” wrote Dr. Benjamin Singer, a pulmonary and critical care physician at Northwestern Memorial Hospital, in an email.

But, if you do choose to congregate with loved ones, he suggests keeping groups small and spending most of the time outside. Masks should be worn, said Singer, and social distancing rules should be followed. The risk isn’t gone, but these precautions can “reduce the risk of spreading COVID-19.”

Illinois Department of Public Health Director Dr. Ngozi Ezike said Nov. 5 that even though we all desire to spend time with friends and family, it’s best to sit it out. If not, she said previously, it could result in a funeral down the line.

Ezike urges people to not travel unless it’s a must, and if so, to drive if possible.

What is the risk of eating or meeting outside, and not socially distancing from people sitting at the table, especially when we’re all from different households and all have been following different levels of precautions?

While spending time outdoors has been said to lessen the risk of spreading COVID-19 to some degree, Singer reiterates that there is no “risk-free gathering.” In May, when the state was beginning to reopen and loosen restrictions after the quarantine period, the general rule of thumb for meeting up with friends was that outside is better than inside, and masks are better than no masks, said Dr. Emily Landon, executive medical director of Infection Prevention and Control at the UChicago Medicine.

What is the most recent breakdown of age groups that have died of COVID-19?

There have been 10,030 reported deaths in Illinois from COVID-19 as of Nov. 5 since the start of the pandemic. A breakdown on those deaths by age, race and gender can be found here. Data on available hospital beds and ventilators can also be found on the same page.

Is it safe to visit your doctors if you’re at higher risk now? What about colonoscopies and other scoping procedures?

“Patients should not defer necessary medical care, as long as it is provided in a safe environment,” wrote Pho.

She suggests finding out what safety measures your doctor’s office is taking, like remote check-in to limit waiting room time, screening before entering the facility, visitor restrictions, increased cleaning procedures, and 100% masking of staff and patients, among other things.

“The same rules apply for procedural areas,” she said. “Additionally, some providers require that patients undergo COVID-19 testing prior to procedures. For less urgent medical issues, some providers offer telehealth (or) video visits, which is the safest option.”

How serious is the potential for ocular transmission of COVID? Should I wear goggles when in proximity to others, like on an airplane or in a grocery store?

“The most common mode of transmission for the virus that causes COVID-19 is respiratory,” wrote Pho.

But transmission through the eyes is “definitely possible,” she said, even though it’s more rare.

“There are receptors for the virus present in the structures of the eye, but this route (of transmission) is less common,” explained Pho. “In situations where masking and social distancing can’t be guaranteed, such as in crowded places, or more enclosed areas like airplanes, I do recommend wearing eye protection. I also strongly recommend them for people who are knowingly in close proximity to someone who is infected, such as caregivers for household members with COVID-19.”

Could we make a big difference in hospitalization rates and death tolls by changing our diet and health habits? How does your personal health increase or decrease your chances of COVID-19 complications or death? Which health conditions are mostly linked to higher death tolls?

While pursuing a healthy lifestyle with good eating habits and regular exercise can be beneficial, Pho says prevention methods are the best way to evade COVID-19 and the complications that can come with it.

“Avoiding exposure to the virus through masking, social distancing and hand sanitizing are essential,” she wrote. “There is a theory that even if masks aren’t 100% effective at preventing all infections, they reduce the amount of virus ... that is inhaled, leading to an overall milder illness.”

Older age, pregnancy, medications that weaken the immune system and medical conditions including diabetes, chronic kidney disease, heart disease, obesity, sickle cell disease and more can increase the risk for severe complications or death in someone who has contracted the virus, said Pho.

Read more here for daily updates on the coronavirus.



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