What you need to know about the COVID-19 pandemic

Udayan K. Shah, MD

Updated 04/19/2020

DISCLAIMER: Please note, the following information is for informational purposes only and is not intended to be medical advice for your situation even if worded as such. For all emergencies, call 911. For all other questions, contact your physician.

What is COVID-19?

COVID-19 is the name of the disease caused by a special type of coronavirus. Coronaviruses are a family of viruses responsible for diseases ranging in severity from the common cold to SARS (Severe Acute Respiratory Syndrome). Coronaviruses derive their name from their "crown-like" appearance. The "spikes" of the crown are actually proteins, and differences in these proteins are what determines how severe a version of coronavirus may be.

Why is COVID-19 so serious?

COVID-19 is so serious because it has a unique spike protein that humanity has never seen before. This new spike protein allows it to be more effectively invade human cells, making it both more serious of an infection and more efficient at transmitting from person to person.

How does coronavirus infect people?


Source: Frieman M. SARS coronavirus and innate immunity. Virus Res. 2008;133(1):101-12.

The genetic code for coronaviruses, unlike that of humans, is stored in RNA. RNA contains instructions for making proteins. Our genetic code is stored in DNA, which can be compacted and store a lot of information in a small space, but DNA cannot result in the creation of protein unless it is first translated into RNA. Therefore, the coronavirus genetic code is well-suited to being rapidly used to make proteins that form the virus because it does not have to be translated first.

The coronavirus is essentially a core of RNA surrounded by the proteins the RNA codes for. Proteins on the virus allow it to dock with receptors on host human cells, and the virus then enters the human cell and releases its RNA. The humen cell follows the instructions contained in the RNA to both copy RNA and generate new virus proteins. The new copies of RNA and new proteins are repackaged into multiple new viruses, which are then released to propagate the infection.

Some additional facts:

  • Transmission is person-to-person through the air after someone coughs or sneezes, or by touching surfaces where those droplets have come to rest and then bringing them to your face
  • The virus can likely be transmitted even when individuals are not yet showing symptoms
  • The incubation period (time from exposure to the virus to having symptoms) is unknown. The average is close to 5 days, with 97.5% of patients showing symptoms within 11.5 days. However, 1% of patients may still come down with symptoms after 14 days

With the virus spreading rapidly, efficiently, and, in many cases, silently, it is important that we all practice social distancing and self-quarrantine as much as possible.

What are common symptoms?

Symptoms of COVID-19 range from none to mild cold symptoms to severe breathing difficulty from infections of both lungs. Those at risk for more severe disease include older adults, those receiving immunosuppression, and those with chronic medical conditions such as diabetes, high blood pressure, and chronic heart/lung/kidney disease. We are still learning more about the different ways COVID-19 can show itself, but the most common symptoms are:

  • Fever
  • Cough
  • Shortness of breath
  • Fatigue
  • Diarrhea
  • Loss of appetite

Many of these symptoms are common with other diseases, like the flu, pneumonia, and food poisoning, which makes it difficult to identify who may have it based on symptoms alone.

Who should be tested?

Given community spread, the Center for Disease Control has assigned priorities for testing:

  • Priority 1: Hospitalized patients and health care workers with symptoms
  • Priority 2: Symptomatic patients who are in long-term care facilities, aged 65+, those with underlying conditions, and first responders
  • Priority 3: Others

The need for testing is determined by the county health department.

What should I do if I have symptoms?

If you have a new cough*, shortness of breath, muscle aches, or fever:

  • If you have a life-threatening emergency (unable to breathe, chest pain, dizziness, confusion, etc.), call 911.
  • If are older than 65, are immunocompromised, or have diabetes or chronic heart / lung / kidney / liver disease, call your doctor.
  • If you are otherwise healthy and your symptoms are mild, the current recommendation is to avoid contact with others, stay hydrated, and wait to get better. Contact the County's Public Health Department to determine whether you should be tested. If you are unsure which category you fall into, contact your doctor.

*New cough: change in quality / severity / frequency / sputum production of cough, associated symptoms such as fevers / muscle aches, decreased exercise tolerance, feeling like you are coming down with an illness, feeling short of breath with light exercise or with sleeping / lying down

A variety of online tools have been developed to help guide decision-making, but call our office with questions since none are a substitute for physician judgement:

How to protect yourself

Proper hand washing can help minimize your risk of contracting COVID-19

Soap and water

  • Wet your hands with clean running water (warm or cold), turn off the tap, and apply soap. Do not use a basin of standing water. Turning off the tap helps to conserve clean water.
  • Lather all parts of your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and particularly under your nails.
  • Scrub your hands for at least 20 seconds. This is the time it takes to hum the "Happy Birthday" song from beginning to end twice.
  • Rinse your hands well under clean, running water. If the water does not automatically shut off, there is no clear data supporting use of a paper towel to shut off the tap, and using the rinsed hands to turn off the tap reduces paper waste.
  • Dry your hands using a clean towel or air dry them. Germs can be transferred more easily to and from wet hands, so drying hands after washing is advisable for further protection.

Alcohol-Based Hand Sanitizers

  • Select a product with at least 60% alcohol.
  • Apply the product to the palm of one hand. Use the amount recommended on the product label.
  • Rub the product all over the surfaces of your hands. Just as with soap and water, all surfaces, including under the nails, need decontamination.
  • Continue to rub the product into hand surfaces until hands are dry. Wiping sanitizer off before it dries will reduce effectiveness.


The CDC now recommends that all people, including people who have no symptoms of infection, wear a cloth face covering when in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies)

Household cleaning & disinfection

Cleaning refers to removal of dirt and germs from surfaces without necessarily killing the infectious agents on those surfaces. Cleaning can still reduce infection transmission by reducing the number of viruses on surfaces.

Disinfection refers to killing of infectious agents using chemicals. Disinfection does not clean the surface, so generally a surface is first cleaned and then disinfected.

Routine cleaning and disinfection of high-touch surfaces (doorknobs, light switches, elevator buttons, handles, tables, banisters, phones, desks, toilets, faucets, sinks) is advisable during pandemic conditions. Use household cleaners and disinfectants appropriate for the surface. Follow the label instructions, wear gloves if available, and ensure good ventilation during use of the product. Follow all cleaning with hand hygiene, even if gloves were used. Apple has changed phone cleaning advice to support use of 70% isopropyl alcohol wipes, gently wiping exterior phone surfaces.

Social distancing

Avoid coming close to people as much as possible. Avoid large groups. Minimize trips to get supplies.

What if I am a VPMG patient?

Our clinics in both Fresno and Visalia are currently seeing patients via telemedicine. All patients with mild respiratory symptoms should self-isolate and contact the Public Health Department of their respective counties to determine whether they should be tested or not. Those with more severe symptoms should call 911 or go to the ER. If in doubt or if any questions arise, call our office.

For those without respiratory symptoms needing simply routine care, we are using telemedicine services in lieu of an in-person appointment. This is for your safety, the safety of our staff, and the safety of our community at large. Please use the link below for additional information.

Telemedicine Information