Coronavirus Disease 2019 (COVID-19) Basics

Coronaviruses are family of virus which include mild virus like the one that cause the Common Cold all the way to the virus which cause the SARS epidemic of 2002. COVID-19 is a new strain within this family of viruses that apperas to have started in Wuhan, China. COVID-19 enters the body through droplets spread by an infected person. These droplets appear to be most commonly breathed in, however it is still possible to get the virus through surfaces.

Key Terms

Active case: Cases in which someone has tested positive and has not yet tested negative. Close contact: If someone you have interacted with gets tested positive for the virus and you were within six feet of them for 15 minutes of more cumalitievely. For example, a server who tests positive for COVID-19 had served you before they knew they were positive. They took 5 minutes to take your order, 5 minutes to deliver your order, and 5 minutes to give you the check/say good-bye. Since that adds up to 15 minutes, you would then be a close contact and would need to contact Public Health for further instructions. Confirmed positive: Cases that have been twice tested to verify that the case is positive Contact tracing: When investigating close contacts, the Health Department is doing "contact tracing." This includes contacting any close contacts and instructing those individuals to quarantine and receive testing. Learn more about contact tracing by visiting the CDC website. COVID-19 Related Death: Coronavirus, like any virus, does not actually cause death, rather it is the response of the body that causes death. Rather, when your body fights a virus, it may cause organ failure, so if someone dies, the death is related to coronavirus. Learn more about COVID-19 fatalities through SciShow’s video Cumulative case: the total of cases in a given place (for example a county or state) Epi-linked: When a person cannot be tested for some reason, either they do not agree to be tested or they are too young to be tested, then that person is considered to be an “epi-linked” case. This means that, while they are not tracked as a positive case, they will still be required to be quarantined. False positive/negatives: If the confirmation test shows that the first test was wrong, then it is either a false positive or false negative, depending on the first diagnosis. False positives occur approximately this percentage and false negatives occur about this percentage. Isolation: separates sick people with a contagious disease from people who are not sick. Presumed/Presumptive Positive: When an individual receives the first test back, see the “How testing works” section for more information, OR when an individual is known to be a close contact of someone is a confirmed positive, then that person is a presumed positive. Recovered cases: Cases in which someone tested positive initially and now tests negative. Deaths are not counted as recovery. Quarantine: separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick. Sentinel testing: Also called "survelliance testing". This is when health officials make a plan to test a specific, asymptomtiac group in order to gain a better understanding of the spread of a virus. For example, a public health department might test asymptomtic first-responders while a hospital tests asymptomatic people age 50 and up. This would be part of a collective effort to understand the virus.

How is COVID-19 spread?

The COVID-19 virus is spread mainly from person-to-person between people who are in close contact with one another (within 6 feet) through respiratory droplets produced when an infected person coughs, sneezes or talks. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Studies suggest that COVID-19 may be spread by people who are not showing any symptoms. Maintaining good social distancing (6 feet or more) is very important in preventing the spread of COVID-19. It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own nose, mouth or eyes. This is not thought to be the main way the virus spreads. CDC recommends people practice frequent hand washing with soap and water or using an alcohol-based hand sanitizer. CDC also recommends routine cleaning of frequently touched surfaces.

What are the symptoms of COVID-19?

Symptoms can be very mild to sever and can show 2-14 days after exposure to COVID-19. Symptoms can include fever greater than 100.4, cough, shortness of breath or difficulty breathing, sore throat, chills or repeated shaking with chills, unexplained muscle pain, nausea/vomiting, diarrhea, new loss of taste or smell, fatigue, congestion/runny nose and headache.

How can I prevent myself and others from getting COVID-19?

The CDC says that the most effective way to prevent the spread of COVID-19 is to wear a mask, socially distance (at least 6-feet apart from unassociated individuals) and avoid crowds. The CDC recommends that masks have two or more layers of washable, breathable fabric, completely cover your nose and mouth, fit snuggly against all sides of your mouth with no gaps, and have a nose wire to prevent air from leaking. Other ways to prevent the spread of COVID-19 include:

• Avoid close contact with people outside of your household when possible
• If soap and water are not available, use hand sanitizer with at least 60% alcohol.
• Wash your hands frequently with soap and water, scrubbing for at least 20 seconds.
• Clean and disinfect frequently touched surfaces.
• Avoid touching your eyes, nose and mouth.

If you do get sick, you can help stop the spread of illness and protect your loved ones by doing the following:

• Stay home if you are ill except to get medical care. Please call your health care provider before visiting them and let them know that you may have COVID-19.
• Separate yourself as much as possible from other people in your home to prevent spreading to them.
• Wear a face mask when going to seek medical care. The mask will minimize the spread of droplets through coughing or sneezing.
• Do not share personal household items such as dishes, drinking glasses, towels, or bedding unless they are thoroughly washed.
• Follow any additional guidance from the health department or a medical provider.”

What cleaners and disinfectants effective against COVID-19?

Current information from the WHO and the CDC indicates that many standard household disinfectants are effective. The CDC recommends looking on disinfectants and seeing if they are effective against human coronavirus, SARS-like viruses, or CoV-2. It is believed that a 70% alcohol or a bleach solution of 1/3 cups per gallon of water or 4 tsp per quart of water will work. The bleach solution should be changed daily or made fresh before use.

What does social distancing mean?

Social distancing means remaining out of congregate settings (or busy public spaces), avoiding mass gatherings, and maintaining distance (approximately 6 feet) from others when possible.

What does physical distancing mean?

Physical distancing is the same as social distancing - it means remaining out of congregate settings (or busy public spaces), avoiding mass gatherings, and maintaining distance (approximately 6 feet) from others when possible. The World Health Organization recently recommended the use of the term "physical distancing" to help people understand that just because you need to keep space between yourself and others, that doesn't mean you need to cut off connections.

Should I avoid public spaces?

If you are sick, please stay home and avoid public spaces. If you are well, you should assess your own risk and practice proper precautions including social distancing. If you are over 60 years of age or have underlying health conditions, you will be at elevated risk, and are encouraged to limit exposure. <gdiv></gdiv>

Should I stay home from work, school, or restrict my everyday activities?

If you are sick, please stay home. If you are well, and not at high-risk for COVID-19, please practice social distancing, and other COVID precautions, and consider the risk to your health when making decisions. If you are well, and at high-risk for COVID-19, please take additional precautions. Employment: Work with your employer to see if there are ways to work remotely or if they can provide other accommodation. Everyday activities and events: Use your judgment and assess your risk. Use online platforms and methods when possible to conduct personal business. Practice social distancing, proper hand washing, and reconsider attending functions with large groups of people. Stay connected with your friends, family, and neighbors for assistance. <gdiv></gdiv>

How are vulnerable individuals protected with the Stay at Home Directive lifted?

Protecting residents at high-risk of a severe case of COVID-19 remains a top priority during the phased reopening. Vaccinations have begun in Missoula County and prioritize the highest risk residents based on DPHHS’s epidemiological data. Additionally, Missoula County’s requirements rely on the latest science and emphasize social distancing, face coverings, and symptom education. Vulnerable residents should continue to follow the stay-at-home guidance and members of households of vulnerable residents should be aware that work and other environments could carry the virus back home. Precautions should be taken to isolate from vulnerable residents.

Why is there a face covering mandate?

The CDC says wearing a mask is one of the best and easiest ways to prevent the spread of COVID-19. Based off current epidemiological data, the Missoula City-County Board of Health believes a mask mandate is critical to stopping the spread of COVID-19. Visit the CDC's website for more information on how and why cloth masks are effective against COVID-19.

What if state and local mask rules differ?

At the county level, Missoula enacted its own mask mandate on July 9, 2020. Updates to this mandate were adopted by the City-County Board of Health on December 17, 2020. That document can be viewed here.

On January 5, 2021, Governor Greg Gianforte announced he will repeal the statewide mask mandate once certain criteria is met, and will defer to local counties to enforce mask mandates if they choose to enact one at the local level. That criteria Gianforte set to repeal the mask mandate includes wider vaccine distribution to Montanans age 70 and older and Montanans age 16-69 with underlying health conditions. The second criteria is that the legislature must pass protections to prevent businesses, schools, and nonprofits from being sued if someone contracts COVID-19 at that location. If Governor Gianforte repeals the state mask mandate before Missoula County repeals its mask mandate, the local mask mandate will still be valid and enforceable.

What is an acceptable face covering?

The CDC recently updated their mask recommendations in light of more contagious variants spreading in the United States. For optimal protection, the CDC recommends masks with a nose wire, layer masks (do not layer N95 or two surgical masks), snug fitting masks, and the use of a mask fitter or brace.

Acceptable face coverings must be a cloth, paper, or disposable face covering that completely covers one’s nose and mouth and fits snugly against the sides of one’s face and is made of two or more layers.

1. Neck gaiters used as face coverings should be folded over to add an additional protective layer.

2. Unacceptable face coverings include hairnets, mesh, lace, standard face shields, and any face covering including an exhalation valve.

3. Standard plastic face shields cannot be used as a replacement for a cloth face covering or mask or as a standalone accommodation for an employee or customer who cannot wear a face covering. Standard face shields are not effective at controlling the spread of respiratory droplets: they direct respiratory droplets down and around the plastic visor.

Certain types of enhanced face shields have an additional fabric barrier around and underneath the plastic shield, providing more respiratory droplet control. An enhanced face shield with this additional fabric cowl/barrier attached to the shield is an acceptable face covering in Missoula County, and is also an adequate standalone accommodation for someone who cannot.

How long will we have to wear face coverings?

Health Officer Ellen Leahy frequently analyzes epidemiological data relating to COVID-19, and she, along with the board of health, routinely communicate and reevaluate the need of the mask mandate based on current data. When the science suggests it is safe to do so, the Board of Health will repeal the mask mandate.

How many face coverings does an employer have to provide?

This falls within the scope and authority of employers. Neither the Health Board rule nor the Governor’s Directive give a specific number, leaving it to individual business to interpret and implement. The key is to make sure that employees have sufficient face coverings (regardless of who provides them) and that laundering practices are in place so that staff can wear a clean face covering to work each day.

What if my employee cannot wear a face covering because of a medical or mental health issue?

Employers must work with employees who cannot wear face coverings to identify a safe, alternative, reasonable accommodation for your specific work setting. Options include but are not limited to things like remote work, wearing an enhanced face shield instead of a mask, or moving/modifying the workspace to ensure that the unmasked employee is not in an area accessible to the public, and is able to maintain 6 feet between coworkers.

What if my employee refuses to wear a face covering?

If your employee can, but does not want to wear a face covering, then, as a business, government entity, or person in charge of an indoor space, you must require that they wear one. We are not in the position to give legal advice on human resource law. We suggest that you think about what you would do if you had an employee refusing to follow a different workplace requirement or policy specific to your work setting.

What if a customer does not want to wear a face covering?

If someone refuses to wear a face covering and they do not meet an exemption in the order, the business needs to ask them to wear one, or ask them to leave and access services through alternative methods. Businesses and customers can explore, develop, and implement alternative options for those that will not wear face coverings. Options include but are not limited to things like curbside pickup and delivery services, and online/remote options.

What if a customer cannot wear face covering because of personal, medical health conditions?

Those who are unable to wear a face covering are not required to disclose their personal, private, medical information to a business. Businesses should take a customer’s statement at face value, and then work with them to find an alternative solution so that other customers and employees are protected. In many cases, the business will be able to provide goods or services without the customer entering the building, through curbside pickup and delivery services, online/remote options, outside seating, or similar reasonable accommodations. For other businesses that require entry into a building or public space for a service, the business should work with the individual to figure out how to provide the goods or service, while continuing to provide protection to employees and other people in the indoor space. Businesses can refer to the Disability Issues Brief on Face Mask Policies from the Southeast Americans with Disabilities Act (ADA) Center for more information.

How far do we have to go to enforce the Face Covering Requirements with customers?

Wearing a face covering is not optional. As a manger or owner of an indoor space that is open to the public, you are obligated to ensure that staff and customers are wearing face coverings. In addition to posting appropriate, accessible, and highly visible signs that notify people before entering, you must have a plan in place to approach patrons or guests that do not have their face covered. Ideally, this happens as the person enters the establishment. If, after speaking with the person:
• You determine that the person isn’t following the face covering requirement because they claim to have a health condition that makes wearing a face covering unsafe or dangerous, you can proceed to offering them a safe alternate accommodation (described above).
• You determine that the person is refusing to wear a face covering but is not claiming a health condition that would justify an exemption, they are not allowed to enter, or remain in, your space. Follow whatever protocols you have in place for patrons/guests that refuse to follow other rules (i.e. not wearing shirts/shoes, wearing backpacks in areas where they are not allowed, filming or using flash photos in areas where it is not allowed, etc.).
We know that requiring face coverings is not always an easy task. To meet the goal of widespread use of face coverings, businesses need to:
o Have clear expectations in place, including signage,
o Have a way to accommodate those who cannot wear a face covering,
o Have a plan in place that clearly describes how your business will effectively exclude those who refuse to wear a face covering for non-health-related reasons,
o Ensure employees wear face coverings and set the expectation/standard, and
o Make it easy/comfortable for customers to wear face coverings inside.

How will this rule be enforced?

The Health Department responds to complaints by talking with the business and helping them identify necessary changes to comply with both the Governor’s Directives and local health requirements. If a business will not come into compliance, the Department can take additional steps, including but not limited to a written violation notice, a Health Officer order to comply or to close, or pursuing compliance through the court system. It is primarily up to the business or manager of the indoor public place to ensure that their employees, customers, and volunteers comply with wearing face coverings as required by the rule.

If I put up a sign that says mask are required unless they have a medical condition, can I/we just assume anyone without one has a qualifying condition?

No. Businesses need to post a sign with language from the order at entries and exits, as well as around the indoor setting. All individuals entering or remaining in your business need to wear a face covering. If a person tells you that they have a medical condition making it unsafe or dangerous to wear a face covering, you can offer them an alternative accommodation as described above.

Can I use my own sign, or do I have to use the one on the Health Department website?

You can make your own sign, but whatever sign you use has to include this language from the order in large enough font for customers to be able to see it easily when entering the building: “Mask or face covering use required for ages 5 or older.”

How many signs do I have to put up?

Post as many as needed to ensure compliance with the order within your indoor settings. A sign at each entry must contain the statement “Mask or Face Covering Use Required for Ages 5 and older” but businesses can put up other signs as needed.

Do the new face covering rules apply to childcare facilities?

Yes, but children younger than 5 years old do not have to wear them, and children under 2 should never wear them. There are also exceptions for when children and adults are engaged in strenuous exercise or are in other conditions that make wearing a face covering unsafe or impractical. Parents/guardians who are picking up/dropping children off must wear a face covering if and when entering and/or exiting a childcare facility.

Does this rule apply to places of worship?

Yes. The order does not exempt places of worship.

Is there a religious exemption?

No, there is no relgious exemption.

My office is not open to the public, do we have to wear masks?

If there is no opportunity for non-employees to enter (even by appointment), then masks are only required for employees in situations where 6 feet of physical separation is not always easily maintained, like in break rooms, entryways, shared vehicles, hallways, and shared restrooms.

What qualifies as “strenuous” exercise?

What qualifies as “strenuous” will be different for everyone because everyone has different fitness and or tolerance levels when it comes to physical activity. Exercisers should take their mask off at the point that the mask makes it hard to breathe.

Who is most susceptible to 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 upon available information to date, those at high-risk for severe illness from COVID-19 include: -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 are at higher risk for severe illness, particularly if the underlying medical conditions are not well controlled. This includes people with: Chronic lung disease or moderate to severe asthma Heart disease with complications Conditions that 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. Severe obesity (body mass index [(BM]I)≥40) Diabetes Chronic kidney disease and who are undergoing dialysis Liver disease People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk Many conditions can cause a person to be immunocompromised, including cancer treatment, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications

Are pregnant women at increased risk?

We do not currently know if pregnant women have a greater chance of getting sick from COVID-19 than the general public, nor whether they are more likely to have serious illness as a result. Pregnant women experience changes in their bodies that may increase their risk of some infections. With viruses from the same family as COVID-19, and other viral respiratory infections, such as influenza, women have had a higher risk of developing severe illness. It is always important for pregnant women to protect themselves from illnesses. Visit the CDC’s page for Pregnancy and Breastfeeding for more information.

Can COVID-19 cause problems during pregnancy?

We do not know at this time if COVID-19 would cause problems during pregnancy or affect the health of the baby after birth.

What is the risk for people with asthma?

People with asthma may be at higher risk of getting very sick from COVID-19. COVID-19 can affect your respiratory tract (nose, throat, lungs), cause an asthma attack, and possibly lead to pneumonia and acute respiratory disease.
For more information and recommendations for persons with asthma, please visit the CDC’s page for people with asthma.

What is the risk for people with HIV?

The risk of serious illness from COVID-19 for people with HIV is currently unknown. The CDC will be updating their page for persons with HIV as information becomes available. Please visit the CDC’s page for persons with HIV for advice and answers to some frequent questions.

I traveled to another state, do I need to get tested or call the health department?

Not at this time. You do not need to get tested for the virus based on travel alone. Travelers arriving in Missoula County may contact the Missoula City-County Health Department at 258-INFO with questions. Travelers who develop symptoms of COVID-19 should contact a health care provider.

Historical Note: On March 30, 2020, the Governor of Montana issued a directive mandating a 14-day travel quarantine for travelers arriving in Montana. This mandate expired on June 1st, 2020 as part of the Phase II opening

Do people staying at a vacation rental need to self-quarantine?

Not at this time.

Former Governor Steve Bullock's travel quarantine expired on June 1st, 2020 as part of the Phase II reopening. <gdiv></gdiv>

My boss wants me to get tested due to recent travel in the US, is this recommended by the health department?

No. The test is not designed to screen exposure but to diagnose illness.

Should I suspend my travel plans?

You should check the CDC’s travel recommendations, keeping in mind that COVID-19 is a rapidly changing situation and that advisories may change during your trip to include your destination or layover locations. When making travel decisions, you not only need to think about the risk of getting COVID-19, but also how your return travel and daily activities may be affected once you get home. If you are in the high-risk group of those over 60 years of age or those with underlying medical conditions, please reconsider all non-essential travel.

What if I was exposed to someone who has developed symptoms of COVID-19?

The person who has developed symptoms should seek a COVID-19 test. If the individual tests positive, the health department will reach out to the patient’s close contacts. The Health Department investigates the travel history and exposure risk of all known COVID-19 cases to identify and communicate with anyone who may have been a close contact with the patient. A close contact is someone who was within six feet of the patient for a prolonged period (at least 15 minutes) or was directly exposed to the patient’s infectious secretions (such as respiratory droplets). People who are concerned that they may have been exposed to a positive case but have not been contacted by the health department or developed symptoms do not need to be tested. If you are identified as a close contact and the health department contacts you, you will be given instructions to follow based upon your level of exposure.

What should I do if I was exposed to someone who is awaiting test results?

Individuals awaiting test results should be in isolation. If an individual’s COVID-19 test result comes back positive, the health department will reach out to the patient’s close contacts. The Health Department investigates the travel history and exposure risk of all known COVID-19 cases to identify and communicate with anyone who may have been a close contact with the patient. A close contact is someone who was within six feet of the patient for a prolonged period (at least 15 minutes) or was directly exposed to the patient’s infectious secretions (such as respiratory droplets). People who are concerned that they may have been exposed to a positive case but have not been contacted by the health department or developed symptoms do not need to be tested. If you are identified as a close contact and the health department contacts you, you will be given instructions to follow based upon your level of exposure.

What should I do if I was exposed to someone who tested positive?

The Health Department investigates the travel history and exposure risk of all known COVID-19 cases to identify and communicate with anyone who may have been a close contact with the patient. A close contact is someone who was within six feet of the patient for a prolonged period (at least 15 minutes) or was directly exposed to the patient’s infectious secretions (such as respiratory droplets). People who are concerned that they may have been exposed to a positive case but have not been contacted by the health department or developed symptoms do not need to be tested. If you are identified as a close contact and the health department contacts you, you will be given instructions to follow based upon your level of exposure.

What is a close contact?

Per the CDC, a close contact is someone who was within six feet of the patient for a prolonged period (at least 15 minutes. The 15 minutes may be cumulative.) or was directly exposed to the patient’s infectious secretions (such as respiratory droplets). People who are concerned that they may have been exposed to a positive case but have not been contacted by the health department or developed symptoms do not need to be tested. If you are identified as a close contact and the health department contacts you, you will be given instructions to follow based upon your level of exposure.

When can someone, who tested positive for COVID-19, return to work?

If someone tests positive for COVID-19, a public health nurse will let them know when they can return to work. If someone has symptoms but doesn’t test positive, they can return when symptoms resolve; however, if a medical professional says to stay home for longer, follow their instructions. We encourage people to remember that this is evolving and that guidance may change as more information becomes available.

What are the risks of food from takeout or drive-thru?

There is no current indication that takeout or drive-thru meals will increase illness This option is a good risk management choice, especially for high risk and elderly groups because it helps maintain social distancing and reduces the number of touch points.

What are the risks of food delivered to home?

Similar to takeout, food delivery helps maintain social distancing and reduces the number of touch points between preparation and serving of food. Many delivery programs have also instituted no touch/no interaction options, which further reduces risk.

Can I get COVID-19 from touching food or packaging exposed to coronavirus?

The risk of transfer of viruses is very low, based on current research. CDC, FDA and USDA are not aware of any reports at this time that suggest COVID-19 can be transmitted by food or food packaging. Current evidence shows the biggest risk of transmission of COVID-19 is being around individuals who are symptomatic. Food businesses should be following employee health policies and health department recommendations to keep these individuals home. To further minimize risk, handling food packaging should be followed by handwashing and/or using hand sanitizer.

What happens in your body if you do ingest coronavirus through food?

If you consumed food that is contaminated with coronavirus, your stomach acid should inactivate the virus since it is very acidic (pH 2.0). Even if your stomach acid did not inactivate the virus, there is no evidence the virus causing COVID-19 can start infecting through the gastrointestinal tract. The only possible way to get sick is if, during eating, the virus comes in contact with a specific type of respiratory cells. This scenario is highly unlikely and not concerning given what is known about modes of transmission currently discussed regarding COVID-19

Would I still be considered a close contact if my exposure was outside?

Yes. No matter the setting, if you were within 6 feet of a person with COVID-19 for a cummulative 15 minutes or more, you would be considered a close contact.

Would I be a close contact if I was wearing a face covering and the person with COVID-19 was wearing a face covering?

Yes. We know that the face coverings are not 100% effective at preventing transmission of COVID-19. Even if you were both wearing a face covering, if you were within 6 feet of someone with COVID-19 for a cummulative 15 minutes or more, you would still be considered a close contact.