COVID-19 FAQ

Sars-CoV-2 is the virus that causes Covid-19. It is a type of coronavirus, the name for this type of virus comes from the way the protein molecules the cover it look like a crown, or corona.

The Sars-CoV-2 virus spreads through the moisture and droplets in the air that we exhale. Once the virus is in our nose, throat and lungs, each time we exhale we send large amounts of virus into the air around us. The viruses can be breathed in by others or can land on surfaces where they can infect others who touch these contaminated surfaces then touch their mouth, nose or eyes. High exertion activities like exercising or singing and yelling appear to spread more droplets from deeper in the lungs that spread further.

Sars-CoV-2 is more contagious than the flu and more recent variants such as Omicron and XBB.1.5 are much more contagious than the original variants.

While most people who are infected with Covid-19 will have only mild symptoms of fever and cough and some may even have no symptoms at all, many will have severe symptoms and many of those infected will die. Children and younger adults are less likely to require hospitalization or to die from their Covid infection, compared to older adults or to those with chronic medical conditions, however even for young, healthy people, Covid-19 is much more deadly and dangerous than a typical flu or cold virus.

Some people who have Covid-19 develop long-term symptoms of weakness or difficulty breathing or difficulty thinking clearly that can last for months, making it difficult to do regular daily activities.

When Covid-19 is surging, the number of very sick people needing intensive hospital care such as mechanical ventilation to keep them alive while their body heals can overwhelm parts of our healthcare system. We do not have enough hospital beds, mechanical ventilators or protective equipment to provide care to a large number of very sick people.

We can reduce our risk of getting or spreading Covid-19 and of needing hospitalization and dying from Covid-19 by

• Getting vaccinated and staying up to date on boosters
• Staying home and testing when we are not feeling well
• Keeping our kids home from school or social events when they are not feeling well or if they have been in close contact with someone with Covid-19
• Using masks when in close contact to people outside of our immediate family when community covid spread is high
• Practicing proper hand hygiene
• Managing our chronic illnesses as well as possible to reduce our risk of severe complications
• Staying up to date on covid news and information from reliable sources such as the WHO, the CDC and your local health department.
• Using home testing effectively to prevent the spread of Covid
  • Testing before and after large social gatherings or traveling and after close contact with someone who might have Covid
  • Testing before visiting someone at high risk
  • Periodically testing when you live or work in high-risk places or if you live or work with others at high risk
  • • Testing when you aren’t feeling well

• Vaccination is the most effective measure we have to limit the spread and severity of Covid-19. Being fully vaccinated and boosted greatly reduces your risk of getting Covid-19 spreading Covid-19, having severe Covid-19 or being hospitalized or dying from Covid-19.
• If you are sick with a cough or fever, difficulty breathing, unusual headache, stomachache, vomiting or diarrhea, fatigue (unusual tiredness) or a change in your sense of taste or smell, do not go out, stay at home. Call your medical provider for advice.
  • If you are very sick and having a hard time breathing, call 911 or go to the nearest ER.
  • If you have access to PCR Covid-19 testing then get tested. If you do not have easy access to PCR testing then do a home covid test as soon as you start feeling sick. If it is negative stay home and do another test in 48 hours. If you have a single negative PCR test or if you have 2 negative home tests at least 48 hours apart then you probably do not have covid. If you are feeling better you can leave isolation, but still wear a mask around others until your symptoms have resolved.
  • • If you are not feeling better, continue isolating and contact your healthcare provider if another testing may be appropriate.
• Stay up to date on covid the spread in our community and the most recent recommendations
  • Hawai‘i DOH: Info & Resources for Managing COVID-19 (hawaiicovid19.com)
    • CDC COVID Data Tracker: County View
• When community levels are LOW, it is ok to gather and socialize, but protect yourself and others from unnecessary risk
  • Stay up to date on your covid booster vaccines
  • Stay home when not feeling well and test as outlined above
  • Use your home tests
    • Any time you start to feel sick. Do a PCR test if readily available or do home testing. If your test is negative, stay home until you are feeling better and do another home test in 2 days
    • After travel, large gatherings, or after close contact with someone suspected of having Covid. The best practice is to do testing on days 1, 3, and 5 after close contact, and if you start having any symptoms of Covid-19, even mild ones
    • Before gathering with or visiting others who may be at high risk for severe covid such as the elderly, those with chronic medical conditions, or unvaccinated
  • If you are at high risk or if you live or work with others at high risk for severe covid illness, wear a mask in indoor public spaces or when in crowded settings
  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Wash your hands often with soap and water.
    • WET your hands with clean, running water.
    • LATHER them with soap. Make sure to get the backs of your hands, between your fingers, and under your nails.
    • SCRUB your hands for at least 20 seconds (about the time it takes to sing “Happy Birthday” twice).
    • RINSE your hands well with clean, running water.
    • DRY them with a clean towel or let them air dry.
    • If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60 percent alcohol. Hand washing is preferred.
  • Get your flu shot to reduce the chance of developing symptoms that can be confused with COVID-19. Everyone ages 6 months or older should be vaccinated against the flu.
  • Get your pneumonia shot If you are 65 or older, or if you are younger and it is recommended by your healthcare provider.
  • Clean and disinfect frequently touched objects such as phones, tablet computers, pens, or doorknobs and surfaces using a regular household cleaning spray or wipe.
  • Leave shoes outside of your home if possible or remove shoes and bag them if you must bring them inside.
  • If you work in healthcare, remove clothes immediately upon arriving home, before contacting anyone or any surfaces, and shower immediately. Wash clothes promptly and wash hands after touching any potentially contaminated clothes or devices.
  • Do not share drinks, food, utensils, or toothbrushes.
  • • If you are sick at home, avoid contact with others, do not share items, and avoid common areas. Avoid close contact (within 6 feet for more than 30 minutes) with anyone at home and especially with anyone over 60 years old or anyone with chronic heart disease, lung disease, or decreased immunity.
• When Community levels are HIGH, do all of the above PLUS
  • Practice social distancing, avoiding large indoor gatherings and maintain at least 6 feet of distance from other people outside of your immediate family.
  • Avoid high-exertion activities in confined spaces such as gyms or yoga classes. Exercise outdoors with at least 12 feet of distance between you and others.
  • Avoid crowded environments such as bars or social gatherings or parties. Crowds combined with social disinhibition from alcohol consumption make social distancing practically impossible.
  • • Wear a face covering whenever you are outside your home and you are unable to consistently socially distance around other people who do not live with you.

• Most people who are infected will start showing symptoms after about 5-6 days, though some may start feeling sick after 2 days or as long as 14 days after getting infected. The symptoms are usually fever, cough and sometimes difficulty breathing. Other symptoms include headache, chills, stomach pain, vomiting, diarrhea, fatigue muscle aches, a change in your sense of taste or smell. Younger children may have more cold-like symptoms, while older adults may have more shortness of breath or pneumonia symptoms.
• The symptoms of Covid-19 can overlap with other more common conditions such as allergies, the flu and milder cold viruses, and you can sometimes have both allergies and a covid infection, so testing is an important tool to help you and your healthcare provider know what’s up.

Covid-19 is much more serious for the elderly or for those with chronic illnesses such as cardiovascular disease or chronic lung disease. The risk of death is higher for these folks. However, it is important to know that Covid-19 can make relatively healthy young people extremely ill. Children and young adults often have milder symptoms, but it can be very serious for any age.

Younger people may think they don’t need to worry much because they are not likely to get very sick, however even if they are healthy, they may spread the disease to others who may be at higher risk for more serious illness or even death. Covid-19 is not a disease of old people, it is a disease of all of us. Every elderly person who dies of Covid-19 got Covid from someone else, it is important for those of us at lower risk to protect those of us at higher risk.

Based on the outcomes of millions of people in the US who have been infected with covid, we know that those who meet the criteria below are more likely than the general population to have a more severe illness or death from a Covid-19 infection. If you or your child have one or more of the risk factors below and test positive for Covid-19, contact your healthcare provider ASAP to discuss medication options that may reduce your risk of hospitalization and death from Covid-19.

• • Conditions confirmed to increase risk
    • Age is the strongest risk factor for severe outcomes from a covid-19 infection: high risk for 50 years old or older, even higher for 65 and older and very high risk for 85 and older
    • Unvaccinated
    • Ethnic minorities
    • Residents of long-term care facilities
    • Asthma
    • Cancer (current or recent)
    • Cerebrovascular disease
    • Chronic kidney disease
    • Chronic liver disease: Cirrhosis, Non-alcoholic fatty liver, alcoholic liver disease, and autoimmune hepatitis.
    • Chronic lung diseases such as COPD, bronchiectasis, interstitial lung disease, pulmonary embolism, pulmonary hypertension
    • Cystic fibrosis
    • Dementia
    • Diabetes types 1 or 2
    • Disabilities that affect ability to self-manage activities of daily living
      • ADHD
      • Cerebral palsy
      • Birth defects
      • Intellectual disability
      • Learning disabilities
      • Spinal cord injuries
      • Down syndrome
    • Heart diseases such as heart failure, coronary artery disease, cardiomyopathy, and possibly high blood pressure
    • HIV infection
    • Immunocompromised or weakened immune system
    • Mental health conditions such as depression or schizophrenia
    • Obesity: BMI of 30 or higher if over the 95^th percentile for children
    • Physical inactivity
    • Pregnancy
    • Current or former smoker
    • Cerebrovascular disease or history of stroke
    • Solid organ or blood transplantation
      • Tuberculosis
  • Conditions that may increase risk (unconfirmed results of clinical studies)
    • Alpha 1 antitrypsin deficiency
    • BMI 25 or higher but less than 30 in adults
    • Children with complex medical conditions or congenital heart defects may be at higher risk
    • Hepatitis B
    • Hepatitis C
    • Sickle Cell Disease
    • Substance abuse such as alcohol, opioids or cocaine
    • • Thalassemia

PCR testing is still the most accurate form of Covid testing, however as fewer places are offering PCR testing, rapid at-home testing can be used effectively to manage most testing situations

We recommend using you home test kits for the 4 situations of surveillance, protection, diagnosis and clearance as explained below.

1. Testing for Surveillance:
   • If you work with the general public or in healthcare or retail, you are likely encountering Covid positive people regularly. Consider weekly or more often rapid at-home testing, especially if you live with someone at high risk. If you were at a social event or recently traveled, do a home test 6 days after or as soon as you start feeling any symptoms. If you are at high risk for severe illness from covid19 or live or work with high risk persons, best practice would be to do a rapid at-home test on days 1, 3 and 5 after your event or travel or as soon as you start feeling any symptoms.
2. Testing for Protection:
   • Do a rapid at-home test before going to visit someone at high risk or if you know you will be around unvaccinated people. Even if you are not having symptoms and feel ok. Test all of your family members together to ensure everyone is cleared to visit. If you are at high risk, ask others coming to visit to do a test before you get together.
3. Testing for diagnosis due to symptoms or close covid contact.
   • If you had a covid infection within the last 30 days, then it is very unlikely that you will be reinfected this soon. Do an a rapid at-home test and contact your healthcare provider for advice
   • If you had a covid infection within the last 3 months, a PCR test may be positive for up to 6 months after an infection. From 30-90 days after an infection, it is recommended to use rapid testing instead of PCR testing.
   • If you are at high risk for severe complications from Covid or other respiratory infections, contact you healthcare provider for advice if you are having symptoms or have been exposed to Covid-19.
   • If you are having symptoms: If you are starting to feel sick at all, a scratchy throat, runny nose, sneezing, congested, having loss of taste or smell or muscle aches, feeling more tired than usual, having headaches or dizziness or having diarrhea or vomiting, isolate from the rest of your household and do a covid test
     • PCR testing is more sensitive and accurate than rapid home testing but is less available than previously. If you have easy access to PCR testing and it has been more than 3 months since your last covid infection then PCR is recommended. If you do not have access to PCR testing then rapid home testing is still a good option.
     • Do a home covid test. If you do not have access to a home test kit, contact your healthcare provider or go to www.hawaiicovid19.com to check for testing access. If you don’t have a healthcare provider, call us at 808-381-7009 for advice.
       1. If your home test is negative, wear a mask around others and sleep separately from your family, use a separate bathroom if possible, and wash your hands well. Do another home test after 48 hours. If both tests are negative then you probably do not have covid and can leave isolation as long as you are feeling better and not having fevers.
       1. If your second home test is negative but you are still not feeling good, stay home and contact your healthcare provider.
       1. If your home test is positive, isolate away from others in your home and call your healthcare provider or call us to schedule a telehealth visit with a medical provider to discuss possible treatment options and clearance.
     • If you had a close covid contact or exposure, such as a family member testing positive or you find out someone in your social circle or at work tested positive, do home testing on day 6 after your exposure or at any time you start to feel sick. If you are at high risk or live or work with high-risk individuals then the best practice would be to test on days 1, 3, and 5 after your exposure and at any time if you start feeling sick.
4. Testing for Clearance:
   1. If you are covid positive, you must isolate for at least 5 days. Current recommendations are that if you are feeling better, you can leave isolation on day 6 after you started feeling sick or tested positive, whichever came first.
   1. A safer practice would be to do a home test on day 6, even if you are feeling better, and if still positive, stay in isolation and test every 1-2 days. You can leave isolation when your rapid test is negative or after 10 days, whichever comes first.
   1. 1. 1. Check with your employer or school policies on when you can return to work, school, or other activities. If you are immunocompromised or had a severe illness then stay in isolation until cleared by your healthcare provider.

There are treatments available for those at high risk of severe disease after exposure and early in their illness course. These treatments can greatly reduce your risk of severe illness and can prevent covid-associated deaths. Please contact your care provider or call us at 381-7009 for more information.

KPHC carries Paxlovid antiviral treatments for those at high risk for severe covid-19 infections. Call us at 381-7009. We only dispense Paxlovid for established KPHC patients when ordered by a KPHC care provider.

We have a dedicated nurse line for your Covid-19 questions. Call 808-381-7009 to speak to a nurse

• Masks are required for all staff and patients who are 2 years old or older at all times in the clinic. If you are unable to wear a mask due to specific respiratory conditions then other visit accommodations will be made.

·  We have screeners at the entrances to our main clinical sites All patients are required to wear a face covering when in the clinic. Patients with symptoms of Covid-19 or who have recently been exposed to someone with Covid-19 will be asked to do covid testing and may be asked to do their visit with their care provider by telemedicine

·  We have reduced seating in our waiting areas and ask that only patients with appointments or who are sick enter the clinic. One adult may accompany minors. Adults with appointments are asked to not bring their children into the clinic unless there is no one to supervise them. Adult patients needing assistance may be accompanied by one caregiver.

·    We have increased the frequency of daily cleanings in our facilities

·    Any staff who are sick with fever or respiratory symptoms are not allowed to work until they are cleared of possible Covid-19 infection and are well. We have daily screening of all staff and require testing of all symptomatic staff.

·  We have limited staff gatherings or in-person meetings

·  We have expanded our telemedicine capabilities. Call ahead of your appointment to see if your visit may be managed by phone.