The current COVID-19 outbreak is continually evolving. Comparisons have been drawn to influenza. Both cause respiratory disease, yet there are important differences between the two viruses and how they spread. This has important implications for the public health measures that can be implemented to respond to each virus.

Please note if you suspect you may be ill with the COVID-19 or you require additional information please contact the Department of Health’s dedicated phone line 0800 029 999.

How are Influenza and COVID-19 Similar:

Firstly, COVID-19 and influenza viruses have a similar disease presentation. That is, they both cause respiratory disease, which presents as a wide range of illness from asymptomatic or mild through to severe disease and death.

Secondly, both viruses are transmitted by contact, droplets and fomites. As a result, the same public health measures, such as hand hygiene and good respiratory etiquette (coughing into your elbow or into a tissue and immediately disposing of the tissue), are important actions all can take to prevent infection.

How are COVID-19 and influenza viruses different:

The speed of transmission is an important difference between the two viruses. Influenza has a shorter incubation period (the time from infection to appearance of symptoms) and a shorter serial interval (the time between successive cases) than COVID-19 virus. The serial interval for COVID-19 virus is estimated to be 5-6 days, while for influenza virus, the serial interval is 3 days. This means that influenza can spread faster than COVID19.

The reproductive number – the number of secondary infections generated from one infected individual – is understood to be between 2 and 2.5 for COVID-19 virus, higher than for influenza. However, estimates for both COVID-19 and influenza viruses are very context and time-specific, making direct comparisons more difficult.

Children are important drivers of influenza virus transmission in the community. In terms of COVID-19 virus, initial data indicates that children are less affected than adults and that clinical attack rates in the 0-19 age group are low. Further preliminary data from household transmission studies in China suggest that children are infected from adults, rather than vice versa.

While the range of symptoms for the two viruses is similar, the fraction with severe disease appears to be different. For COVID-19, data suggest that 80% of infections are mild or asymptomatic, 15% are severe infection, requiring oxygen and 5% are critical infections, requiring ventilation. These fractions of severe and critical infection would be higher than what is observed for influenza infection.

Those most at risk for severe influenza infection are children, pregnant women, elderly, those with underlying chronic medical conditions and those who are immuno-suppressed. This is different to the COVID-19 virus, where older age and underlying conditions increase the risk for severe infection.

Mortality for COVID-19 currently appears higher than for influenza, especially seasonal influenza. While the true mortality of COVID-19 will take some time to fully understand, the data we have so far indicate that the crude mortality ratio (the number of reported deaths divided by the reported cases) is between 3-4%, the infection mortality rate (the number of reported deaths divided by the number of infections) will be lower. For seasonal influenza, mortality is usually well below 0.1%. However, mortality is to a large extent determined by access to and quality of health care.

Medical intervention. While there are a number of therapeutics currently in clinical trials in China and more than 20 vaccines in development for COVID-19, there are currently no licensed vaccines or therapeutics for COVID-19. In contrast, antivirals and vaccines available for influenza. While the influenza vaccine is not effective against COVID-19 virus, it is highly recommended to get vaccinated each year to prevent influenza infection.

Basic Protective Measures Against the New Coronavirus:

  • Regularly and thoroughly clean your hands with soap and water. When washing your hands they should be covered with the soap for at least 30 seconds while vigorously rubbing your hands together (including the back of your hands and fingers). If soap and water are not readily available, use a hand sanitizer that contains at least 70% alcohol.
  • Social distancing, maintain at least 1 meter (3 feet) distance between yourself and anyone who is coughing or sneezing. Avoid unnecessary crowds such as clubs, major sporting events etc.
  • Avoid touching eyes, nose and mouth.
  • Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately into the bin.
  • Do not spit on the ground.
  • Stay home if you begin to feel unwell. If you have a fever, runny nose, cough and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority.
  • Stay informed on the latest developments about COVID-19. Follow advice given by your healthcare provider, your national and local public health authority or your employer on how to protect yourself and others from COVID-19. Be aware of social media hype and misinformation.
  • Stay at home if you begin to feel unwell, even with mild symptoms such as headache and slight runny nose, until you recover.
  • Clean AND disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, counter tops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
  • If surfaces are dirty, clean them: Use detergent or soap and water prior to disinfection.

Who is at Higher Risk?

Although anybody can contract COVID-19 some will be more effected by the infection resulting in them being far “sicker” than others. Those at higher risk include:

  • Older adults
  • People who are immuno-compromised.
  • People who have serious chronic medical conditions like:
    • Heart disease
    • Diabetes
    • Lung disease

What symptoms can be expected from COVID-19?

The following symptoms may appear 2-14 days after exposure.

  • Fever
  • Cough
  • Shortness of breath

Contact Your Health Care Professional if:

You develop symptoms, and have been in close contact with a person known to have COVID-19
OR
Have recently traveled from an area with widespread or ongoing community spread of COVID-19

Useful Snippets:

  • The coronavirus cannot be transmitted through goods manufactured in China or any country reporting COVID-19 cases. Even though the new coronavirus can stay on surfaces for a few hours or up to several days (depending on the type of surface), it is very unlikely that the virus will persist on a surface after being moved, travelled, and exposed to different conditions and temperatures.
  • To date there has been no information nor evidence to suggest that the new coronavirus could be transmitted by mosquitoes.
  • If you are NOT sick: You do not need to wear a face mask unless you are caring for someone who is sick (and they are not able to wear a face mask). Face masks may be in short supply and they should be saved for caregivers.
  • At present, there is no evidence that companion animals/pets such as dogs or cats can be infected with the new coronavirus.

Handwashing is one of the best ways to protect yourself and your family from getting sick. Learn when and how you should wash your hands to stay healthy.

Wash Your Hands Often to Stay Healthy

You can help yourself and your loved ones stay healthy by washing your hands often, especially during these key times when you are likely to get and spread germs:

  • Before, during, and after preparing food
  • Before eating food
  • Before and after caring for someone at home who is sick with vomiting or diarrhea
  • Before and after treating a cut or wound
  • After using the toilet
  • After changing diapers or cleaning up a child who has used the toilet
  • After blowing your nose, coughing, or sneezing
  • After touching an animal, animal feed, or animal waste
  • After handling pet food or pet treats
  • After touching garbage

Follow Five Steps to Wash Your Hands the Right Way:

Washing your hands is easy, and it’s one of the most effective ways to prevent the spread of germs. Clean hands can stop germs from spreading from one person to another and throughout an entire community—from your home and workplace to childcare facilities and hospitals.

Follow these five steps every time:

  1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
  2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
  3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  4. Rinse your hands well under clean, running water.
  5. Dry your hands using a clean towel or air dry them.

Use Hand Sanitizer When You Can’t Use Soap and Water

You can use an alcohol-based hand sanitizer that contains at least 70% alcohol if soap and water are not available. Washing hands with soap and water is the best way to get rid of germs in most situations. If soap and water are not readily available, you can use an alcohol-based hand sanitizer that contains at least 70% alcohol. You can tell if the sanitizer contains at least 70% alcohol by looking at the product label.

Sanitizers can quickly reduce the number of germs on hands in many situations. However,

  • Sanitizers do not get rid of all types of germs.
  • Hand sanitizers may not be as effective when hands are visibly dirty or greasy.
  • Hand sanitizers might not remove harmful chemicals from hands like pesticides and heavy metals.

Caution! Swallowing alcohol-based hand sanitizers can cause alcohol poisoning if more than a couple of mouthfuls are swallowed. Keep it out of reach of young children and supervise their use.

How to use hand sanitizer:

  1. Apply the gel product to the palm of one hand (read the label to learn the correct amount).
  2. Rub your hands together.
  3. Rub the gel over all the surfaces of your hands and fingers until your hands are dry. This should take around 20 seconds.

How to clean and disinfect:

Surfaces:
  • Wear disposable gloves when cleaning and disinfecting surfaces. Gloves should be discarded after each cleaning. If reusable gloves are used, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other purposes. Consult the manufacturer’s instructions for cleaning and disinfection products used. Clean hands immediately after gloves are removed.
  • If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
  • For disinfection, diluted household bleach solutions, alcohol solutions with at least 70% alcohol, and most common registered household disinfectants should be effective.
    • Diluted household bleach solutions can be used if appropriate for the surface. Follow manufacturer’s instructions for application and proper ventilation. Check to ensure the product is not past its expiration date. Never mix household bleach with ammonia or any other cleanser. Unexpired household bleach will be effective against coronaviruses when properly diluted.
      • Prepare a bleach solution by mixing:
        • 80 ml of bleach per 3 liters of water or
        • 20 ml bleach per 900 ml of water
    • Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).
  • For soft (porous) surfaces such as carpeted floor, rugs, and drapes, remove visible contamination if present and clean with appropriate cleaners indicated for use on these surfaces. After cleaning:
    • Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely.
Clothing, towels, linens and other items that go in the laundry:
  • Wear disposable gloves when handling dirty laundry from an ill person and then discard after each use. If using reusable gloves, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other household purposes. Clean hands immediately after gloves are removed.
    • If no gloves are used when handling dirty laundry, be sure to wash hands afterwards.
    • If possible, do not shake dirty laundry. This will minimize the possibility of dispersing virus through the air.
    • Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely. Dirty laundry from an ill person can be washed with other people’s items.
    • Clean and disinfect clothes hampers according to guidance above for surfaces. If possible, consider placing a bag liner that is either disposable (can be thrown away) or can be laundered.

Guidance for schools which do not have COVID-19 identified in their community:

To prepare for possible community transmission of COVID-19, the most important thing for schools to do now is plan and prepare. As the global outbreak evolves, schools should prepare for the possibility of community-level outbreaks. Schools want to be ready if COVID-19 does appear in their communities.

  • Review, update, and implement emergency operations plans (EOPs). This should be done in collaboration with local health departments and other relevant partners. Focus on the components, or annexes, of the plans that address infectious disease outbreaks.
    • Ensure the plan includes strategies to reduce the spread of a wide variety of infectious diseases (e.g., seasonal influenza). Effective strategies build on everyday school policies and practices.
    • Ensure the plan emphasizes common-sense preventive actions for students and staff. For example, emphasize actions such as staying home when sick; appropriately covering coughs and sneezes; cleaning frequently touched surfaces; and washing hands often.
    • Ensure handwashing strategies include washing with soap and water for at least 20 seconds or using a hand sanitizer that contains at least 60% alcohol if soap and water are not available.
      • CDC offers several free handwashing resources that include health promotion materials, information on proper handwashing technique, and tips for families to help children develop good handwashing habits.
    • Reference key resources while reviewing, updating, and implementing the EOP:
      • Multiple federal agencies have developed resources on school planning principles and a 6-step process for creating plans to build and continually foster safe and healthy school communities before, during, and after possible emergencies. Key resources include guidance on developing high-quality school emergency operations plans, and a companion guide on the role of school districts in developing high-quality school emergency operations plans.
      • The Readiness and Emergency Management for Schools (REMS) Technical Assistance (TA) Center’s website contains free resources, training, and TA to schools and their community partners, including many tools and resources on emergency planning and response to infectious disease outbreaks.
    • Develop information-sharing systems with partners.
      • Information-sharing systems can be used for day-to-day reporting (on information such as changes in absenteeism) and disease surveillance efforts to detect and respond to an outbreak.
      • Local health officials should be a key partner in information sharing.
    • Monitor and plan for absenteeism.
      • Review the usual absenteeism patterns at your school among both students and staff.
      • Alert local health officials about large increases in student and staff absenteeism, particularly if absences appear due to respiratory illnesses (like the common cold or the “flu,” which have symptoms similar to symptoms of COVID-19).
      • Review attendance and sick leave policies. Encourage students and staff to stay home when sick. Use flexibility, when possible, to allow staff to stay home to care for sick family members.
      • Discourage the use of perfect attendance awards and incentives.
      • Identify critical job functions and positions, and plan for alternative coverage by cross-training staff.
      • Determine what level of absenteeism will disrupt continuity of teaching and learning.
    • Establish procedures for students and staff who are sick at school.
      • Establish procedures to ensure students and staff who become sick at school or arrive at school sick are sent home as soon as possible.
      • Keep sick students and staff separate from well students and staff until they can leave.
      • Remember that schools are not expected to screen students or staff to identify cases of COVID-19. The majority of respiratory illnesses are not COVID-19. If a community (or more specifically, a school) has cases of COVID-19, local health officials will help identify those individuals and will follow up on next steps.
      • Share resources with the school community to help families understand when to keep children home. This guidance, not specific to COVID-19, from the American academy of Pediatrics can be helpful for families.
    • Perform routine environmental cleaning.
      • Routinely clean frequently touched surfaces (e.g., doorknobs, light switches, counter tops) with the cleaners typically used. Use all cleaning products according to the directions on the label.
      • Provide disposable wipes so that commonly used surfaces (e.g., keyboards, desks, remote controls) can be wiped down by students and staff before each use.
    • Create communications plans for use with the school community.
      • Include strategies for sharing information with staff, students, and their families.
      • Include information about steps being taken by the school or childcare facility to prepare, and how additional information will be shared.
    • Review CDC’s guidance for businesses and employers.
      • Review this CDC guidance to identify any additional strategies the school can use, given its role as an employer.

Childcare administrators can also support their school community by sharing resources with students (if resources are age-appropriate), their families, and staff. Coordinate with local health officials to determine what type of information might be best to share with the school community.

Consider sharing the following fact sheets and information sources:

>