Your No-Panic Guide To LA Life, And The New (And Changing) Coronavirus Rules
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UPDATED: May 29, 2020
Life in L.A. has been fundamentally changed. And it keeps changing. After months of shut downs, lost work, and stay-at-home orders, things are reopening in fits and starts. California is technically in Stage 2, but it doesn't look the same for every county. It also doesn't mean what it used to mean.
Some "higher risk" locations originally set for Stage 3 (churches, for example) were allowed to reopen early statewide. And county-by-county, special permission "variances" are allowing more activities to resume ahead of such blanket changes.
It's confusing, and the stages, phases, steps, and pillars have gotten a little tangled. "Where are we in this process?," is not a simple question, because the answer is covered in asterisks with exceptions and caveats. It's somewhat easier to answer the question, "What am I allowed to do?"
To that end, we recently asked L.A. Mayor Eric Garcetti how Angelenos should evaluate risk as more of the region reopens. He said people have to make their own assessments about the risks they want to take, adding, "I think it's okay to take a step forward, but don't dash forward."
Below is everything we know about the coronavirus in L.A., and it's updated as new information becomes available. We've been publishing this resource since January, and it reflects reporting from every corner of our newsroom and beyond. It's also a reflection of the 2,600 questions you've asked and we answered. Keep asking.
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Timeline | Reopening L.A. | Officials and Orders | About the Virus | COVID-19 and MIS-C Symptoms, Testing, Treatment | Masks and Sanitizers | Food Help and Food Safety | Daily Life | Is Nature Closed? | Enforcement | Rent, Loans, Unemployment | Other Kinds of Help | Hospitals | Schools | City and County Operations | Homelessness | More Q&A | Ask A Question |
A FEW KEY DETAILS BEFORE YOU HEAD OUT
1) The official stay-at-home order for L.A. County will extend into the summer. Restrictions will be "gradually relaxed" along the way. There is no specific end date. Here is the revised Health Officer Order from May 29.
2) Face coverings are still mandatory in L.A. County. You are required to wear one when you're out of your home and interacting with people you don't live with — even outdoors, and even in nature. If no one is around, keep a face covering in your pocket in case other humans appear. For the runners out there, put one on when passing. The idea with cloth masks is to stop the virus from getting out, not in.
3) Anyone showing symptoms, or who tests positive for COVID-19, should self-isolate for at least 10 days. Anyone who's had contact with someone known to be infected should self-quarantine for 14 days.
4) Physical distancing still in effect.
REOPENING DATES / WHAT'S ALLOWED IN L.A.
May 8: Some retail shops in L.A. County were allowed to reopen, with restrictions.
May 9: Some hiking trails and golf courses in L.A. County were allowed to reopen, with restrictions.
May 13: More retail shops and manufacturing businesses in L.A. County were allowed to reopen, with restrictions.
May 13: Tennis courts, archery ranges, equestrian centers, community gardens and other select recreational facilities in L.A. County were allowed to reopen, with restrictions.
May 16: Angeles National Forest trails reopened, with restrictions.
May 16: Descanso Gardens reopened, with restrictions.
May 19: Pet grooming/training/retail/mobile businesses and services in L.A. County were allowed to reopen, with restrictions.
May 19: Car washes in L.A. County were allowed to resume operations, with restrictions.
May 22: Beach bike paths and parking lots in L.A. County were allowed to reopen, with restrictions.
May 26: Runyon Canyon was allowed to reopen as a one-way hiking loop, with restrictions.
May 27: In-store shopping, malls, houses of worship, flea markets, drive-in theaters, and pools at multi-unit residences were allowed to reopen in L.A. County, with restrictions.
- Churches can't exceed 25% capacity or 100 people, whichever was smaller.
- Physical distancing and cloth face coverings were required.
May 29: The City of L.A. also released reopening guidance and introduced a new program called L.A. Al Fresco "to support outdoor dining opportunities." Think: eating on sidewalks, in parking lots, and maybe out in the streets, to help keep physical distance. Here's the website for restaurants to apply.
May 29: Offices were allowed to reopen in L.A. when telework was not possible.
Ongoing: Joshua Tree National Park, some California state parks, various campgrounds, and other natural spaces are reopened, with restrictions. Haircuts in some nearby counties are legally allowed, but not yet L.A.
Reopened, but then closed again 🤦♀️: Eaton Canyon
WHAT ABOUT HOLLYWOOD?: The state said on May 20 that it was close to releasing guidelines for resuming film, television and commercial production. The expected release date was later pushed as Newsom said the state was working more formally with the film industry.
State guidance for reopening gyms was expected soon as well.
TIMELINE REALITY CHECK
If it feels like the recovery process is moving a lot faster all of a sudden, that's because it is. A week before the May 29 announcements, County Supervisor Kathryn Barger had proposed July 4 as the target date to fully or partially reopen retail, restaurants, and malls in the county.
At that time, Ferrer said of the July 4 date, that county leaders and residents "have do a lot of things right so that we can actually get to that date... and we're still going to need to pay a lot of attention to what the data's telling us." Garcetti had a similar response.
California Health and Human Services Secretary Dr. Mark Ghaly defined those metrics as:
- No more than a 5% increase in hospitalizations over seven days
- And EITHER less than 25 coronavirus positives per 100,000 residents OR less than 8% positive tests.
When we talked to Ferrer again on May 28, she said she felt the data supported moving ahead now.
"We're well positioned to enter into the recovery phase," she told us. "I don't think we're going too fast... It's easiest on all of us if, wherever possible, the county can move in alignment with the state and I think that's what we've done."
We asked Garcetti at the beginning of Memorial Day weekend how Angelenos should evaluate risk as things reopen.
He said: "We've never been fully closed," and we should get comfortable living in a "gray area" between being open and closed for a while. People will need to make their own individual assessments of the risks they want to take by going out, he added.
"I think it's okay to take a step forward, but don't dash forward. Don't go crazy and stay out all weekend."
Simply, it's permission for a county to skip ahead in the reopening process.
The reopening process works like this: The state decides when California moves into a new stage (or phase within a stage) of changes. But individual counties need to qualify to make those changes based on their own circumstances.
The state lifts closure orders and provides guidance on how to open, but doesn't say when to open.
Sometimes counties want to reopen behind the state pace.
Sometimes counties want to move faster than the state pace.
That's where the "variance" comes into play. It's when a county requests, and is approved by the state, to go further, faster, and reopen areas not covered in the current statewide status.
There are additional "mitigation strategies" for: first responders, law enforcement, homeless populations, retirement communities, tribal communities, correctional and detention facilities, shared housing, community events, faith-based organizations, and more.
In the past, state and local health departments viewed the CDC "as the central federal agency responsible for communicating to the public" during a crisis, Politico reports. "But since March, the White House has shifted much of that work to its coronavirus task force."
A local public health emergency was declared by county officials on March 4.
L.A. County announced the first death from COVID-19 on March 11.
Confirmed cases and deaths are being tracked on the public health department's website.
On March 15, L.A. County officials said they were closing all offices to the public, Los Angeles Mayor Eric Garcetti issued a moratorium on evictions, and an executive order banning dine-in restaurants and entertainment facilities went into effect at midnight.
L.A. County followed with a similar list of actions, closures, and restrictions the following day, including strongly discouraging gatherings of more than 50 people.
The "Safer at Home" emergency order was issued by L.A. County and city leaders on March 19. It included the following directives:
- Residents should remain at home.
- Do not gather in enclosed spaces with more than 10 people.
- Close all non-critical businesses (that can't operate remotely) until further notice.
"I want to be clear about this," said L.A. Mayor Eric Garcetti during the announcement, "that the only time you should leave your home is for essential activities and needs — to get food, care for a relative or a friend or child, get necessary health care," and the like.
Jobs that are critical to safety, health, and the security of city, as well as an "economy of recovery," are exempt. Examples Garcetti cited:
- Emergency personnel
- First responders
- Government employees
- Medical personnel
- Vital infrastructure workers
- Health care providers
- Transportation services
- Grocery stores
- Restaurants (but for take-out or delivery only)
- News outlets
- Hardware stores
- Gas stations
- Banks and financial institutions
- Plumbers, electricians
- Dry cleaners and laundromats
But social distancing must be enforced in all of these cases.
On March 25, Garcetti said the stay-at-home order would likely be in place until May.
On March 27, Garcetti tonight used what may have been his strongest language yet to urge people to heed his stay-at-home orders.
"These aren't suggestions, I remind you, these are orders. We are in the midst of a pandemic," Garcetti said.
The city punctuated that message with a piercing emergency alert sent moments after his nightly address reminding people to keep staying at home, and to only go out for essential activities. L.A. County sent an alert as well.
Official guidance on general mask-wearing arrived on April 1. Garcetti made the recommendation that all residents wear face coverings whenever they're out of the house and interacting with people.
About a week later, that was changed to a requirement. Shoppers and store employees must wear face masks starting April 10.
L.A. County echoed with a face covering ordinance a few days later, bringing some uniformity to the patchwork of mask rules across the 88 cities. You now have to wear a mask when shopping anywhere in L.A. County.
County health officials have also extended the stay-at-home order to May 15. They laid out new data that shows current social distancing practices are working — but we need to do better.
We are bending the curve, but if we stop physical distancing, the projection is that "virtually all residents in Los Angeles County would have been exposed or infected with COVID-19" by mid-summer, said the director of L.A. County's Department of Health Services.
Testing was still only being recommended for people who were symptomatic.
Garcetti said he doesn't see large gatherings like concerts happening again this year, but relative normalcy may come sooner. Similar to Gov. Gavin Newsom's six strategies, the mayor laid out five key marks for the city to hit in order to lift the stay-at-home order:
- Widespread virus and blood testing
- Real-time disease surveillance to detect outbreaks faster
- Rapid, aggressive response to potential outbreaks
- Increase hospital capacity
- Ongoing research and development
Based on the current modeling, mid-May is the projection to begin rolling back the current restrictions, said Barbara Ferrer, director of the L.A. County Department of Public Health at a briefing on April 21. But, she said, there is no "magic day."
Ferrer said on April 22 that CDC staff members would be helping the health department improve infection control practices at skilled nursing facilities, and that approximately 40% of all deaths countywide have been at institutional facilities.
On April 27, Ferrer said that county residents living in areas with high rates of poverty are dying at a rate about three times that of communities with low poverty rates.
"This data is deeply disturbing and it speaks to the need for immediate action... this would mean increased testing, better access and connection to health care and support services, and more accurate culturally appropriate information about COVID-19, and we're joining with our partners in the community to make sure this happens."
On the same day, Mayor Garcetti said L.A. might be baby stepping toward normalcy in the next two to six weeks. There are plenty of caveats. There's also this: because what we've done is working, most of us could still get the coronavirus. "If we open up the wrong way," he said, 95% of us could get COVID-19 by August 1, citing a USC study.
Garcetti added "it's not really about a date, or how few cases you have — it's about the infrastructure you have to handle opening up."
A day later he announced a major testing change: all L.A. city residents, even those without symptoms, could get tested for COVID-19, for free.
On May 4, Garcetti called the reopening situation "fluid," and said he thought by May 15 the city would be ready to take some steps forward. Ferrer said the city would be releasing recovery plan guidelines. This was in response to the Governor's expected order which may allow some businesses to re-open beginning May 8.
On March 15, Gov. Gavin Newsom called for far stricter guidelines in the state. He asked all seniors and people with underlying conditions to isolate at home, restaurants to operate at diminished capacity, and wineries, bars, and brewpubs to close.
In a March 18 letter to President Trump, Newsom projected that more than half of the population of California will be infected with the virus over an eight-week period. He asked for $1 billion in federal funding and requested the hospital ship USNS Mercy be sent to Los Angeles.
On March 19, about an hour after the L.A. County orders were announced, Gov. Gavin Newsom ordered all residents of California to stay home or otherwise remain at their place of residence in order to slow the spread of the virus. There are exceptions for people who maintain critical infrastructure in 16 key sectors, including:
- Commercial Facilities
- Critical Manufacturing
- Defense Industrial Base
- Emergency Services
- Financial Services
- Food and Agriculture
- Government Facilities
- Health Care and Public Health
- Information Technology
- Nuclear Reactors, Materials, and Waste
- Water and Wastewater Systems
On April 13, Newsom announced what he described as a shared framework with Oregon and Washington about how to economically reopen California. More details came April 14 with a plan that includes six key metrics for loosening the stay-at-home orders. They include:
- More testing, tracking, isolating/quarantining, and supporting people who are positive/exposed.
- Protecting the most vulnerable from infection and spread.
- Hospitals and health systems being able to handle surges.
- The ability to develop therapeutic drugs to meet the demand.
- The ability for businesses, schools, and child care facilities to allow for physical distancing.
- The ability to determine when/if to reinstitute measures like stay-at-home orders.
The governor's tasked 80 leaders to help plan for the state's economic recovery, with an advisory council that includes all four of the state's living governors. He said the task force — which will divide up into sub-groups covering entertainment, hospitality, retail, manufacturing, regional issues, etc. — will work on actionable ideas in real time, not some future report.
Newsom said on April 21 that local officials can lift some stay-at-home restrictions, as long as they don't conflict with state orders. His comments, made a daily press briefing, were in response to a question about Riverside County opening up golf courses and Port Hueneme opening beaches.
The governor reviewed testing numbers on April 22, saying the 465,000 tests administered so far in California were not enough to modify stay-at-home orders.
On April 27, Newsom said he hoped the state was weeks, not months, away from making significant changes to the stay-at-home orders — but that those decisions will be driven by data, and require people to abide by physical distancing orders.
Newsom has phases on phases to go with his six key metrics. On April 28, he laid out a "resilience roadmap" with four steps towards a full reopen. He also said that despite distributing millions of masks, the state is not even close to where it need to be with personal protective equipment yet.
Newsom said on April 29 that the state was possibly "a week or two away from significant modifications on our stay-at-home order," as long as coronavirus numbers remained stable.
Two days later the governor said the state is now "days, not weeks" away.
On May 4, Newsom said parts of the state would start moving into Phase 2 of reopening on May 8, and that guidlines would be forthcoming. This phase includes changes like retail beginning to reopen for pickup. Here's more on the six key metrics on the "State Reopening Roadmap Report Card."
Social/physical distancing is even more important in Phase 2, he said on May 5.
Announcements about counties moving further into Phase 2 were expected May 12, with detailed guidelines for dining, offices, and malls.
Ten counties got that green light for May 13. L.A. was not one of them.
The state said on May 20 that it was close to releasing guidelines for resuming film, television and commercial production. The expected release date was then pushed about a week as Newsom said the state was working more formally with the film industry and labor.
There are a variety of metrics counties need to hit to move forward, California Health and Human Services Secretary Dr. Mark Ghaly said. These include:
- No more than a 5% increase in hospitalizations over seven days
- And EITHER less than 25 coronavirus positives per 100,000 residents
- OR less than 8% positive tests
Newsom said on May 22 that the state was days away from putting out guidelines for reopening churches, synagogues, and other houses of worship.
On Memorial Day, the California Department of Public Health announced that churches, temples, mosques and other places of worship had permission to reopen statewide. In-store retail was also approved to reopen, with restrictions.
Changes were subject to approval by each county's public health department, and L.A. County was not approved.
On May 26, Newsom announced that counties with approved "variances" could skip ahead and reopen barbershops and hair salons instead of waiting for a statewide greenlight. That did not include L.A.
Note: President Trump usually opens coronavirus news briefings with his own remarks. His comments in a number of past briefings have later been contradicted by information provided by other officials. He has also repeatedly used stigmatizing language to describe COVID-19. Following the president's remarks, health experts and other adminstration leaders provide additional updates.
Voluntary, nationwide guidelines were announced on March 16, initially set to last for 15 days.
President Trump and the White House coronavirus task force asked Americans to close schools, avoid groups of more than 10 people, homeschool kids where possible, avoid discretionary travel, and refrain from visiting bars, restaurants, and food courts.
Meanwhile, a Level 4, "Do Not Travel" global health advisory was issued by the U.S. State Department advising all citizens to "avoid all international travel due to the global impact of COVID-19."
At a March 23 briefing, Trump said the REAL ID deadline will be postponed and that surgical and N95 masks would be distributed by FEMA. An executive order was also announced by Attorney General William Barr making certain items illegal to hoard.
On March 27, Trump announced at a briefing that he invoked the Defense Production Act, "to compel General Motors to accept, perform and prioritize federal contracts for ventilators." He put it differently on Twitter that day.
The task force said on March 31 that Americans should brace for 100,000 or more people to die in the coming months in the pandemic. Dr. Anthony Fauci and Dr. Deborah Birx renewed pleas to observe precautions. Birx said she's "reassured" by what L.A. has accomplished with social distancing in terms of how other cities might be able to respond as well.
On April 3, Trump said hospitals treating uninsured coronavirus patients would be reimbursed by the administration with funds from the economic relief package. The president also announced new CDC recommendations that people wear non-medical cloth face coverings when out in public.
Treasury Secretary Steven Mnuchin said eligible taxpayers could receive stimulus payments within two weeks (others said some checks could take months).
On April 9, the federal government released new guidelines about when people in critical infrastructure roles can go back to work if they've been exposed to a confirmed or suspected case of the coronavirus. The CDC recommendations include taking temperatures before work, wearing face masks at all times, and practicing social distancing as much as duties allow.
On April 16 came a three-phased approach to normalization, albeit without time requirements. The strategy is contingent upon states having data about case levels, the capacity to treat all patients and test healthcare workers, and the ability to trace the contacts of those infected. States can decide on a county-by-county approach, according to an 18-page document obtained by NPR.
Each phase would require a 14-day period of a "downward trajectory" of cases to advance to the next one. Here's an overview —
- states or regions would have social distancing guidelines similar to those in place now
- a prohibition on gatherings of more than 10
- maximized physical distance
- working from home when possible
- the closures of schools and bars etc.
- strict physical distancing protocols would be ordered for places like restaurants, theaters, sporting venues, churches and gyms.
- vulnerable people would be urged to stay home.
- states and regions that show no signs of a rebound could expand gatherings to 50 people.
- resume non-essential travel.
- working from home would still be encouraged.
- schools could reopen and bars could operate with "diminished standing-room occupancy."
- vulnerable people still would be urged to stay home.
- states and regions could expand guidance so that vulnerable individuals could go out in public.
- visits to hospitals and nursing homes could resume.
NPR has the full guidelines documents.
On April 20, Trump announced via Twitter his intention to "temporarily suspend immigration."
"In light of the attack from the Invisible Enemy, as well as the need to protect the jobs of our GREAT American Citizens, I will be signing an Executive Order to temporarily suspend immigration into the United States!"
He gave more details during an April 21 news briefing, and said the measure was needed to protect the jobs of U.S. workers. He also said secondary orders were under consideration.
On April 22, Trump signed an executive order to temporarily ban some green carder seekers from coming to the U.S. It goes into effect on April 24 and will last for two months, further extending the wait for green card seekers, some of whom first applied decades ago.
But the move is far less wide-ranging than Trump had indicated in his tweet.
His order exempts green card applicants who are the minor children and spouses of U.S. citizens. It also has a carve-out for health care workers, including nurses and doctors and people doing work that is "essential to combating, recovering from, or otherwise alleviating the effects of the COVID-19 outbreak."
There were mixed messages out of Washington on May 22.
The U.S. Department of Justice sent a letter to the office of L.A. Mayor Eric Garcetti, warning him that the city's long-term stay-at home orders may be "arbitrary and heavy handed." Meanwhile, Dr. Deborah Birx, one of the White House's main medical advisors included Los Angeles as one of the regions where the spread of coronavirus remains a concern.
Garcetti responded to the DOJ letter in a coronavirus briefing: "We are not guided by politics in this, we are guided by science."
Birx said she would ask the CDC to investigate the problem areas "to really understand where are these new cases coming from, and what do we need to do to prevent them in the future."
L.A.'s latest stay-at-home order was originally supposed to be lifted May 15. It's still in place, but the reopening timeline has greatly accelerated in recent days.
On January 30, a "Public Health Emergency of International Concern" was declared by the World Health Organization over an outbreak of a new, deadly, novel coronavirus which began in Wuhan City, China.
On March 4, L.A. County declared a local and public emergency, and Gov. Gavin Newsom made the call to declare an emergency for the state of California the same day.
On March 11, WHO made it official: COVID-19 is a pandemic.
On March 26, the United States surpassed China as the country with highest total number of confirmed COVID-19 cases in the world.
On April 11, the U.S. became the nation with the most confirmed COVID-19 deaths.
As of May 29, the U.S. still has the highest number of confirmed COVID-19 cases in the world, and our local numbers were still rising.
SARS-CoV-2 is in the family of coronavirus pathogens that usually cause short-lived illnesses.
They get their name because of how they look, which is spiny around the edges, like a crown. And some coronaviruses are scarier than others. Scientists are still trying to figure out how dangerous this new (or "novel") coronavirus is.
"Most people get infected with these viruses at some point in their lives," according to the Centers for Disease Control and Prevention.
Symptoms may include fever, cough, difficulty breathing, runny nose, and headache. But they can vary in severity. Thousands of people have died, but "other patients have had milder illness and been discharged," the CDC said.
Coronaviruses generally jump from person to person on the droplets from coughs and sneezes.
The CDC's current best guess is that the incubation period for novel coronavirus — that's the time from exposure to when symptoms first start showing up — is somewhere between two and 14 days.
We still don't know how easily this coronavirus can spread through the air.
L.A.'s public health director Barbara Ferrer said the virus is too big and heavy to linger in the air, while others are investigating the possibility of spread via "bioaerosols." The World Health Organization says it doesn't seem to linger or travel more than 3 feet, but at least one medical expert says it's way too soon to know that.
Another question is viral load, or the amount of the virus in your system. It's still unclear whether viral load can affect your chances of getting sick, and recent studies suggest that it could affect the severity of your illness, Ferrer said.
On May 15, public health officials announced that L.A. County had reduced the rate of COVID-19's spread from three people for every one person infected, to just one.
It depends on where it is.
The coronavirus that causes COVID-19 is "stable for several hours to days in aerosols and on surfaces," according to a study from National Institutes of Health, CDC, UCLA and Princeton University scientists in The New England Journal of Medicine.
detectable in aerosols for up to three hours
up to four hours on copper
up to 24 hours on cardboard
up to two to three days on plastic and stainless steel
MERS (Middle East Respiratory Syndrome) and SARS (Severe Acute Respiratory Syndrome) are two members of the coronavirus family that tend to make people sicker. "About 3 or 4 out of every 10 patients reported with MERS have died," according to the CDC. And SARS was responsible for a global outbreak in 2002-2003 that killed 774 people.
"The novel coronavirus is more genetically related to SARS than MERS," said Dr. Nancy Messonnier.
But scientists don't know yet if novel coronavirus will act the same way as SARS or MERS; they're using information from both pathogens to guide their research.
Maybe. It has happened.
A tiger in New York City with a respiratory illness (I know, nothing makes sense) was the first animal to test positive in the U.S. That was in early April.
On April 22, two pet cats in New York were confirmed to have COVID-19 by the U.S. Centers for Disease Control and Prevention,and the U.S. Department of Agriculture's National Veterinary Services Laboratories.
- Don't let pets interact with people or animals from outside of your home.
- Keep cats indoors when possible to prevent mingling with other animals or people.
- Walk dogs on a leash and keep at least 6 feet away from other people and animals.
- Avoid dog parks or public places where a large number of people and dogs gather.
If you're sick (either suspected or confirmed COVID-19), you should:
- Avoid contact with your animal friend, and isolate.
- That means no petting, snuggling, being kissed or licked, or sharing food or bedding.
- Have another member of your household care for your pet if possible.
- If that's not possible, wear a cloth face covering and wash your hands before and after interactions.
Meanwhile, adoptions of shelter pets in L.A. have been "off the charts."
You can track the global scope and spread of COVID-19 with this map and list from Johns Hopkins Coronavirus Resource Center. Also, these U.S. numbers from the CDC are updated daily.
The map below also shows cumulative confirmed cases, deaths, and recoveries. It's updated in near real-time throughout the day. Zoom out to see more of the world.
Symptoms can include: low-grade fever, body aches, fatigue, coughing, nasal congestion, runny nose, sore throat, diarrhea, new loss of taste or smell.
Severe symptoms can include: high fever, severe cough, shortness of breath, inability to wake or stay awake, persistent chest pain or pressure, confusion, bluish lips or face.
These symptoms may appear 2-14 days after exposure. However, some people infected with the virus have no symptoms at all.
There also may also be additional symptoms beyond what we've listed above.
Meanwhile, across the country, doctors are reporting cases of children with a rare inflammatory condition linked to the coronavirus.
The illness, initially known as Pediatric Inflammatory Multi-System Syndrome (PIMS) and renamed the Multisystem Inflammatory Syndrome in Children (MIS-C), is similar to a disorder known as Kawasaki Disease. Symptoms include high fever, rashes and inflammation that can affect organs, including the heart.
Doctors at Children's Hospital Los Angeles have treated patients who've exhibited symptoms consistent with this condition since April. Specialists say symptoms can range broadly, and there's been concern over coronary artery enlargement or aneurysms in kids.
The CDC says "different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. We do not yet know what causes MIS-C. However, we know that many children with MIS-C had the virus that causes COVID-19, or had been around someone with COVID-19. MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care."
If a child shows the following symptoms, contact a medical professional immediately:
Feeling extra tired
If a child shows the following symptoms, seek immediate emergency care:
Pain or pressure in the chest that does not go away
Inability to wake or stay awake
Bluish lips or face
Severe abdominal pain
The orders from L.A.'s public health department set out timeframes, restrictions, and criteria for self-isolation and self-quarantine.
For people who have contracted COVID-19, the guidance from the CDC is to self-isolate for 10 days, plus 3 days without fevers and/or symptoms. The virus may shed for longer than initially thought, which means a person may be able to infect other people for a longer.
If you think you might have been exposed, or if have COVID-19 symptoms, isolate, and call your doctor for next steps (or dial 211 in L.A. County if you need to find a clinician).
If you experience severe symptoms, get immediate medical attention.
If you are caring for someone with COVID-19 at home, here are some things to keep in mind. These tips come from UCLA's Dr. Robert Kim-Farley with the Fielding School of Public Health (and a former staffer with the CDC):
- Make sure they wear a mask
- Make sure you wear a mask
- Monitor for trouble breathing
- Monitor for persistent chest pain or pressure
- Call their healthcare provider if symptoms become more severe (especially if they're elderly or have pre-existing conditions).
- Clean surfaces frequently
- Try to keep the patient in one bedroom, and ideally one bathroom
- Don't shake the laundry before washing (to avoid aerosolizing virus particles that may be on their clothes).
- Restrict unnecessary visitors
- Wash hands frequently
The CDC requires people who have tested positive for COVID-19 to notify everyone they were in close contact with — including during the 48 hours before symptoms started — so those people can self-quarantine for up to 14 days. Close contact means less than 6 feet apart for 10 minutes or more.
People who have tested positive also need to self-isolate for 10 days, plus 3 days without fevers or symptoms, according to the CDC.
- Quarantine: a separation for people who have a contagious disease, have symptoms consistent with a contagious disease, or were exposed to a contagious disease. A person's movements are restricted when they are quarantined
- Isolation: a less restrictive separation that keeps people who are sick away from people who are not sick
- Self-Isolation: a voluntary action to stay at home by people who are sick (or are likely to be sick) and are experiencing mild symptoms
- Self-Quarantine: a voluntary action to stay at home by people who may have been exposed but are not experiencing symptoms
- Social Distancing: keeping your distance from other people. The distance reduces the risk of breathing in droplets that are produced when an infected person coughs, sneezes, or, in some cases, breathes. It can also mean cancelling events or gatherings (the term "physical distancing" means the same thing.)
1) APPLY ONLINE if you live anywhere in L.A. County. You can get screened via the online portal.
COUNTY: Anyone in the county experiencing COVID-19 symptoms can apply for a test, but it doesn't necessarily mean everyone will get one. You'll be asked some questions on the eligibility form, and then you'll be asked for your contact information for next steps.
CITY: If you live in the city of L.A., you do not need to have symptoms to register for a test.
2) GET A DIRECTIVE from a health care provider. Call your doctor and they'll give you the next steps. If you don't have a health care provider, call 211 and they'll direct you to a nearby clinician. L.A. public health officials are asking people not to call 911 and not go to the emergency room unless you're experiencing severe symptoms and need immediate medical attention.
Initially, the tests were limited to people most at risk. Restrictions were relaxed a few times to allow for same-day or next-day testing for anyone with symptoms, and testing of certain front-line workers without symptoms.
On May 6, Gov. Gavin Newsom announced that the state was launching a new site where people can enter their zip code to find testing locations and schedule a test. It includes mobile testing sites, although it doesn't include private hospitals.
Pharmacies were also given permission to test for coronavirus, under state guidelines released May 12. There are 6,492 pharmacies in the state where that could potentially happen.
But, testing or not, if you experience severe symptoms, get immediate medical help.
No. California health officials are waiving all co-pays for COVID-19 testing. That applies to people on all insurance plans, and people who don't have health coverage.
You can also be tested for free regardless of your immigration status. And the federal government has said that getting tested or treated for coronavirus will not count toward the public charge test for getting a green card.
And if you don't have insurance, here are some options for getting it: Covered California and the entire individual health insurance market has extended the enrollment window to June 30; enrollment for Medi-Cal is open year round; and in L.A. County, there's the no-cost health care plan My Health LA.
Here's a map of the locations.
But, again, you can't just show up.
You have to be approved first.
Get screened online to request a test, or try to get a directive from a health care provider.
At some testing sites, a health professional will administer a nasal swab.
At other places, you'll be given a testing kit for an oral swab that you can administer yourself.
The turnaround is "about three days" for L.A. County-operated sites.
"There are certainly some cases in which it's taking longer than three days," Christina Ghaly, director of health services at Los Angeles County Health Agency, told us. "That number is an average."
Many of you asked us about this.
Some people were told their test results would be available in one or two days, and it wound up being five. Others said they were told five days, and they were still waiting.
The city/county guidance says results typically take "3-5 days."
When they're ready, you will be notified by email. Results can then be viewed online.
If you don't have an email address, you will get a call.
And here are some steps you can take if it's been more than five days and you're still waiting.
It's a blood test to see if you've formed antibodies against the coronavirus, which is a way of telling whether you've ever had it, even if you never developed symptoms. Antibodies are proteins your body produces to fight infections.
This test hasn't gotten as much attention as the test to see if you actively have the coronavirus, but widespread testing for antibodies will be crucial to figuring out how much the virus has spread, how deadly it is, and when we might get back to something approximating normal life.
To help kickstart that effort, L.A. County and USC teamed up to test for antibodies in 1,000 Angelenos.
County Health Officer Dr. Muntu Davis told us that people will be tested to determine if they've been infected, and if so, "what their antibodies look like." Davis said the data will help to make some "general estimates and predictions" about how far the virus has spread and how deadly it is.
At least one SoCal hospital is experimenting with transferring antibodies from a recovered patient. The hope is that the antibodies will attack the virus to help a sick person heal.
The county/USC study participants are all adults, and they were selected to create a random sample that reflects the county's demographic makeup. They'll got the "serology" test at six drive-thru sites on April 10 and 11, according to ABC7.
Those leading the study intend to repeat the tests every two weeks for three months.
Neerja Sood, a vice dean at USC involved in the project, told The Washington Post that the test kits were donated by a private individual who read his Wall Street Journal op-ed about the importance of randomized testing.
Preliminary findings were announced April 20. The data suggests many more people in L.A. County could potentially be infected than the official count. It also suggests the mortality rate for the county could be lower.
You could be contagious for up to 14 days, according to Dr. Shruti Gohil, University of California Irvine Medical Center.
However, Gohil said, since asymptomatic carriers may not know when Day 1 was, it's "encouraging to know ... their ability to spread the disease is far less than those who are actively symptomatic."
Barbara Ferrer, director of the L.A. County Department of Public Health, told us: "We don't have conclusive evidence on that."
She said that "in general you can be protected when you've had an infection, but not always. We're just going to have to wait for the researchers and the scientists to let us know what they're finding out about that."
There is no vaccine yet. Scientists started working on a plan in January, before COVID-19 even had a name. A number of companies have been working on vaccine development, and clinical trials are underway. The timeline is unknown, but experts have been weighing in with estimates.
For treatment, at least one SoCal hospital is experimenting with transferring antibodies from a recovered patient. The hope is that the antibodies will attack the virus to help a sick person heal.
Cedars-Sinai is participating in a clinical trial of the drug remdesivir. A small trial of an experimental antiviral drug has shown encouraging results, the hospital announced on April 10. And on May 1, the FDA approved the drug for emergency treatment for COVID-19. Prior to that, the FDA's FAQs had advised "there are no FDA-approved drugs specifically for the treatment of COVID-19."
But the effectiveness of remdesivir is still being studied.
"This is not a cure-all," said Jonathan Grein, who is the director of epidemiology for Cedar-Sinai. "Specifically, not everyone with COVID-19 will need this drug or even benefit from this drug."
The president has promoted malaria drugs as a possible treatment. The AP reported that a nationwide study — not peer reviewed — of hydroxychloroquine use at U.S. veterans hospitals found no benefit and more deaths among those given the drug, versus standard care. (And, despite FDA warnings, President Trump said on May 18 that he'd been taking hydroxychloroquine with zinc to protect against symptoms, should he get the coronavirus.)
The CDC's guidance for for clinical management of the coronavirus includes, "infection prevention and control measures and supportive care, including supplementary oxygen and mechanical ventilatory support when indicated."
For children with the associated illness MIS-C, the CDC says doctors may order blood tests, chest x-rays, echocardiograms, and abdominal ultrasounds to look for inflammation or other signs of disease. They may also provide supportive care like medicine and fluids for symptoms, and medication to treat inflammation, noting:
"Most children who become ill with MIS-C will need to be treated in the hospital. Some will need to be treated in the pediatric intensive care unit (ICU)."
There's currently no established link between ibuprofen and coronavirus complications, but there is a lot of conflicting information being circulated.
The World Health Organization officially weighed in on Twitter on March 18 with this guidance, in all its double negative glory:
Based on currently available information, WHO does not recommend against the use of of ibuprofen.
The CDC has issued no coronavirus-related guidance regarding the use of anti-inflammatories as of March 20.