The Day has been getting a lot of questions about COVID-19, and we sent some to the New London-based Ledge Light Health District. Mary Day, a nurse practitioner, graciously answered them via email this past week.

Is it possible to have had the virus in late January into February before we began hearing about cases and social distancing?

The first case of COVID-19 in the U.S. was reported Jan. 21, 2020. Because some individuals infected with COVID-19 are asymptomatic, it is possible that an individual who traveled to an affected area such as Wuhan, China, prior to that date could have become infected but was unaware. In that scenario, however, you would expect to see an outbreak as others were exposed to the virus and developed symptoms.

Does the coronavirus test show if you had it as well as if you have it?

The COVID-19 test shows if you currently have the virus. Keep in mind that it is possible to have COVID-19 but have a "false negative" test, because of a bad sample or for other reasons.

If a person recovers from COVID-19 are they immune from future infections?

Because it is a new virus, it is unclear whether people who recover from COVID-19 develop immunity, or how long the immunity lasts. Generally speaking, after exposure to a virus, the human body produces antibodies, which provide some level of immunity to that specific virus. Over time, the levels of antibodies decline and hosts become susceptible to reinfection from the virus. Being immune to one type of coronavirus does not necessarily provide immunity to another type of coronavirus. Also, viruses have the ability to mutate. According to Harvard Medical School, "most people would likely develop at least short-term immunity to the specific coronavirus that causes COVID-19. However, you would still be susceptible to a different coronavirus infection. Or this particular virus could mutate, just like the influenza virus does each year. Often these mutations change the virus enough to make you susceptible, because your immune system thinks it is an infection that it has never seen before."

Are they going to release where the people who tested positive worked so the rest of us can get tested or do more to protect our loved ones?

No, that is confidential information. Contact tracing protocols vary, depending on occupation, exposure, travel history, etc. The time period from when a person is exposed to when they develop symptoms could be anywhere from two to 14 days, so getting tested and having a negative result may provide a false sense of security. We can help protect ourselves and our loved ones by being vigilant about hand washing, avoiding touching our faces, disinfecting "high-touch" surfaces, and practicing social distancing.

We subscribe to The Day in print, which my wife likes to read at the breakfast table. If the virus remains viable on cardboard for 24 hours, and newsprint seems even less absorptive than cardboard, is it safe to handle the newspaper, and have it on our table? What about packages that are delivered, do we have to wear gloves while handling them and wipe them with disinfecting wipes? Same thing with mail?

According to the Centers for Disease Control and Prevention, "it may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it then touching their own mouth, nose, or possibly their eyes, though this is not thought to be the main way that the virus spreads." Because this is a new disease, researchers are still learning about how it spreads. An important measure is good hand washing and avoiding touching your face.

Does high heat kill the virus? Microwave oven?

The CDC reports that, "generally coronaviruses survive for shorter periods of time at higher temperatures and higher humidity than in cooler or (drier) environments. However we don't have direct data for this virus, nor do we have direct data for a temperature-based cutoff for inactivation at this point."

Does the virus have to be transmitted by another person? Or can a person just get it on their own?

The virus is transmitted primarily through respiratory droplets through close person-to-person contact (within 6 feet) or through contact with surfaces that have been contaminated with respiratory droplets.

Is it known whether or not people over 70 have experienced only mild symptoms or is that only true for younger people?

According to the CDC, in the United States for the period Feb. 12 to March 16, 2020, the data for adults aged 75-84 shows that 30.5% to 58.7% of patients in this age group were hospitalized, 10.5% to 31.0% required ICU (intensive care unit) admission, and 4.3% to 10.5% suffered fatalities. There is still a lot that we don't know, as this is a new virus.

Coronavirus is said to be shed in fecal matter. What risk is there in public toilets that flush forcefully and could potentially spray and aerosolize the virus?

The CDC states, "the virus that causes COVID-19 has been detected in the feces of some patients diagnosed with COVID-19. The amount of virus released from the body (shed) in stool, how long the virus is shed, and whether the virus in stool is infectious are not known. The risk of transmission of COVID-19 from the feces of an infected person is also unknown. However, the risk is expected to be low based on data from previous outbreaks of related coronaviruses." Flushing toilets without lids could potentially aerosolize viruses and also contaminate surfaces.

What about blended families who normally send kids back and forth for visitations? Should visitation stop during the quarantine?

In a situation where one parent/member of a household is quarantined, then the visitation should be rescheduled until the quarantine period is over. Otherwise, that is an individualized decision. Either way, all involved parties should practice social distancing, good hand hygiene and respiratory etiquette, and disinfect high-touch surfaces.

Can a person be more at risk for contracting COVID-19 if they are already fighting the flu or cold?

It is possible, however there is not much data available. Generally speaking, the immune system is taxed by fighting illness. We do know that co-infection (having two infections simultaneously) with COVID-19 and other respiratory illness is possible.

I take a blood thinner daily (warfarin) because of two mechanical heart valves, and am in otherwise good health at age 43. Does being on blood thinner alone put me at risk for serious COVID-19?

Warfarin as a medication does not put you at higher risk for COVID-19 or complications, but some of the underlying conditions that are managed with warfarin or other anticoagulants may make you higher risk for complications from COVID-19. According to the CDC, conditions that place individuals at high risk for serious illness from COVID-19 include chronic lung disease, asthma, heart disease or serious heart conditions, severe obesity, diabetes, renal failure, liver disease and any condition or treatment that compromises the immune system. This list may not include all underlying conditions that increase risk for serious illness from COVID-19, so you should consult your health care provider with concerns.

If I had open gallbladder surgery am I more susceptible of getting COVID-19?

Surgery is a major stressor on the body. The stress response of the immune system could, in theory, make a person more susceptible to illness from COVID-19. Open gallbladder surgery may require inpatient hospitalization for three to five days. Being hospitalized could potentially expose you to COVID-19.