COVID-19 FAQ

The answers to your questions about COVID-19, testing, self-isolation, quarantine, certificates, and a lot more.

Virus and disease

What is a Coronavirus?

Coronaviruses are a large family of viruses known to cause diseases ranging from a common cold to more serious diseases such as Middle East respiratory syndrome (MERS) and Severe acute respiratory syndrome (SARS).

They are positive-sense single-stranded RNA viruses with a crown-like appearance under an electron microscope. The subfamily Orthocoronavirinae in the family Coronaviridae is classified into four genera of Coronavirus (CoV): Alpha-, Beta-, Delta- and Gamma-coronavirus. The Betacoronavirus genus is further separated into five subgenera (including Sarbecovirus).

Coronaviruses were identified in the mid-1960s and are known to infect humans and certain animals (including birds and mammals). The primary target cells are the epithelial cells of the respiratory and gastrointestinal tract.

As of today, seven Coronaviruses have been shown to be capable of infecting humans:

  • Common human Coronaviruses: HCoV-OC43 and HCoV-HKU1 (Betacoronavirus) and HCoV-229E and HCoV-NL63 (Alphacoronavirus); they can mainly cause common colds, but can occasionally cause lower respiratory tract infections.

  • other human Coronaviruses (Betacoronavirus): SARS-CoV, MERS-CoV and SARS-CoV-2.

What is the novel Coronavirus SARS-CoV-2?

The novel Coronavirus is a new strain of virus that has never been identified in humans before.

The virus causing the current pandemic (formerly called 2019-nCoV) is called SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2). This was reported by the International Committee on Taxonomy of Viruses (ICTV), which is made up of a group of experts in charge of the designation and naming, in general, of viruses (i.e. species, genus, family, etc.). This pool of scientists has defined the novel coronavirus as the “brother” of the one that caused SARS (SARS-CoV), hence the chosen name of SARS-CoV-2.

Is the novel Coronavirus the same as SARS?

No, the novel Coronavirus called SARS-CoV-2 belongs to the same family as the Severe acute respiratory syndrome (SARS-CoV) virus, it is similar, but not the same virus.

Therefore, SARS-CoV-2 is closely related to SARS-CoV and is genetically classified within the same genus, Betacoronavirus.

What is COVID-19?

The disease caused by the novel Coronavirus is called “COVID-19” (where “CO” stands for Corona, “VI” for virus, “D” for disease and “19” for the year when the disease emerged). WHO Director-General Tedros Adhanom Ghebreyesus announced this on 11 February 2020 in a briefing with the press during a break at the extraordinary Forum dedicated to the virus.

Is the source of the Coronavirus causing COVID-19 known?

As of today, the source from which SARS-CoV-2, the Coronavirus causing COVID-19, originated has not yet been identified. The available scientific evidence suggests that SARS-CoV-2 has a natural animal origin and is not a constructed virus. Most likely, the ecological reservoir of SARS-CoV-2 resides in bats. SARS-CoV-2 belongs to a group of genetically related viruses, including SARS-CoV (the Coronavirus causing SARS) and a number of other Coronaviruses isolated from bat populations (Source: World Health Organisation).

Transmission

Can Coronaviruses and the novel Coronavirus be transmitted from person to person?

Yes, some Coronaviruses can be transmitted from person to person, usually after close contact with an infected patient, for example between family members or in a healthcare environment.

The novel Coronavirus responsible for respiratory disease COVID-19 can also be transmitted from person to person through close contact with a probable or confirmed case.

How is the novel Coronavirus transmitted from person to person?

Current evidence suggests that SARS-CoV-2 spreads between people:

  • through direct contact

  • through indirect contact (through contaminated objects or surfaces)

  • or close contact with infected people via mouth and nose secretions (saliva, respiratory secretions or secretion droplets).

These secretions are expelled through the mouth or nose when an infected person coughs, sneezes, talks or sings. People who are in close contact (at a distance of less than one metre) with an infected person may become infected if these droplets enter the mouth, nose or eyes.

To avoid contact with these droplets, it is important to stay at least 1 metre away from others, clean hands frequently, and cover the mouth with a tissue or bent elbow when sneezing or coughing. When physical distancing (standing one metre or more away) is not possible, wearing a face mask is important since it can protect others. It is also essential to wash your hands frequently with soap and water or an alcohol-based product.

Infected people may leave infected droplets on objects and surfaces (called fomites) when they sneeze, cough on, or touch surfaces, such as tables, doorknobs and handrails. By touching these objects or surfaces, other people can become infected by touching their eyes, nose or mouth with contaminated (unwashed) hands.

This is why it is essential to thoroughly clean hands regularly with soap and water or an alcohol-based hand rub product, and to clean surfaces regularly with alcohol-based disinfectants or sodium hypochlorite.

What do we know about aerosol transmission?

Some medical procedures can produce very small droplets (called aerosolised droplet nuclei or aerosols) that are able to stay suspended in the air for longer periods of time. When such medical procedures are conducted on people infected with COVID-19 in health facilities, these aerosols can contain the COVID-19 virus. These aerosols may potentially be inhaled by others if they are not wearing appropriate personal protective equipment. Therefore, it is essential that all health workers performing these medical procedures take specific airborne protection measures, including using appropriate personal protective equipment. Visitors should not be permitted in areas where such medical procedures are being performed.

There have been reported outbreaks of COVID-19 in some closed settings, such as restaurants, nightclubs, places of worship or places of work where people may be shouting, talking or singing. In these outbreaks, aerosol transmission, particularly in these indoor locations where there are crowded and inadequately ventilated spaces where infected persons spend long periods of time with others, cannot be ruled out. More studies are urgently needed to investigate such instances and assess their significance for transmission of COVID-19.

When can infected people transmit the virus?

Based on what we currently know, the virus is primarily transmitted from people showing symptoms, and can also be transmitted just before they develop symptoms, when they are in close proximity to others for prolonged periods of time. People who never develop symptoms can also pass the virus to others, but it is still not clear to what extent this occurs: more research is needed in this area.

In order to break chains of transmission, it is necessary to limit contact with COVID-19 positive people, wash hands regularly and thoroughly and wear a face mask when a physical distance of at least 1 metre cannot be guaranteed.

Can a novel Coronavirus infection be contracted by a case that shows no symptoms (asymptomatic)?

Yes, infected people can transmit the virus both when they have symptoms and when they are asymptomatic. This is why it is important to identify all infected people by performing microbiological diagnostic testing, isolate them and, depending on the severity of their illness, provide medical treatment. People who are infected with SARS-CoV-2, but who are asymptomatic, must also be isolated to limit contact with others. These measures are crucial to interrupt the transmission chain of the virus.

This is why it is always important to stay at least 1 metre away from others, cover your mouth and nose with a bent elbow or tissue when coughing or sneezing, wash your hands regularly and stay at home in case of symptoms, or if requested by your GP or by the Department of Prevention. It is also important to wear a face mask when physical distancing and other prevention and control measures cannot be applied.

What is the difference between asymptomatic and pre-symptomatic people: does this mean that they are both symptom-free?

Yes, both terms refer to people who have no symptoms. The difference is that the term “asymptomatic” refers to people who are infected, but never develop symptoms, while the term “pre-symptomatic” refers to infected people who have not yet developed symptoms, but will develop them later on.

Such a distinction is crucial when it comes to public health strategies for controlling transmission. Laboratory data suggest that people may be more infectious when they develop symptoms. As a result, during investigations and contact tracing, it is recommended that public health professionals identify all individuals who have been or may have been in contact with a confirmed or probable COVID-19 case, focusing their search especially on the 48 hours before the onset of symptoms until the case has been diagnosed and isolated.

Is further information necessary to better understand the transmission of the virus?

Yes, COVID-19 is a new disease, more information is available every day, but there are still many aspects that need to be clarified:

  • the different transmission routes: through droplets of different sizes, physical contact, fomites, and the role of airborne transmission in the absence of aerosol-generating procedures;

  • the concentration of virus needed for transmission;

  • the characteristics of people and situations that facilitate superspreading such as those observed in some closed environments;

  • the percentage of infected people who remain asymptomatic during the infection period;

  • the percentage of truly asymptomatic people who transmit the virus to others;

  • the specific factors that determine asymptomatic and pre-symptomatic transmission;

  • the proportion of all infections transmitted by asymptomatic and pre-symptomatic individuals.

Swabs and serological tests

What is a nasopharyngeal swab?

A swab is a diagnostic test that involves searching for fragments of the genetic material that the virus is made up of (detection of the virus in respiratory secretions by means of Real Time PCR methods for the amplification of viral genes. The biological material analysed comes from the nasal, pharyngeal and tonsil cavities of the person suspected of being positive for the virus. The presence of these fragments shows contact with the virus and, therefore, positivity. Also known as a “molecular test”, the swab is the main and most reliable test to determine whether the virus is present.

The only real limitation of the test is that it takes a long time for the results to come back. From a few hours for well organised labs to several days in other cases.

What is an antigen test?

Rapid antigen tests look for the virus’ surface proteins (antigens) and not for the viral genome (as with the molecular test). The sample is always collected with a nasopharyngeal swab with very short response times (about 15-30 minutes, while the molecular test takes about 24-48 hours). The sensitivity and specificity of the so-called rapid test seem to be lower than those of the molecular test, so those who have a positive rapid test result should then take the molecular test in order to confirm the diagnosis of infection and rule out a so-called false-positive result.

What is a serological test?

A serological test is a venous blood test that detects the presence of antibodies produced by our immune system in response to the virus. It is not enough to diagnose an ongoing infection since the absence of antibodies does not rule out the possibility of infection at an early stage, with the associated risk that an individual may be contagious, even if the serological test is negative.

Antibodies, which appear in the bloodstream about two weeks after infection, persist even after the virus has disappeared. Therefore, serological tests are also an excellent tool to estimate how the virus circulated in the community and, as a result, are an essential epidemiological tool.

When is it necessary to take a swab test to search for SARS-CoV-2?

The GP will assess whether a swab test is necessary when the patient has symptoms that are compatible with COVID-19.

If resources allow it, it is worth considering examining asymptomatic contacts at the end of the quarantine period.

In the event of outbreaks, the test should be offered to all possible close contacts of a confirmed COVID-19 case, identified after thorough epidemiological research (contact tracing), which is normally conducted by the staff of the Departments of Public Health.

In the event of a non-controlled history of infection/disease, the swab test is performed even if the serological test comes back positive.

Does having a positive serological test against SARS-CoV-2 mean you are immune?

The detection of specific serum antibodies against SARS CoV-2 is evidence of infection, but it is still unclear whether this immunity protects against COVID-19. The answer to this question will be crucial to give full meaning to the detection of anti-SARS CoV-2 antibodies and to implement the vaccination strategy. This is why serological investigations will be useful.

Does doing blood tests or taking other biological samples (serological tests) tell you if you have contracted the novel Coronavirus (SARS-CoV-2)?

In the current state of technological advancement, the standard diagnostic approach remains the one based on the search for viral RNA in the nasopharyngeal swab. The swabs for SARS-CoV-2 detection can only be provided by specialised operators, who report to the Department of Prevention of the competent Local Health Authority (ASL). Molecular analysis for SARS-CoV-2 infection must be conducted at regional reference laboratories and at additional laboratories identified by the Regions according to the methods and procedures agreed with the National Reference Laboratory of the Italian National Institute of Health.

Although serological tests are important for the epidemiological research and evaluation of viral circulation, they are not enough to diagnose an ongoing infection since the absence of antibodies does not rule out the possibility of infection at an early stage, with the associated risk that an individual may be contagious, even if the serological test is negative. Moreover, since there is a possibility of cross-reactivity with other similar pathogens (such as other Coronaviruses of the same family), the detection of antibodies may not be specific to SARS-CoV-2, so people who have actually had other types of infections, and not COVID-19, may test positive for antibodies to SARS-CoV-2.

Definitions, contact tracing, isolation/ quarantine and surveillance

What is the definition of a "suspected case" of COVID-19?

  •  A person with an acute respiratory infection (defined as acute onset of at least one of the following sign/symptoms: fever, cough, respiratory difficulty breathing) and without another etiology that completely explains the clinical presentation and history of travels/stay in countries where there has been documented local transmission within the 14 days preceding symptoms onset;

or

  • A person with an acute respiratory infection and history of close contact with a probable or confirmed COVID-19 case in the 14 days preceding symptoms onset;

or

  • A person with a severe respiratory infection (fever and at least one sign/symptom of respiratory disease e.g. cough or difficulty breathing) who require hospital admission (SARI) and without another etiology that completely explains the clinical presentation. In the setting of primary care/A&E department in countries/areas where autochthonous transmission has been observed, all patients with sings/symptoms of acute respiratory infection should be considered as suspected cases.

What is the definition of a "probable case"?

A suspected case in which the result of SARS-COV-2 Real Time PCR performed at Regional reference laboratories is doubtful or not conclusive or the result of a pan-coronavirus test is positive.

What is the definition of a "confirmed case"?

A case with laboratory confirmation of SARS-CoV-2 infection, performed at the National Reference Laboratory of the Italian National Institute of Health or by regional reference laboratories, irrespective of clinical signs and symptoms.

What is contact tracing?

Contact tracing is the process of identifying and managing the contacts of a COVID-19 confirmed case. It is an essential public health measure to fight the current epidemic. Identifying and managing the contacts of confirmed cases of COVID-19 allows any secondary cases to be quickly identified and isolated, thus interrupting the transmission chain.

What is the definition of a "close contact"?

A “close contact” (high risk exposure) of a probable or confirmed case is defined as:

  • a person living with a COVID-19 positive case;

  • a person who has had direct physical contact with a COVID-19 case (e.g. handshake);

  • a person who has had unprotected direct contact with the secretions of a COVID-19 case (e.g. touching used paper tissues with bare hands);

  • a person who has had direct (face-to-face) contact with a COVID-19 positive case, at a distance of less than 2 metres and for at least 15 minutes;

  • a person who was in a closed environment (e.g. classroom, meeting room, hospital waiting room) with a COVID-19 positive case without wearing adequate PPE;

  • a healthcare professional or other person providing direct assistance to a COVID-19 case or laboratory personnel handling samples of a COVID-19 case without using the recommended PPE or using unsuitable PPE;

  • a person who has travelled on a train, plane or any other means of transport seated within two seats of a COVID-19 case, in any direction; close contacts are also travelling companions and staff in the section of the plane/train where the index case was seated.

Based on individual risk assessments, healthcare professionals may decide that some people, regardless of the duration and setting where they came into contact with a COVID-19 case, have had a high risk exposure.

I was identified as close contact of a confirmed COVID-19 case, but my swab test came back negative. Can I avoid quarantine or finish it early?

No. If you have been identified by Public Health Authorities as a “close contact” of a confirmed COVID-19 case, you must quarantine, even if your test comes back negative, for 14 days from the date of exposure or for 10 days since the last exposure, after which you must take an antigenic or molecular test on the tenth day, which must also come back negative.

How should a close contact of a COVID-19 case be handled?

Based on ministerial circular letters and ordinances, the competent Local Health Authorities must apply the following to the close contacts of a COVID-19 case:

  • a 14-day quarantine period with active surveillance since the last exposure to the case, or

  • a 10-day quarantine period with active surveillance since the last exposure and perform an antigenic or molecular test on the tenth day, which must come back negative.

In both cases, the patient will be free to leave their home only after having received instruction on when to end quarantine from the Public Health Service.

What should I do if I know I have been in contact with a confirmed Covid case and the Department of Public Health has not yet contacted me?

Autonomous Regions and Provinces, through local health authorities, are in charge of the health surveillance of contacts living within their respective areas of competence. The Department of Prevention of the Local Health Authority (ASL) is in charge of these activities.

While waiting to be contacted by the Department of Prevention of the competent Local Health Authority (ASL), first of all it is always necessary to self-isolate and, if necessary, to contact a GP, paediatrician of free choice or out-of-hours service doctors, who can provide specific instructions on how to proceed to contact the competent Local Health Authority, or call the regional toll-free numbers activated to respond to requests for information on the measures adopted for the containment and management of the COVID-19 emergency in Italy, which are available on the website of the Ministry of Health or on the websites of the individual Regions.

Quarantine and isolation: what are they?

Quarantine and isolation are important public health measures implemented to avoid further secondary cases due to SARS-CoV-2 transmission and to avoid putting pressure on the hospital system.

Quarantine applies to a healthy person (close contact) who has been exposed to a COVID-19 case in order to monitor symptoms and ensure early identification of cases.

Isolation involves separating people affected by COVID-19 from healthy people as much as possible in order to prevent the spread of the infection during the period of transmissibility.

Active surveillance and passive surveillance: what are they?

Active surveillance is a measure whereby a public health professional contacts a person under surveillance on a daily basis to find out about his/her health condition.

Passive surveillance is a measure whereby people monitor their own health condition for 14 days after the date of low risk exposure (random or occasional contact) with a confirmed COVID-19 case. If even mild symptoms occur (especially fever, sore throat, cough, rhinorrhoea/nasal congestion, difficulty breathing, muscle pain, anosmia/ageusia/dysgeusia, diarrhoea, asthenia) you should notify your general practitioner and report possible exposure.

I have a positive molecular test result. What should I do?

Students, teachers and staff are required to inform the University if found positive after taking the molecular or rapid antigen swab test. Fill in the form to notify you tested positive to the virus

If you were not in any of the University’s facilities in the 48 hours after the onset of symptoms or after taking the swab, you will not need to identify any work/study contacts; otherwise, you will be contacted.

The Ministerial circular letter of 12 October 2020 sets out the criteria for ending the isolation of confirmed COVID-19 cases:

  • COVID-19 positive case without symptoms: the patient can re-enter the community after a period of isolation of at least 10 days after being found positive, at the end of which a molecular test with a negative result is performed (10 days + test).
  • COVID-19 positive case with symptoms: the patient can re-enter the community after a period of isolation of at least 10 days after the onset of symptoms (not considering anosmia and ageusia/dysgeusia, which may persist over time) and must take a molecular test, which must come back negative, after at least 3 days without symptoms (10 days, of which at least 3 days without symptoms + test).
  • Long-term positivity to COVID-19: if the molecular test keeps coming back positive, the patient may interrupt the isolation period 21 days after the onset of symptoms, if he/she has been without symptoms for at least a week (except for loss of taste and smell, which may last for some time after recovery). However, it is up to the doctor to decide according to the patient’s condition, also taking into account the immune status of the person concerned (in immunocompromised patients, the period of contagiousness may be longer).

How do I notify to the University my positive COVID-19 test result?

Students, teachers and staff are required to inform the University if found positive after taking the molecular or rapid antigen swab test.

Fill in the form to notify you tested positive to the virus

Who certifies the end of isolation period?

According to the Ministry’s guidelines, the end of the isolation/quarantine period may be certified, depending on the organisation adopted by each Region, by the Doctor of the Department of Prevention or Public Hygiene Service of the competent Local Health Authority (ASL) or by the General Practitioner or Paediatrician of free choice. At present, in Emilia-Romagna, it is necessary to wait for official communication from the Department of Public Health (recovery certificate).

I was hospitalised with COVID-19: what do I need to do to get back to work?

The competent doctor must issue a certificate of suitability to return to work since the illness may have left you with disabling effects. You should therefore contact your doctor to schedule a medical examination before you return to work and bring all available medical documentation (discharge letter, recovery certificate (servmedlav.medicinadellavoro@unibo.it).

COVID Contact Person

Who is the COVID Contact Person?

The COVID Contact Person is a figure involved in the so-called “secondary prevention” of COVID-19 outbreaks, through the identification of COVID-19 cases and the timely management of any casual contacts. Faced with a confirmed COVID-19 case, the Department of Public Health, the COVID Contact Person, and the Prevention and Protection Service effectively collaborate to identify any casual contacts, inform them, decide whether to hold lessons remotely, sanitize facilities (within a certain period of time). Further information can be found in annex 22 to the Ministerial Decree 7/8/2020 (issued as annex E to Ministerial Decree 7/9/2020).

What does (low risk) random contact mean?

This definition emerges from Annex 22 of the Prime Ministerial Decree of 7/8/2020. In the University’s lecture rooms, Libraries or study rooms, and practical work rooms, in the presence of a confirmed COVID-19 case, (low risk) random contacts are defined as anyone who has been in the same room withwhat will later be identified as a confirmed COVID-19 case, even in the presence of adequate safety measures (distancing/face mask/hand washing) and in a specific timeframe in which the case is potentially contagious (48 hours before the onset of symptoms or before taking a swab test, if asymptomatic).

The COVID Contact Person only notifies random contacts of a potential contact, advises them to put themselves under passive surveillance and, if necessary, to attend classes remotely. They can be students, teachers, technical and administrative staff supporting teachers, or teaching tutors. In some cases, in agreement with the Department of Public Health, they are offered the opportunity to take a swab test on a voluntary basis.

What is the role of the COVID Contact Person at the University?

It is a person who acts as an interface with the Department of Public Health. The University’s COVID Contact Person (which at UNIBO is one of the competent doctors) represents the link between the University and the Health Authority in charge of COVID-19 case management procedures. Whenever a new COVID-19 case is identified, notified by the Department of Public Health or by the person concerned, the Contact Person must initiate the procedure.

If the case is reported by the person concerned (or his/her manager/teacher/director), the COVID Contact Person will need to be informed of all the details that can be useful to understand whether the procedure should be initiated and with whom (date of onset of symptoms, days of attendance during the period when the person concerned was potentially contagious, date of swabbing, classes attended, etc.). This is why it is essential to give the COVID Contact Person the phone number of the case.

Who is the University’s COVID Contact Person?

The COVID Contact Person at the University is a doctor: the staff is formed by occupational doctors from the Occupational Medicine Specialist Unit (University Centre for health and safety) who coordinate a team of trainee specialist doctors. 

COVID Contact Person

Write to: referente.covid19@unibo.it