Surviving Covid at home

What to do if you have Covid 19 at home?

Having just been through the experience with all my family, here are my tips on staying safe:

1. Isolation. Once someone in the family is suspected or diagnosed with Covid that person and all close contacts must isolate. Ideally this means confining an infected person to 1 room with a separate bathroom and leaving meals outside the door for collection. Dirty plates must we washed with care, and any waste put in 2 plastic bags before being disposed of.

2. Test the rest of the household even if they have no symptoms. PCR test picks up the disease earliest, or an Antigen testing which is cheaper and faster. Check with your doctor which is most suitable according to your circumstances. If you all end up positive, at least you no longer have the chore of 1 or more family members confined to a room.

3. Prepare. The first few days are often relatively mild, so use this time to order supplies on-line, ask a friend to bring round medication like Paracetamol or Ibuprofen, do any reorganization for work like setting up a home office. Any deliveries of course must be left at the entrance with no contact with the occupants.

4. Medical equipment. Especially if anybody is at risk because of age or other health problems make sure you have an infra-red thermometer (contactless), and I recommend a blood pressure monitor (upper arm, not wrist) and pulse oximeter. You can buy these from pharmacies or on-line. Don’t rely on phone apps or smart watches, which may not be reliable enough. With these 3 pieces of kit and video access to your doctor you can do a pretty effective monitoring of everybody’s health. 

5. Day 5 deterioration. It is common for patients to feel worse around day 5 to 7. If you have some meals already prepared/frozen you will be glad not to have to cook.

6. Symptom relief. 
   1. Paracetamol or Ibuprofen is best for fever and muscle and joint aches and pains.
   2. Cough: Try honey (if over 1 year old) or if distressing, a codeine based cough medication may be helpful, on the advice of your doctor. Avoid sleeping on your back if possible.
   3. Keep well hydrated. It is easy to forget to drink if you are sleeping most of the time. Your urine should be pale in colour. If dark, you may be dehydrated.

7. Monitor. Those at risk or who deteriorate need close watching. The warning signs that indicate medical advice may be needed are shown in the table below. Green values are reassuringly acceptable.  The more abnormal readings there are, and the closer to the red end, the more serious the situation may be. An isolated abnormal reading can be repeated to see if it persists. Take into account the general trend. If things are getting progressively worse contact your doctor. Don’t delay or think you will wait until the morning because sometimes changes happen fast. It is a good idea to have a written record of your readings to send to him. Another important warning sign is any confusion or reduced level of consciousness.

This table is just for guidance and only applies to patients 16 years or older. It is not a substitute for medical advice

8. What about antibiotics, Ivermectin, steroids, antivirals…..?
   1. Many patients feel a pressure to do something more active to fight the infection and request all kinds of treatments they may have read about “just in case”. For patients not needing admission to hospital there is at present (Jan 2021) no good evidence to support giving these medications as a preventative or treatment for Covid 19. It is important to be guided by the science and not by wishful thinking based on inadequate evidence.
   2. Vitamin D deficiency has been linked with poorer outcomes in Covid 19 infections. That doesn’t mean that taking extra vitamin D will help you if you are not deficient, but it is a good idea to ensure you have enough. Diet and sunshine are natural sources or supplement if your doctor advises.

9. Ending isolation. If all goes well you can end your isolation if the following conditions are met (for Spain):
   1. At least 7 days have passed since a positive test or since the last contact with a positive Covid person
   2. AND you have been at least 3 days with no fever without taking any fever-lowering medication (eg. Paracetamol or Ibuprofen).
   3. AND your symptoms have significantly improved.

10. Retest. If you want to confirm that you are no longer infectious (especially for example if you will be in contact with vulnerable people) ask for an IGG ELISA antibody test. If positive, you have developed antibodies and are not contagious, irrespective of your IGM or PCR result. 

Equally valid is a negative PCR test. But even if the PCR shows positive you may still be in the clear: ask for the cycle threshold  (ct or umbral de ciclos). If above a certain value it means the viral load is too low to be contagious.

Dr. Anthony Crichton-Smith- GP