While COVID can be a mild infection in many people, when it is more severe– but not serious enough to require hospitalization– it can present challenges both for those who are sick and for those taking care of them.
I found vanishingly little concrete guidance on the Massachusetts Department of Public Health’s website regarding how to treat COVID in the home setting. The following is a summary of recommendations from the CDC and from the state of Washington’s Department of Public Health website; valuable input from my colleague Dr. Gaurab Basau at Harvard Global Health who sees many patients with COVID at the Cambridge Health Alliance; as well some helpful pointers from patients, described in a recent New York Times article, How to Get Through COVID-19 at Home.
The takeaway:
- Talk to your doctor or healthcare provider early in the course of illness and let them know you have had a positive test;
- Stay well hydrated--details below on how to do that. Because COVID interferes with your sense of smell, you won’t have much of an appetite and may not be thirsty. But staying hydrated could help keep you out of the hospital.
- Have just one person in your family care for you. If you live alone, try to identify one person who can check in with you each day until you are recovered to see how you are doing.
- Watch your breathing: breathing difficulties, if they happen, usually start about 4-7 days into the illness and can progress rapidly. Ways to check your oxygen levels and improve your breathing are discussed below.
- Self-isolate so you don’t infect others: This means staying in a separate room and using a separate bathroom to protect others in your household. You should try to wear a mask if possible when around others and clean commonly used surfaces and wash hands often.
- Let the people you have been in contact with know that you have COVID if you feel comfortable doing that; if you don’t, let your provider know so that the DPH can get in touch with contacts without telling them that you are the one they had contact with..
The Nuts and Bolts of Treating COVID at Home–for those who want the deep dive.
- Pay attention to your symptoms: several patients recommend keeping a daily chart of your symptoms and fever.
- If your symptoms get worse, call a healthcare provider for guidance.
- Get a thermometer and take your temperature at least a couple of times a day.
- Using a pulse oximeter, which measures the amount of oxygen in the blood, can be very helpful. According to Dr. Basau, a pulse oximeter “certainly helps your provider manage your case when you can provide these numbers.” He adds, “Individuals who are COVID positive can ask their PCP if there is an appropriate need for a pulse oximeter in their case.” At this time, unfortunately, pulse oximeters are not expensive but are in short supply. This is unfortunate, because using one is a helpful way to monitor for one of the more worrisome aspects of COVID infection: so-called “silent hypoxia,” when patients’ oxygen levels can drop to very low levels without their being aware of it.
- Lying on your stomach in a “prone” position may improve your breathing. Dr. Basau says, “we are finding that prone sleeping is a valuable way to increase aeration” or oxygen supply to the lungs; he feels that this is “a strong recommendation.”
- Good nutrition: it is really important to have access to adequate food and water with this illness. Dr. Basau welcomed a new collaboration between Project Bread (hotline: 800-645-8333) and the Cambridge Health Alliance to deliver food to patients who are food insecure (more information on resources for food assistance here).
- If you live alone, ask a friend or relative to check in with you every day until you are improved–both for emotional support and to follow along with you. Dr. Basau says: “checking in with friends is great.” He shared that some health centers like CHA have provided case managers who will call patients to check in on them.
Additional Tips from the Washington Department of Public Health:
Provide comfort
- Make sure to get plenty of rest.
- Use over-the-counter medication for fever, sore throat and general discomfort as recommended by your healthcare provider. You can also ask your provider to prescribe anti-nausea medications.
- Other medications: as of this writing, a medication called remdesivir has shown some promise in treating COVID, and based on preliminary studies, it has been granted temporary emergency approval from the FDA for that purpose; but it is only available to hospitalized patients.
- There are no other medications known to be effective against COVID. So please don’t buy medications online based on potentially misleading claims that they help treat this infection.
Prevent dehydration
This is really critical with COVID, because very often the person who is sick will not feel like eating or drinking; losing the sense of smell plus the nausea that many patients describe can really interfere with appetite and the desire to eat.
Try to drink liquids (water, broth, herbal tea, juice, etc.).
- If you feel you can’t eat solid foods, drink fluids that contain sugars and salts, such as Pedialyte® or Lytren® (undiluted), broth, or sports drinks (make sure to dilute sports drinks half and half with water).
- Drink small amounts of fluid frequently, even if you do not feel thirsty.
Don’t drink alcohol, caffeinated, or diet drinks because these will dehydrate you, and with a fever and the lack of appetite that goes along with this virus, you are at high risk for dehydration. Avoid smoking tobacco, since that can hurt your lung function. Preserving the health of your lungs is really important to successfully combat this illness.
Watch for signs of dehydration. Someone who is dehydrated may:
- Be weak or unresponsive (if someone is unresponsive, call 911)
- Have a dry mouth and tongue
- Produce less urine, which becomes dark in color.
How to check for dehydration
- Gently pinch layers of skin between your thumb and forefinger for one second (best done on the belly skin of a child and on the upper chest of an adult).
- Normally, the skin will flatten out into its usual shape right away. If you are dehydrated, the skin will “tent” or take two or more seconds to flatten out.
If you or a person you are caring for have signs of dehydration:
- Call a healthcare provider
- Give plenty of fluid through frequent sips or spoonfuls of fluid
- Watch for an increase in urination and a lighter color of the urine.
When to call your health provider:
- If the above symptoms get worse, call a healthcare provider for guidance.
- Watch for emergency signs. Call 911 if the sick person has:
- Trouble breathing
- Persistent pain or pressure in the chest
- New confusion or inability to arouse, and/or
- Bluish lips or face
Prevent the spread of COVID-19 in and outside the home
Anyone ill should:
- Stay home, except to get medical care.
- Call ahead before visiting your doctor. If you have an appointment, be sure you tell them you have or may have COVID-19.
- Do not go to work, school or public areas.
- Avoid using public transportation, taxis, or ride-share.
Friend/Family caregivers should:
- Try to identify a dedicated caregiver–so only one person is exposed
- Wear a cloth face mask and gloves when providing care, if available. Cloth face masks should be worn by the sick person and caregiver when in close contact. Bandanas or other cloth that covers the mouth and nose can serve as masks.
- Clean surfaces throughout the home daily. Use soap and water or other household cleaners, then use a disinfectant. If you don’t have a disinfectant, a paper towel dipped in 60% or greater isopropyl alcohol will kill the virus.
- Wash laundry thoroughly. Keep the laundry away from your body. Wash your hands immediately after handling laundry.
Everyone in the household should:
- Cover coughs and sneezes:If you can’t wear a mask because it’s hard for you to breathe while wearing one, then keep people who live with you out of your room, or have them wear a facemask if they come in your room.
- Clean hands thoroughly and often. Wash with soap and water for at least 20 seconds.
- Avoid sharing personal household items (dishes, towels, bedding, etc.).
- Clean all “high touch” surfaces every day, such as counters, tables, doorknobs, bathroom fixtures, phones, and keyboards.”
Most transmission happens in family clusters or anywhere that close contact is unavoidable, such as nursing homes and other crowded settings. Taking the precautions outlined above is an effective means of protecting those you live with.
Support for stress and anxiety
It can be very stressful to take care of yourself or a relative with COVID-19, according to Dr. Basau: “Don’t hesitate to reach out for therapy and social support,” he says. You can talk to your doctor or healthcare provider to share your anxieties; or you can also call the Massachusetts 24-Hour Crisis Line at 1-800-985-5990 for support.
Medical Disclaimer: The suggestions given here are not intended as a substitute for the medical advice of your physician. The reader should regularly consult a physician in matters relating to his/her health and particularly with respect to any symptoms that may require diagnosis or medical attention. For additional questions, please call your healthcare provider for reliable, up-to-date information on testing, symptom management and transmission of COVID-19.
For More Information
What Should You Do if You Think You Have Covid?
What Should You Do if You Are Exposed to Someone with COVID-19?
Three excellent articles written by patients who had COVID or by the relatives who took care of them:
“Please learn from us” an excellent New York Times (NYT) op-ed about a patient with COVID.
How to Get Through COVID-19 at Home–NYT article with a lot of ideas that patients have found helpful to treat COVID at home.
A riveting NYT story of a wife taking care of a sick husband with COVID.
CDC: on taking care of COVID at home
MGH website: on treating corona virus at home.
How to treat a child with COVID
Mayo clinic:how to treat COVID
Photo credit: photo by Kelly Sikkema, from Unsplash.com
