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Even with people across the U.S. taking drastic measures to practice “social distancing” and slow the spread of the novel coronavirus that causes COVID-19, many are likely to contract the illness in the weeks and months ahead, according to estimates by some public health experts.
Luckily—especially given the limited number of hospital beds—most of those who do contract it can and should be cared for at home. “What we know is that 80 percent or so of COVID-19 patients are not sick enough to require hospitalization,” says Daniel Barnett, M.D., M.P.H., an associate professor at the Johns Hopkins Bloomberg School of Public Health.
Mild or severe, however, any case of COVID-19 needs to be taken seriously to prevent its further spread, both within a household and to others in the community, says Jennifer Nuzzo, Dr.P.H., S.M., a senior scholar at the Johns Hopkins Center for Health Security and an associate professor in the department of environmental health and engineering and the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health.
Few of us, however, have experience taking care of a highly contagious patient at home. So we’ve compiled a guide to doing so, based on interviews with medical and infectious disease experts as well as guidance from the Centers for Disease Control and Prevention (CDC) and state health agencies.
This advice is intended for those with a known or suspected case of COVID-19 in their household. After all, testing for the virus may not be available or deemed necessary—even for someone who shows mild symptoms of infection or has been exposed to someone with COVID-19. “If you or a loved one becomes ill but you aren’t sure if it’s COVID-19 because you can’t get tested, my advice is to act as though you or your loved one may be infected,” Nuzzo says.
Even the more common “mild” symptoms of COVID-19 can be quite hard on someone. But if symptoms worsen to the point of experiencing shortness of breath, Nuzzo says, call your health care provider for advice. People who are older or at a higher risk for complications from COVID-19 should call a healthcare provider at the first sign of symptoms. And if there is an emergency, like serious trouble breathing, don't hesitate to call 911.
Isolating the Patient
The key to treating someone with COVID-19 at home is separating the patient from others. To that end, the Washington State Department of Health—which was among the first in the country to help manage a significant number of novel coronavirus cases—recommends that (if possible) only people essential for providing care should be in the same home at all. “Other household members should stay in another home or place of residence,” it says, in a guide (PDF) for COVID-19 patients.
But if that’s not possible, says Barnett, the sick person should at least be in a separate bedroom and, ideally, use only dedicated bathroom facilities. (If a separate bathroom is not available, it should be thoroughly cleaned each time the person who is sick uses it. More on cleaning procedures below.)
The CDC says separation is especially crucial for older adults and those who have compromised immune systems, diabetes, or chronic heart, lung, or kidney conditions.
As a precaution, pets should also be kept away from the patient. Although there are no known cases of pets becoming ill with COVID-19, the CDC recommends limiting contact with animals until more is known about the virus.
Caring for the Patient
Treat the person who is ill with the same measures you would use for a cold or flu virus, says Michael Hochman, M.D., associate professor of medicine at USC’s Keck School of Medicine. That means plenty of fluids (particularly those with salts such as soup), plenty of rest, and over-the-counter remedies to control symptoms.
Many over the counter medications aren’t particularly effective and have side effects, Hochman says, but he has been encouraging his patients to use saline nasal/sinus rinse (such as a neti pot) and fever reducers like Tylenol (acetaminophen). As for how much fluid to take, he says a good barometer is to make sure your urine is a normal color (not too dark) and that you are making a normal amount.
Monitor the patient to check fever levels and for severe symptoms that would indicate the need for medical attention, such as shortness of breath, confusion, or light-headedness, Hochman says.
Call a primary care doctor or local health authorities for guidance if you feel the person you are caring for needs medical attention. If they’re acutely ill, call 911 and let the dispatcher know right away that they might be dealing with a COVID-19 case. (Learn more about the symptoms of COVID-19.)
Protecting the Caregiver
Isolating Your Household
Because those living in a household with someone known or suspected to have COVID-19 are at a high risk for contracting the virus themselves, everyone in the house should isolate themselves from other members of their community. Such measures can help stop further spread of the virus.
The CDC suggests monitoring your health starting from the day you were first exposed and to continue doing so for 14 days after your most recent possible exposure. Watch for fever (take your temperature twice a day), coughing, shortness of breath, chills, body aches, sore throat, headache, diarrhea, nausea/vomiting, and runny nose.
If after 14 days without any exposure to others you do not have any symptoms, you can continue with your daily activities, says the CDC—though, of course, that doesn’t mean you should curtail any broader effort to help slow the spread of COVID-19 through social distancing or staying home as much as possible. You can also review the CDC's guidelines on when a person who is sick can end their own isolation.
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- Wear a mask. Though it remains true that most healthy people do not need to wear masks, that broad guidance changes when someone is sick or caring for someone who is sick. Sick people should use a mask when they can't avoid being in the same room as others, says Barnett. And anyone caring for a sick household member directly should also wear a mask.
- Wear gloves. Disposable medical gloves are recommended for tending to a patient, cleaning in the isolation room, and collecting things like tissues, eating utensils, and linens that could be carrying the virus, says Jason Kindrachuk, Ph.D., an assistant professor in the department of medical microbiology at the University of Manitoba and an emerging virus specialist. Disposable gloves should be thrown away after each visit to the isolation room. (Wash your hands thoroughly after removing.) Alternatively, Kindrachuk says, standard rubber dishwashing or utility gloves also work but need to be disinfected after each visit to the isolation room by submerging them in a 1-to-9 bleach-to-water solution.
- Wash hands frequently with soap and water. This is true even if you are using gloves and especially every time you leave the isolation room.
- Clean shared objects thoroughly, or don't share objects. Any objects that leave the room—linens, eating utensils, tissues, etc.—should immediately be disinfected, laundered, or carefully thrown away in a trash can lined with a plastic bag that can be easily sealed and disposed of. If possible, the CDC says, you should completely “avoid sharing household items” with the patient.
- Clean all “high-touch” household surfaces at least daily, says the CDC, including counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Also, clean any surfaces that may have blood or body fluids on them. Barnett says most standard household cleansers or disinfectants are effective, as is a 9-to-1 water-to-bleach solution. (Do not mix bleach with other cleaners.)
- Let in some fresh air. The CDC recommends opening windows or using an air conditioner to ensure that your home has good airflow, weather permitting.
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