HOME CARE FOR COVID-19

OSMS has compiled information from 40 resources to produce a comprehensive guide on the home management of COVID-19. This is a summary of current guidance and research as of July 9, 2020. We are not a medical institution. Please visit  cdc.gov/coronavirus for the latest Coronavirus Disease (COVID-19) updates and guidance.

Identifying COVID-19

Symptoms

COVID-19 symptoms range from mild to life-threatening in some patients.[1] Knowing the symptoms of the virus can help you determine if you, or someone in your household, should seek testing, and can help guide what actions you can take to care for yourself or someone else. COVID-19 is very infectious, so it is also important to consider taking additional actions to reduce the risk of transmission to other members of your home.[2] A sudden and serious illness can be devastating, but taking a proactive approach can reduce the risk of complications in the patient and prevent the spread of illness to others.

Symptoms can vary in severity and can include a combination of any of the following: fever/chills, cough, difficulty breathing/shortness of breath, loss of taste or smell, fatigue, headaches, body aches, nausea/vomiting, diarrhea, sore throat, and rashes.[3] Symptoms can appear anywhere from 2-14 days after exposure to the virus, and the potential for severe complications to develop has been noted to occur anywhere between 5 and 10 days after the initial symptoms appear. Symptoms may also worsen at night; feeling better during the daytime may not be an indication that the illness has resolved.[4]

Testing

If you are experiencing symptoms consistent with COVID-19 infection, it is strongly advised that you get tested. Due to the nature of the global pandemic, many facilities are changing the ways in which they evaluate patients, including offering virtual appointments known as “telehealth” appointments.[5] If you do visit a clinic in person, you should inform the clinic that you are coming in for COVID symptoms and it is imperative that you wear a mask or cloth face covering to reduce the risk of spreading the virus to healthcare providers or other patients.[6]

In some areas, testing may be unavailable or unaffordable without health insurance.[7] The CDC has created a COVID-19 “Self-Checker” to determine whether or not you should seek medical care.[8] Additionally, Google has also created a “COVID-19 Self-Assessment” resource which can help you decide what kind of medical care you may need.[9] While these tools should not be a replacement for clinical testing, clinical care may not be accessible to everyone, and you may need to consult these resources to self-assess for COVID-19 infection for your own protection.

Home Quarantine

Isolating at Home

If you or other members of your home are symptomatic with or without a positive COVID-19 test, it is important that you take precautions to prevent others within your household or community from getting sick. It is possible to prevent COVID-19 transmission within your home if precautions are taken.[10] Isolating yourself or the sick patient from others is the most important preventive action.

Isolation means keeping the infected person away from others. Establishing a designated “sick room” that infected household members stay in through the duration of their symptoms, and for 3 days afterwards, will help minimize the risk of COVID-19 transmission to other members of the household. If possible, a separate bathroom should be designated for use only by someone who is sick. If a separate bathroom is not possible, consider leaving the door open for air circulation and scheduling daily cleaning routines.[11] Household items such as towels, bedding, cups, and utensils should not be shared with anyone who has symptoms and pets should be kept away from the sick person.[12][13]

If you live alone, try to order your supplies online, or through a grocery delivery service. If you are unable to access these services where you live, try to visit the store early and shop for 2 to 3 weeks of supplies and groceries at once. Always wear a mask when shopping or accepting deliveries.  

Cleaning & Disinfecting 

Cleaning and disinfecting are important measures to take in limiting the survival of COVID-19 within an environment. High-touch surfaces like kitchen counters, door handles, sink handles, and the like should be disinfected daily in household common areas with approved cleaning agents. A list of products that are EPA-approved for use against COVID-19 can be found here. Always read and follow directions on a product label for safe and effective use. Wear appropriate skin and eye protection, ensure adequate ventilation, and avoid mixing chemical products.[14]

For the designated “sick room,” consider only cleaning it as-needed (e.g., only clean soiled items and surfaces) to avoid unnecessary contact with the sick person, or consider leaving cleaning supplies so that the sick person can disinfect their personal areas.[15] You should wear a mask and gloves, if possible, when cleaning and handling laundry, dishes, or other supplies from an infected person, and thoroughly wash your hands immediately afterwards.

Air Circulation

Research has indicated strong evidence that aerosols (respiratory droplets) are a primary mode of COVID-19 transmission, and that indoor air is more likely to harbor aerosols due to both decreased air circulation overall and recirculated indoor air that is not refreshed or exhausted.[16] Decreasing recirculated indoor air and increasing refreshed/exhausted ventilation should be part of your plan to protect yourself and your household. To increase refreshed/exhausted ventilation within your home consider: opening windows and screened doors, operating a window air conditioner unit that has an outdoor air intake vent (and make sure it is drawing in outside air instead of recirculating inside air), and operating bathroom exhaust ventilation fans continuously.[17] To decrease recirculated ventilation within your home, consider: turning off furnaces or air conditioners that only draw air from within the home and turning off any overhead or floor stand fans that circulate air between the “sick room” and other areas of the house.

Home Treatment

Supportive Care

Most people who become sick with COVID-19 will only experience mild illness and can recover at home, but sick people and their caretakers should remain vigilant because the patient’s condition can rapidly deteriorate within hours, particularly 5-10 days after symptoms appear. Home treatment is aimed at relieving symptoms and includes rest, fluid intake and over-the-counter medications.[18] Monitoring your vital signs (temperature, heart rate, and blood oxygen) can alert you to a rapidly-worsening condition and can indicate the need to seek emergency care.[19] Thermometers can be purchased at any pharmacy, and pulse oximeters can be purchased online for home use to monitor blood oxygen levels and heart rate.

Staying hydrated is important, especially if you are experiencing a fever, diarrhea, or vomiting.[20] Adequate intake of electrolytes is required to maintain hydration and should be consumed in a 1:1 ratio of water to electrolytes (32 oz of water, and 32 oz of electrolytes per day). Some examples of good electrolyte candidates include Pedialyte, powdered oral rehydration salts, sports drinks, and broth (chicken, bone, or vegetable). Popsicles are a good choice for getting fluids in while nauseated. Liquid foods like soups can be easier to prepare, consume and digest while sick.[21]

COVID-19 can cause significant respiratory symptoms, including coughing and shortness of breath. It is important to regularly fully expand the lungs, even if it is uncomfortable, to prevent complications and facilitate improved oxygen intake.[22] An incentive spirometer, purchasable online, can be used to complete deep breathing exercises, which help to expand the lungs. [23] Additionally, a breathing technique known as Active Cycle of Breathing (ACBT) can be performed to clear mucus from the lungs.[24]

Over-the-Counter Medications

While common over-the-counter (OTC) medications cannot treat the virus itself, many products can relieve some of the discomfort associated with COVID-19.[25] Consult your doctor before taking any medication and always follow the dosage instructions on the label. Tylenol (acetaminophen/paracetamol) is a pain reliever and fever reducer. Do not take more than 3,000 mg (3 grams) per day and avoid combination products, which may contain additional acetaminophen. NSAIDS (non-steroidal anti-inflammatory drugs), like Advil (ibuprofen), Aleve (naproxen), and aspirin are an alternative option for reducing fever and managing pain. Antitussives (cough medications) like Robitussin (dextromethorphan) can reduce coughing, making it easier for patients to rest. Expectorants like Mucinex (guaifenesin) can make it easier for patients to clear mucus from their airways. Sudafed (pseudoephedrine) can be taken for congestion, but should not be used by anyone with high blood pressure or anxiety disorders.[26][27

Please read medication labels carefully and follow dosage instructions – do not exceed the dosage indicated on the label. For additional information regarding the use of OTC medications, please refer to FDA guidelines here.

Precautions While on Bedrest 

It is very important to get adequate rest while recovering from COVID-19, which means spending long amounts of time inactive in bed for more-affected patients. Special precautions should be taken to reduce the likeliness of developing a blood clot from prolonged inactivity, as blood clots are a significant COVID-19 risk. Sitting up for a few hours and getting out of bed for brief periods of time encourages blood movement and can reduce the risk of developing clots. Stretching and moving the legs while on bedrest is also advised for clot prevention.[28]

Additional considerations should be given to positioning your body when spending an extended amount of time in bed. Lying flat on your back for extended periods of time can increase breathing problems, and is not recommended. It is recommended to regularly change positions between sitting up, lying on one side, lying on your front, and lying on your other side every 30 minutes to 2 hours.[29]

Mental Health Considerations

Coping with illness and isolation can be emotionally difficult. Everyone responds differently to stressful life events, and it is entirely normal to feel a range of emotions including anxiety, loneliness, fear, and depression.[30] There are many ways to connect with friends and loved ones during quarantine or isolation. Consider having phone calls or video hangouts with friends and family (Google Hangouts, Zoom, Skype). Schedule Netflix watching parties with friends or collaborate on group Spotify playlists.[31] If you need immediate help during a crisis please consult the resources available here.[32]

When to Seek Emergency Medical Treatment (ER)

Some cases of COVID-19 may start out mild and progress to more serious symptoms between the 5th and 10th days of illness, and symptoms can become worse at night. Monitoring your vital signs at home and knowing which severe symptoms to be alert to will help you determine if and when you need to be treated in a hospital.[33] A reading of 90% saturation of hemoglobin or lower on a pulse oximeter is an emergency and should be treated in a hospital.[34] Additionally, be watchful for these warning signs and consider seeking emergency care if any of these are present: significant trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, a high fever (103 degrees Fahrenheit), or bluish lips or face.[35]

If you know you have, or suspect you might have COVID-19, keeping a hospital “go-bag” ready will ensure you have some important items should you need to seek emergency care. You should write down all of your medications, how often you use them and in what doses, and the name and phone number of your primary care physician, as well as the names and phone numbers of two emergency contacts. Consider writing down unlocking instructions for your phone, in case medical professionals want to set up calls for you. Bring a charger for your cell phone and clothing to change into when you are discharged from the hospital. While most hospitals provide very basic toiletries, you may wish to pack your own for comfort.[36]

For more information on when to seek emergency care, please visit the US Department of Health & Human Services “When to Seek Emergency Care” webpage.

What to Expect After COVID-19 Infection

Ending Isolation & Returning to Work

Persons with COVID-19 who are symptomatic may end isolation when at least 3 days (72 hours) have passed since resolution of fever and improvement in respiratory symptoms, and since at least 10 days have passed since the first onset of symptoms, according to the CDC.[37]

Currently, the CDC recommends someone may return to work if it has been 10 days from the onset of symptoms and 3 days without a fever, and respiratory symptoms have resolved. The person should maintain social distancing of 6 feet away from co-workers and visitors, and a mask or cloth face covering should be worn at all times in the workplace.[38] It is important to note that employers may have their own policies about returning to work after illness.

Lingering Health Effects

Several physicians have reported treating, or hearing about patients who had recovered from COVID-19 and were experiencing cyclical recurrence of symptoms. Patients have reported similar accounts of lingering fatigue, fevers, and nausea that have come and gone, even months after their initial illness.[39] Even young, previously healthy patients have reported waves of symptoms that make it hard to concentrate, exercise, or carry out physical tasks.[40] Infectious disease specialists say they don’t have a full understanding of the long-term health implications of COVID-19, but are aware of lingering effects that are being reported by patients and their physicians.[41] Be mindful that you or the person you are caring for may have a relapse of symptoms, and may need to isolate again if they recur.

COVID Care Package

The following items can be bought and used to care for someone sick with COVID-19; note that you only need to purchase one item from each category. Consult your doctor before taking any medication and always follow the dosage instructions on the label. Information on OTC medications from the FDA: Understanding Over-the-Counter Medicines.  

Hydration

Choose at least one electrolyte, combined with water, for each day of significant illness. Typical courses of illness can be 10-14 days long. 

  • Pedialyte: Drink 1L (1 bottle) per day while experiencing fever or diarrhea/vomiting.
  • Normalyte: Equivalent to Pedialyte, convenient packet form. Mix 1 packet with 500 mL of water. Drink 1L of prepared mixture per day while experiencing fever or diarrhea/vomiting.
  • Nuun: Add tablets to water bottle to supplement electrolytes.
  • Cans of Broth: Vegetable, Chicken, Bone, Beef, etc. Consume daily to increase sodium intake and maintain hydration.
  • Water: Drink 1L in addition to 1L of electrolytes per day while experiencing fever or diarrhea/vomiting. A water bottle with measurement lines on it can be helpful for tracking intake.

OTC Medications

The following over the counter medications can help reduce the severity of symptoms. Do not take more than one type of NSAID at the same time. Consult your doctor before taking any medication and always follow the dosage instructions on the label.

Pain Reliever/Fever Reducer

NSAIDs
  • Advil, Motrin (ibuprofen): 200 mg; Take 1 tablet every 4 to 6 hours while symptoms persist. If pain or fever does not respond to 1 tablet, 2 tablets may be used. Do not exceed 6 tablets in 24 hours.
  • Aleve (naproxen): 220 mg: Take 1 capsule every 8 to 12 hours while symptoms last for the first dose. You may take 2 capsules within the first hour. Do not exceed 2 capsules in any 8- to 12-hour period. Do not exceed 3 capsules in a 24-hour period.
  • Aspirin: 325 mg: Take 1 or 2 tablets every 4 hours or 3 tablets every 6 hours, not to exceed 12 tablets in 24 hours. Drink a full glass of water with each dose.
Acetaminophen
  • Tylenol (acetaminophen): 500 mg; Take 2 gelcaps every 6 hours while symptoms last. Do not take more than 6 gelcaps in 24 hours.

Cough Medicines/Expectorants

Decongestants

  • Sudafed (pseudoephedrine): Available for purchase at most pharmacies. Must ask the pharmacist and present identification/sign form.

Pulse Oximeters

The following pulse oximeter options can help patients or their caretakers monitor dissolved oxygen content for severe illnesses. 

Spirometers 

The following spirometer options can be used to exercise patient lungs.