As the cooler weather takes hold, a viral pandemic is blanketing the U.S. with infection rates like we've never seen.
As of early December, there are more than 200,000 new U.S. cases reported every day. More than 100,000 people are currently hospitalized with severe cases. But far more people are having to manage less severe cases at home.
Patients are facing time alone with a notoriously unpredictable virus — and that can feel scary, confusing and overwhelming. Those are all sentiments I've heard a lot in my own practice as a family doctor lately.
If you've gotten a positive test result, here's advice from doctors about how to handle a mild to moderate, or even asymptomatic, case on your own — and when you need to seek emergency help.
Isolate yourself from others, starting as quickly as you can
You've probably heard this one plenty, but it's as important as ever: The Centers for Disease Control and Prevention recommends 10 days of isolation after a positive coronavirus test if you're asymptomatic, or at least 10 days of isolation from the start of symptoms if you have them. If your positive test was after symptoms started, isolation days would still start counting from the first day of symptoms.
If you're in this situation and live with other people, it takes a bit of planning to follow that advice. It's important to stay in separate rooms (including during meals and sleep), and everyone else in the house should wear a mask in common areas. Also, be sure to step up the sanitizing of shared surfaces and avoid sharing things such as cups and towels.
Members of your household and your close contacts need to quarantine, too
If you've tested positive for the virus, everyone you live with has been exposed, so they, too, will need to quarantine as well as anyone you had close contact with in the two days leading up to your positive test being collected or the start of symptoms.
So what's close contact? The CDC says 15 cumulative minutes of exposure to the sick person and within 6 feet of them — even with masks on. It's fair to assume anyone who has been gathering with you, especially indoors, was exposed, so plan to reach out to close contacts and ask them to quarantine.
But there's new recommendations for how many days they need to quarantine. The CDC still maintains a full 14 days of quarantine after being exposed is the best method to keep from spreading COVID-19, but it now offer alternatives if that's not possible. Exposed people can quarantine 10 days from the exposure if there's no testing and symptoms don't develop, or as few as seven days if there are no symptoms and they get a negative test.
If the shorter quarantine schedule is followed, exposed people should keep watching closely for symptoms for a full 14 days since an infection can take that long to develop. But keep in mind, these are general recommendations and may differ from state to state depending on the number of cases, so be sure to look up local guidance.
Assess your symptom severity and know when to seek emergency care
If your symptoms are the common nasal congestion, dry cough, body aches, loss of taste or smell or headache, it's suitable to stay home and treat yourself with rest and plenty of liquids. But be alert to changing symptoms, says Roger Alvarez, a pulmonologist and professor of clinical medicine at the University of Miami's Miller School of Medicine. He says that although mild to moderate COVID-19 cases can be managed at home, symptoms that start out mild can wax, wane and evolve into severe symptoms that need treatment at a hospital.
Red flag symptoms that suggest you need to call 911 no matter how many days you've been sick include (but aren't limited to): trouble breathing, chest pain, blue lips, confusion, being unable to tolerate food or drink, weakness or feeling like you can't stay awake.
Consider getting a basic oxygen monitor — a pulse oximeter — for your finger at home, watching for a drop in your oxygen levels down to 94% or below. When levels drop below this, it's time to call your doctor immediately. If you don't have a primary care provider, go to an urgent care or emergency room — or, if you feel like you can't breathe, call 911. Similarly, a high fever (above 103 F) that doesn't get lower with fever-reducing medicines is another reason to call, or visit, a doctor.
But don't get too caught up in the numbers: If you get a feeling that "something's not right," don't delay medical care.
Reach out to your doctor, but know there's no magic pill
If you've just tested positive and started isolating, it's a good time to reach out to your primary care doctor or other health care provider (if you haven't already) and get advice tailored to your symptoms and medical history. This is especially important for patients with any chronic illnesses such as lung disease or diabetes, but also for healthy people.
The good news? Doctors are easier to reach than ever with the popularity of telephone and video visits, so no need to leave your home to talk to them. The bad news is that the coronavirus is a virus, just like the flu, which means an antibiotic won't stop the illness or the symptoms.
Dr. Matthew Anderson, senior medical director of primary care at the University of Wisconsin, tells NPR that he sometimes gives oral steroids to patients with chronic lung disease who get COVID-19 and are wheezing. But he says steroids or other drugs you may have heard about — including one of the monoclonal antibody cocktails or remdesivir — "aren't the standard of care" for mild or moderate COVID-19, and might do more harm than good in those cases. While there's been lots of talk about those drugs given to patients with severe illness who are hospitalized – maybe most famously, President Trump – these treatments aren't currently recommended for milder cases that are best managed at home.
Make an isolation and care plan early, and ask for help
Doctors and health care teams that include nurses and care navigators can also be a good resource for figuring out and lining up the sort of logistical help you'll need to isolate yourself. You won't want to run out of your routine medications, so ask your health team about how to get them via mail order or from pharmacies that deliver.
Also important: How will you and your quarantining housemates get and keep groceries, toilet paper and other goods in the house? Most cities now have grocery delivery services you can access online; typically health care systems also have social workers that can connect you with other food services if you need them. Make a list of your needs and ask friends for help. If you're isolated and sick, pets will still need to be walked, snow shoveled and bills paid.
Rest and rehydrate but try to avoid lingering in bed
It can feel frustrating if you've got a positive coronavirus test with mild symptoms such as a runny nose or sore throat for which there's no definitive treatment. But that just means you should stick to the well-worn advice for healing from any viral infection: Get extra rest, drink plenty of fluids and take an over-the-counter fever-reducing medicine such as acetaminophen if you need it.
Fluids may also be hard to gulp down when you're feeling bad, but dehydration can land people in the hospital on its own. That's especially true for children and older folks, so try to sip plenty of water, juice, soup or electrolyte drinks throughout the day. Noncaffeinated tea with honey might soothe your sore throat, but avoid drinks with lots of sugar or caffeine.
Rest is also important to recovery, but be wary of the urge to stay in bed. "You don't want to overwork yourself but avoid strict bed rest – we don't want patients to be totally sedentary because we know that patients who move around seem to do better," says Alvarez, who has recovered from a case of COVID-19 himself. He encourages patients to walk around their homes as they're able or sit upright on the couch – all things that help expand the lungs and improve the movement of air.
Don't forget your mental health
Whether or not you've got symptoms, getting a positive test for the coronavirus can be stressful, and isolating alone can make that even worse. When it comes to isolation, adding structure to your days can help a lot, says Dr. Frank Ghinassi, president and CEO of Rutgers University Behavioral Health Care and senior vice president at RWJBarnabas Health. Ghinassi recommends scheduling sleep and meals at the same time every day and penciling in at least one thing that provides pleasure daily — even if it's as simple as streaming a movie.
The most important part is "actually making the schedule," Ghinassi says. And be sure to include some socializing — virtual socializing, that is. Also put a bit of simple exercise on the calendar if you're feeling up to it — 30 minutes of light physical activity several times a week will help lift your mood. Maybe take a video exercise class or, if you're asymptomatic or have mild symptoms, climbing stairs will get your heart rate up in a good way. And if you're unwell and stairs are too much, try taking a room-to-room stroll within your home. Every little bit counts.
If your symptoms linger longer than 10 days, keep isolating
Unfortunately, you can't schedule how long symptoms might last when it comes to the coronavirus. Doctors have been studying the nitty-gritty of statistics and numbers for months, and although the CDC recommends isolating at least 10 days from when mild or moderate symptoms started (or 10 days from a positive test if you never had symptoms), there's no definite number of days to isolate if you've still got symptoms after that.
The CDC says you can stop isolating if you've been free of fever without fever-reducing medicines for 24 hours and your symptoms are "improving." But if you're fever-free and still feeling bad with symptoms such as cough, headache or body aches, it's best to keep staying away from people longer – at least until symptoms have continued to improve significantly for a few days.
For otherwise healthy people who test positive for the coronavirus, there's no need to retest before stopping isolation with or without symptoms. But it is important to go right back to your mask-wearing, hand-washing and social-distancing routines after that isolation period. And be sure to follow up with your primary care providers – they can help counsel you about your health needs after COVID-19 and about becoming a part of clinical trials that can help researchers learn more about the virus and its treatment.
Tell your cautionary tale
If you're out of the woods after a positive coronavirus test, you might consider passing along your experience to friends and family — especially any words of cautious wisdom if you traced your own case back to a pandemic-fatigued moment of weakness, such as going to a gathering or forgoing your mask. But let's not make it a shame game: We are all human, and talking openly about your story might encourage others to keep their guard up.
And be sure to consider sharing acts of kindness and lending a virtual ear or hand to family, friends and neighbors you hear about who test positive later on. The best treatment for all of us to give and get right now may be looking out for each other – no prescription needed.
Kristen Kendrick is a board-certified family physician in Washington, D.C., and a health and media fellow at NPR and Georgetown University School of Medicine.
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