Updated June 2021
COVID home care and isolation is an effective way of treating the majority of people infected, and the following important points can help in the right guidance and timely action.
WHO IS CONSIDERED TO HAVE COVID
One is considered as a case of COVID and should isolate immediately when –
- RT-PCR COVID test is positive
- RT-PCR test is pending/negative, but symptoms are strongly suggestive of COVID like loss of smell/taste along with fever, cough, cold, body ache, headache, indigestion, etc.
- RT-PCR is pending/negative, but any of the above symptoms are present and there is a history of being in close contact with COVID positive family/household member in the last 7-10 days.
- RT-PCR is negative, but HR-CT chest scan was done on strong suspicion which revealed typical COVID induced lung changes.
IDENTIFYING DAY 1 OF ILLNESS
- It is important to record the first day of illness as accurately as possible, for monitoring the course of illness and taking timely action.
- For people with symptoms: Day 1 is the day one first started experiencing symptoms (fever, cough, cold, body ache, loss of smell/taste, headache, indigestion, etc.)
- For asymptomatic positive people (without symptoms but tested due to contact with COVID case, travel, or other requirements): Day 1 is the day the nasal/throat swab was taken for testing.
MONITORING AND DECIDING ON HOME CARE OR HOSPITALIZATION
- On diagnosis or suspicion of COVID, a treating physician should immediately be contacted and briefed to oversee your progress and treatment. The doctor will start appropriate medicines and supplements, and may also advise blood tests when required like CBC, CRP, and other inflammatory markers. CT scan of the chest may be advised only in certain cases at the appropriate time.
- Daily monitoring of oxygen saturation by the pulse oximeter, and temperature by an oral thermometer, is mandatory every 4-6 hours for 14 days. An individual chart of the same should be maintained day-wise.
- Isolation and treatment can be done at home if the oxygen level is being maintained above 94% and there is no breathlessness. The isolation room should be well ventilated (having openable windows) with an attached toilet. If home isolation is not possible due to other family members not being infected and the absence of a separate room, shifting to COVID care isolation centers (repurposed care centers – not hospitals) can be considered.
- 6-minute walk test – This should be done at least once daily for 14 days. Walk for 6 minutes at a normal pace in your room, and measure oxygen saturation just before and after. If the oxygen level decreases by more than 3-5% (for example if 99% falls to 94% or less; 95% falls to 92% or less), it can suggest ‘happy hypoxia’ (subclinical oxygen deficiency) which is an alert for compromised lung function and risk/tendency for falling oxygen levels.
- Proning – This is a technique (as shown) of lying on the belly with a pillow under your head and neck, lower belly and thighs, and legs. This should be done 2-3 times daily (not within 1-hour post-meals). While lying prone, 5-10 deep breaths should be taken every 5-10 minutes. This helps improve lung ventilation and function, and can bring up intermittent dips in oxygen saturation of 90-94% above the 94% desired mark in many cases. (Note: People with obesity, spine/joint or heart problems, and pregnant women are advised not to do proning).
- Hospitalization should be considered in the following cases after more detailed evaluation in consultation with the treating physician:
- breathlessness or chest pain/pressure
- oxygen saturation constantly at or <94%, not improving by proning, or dropping anytime below 90%
- high-grade fever (>101 deg F), and cough with phlegm beyond the first week of illness, non-responsive to medications
- feeling very sick or weak, not able to eat or take medicines orally
- mental confusion, disorientation or reduced consciousness
- associated comorbidities (uncontrolled diabetes, illness of heart, lung, kidney or liver, cancer and post-surgery/transplant)
- HR-CT chest showing severe lung involvement
- high or rapidly rising levels of inflammatory markers like CRP, D-dimer, ferritin, LDH, IL6, etc. along with persistent moderate-severe clinical symptoms suggesting increasing inflammation or clinical deterioration.
HOME CARE AND TREATMENT
This treatment consists of the following components-
GENERAL HEALTH AND HYGIENE
- Drink plenty of water along with healthy liquids like coconut water, buttermilk, lemon juice, and fresh fruit juices. Remain well hydrated at all times.
- Eat a healthy diet with vegetables, fruits, nuts, curd, protein-rich foods like eggs or pulses, and turmeric milk. Avoid spicy, irritant and cold food items. Take meals at regular times.
- Vitamin supplements are usually given for improving health and immunity like vitamin C, D, B complex.
- Apart from proning sessions and 6-minute walk test, do only that much physical activity as you feel up to without getting tired. This can include relaxed or medium-paced walking in the room, pranayama breathing exercises and light body stretches.
- Gargling (with antiseptic betadine/chlorhexidine) can be done twice daily. Steam is not required routinely but may be taken once daily if nasal/throat congestion or phlegm is present.
- Keep the mind relaxed by reading and watching pleasant content, listening to music and having video chats with friends/family. Unnecessary panic, anxiety and stress can worsen health, and induce a feeling of breathlessness, palpitation and worsening of symptoms. This can lead to taking inappropriate decisions by you, your family or the treating physician.
- Wear 2 triple-layer disposable surgical masks or N95 mask when near a family member, care-giver or health worker who should also do the same.
- Sanitize/wash hands frequently
All medicines should be taken as prescribed by the overseeing doctor in the dose and duration advised. Do not add or stop medicines, or change dosage/frequency on your own. Clinical symptoms and progress along with oxygen saturation are the best guides to treatment. Investigations and tests only play a supportive role.
- Fever-Pain medications – Paracetamol is prescribed for fever and body pain 4-6 hourly. Sometimes the doctor may add combinations with aceclofenac, mefenamic acid or naproxen but only in select cases when required.
- Cough-Cold medicines – Antiallergics (like levocetirizine and montelukast), or cough syrups may be prescribed for symptomatic relief.
- Antivirals – Antivirals like favipiravir or antiparasitic medicines with antiviral action like ivermectin or hydroxychloroquine may be prescribed by the treating doctor depending on viral load, symptom severity, and clinical experience. Antiviral agents may help reduce viral shedding and recovery time. However, none of these medicines have definite or proven value in treating COVID. Therefore, do not panic if these medicines are not prescribed or available, and do not take these medicines on your own without a doctor’s prescription or advice.
- Antibiotics – These drugs like azithromycin and doxycycline are prescribed when a secondary bacterial infection is suspected. Symptoms like significant throat pain, difficulty in swallowing, and thick greenish-yellow mucus (phlegm) being coughed out, are suggestive. They are not to be used routinely.
- Corticosteroids – These drugs are commonly called steroids. They are not to be taken in the first week of symptoms (unless indicated for other reasons or conditions) as they can do more harm than good. In case of persistent symptoms like fever and cough beyond the first week with evidence of oxygen saturation being borderline or tending to fall below 94%, or rising blood inflammatory markers like CRP, the doctor may choose to prescribe these medicines. These may be given as inhaler (budesonide MDI), or as low dose oral tablets (methylprednisolone, dexamethasone, prednisolone). These medicines should never be started, modified or stopped without medical advice or monitoring.
- Other medicines – The doctor may give medicines for acidity and indigestion which is common due to the infection and the above medicines. There is currently no recommendation for blood thinners in home care, and do not start any such medicines on your own. Medicines being taken for other conditions and comorbidities like heart disease, high BP, diabetes, cholesterol, etc. should be continued as before and the doctor informed about it. Drugs like remdesivir, tocilizumab, baricitinib, enoxaparin and high dose corticosteroids are not to be used in home care setting and are for use only on hospitalization.
- Antibody cocktail – Recently a biological monoclonal antibody drug casirivimab-imdevimab combination has been approved and made available in select hospitals for treating mild-moderate COVID patients 12 years or older at high risk for progressing to severe COVID, complications, and hospitalization. This includes those who are 65 years of age or older, or who have certain associated comorbid medical conditions like diabetes, hypertension, heart/kidney/respiratory conditions, high obesity (BMI of 35 or more), and immunosuppressive disease or therapy. These agents are given together as a single intravenous infusion and act specifically against the spike protein of the coronavirus to prevent its entry into human cells. These agents work best if given within 72 hours of symptom onset (maximum within a week). They are not to be used in already hospitalized patients and those requiring oxygen therapy or ventilation.
- Oxygen therapy in home care may be rarely needed only in case of breathlessness and falling or persistently low oxygen levels in the event of non-availability of immediate hospital admission.
- Home-based oxygen cylinders and concentrators are to be used only temporarily to buy time, and not as a substitute for hospitalization, as firstly these may not deliver the recommended and standardized flow rate and concentration of oxygen, and secondly there will be need for other injectable medicines at this stage to tackle the inflammation and disease severity.
- Oxygen delivery devices should be procured and used only under a doctor’s guidance.
UNDERSTANDING THE COURSE OF THE DISEASE
- It is important to note that the disease course consists of the first week of viremia (viral replication) and the second week of inflammation (due to the body’s immune response). Majority of people show a decline in symptoms after the first week with recovery in 10-14 days.
- The 7th-10th day post symptom onset is crucial as that is the time some people doing well in home care can deteriorate with falling oxygen saturation due to disease progression. Therefore, monitoring of symptoms especially fever and cough with temperature and oxygen saturation is important till the end of the 2nd week.
- The doctor may also advise some blood tests in the 2nd week to check progress and pick up signs of disease progression and deterioration.
- After 10 days, one is declared recovered from COVID if no fever has been present for 3 consecutive days and oxygen saturation is maintained >94%. Thereafter an additional one-week self-care period of staying at home is recommended before public contact.
- COVID appropriate behavior of social distancing, mask, and sanitizer use (SMS) should be continued thereafter in public.
- Post-COVID recovery, there can be reduced lung capacity, energy levels, and general health-well being along with many symptoms for a few weeks to months. It is important to take adequate care and precautions in the 3 month period post-COVID recovery.