Because of the ever-changing nature of coronavirus, information and advice regarding COVID-19 is constantly evolving. Not only is new information coming up daily about the virus itself, but we’re also learning more about everything from testing to treatment. Having said that, with many reports claiming that a high percentage of patients experience mild symptoms, there are more and more people wondering how they can treat COVID-19 from home. Simply because they don’t feel sick enough to go to hospital.
We spoke to local physician at Netcare Olivedale Hospital Dr Donald De La Cour to find out more about the virus, and how we can safely treat it while we’re at home during lockdown.
Expert feedback on how to treat COVID-19 from home
Firstly, some provisos
According to Dr De La Cour, information is evolving quickly. Patients sick enough to be in ICU are being treated differently today than they were two weeks ago. Likewise, the WHO are updating their advice and information, and the Centers for Disease Control and Prevention has recently changed their stance on wearing masks. As such, anything advised now is subject to change as knowledge about the virus grows.
Secondly, any discourse on management of COVID-19 must reiterate social distancing. According to Dr De La Cour, it remains our “closest to evidence-based” treatment for the virus. He also says that at a time like this, when our president has made a very difficult decision extending the lockdown, which is inconvenient and very economically costly, we need to be supporting him and each other. “To my mind, that is more important than any other single factor,” says Dr De La Cour. He also commented, “And please, could we keep conspiracy theories to a minimum?”
Onto our questions for Dr De La Cour on how to treat COVID-19 from home…
What medication can you take?
Paracetomol (Panado) for fever has always been good and safe. There was initially some controversy about anti-inflammatories, but current evidence supports their use. So, use paracetomol for pain and fever, and add an anti-inflammatory (brufen, voltaren, cataflam etc) if it’s really needed.
Can specific food and drinks help?
No specific foods are required, although common sense says that, with a fever, you should stay hydrated. Try to keep up with nutrition, but don’t stress if you don’t feel like eating much for a few days. I saw someone suggested freezing your kids’ favourite drink to use as a sucker when the throat is sore, which I thought was sensible.
Fresh produce and good, clean eating remain the cornerstones of nutritional recommendations and do not need to be significantly altered to cater for COVID-19.
And, there are no formal recommendations about vitamins. There has been some talk about vitamin D and vitamin C possibly playing a beneficial role. But, at this time, it would be irresponsible to make that a recommendation.
What if you can’t get a script, or get to the pharmacy?
There shouldn’t be much need for a script. If you’re treating COVID-19 from home, I’d stick to Panado, the occasional anti-inflammatory, bed rest, hydration, and eating what you can.
If you do need a script, most doctors have a telephonic service now as we are trying to avoid contact with patients. The Medical and Dental Council has also eased their regulations regarding telephonic consultations for existing patients. In other words, pick up the phone and chat to your doctor. They will prescribe something if you need it, and will also arrange for you to be seen if needed.
If your kids or partner gets it, what should you do about personal protective equipment (PPE)?
The WHO has some excellent guidelines here.
An interesting question I suspect many people are asking is, should you abandon PPE altogether in this situation? I have been back and forth with this in my own home. Part of me knows that if I get COVID-19, the likelihood of spreading it to my wife is high. The likelihood of either of us or my children getting seriously ill is low. Therefore, wouldn’t it be better to contract it and get it over with? However, there are a few problems with this thinking, which I think make it ill-advised at best. Most notably:
a. There are many unknown factors, including how many people are actually infected. Are we mainly testing the people who have more serious presentations? What is the absolute case fatality rate? We don’t have those exact numbers, which makes it difficult to assess the absolute risk and if one doesn’t know for sure what the risk of complications are, how can one decide on whether it is reasonable to try to develop immunity in this way? The general consensus appears to be that although your individual risk of getting seriously ill is low, COVID-19 seems to be both more infectious and more serious than your average flu.
b. Although the consensus among experts is that infection would provide immunity, we have no idea to what extent and for how long. There have been recent reports of patients in Korea who recovered and have tested positive again. There is a lot of debate about this representing ‘reactivation’ rather than new infection, but we don’t know. Imagine getting it to get it over with, but then contracting it again? This may represent an unacceptable level of risk (and does to me).
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I therefore obviously advocate maintaining aggressive distancing and PPE use, remaining as vigilant as your situation allows.
If I got sick and needed to treat COVID-19 from home, I’d isolate in our guest room wearing a mask constantly. I’d keep the room well ventilated and use my own utensils. Clothing would be double bagged and left to stand for 3 days before washing. Surfaces in my room would be wiped down with alcohol swabs on a regular basis and I’d wash my hands constantly. There would be no contact with any family members, as far as humanly possible.
In fact, my policy is do all this even in the event of first contact with a positive patient – and even if I’m wearing full PPE! But I’m extremely fortunate to have these options, while many South Africans do not…
How/when will you know you need to go to the hospital?
Probably the most difficult question to answer. You don’t want to go to hospital unnecessarily, but you also don’t want to wait too long if you are running into trouble.
Timing is important. Many patients who end up seriously ill start deteriorating around Day 7. Don’t get complacent if you’ve been sick for a week and start to feel better. That 7 to 14 days is the time to be keeping a close eye on yourself.
Fever can persist without showing signs of getting worse, so this can be unreliable. The problem is that many patients in the early phases have a cough and shortness of breath, but shortness of breath would be the most reliable indicator of something to be concerned about.
So I’d say anyone getting more short of breath should precipitate concern and an opinion from your doctor. I’ve seen recommendations that doctors should telephonically follow up with patients daily, which I agree with. Ultimately it is a subjective sense of worsening which should mandate at least seeking medical care.
What are some of the first signs you’re on the mend?
This can also be tricky. Somewhat cruelly, many patients start feeling better around Day 6 or 7 when the fever often improves, but then shortness of breath can worsen (look at Boris Johnson) and hospitalisation may be needed.
There are no hard and fast rules to say you are getting better but, to be as specific as I can be, if you’ve hit 14 days (after diagnosis) and have no fever or shortness of breath and the worst symptom is mild fatigue, you are almost certainly over the worst of it.
Further, if you’re at Day 10 and feel pretty good you’re probably also past the worst of it . At Day 7 with no symptoms, it is possible you could still develop complications and feel worse but it would be starting to become less likely.
Keep an eye out for any more COVID-19 related news – and stay safe!
Compiled by Features Editor Stephanie van der Plank