As practising family physicians, we often receive calls from patients and families who have self-isolated after testing Covid-19 positive. A few weeks ago we received a panicked call from a Mr. Khan, saying that he had had fever and body aches for three days and his test was positive. He had multiple queries, which he wanted addressed. After calming him down, we gathered some details about the caller. Mr. Khan is 55 years old, a banker by profession and with no chronic medical problems. He lives with his wife and two sons in a three-bedroom apartment.

He wanted to visit the clinic for a consultation. However, we counselled him to stay at home and keep in regular touch with us through tele-consultation. In addition, he was provided advice for precautions and medicines that should be taken while in isolation. Mr. Khan recovered in two weeks without infecting others by following the advice given.

This is only one story of our patients. We receive multiple similar calls at our tele-consultation clinic. The queries below are based on frequently asked questions by patients, and our answers to them use recent national and international guidelines, covering essential precautionary measures, medicines which can be taken and warning signs which need immediate medical attention.

What are the symptoms of Covid-19?

In milder cases, patients may experience a sore throat, cough and fever without any difficulty in breathing, fatigue, headache and body pain. Some patients may also develop diarrhoea and vomiting. Most patients will fall in this category and will recover without any specialised treatment within two weeks. Some patients may also develop difficulty in breathing and they should immediately contact their physician.

As a Covid-19 patient, how do I prevent others from getting infected?

Stay confined in a well-ventilated single room. If more than one infected person is in the house, they can share the room if no alternative is available. If a separate room for isolation is not possible, it is best to shift to a quarantine facility. Ideally, patients should use a separate bathroom. If that is not possible, clean the bathroom with disinfectants after every use. Use separate linen and eating utensils, cleaning with soap and water after every use. Clean frequently touched surfaces, such as bedside tables, door handles and other bedroom furniture with disinfectants (1% sodium hypochlorite, i.e., bleach), daily.

Wear a face mask when others are in the room and maintain a distance of at least two metres (six feet) with others. Change your face mask daily. If a face mask cannot be tolerated, use a disposable paper tissue or elbow to cover the mouth and nose when coughing or sneezing. Materials used to cover the mouth and nose should be discarded in a closed bin.

As a caregiver of a Covid-19 patient, how do I protect myself?

Stay in a different room. If that is not possible, maintain a distance of at least two metres from the ill person and sleep separately. Wear a mask that covers your mouth and nose when in the same room as the patient. Do not touch or handle the mask during use. Use gloves when cleaning and disinfecting the patient’s room or before any contact with the sick person’s blood or body fluid. Do not reuse masks or gloves. Discard mask and gloves in a closed bin and tie the garbage bags before disposal. Avoid contaminated materials such as bed linen and clothes coming into contact with your skin and clothes. Disallow visitors in the house until the patient has completely recovered.

Note: Ideally, assign one person who is in good health and has no medical problems as caregiver.

What type of diet and medicines should I take as a Covid-19 patient?

Eat healthy meals with plenty of fruits and vegetables, keep yourself well hydrated (eight to 10 glasses of water a day), get adequate sleep and rest. Also try to engage in physical activity as much as you can tolerate. Keep in touch with your social contacts through phone/ video chat. Medications which can improve immunity include multivitamins containing Vitamin A, C, D, zinc and calcium. If you are taking any home remedies, consult your physician before use, as some of them may cause harm.

What should I take for my cough?

Use honey (if not diabetic) and hot drinks such as yakhni, joshanda, etc. Preferably lie on your tummy (prone position) to allow lungs to expand and reduce cough. If the cough is dry, you can take a cough syrup containing the codeine compound. For a productive cough, a cough syrup containing the dextromethorphan compound can be used. Please note that steam inhalation and nebulisation increase the chances of spreading the virus, so if used, it should be done in the patient’s room without others present.

Do I need to take any specific medicine for fever/ bodyaches?

For bodyaches or fever of more than 38°C /100°F use paracetamol every six to eight hours. Maintain a temperature chart for consultation with physician.

Runny nose irritates me, what can I take?

Anti-allergic tablets can be used once daily. For nasal blockage, use normal saline nasal drops six to eight hourly.

Diarrhoea and vomiting weakens me. What should I do?

Increase your fluid intake. You can take a khichrri, yogurt and banana (KYB) diet and have one to two tablespoon of Isphagol daily. Use safe water (boiled or mineral water) for drinking. Make sure to frequently wash your hands thoroughly with soap and water. Also take ORS — one glass after every loose stool or vomit. Probiotics sachets can also be used two to three times daily. For nausea and vomiting, domperidone tablets can be used as directed by a physician.

I have heard that having difficulty in breathing is dangerous. What should I do if I experience it?

Contact your physician immediately if you experience any difficulty in breathing. Until you get in contact with your physician, check your oxygen saturation with a pulse oximeter (if available); it should be more than 94%. If it is 94% or lower, immediately visit the nearest hospital emergency. Measures that can help in breathing include positioning and breathing techniques. Sit upright, lean forward with arms bracing a chair and upper body supported. Relax and drop your shoulders, inhale through your nose for several seconds with mouth closed and then exhale slowly through pursed lips for four to six seconds. If possible, practise mental relaxation techniques to calm yourself, such as visualisation of a pleasant memory.

What necessary equipment should I have at home during isolation?

You should have an ample supply of disposable gloves, surgical masks, bleach solution, pulse oximeter (if possible), infra-red thermometer (if using mercury thermometers, they should not be shared), 70% alcohol-based hand sanitisers, covered bins, tissue paper and plastic bags for waste disposal.

Am I at high risk for developing a severe disease after having tested positive?

The virus is unpredictable and can cause severe disease in anyone. However, the chances of severe disease are highest in people aged 65 years and older and people with certain underlying conditions, especially when not well-controlled, including: high blood pressure, diabetes, heart/ lung/ kidney/ liver disease, cancers and obesity. Patients on immunity-lowering drugs, such as steroids, are also at high risk.

When should I rush to the hospital?

You should call an ambulance or shift to a hospital if your oxygen saturation is 94% or below and you experience difficulty breathing, have bluish lips or face, have persistent pain in the chest, drowsiness, severe diarrhea and vomiting or develop any new symptoms, such as severe headache or confusion.

In emergency, you can phone the coronavirus contact helpline in your city.

When should I break isolation?

Patients who test positive by PCR for Covid-19 and who have no symptoms should self-isolate at home. If you don’t have any symptoms, you can discontinue isolation after 10 days, with the advice of your physician.

Symptomatic patients should break isolation only after consulting with their physician.

Disclaimer

Readers of this article are responsible for their own medical care, treatment, and oversight. Readers must always seek the advice of a physician or other qualified health provider with any questions or concerns they may have regarding their health. Medical information changes constantly. Therefore, the information of this article should not be considered complete or exhaustive.

The writers are faculty of Family Medicine at Jinnah Sindh Medical University

Published in Dawn, EOS, July 12th, 2020