IN PARTNERSHIP WITH DR. HANK TALIAFERRO, DUKE CITY URGENT CARE; DR. JOSE TORRADAS, BOARD CERTIFIED EMERGENCY PHYSICIAN; DR. LEIGH VINOCUR, SPOKESPERSON FOR THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS; DR. SUSAN WILCOX, HARVARD MEDICAL SCHOOL; AND THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS.
What To Do If You Have COVID-19: A Toolkit
Dr. Hank Taliaferro, Duke City Urgent Care: "How To Manage COVID-19 At Home."
In this toolkit, you’ll learn how to:
- Prepare in case a member of your household contracts COVID-19.
- Track and recognize symptoms of COVID-19, such as fever, dry cough, shortness of breath, and nausea.
- Manage key symptoms of COVID-19, including with breathing exercises.
- Know when to go the hospital.
Note: These videos and content represent the Center for Disease Control guidance and research from April 2020, and the CDC may change recommendations with the most up to date research on the virus and prevention.
Chapter 1. How To Prepare For COVID-19
Dr. Hank Taliaferro, Duke City Urgent Care: "How To Prepare for COVID-19 At Home"
As the coronavirus continues to spread, many people are facing difficult questions: What do I do if I get the coronavirus? What steps should I take if someone close to me is showing symptoms of COVID-19? What breathing exercises should I do? What even is a pulse oximeter? How do I care for someone with COVID-19 at home?
This toolkit will help answer those questions and help people with mild to moderate COVID-19 symptoms recover at home. Indeed, studies show that as many as 80 percent of patients experience only mild flu and cold symptoms.
Note two important details:
This guide is not a substitute for expert medical advice. If you have symptoms, be sure to contact your physician. Many clinics are now practicing telemedicine. This resource will be updated in real-time as news warrants. It should be considered a “work-in-progress.”
Watch for the major emergency warning signs. Patients who are older than age 65 as well as those with conditions such as diabetes, heart disease, cancer, immunocompromised states, asthma, or COPD are at greater risk of complications from COVID-19. As such, they should contact their doctor as early as possible if exposed to COVID-19 or if they develop symptoms of possible illness.
Also, if you have any of the following, go to the ER immediately:
- Having trouble breathing. This means feeling out of breath, or having difficulty breathing normally, or in the worst case, feeling like you can’t breathe at all.
- Persistent pressure in the chest. This might feel like an intense tightening in the chest, also known as “air hunger.”
- Confusion or unconsciousness. If the person feels very disoriented or confused, this may be a sign of not getting enough oxygen.
- Bluish lips or face. Bluish color in the face could signal a lack of oxygen in the blood or the onset of pneumonia.
Make a Household Action Plan
Caring for someone with COVID-19 at home is not an easy task. COVID-19 is highly contagious. It typically spreads via droplets of moisture in the air. When someone coughs, sneezes, or breathes, virus droplets disperse, and they can travel six feet or more.
The need for sick people to isolate themselves at home is one of the most difficult aspects of this crisis. However, if you are careful and follow the advice of experts you can substantially improve the protection of yourself and your loved ones. “The goal is to minimize the spread further within our household units,” explains Dr. Taliaferro.
One important step is to create a household action plan. Here is how to set up your plan:
- Discuss with household members what to do if a COVID-19 outbreak occurs and the needs of each person. Plan to care for those who might be at greater risk for serious complications.
- Create an emergency contact list, including family, friends, neighbors, and medical resources.
- Select a room in your home for use by sick household members. This room should be totally separate from those who are healthy. The room should preferably have windows for ease of ventilation. Designate a separate bathroom for the sick person, if possible.
- In the case of an infection, only one household member should interact with the patient. The caregiver will need to be able to provide food. The safest way is to place food on a tray or large plate, and deliver to the patient. When retrieving dishes, they will need to be thoroughly cleaned and disinfected, separately from the dishes of the rest of the household.
- Decide upon individual vs. family quarantine. Though separate rooms for sick family members is recommended, individual quarantine might not be possible in some homes. In this case, quarantine as a household “unit.” In other words, assume that everyone in the house has been exposed and only leave the home for necessities.
Dr. Hank Taliaferro, Duke City Urgent Care "3 Rules To Protect Yourself From COVID-19"
Identify Potential Personal Protective Equipment
The first thing to note about personal protective equipment (PPE) is that hospital-grade PPE should be in the hospital. Severe shortages of medical-grade PPE has put our front-line professionals and first responders at tremendous risk. In short, they need the most effective PPE more than you do.
If you follow the steps outlined in this guide, you have gone a long way toward protecting yourself and loved ones without the need for medical-grade PPE.
If someone in your house has COVID-19, their caregiver should take some basic precautions and fashion PPE out of common household materials, or non-medical-grade resources.
It is prudent to think through what PPE you might need:
Face mask. Anyone who is sick or taking care of someone who is sick should wear a mask. Masks can help stop the spread of virus droplets. There are several different kinds of masks. Any of them is more efficient than no mask at all.
If you don’t have access to masks, make a DIY mask as recommended by the Surgeon General. You can also find out more information about different types of masks, or learn how to properly wear and dispose of a face mask when it’s been used. It is also crucial that you clean and sanitize your mask after each use.
Dr. Leigh Vinocur, American College of Emergency Physicians, "Here's The Best Way To Wear A Mask"
Gloves. Latex gloves or food preparation gloves found in most grocery or home center stores will do the job. They protect you from picking up the virus from infected surfaces.
However, it is crucial to dispose of gloves after a single use and you must remove them in a certain way to avoid touching the exterior material. Here are the guidelines for how to remove and replace gloves without reinfecting your hands.
Clothes. Protective clothing may range from water-resistant gowns to coats, pants, hats, hoods, and sleeves. Most important is that clothing be regularly washed and disinfected after use.
Another option that does not require cleaning is make-shift gowns. You may have seen pictures of nurses and medical professionals resorting to wearing makeshift gowns made out of trash bags because they lacked proper PPE. If you’re in a total pinch, you could take a similar approach.
Goggles. Likewise, face shields are not available for most people—and should be reserved for front-line medical professionals.
But medical or swimming goggles can be used as a substitute. The aim is to prevent exposure of the eye mucosa to the virus. The best way to do that: wear glasses, which will create a physical barrier to protect your face—and your eyes—from germs in the air.
Protective eyewear will also discourage or prevent you from touching or rubbing your eyes while providing care to someone with COVID-19. Touching your eyes, nose or mouth with contaminated hands or gloves is a significant way the virus spreads.
Make Your Hospital “Go-Bag”
If you or a person you are caring for begins to show coronavirus symptoms, prepare for a hospital stay. Many sources give recommendations for what to bring, but a hospital “go-bag” should be packed in advance of emergency warning signs, and include the following:
- Cell phone
- Cell phone charger
- A change of clothes
- Prescription medications
- Face masks and gloves
Monitor Information and Resources
Because coronavirus is impacting communities differently, you should seek out reliable, local sources of information about stay-at-home orders, essential workers, daycare closings, and more.
Local newspapers are often a reliable source for up-to-date information of this type. Find out if your community has a website or social media page you can monitor for information and resources.
State health departments are providing updated information as well as state-specific rates of infection and deaths. Of course, the CDC is the authority on infectious diseases and how you can best keep yourself and your family safe. Another great resource is the “Ask A Scientist” tool from the Federation of American Scientists.
Chapter 2. How To Track COVID-19 Symptoms
Dr. Hank Taliaferro, Duke City Urgent Care: "How To Recognize & Track COVID-19."
Below we look at COVID-19 symptoms and how to track them at home.
The Most Common Signs and Symptoms of COVID-19
The usual acute symptoms of COVID-19 are cough, fever, and difficulty breathing. Headaches, digestive issues, body aches, and fatigue are also fairly common.
A World Health Organization report from February based on 56,000 confirmed cases revealed the most common symptoms to be:
- Fever (88%)
- Dry cough (82%)
- Fatigue and tiredness (70%)
- Digestive issues (50%)
- Shortness of breath (40%)
- Aching muscles or joints (35%)
- Coughing up sputum (33%)
- Loss of smell (30%)
How To Decide If You Have the Virus
Answer questions in the flow chart to determine whether your symptoms correlate to COVID-19 markers.
Detailed Descriptions of Common Symptoms of COVID-19
Or take Christopher Gonzales Lacorte, who in an interview with NPR described pain so bad that he could not move his eyes: “I had a headache behind my eyes to the point that I couldn’t move my eyes. I had fever and night sweats, body aches and tightness in my chest.”
Below we examine the symptoms one by one:
Each person’s baseline body temperature varies over the course of the day. If you have a temperature of 99°F or even 99.5°F, don’t consider this a fever. The body’s normal immune response to fighting a virus is to raise it’s inner temperature. In fact, the fever can help your body fight off the virus.
Note that although a key and perhaps the most common symptom of COVID-19, fever may not always be the first symptom to develop. Many people first report fatigue or feeling “run down.”
Dr. Susan Wilcox, Harvard Medical School: "Should I Use Fever Medication"
When coronavirus produces a cough, it’s a dry cough felt down in your chest. “Dry” means that the cough produces no mucus or phlegm. Mucus or phlegm normally filter and lubricate; that isn’t happening if you have a dry cough. There may be a consistent barking sound, or it may be triggered by a tickle at the back of the throat.
In New York, 29-year-old Tarek Soliman first experienced only mild headaches, before his condition worsened significantly: “The virus extended to my lungs, and I started developing pneumonia. […] There was fluid in my lungs, and I was coughing blood. It freaked me out. I’m still not healed.” While most patients do not cough blood, this is a sign of a very advanced dry cough.
For patients with advanced symptoms, simple tasks like walking to the kitchen or even getting dressed become difficult. “It would take me 20 minutes to get from my bed to the bathroom,” Kevin Harris of Ohio explained to a reporter.
Harris tested positive for the illness. “I would go a few steps and have to lay down on the floor to catch my breath and pause because I would get so dizzy and nauseous,” he said. “There were times it took me an hour to go downstairs to the refrigerator.”
Dr. Susan Wilcox, Harvard Medical School: "How To Deal With Fatigue and Tiredness"
Digestive Issues. The presence of digestive issues in COVID-19 patients may be more common than previously thought. A recent study of 204 people found that more than half reported experiencing digestive issues.
Primarily, patients experienced a lack of appetite (40% of patients studied) and diarrhea (17%). Other symptoms included vomiting and abdominal pain. The study found that digestive symptoms often got worse as the severity of COVID-19 increased. Given these findings, the authors advise that “the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms.”
More rarely individuals might have abdominal pain or vomiting. In pneumonia, which can develop from COVID-19, vomiting and nausea are frequent symptoms. Research shows the virus may be able to replicate in the gastrointestinal system.
Among the group who had diarrhea, it lasted an average of more than five days, and a frequency of about four bowel movements per day. Doctors noted concurrent fever in 62% of patients with a digestive symptom, meaning almost 40% did not have a fever. Diarrhea, nausea, and vomiting are likely to appear after respiratory symptoms.
Dr. Leigh Vinocur, American College of Emergency Physicians: "Digestive and Gastrointestinal Symptoms"
Difficulty breathing happens when the infection reaches the respiratory tree, i.e. air passages that move air in and out of the lungs. The lining is injured, and becomes inflamed. This causes irritation in the nerve endings located in these airways and makes it harder to get oxygen.
One patient who tested positive for the disease made a viral Facebook post about her shortness of breath: “I had trouble catching my breath and my chest felt tight every time I coughed.” In another case, where a whole household was infected with COVID-19, a parent stated: “My chest felt as if there were an anvil sitting on top of it. When I attempted to take a deep breath, I could not get enough air into the bottom of my lungs to fill them.”
Shortness of breath can lead to dizziness from lack of oxygen, and bluishness in the face or extremities. In a “mild” case, a patient said her lungs started to “feel weird.” Days later her lips, fingers, and toes were “tinged blue.” She visited the ER but went home, and after 12 days, she felt well enough to consider herself recovered
Jonah Stillman, another patient, reported terrible muscle aches. “The worst body aches I’ve ever had,” he said. “It felt like I was in a horrible car accident almost. I couldn’t move.” Luis Mancheno, a 33-year-old, reported similar issues. As a result of muscle pain, “for two days, I was unable to do anything,” he said.
Coughing up Sputum. The initial onset of COVID-19 is marked by a dry cough. Over time it can transition into a more substantive cough, similar to pneumonia, which produces sputum—a mixture of saliva and mucus. Though dry cough is more often associated with the virus, “productive” coughs with sputum are seen in 33% of patients.
Jonathan Raskin, a pulmonologist and COVID-19 patient, detailed his experience for Slate: “After a week of having a dry relentless cough I began to cough up black sputum! … jet black sputum—obsidian black, as black as your cell phone.” A different patient had less vivid words but expressed much of the same, describing the cough as feeling like “hacking up a lung.”
Dr. Susan Wilcox, Harvard Medical School, "What Is Coughing Up Sputum?"
Smell. Another characteristic symptom is the temporary inability to smell or taste things. These symptoms are significant because they onset early and can serve as an early indication of a coronavirus infection. Doctors in Britain called for adults who lost their senses of taste and smell to quarantine themselves. In South Korea, about 30 percent of coronavirus patients experienced a loss of taste and/or smell.
Data collected from patients indicates that their loss of smell and taste often precedes other symptoms by several days and even weeks. For that reason, these symptoms are seen as important precursors to infection.
In an interview, David Lat described losing his sense of taste. Several days later he had fever, chills, and aches, and went to the ER for shortness of breath. The two-time New York City marathon runner was soon attached to a ventilator, which he says saved his life.
Dr. Leigh Vinocur, American College of Emergency Physicians: "Less Common Symptoms of COVID-19"
Tracking COVID-19 Symptoms Using A Worksheet
When symptoms arise, you should begin by tracking developments in a notebook, or use this worksheet (PDF or online). To monitor symptoms, record the date, time, and a detailed description on an hourly basis.
“It’s very important to understand how to track and record symptoms on a frequent basis,” explains Dr. Hank Taliaferro. “For example, this means using a thermometer and perhaps using a pulse oximeter to measure blood oxygen level.” Record other symptoms like fatigue, cough, and digestive issues as they arise.
Use A Worksheet To Track Your Symptoms
Many COVID-19 patients and doctors say symptoms can quickly turn from mild to severe. A person may have mild symptoms for about one week, then worsen rapidly. Let your doctor know if your symptoms quickly worsen over a short period of time.
In addition, for older patients or other high risk groups, it is important to track symptoms from early on, and be ready to go to an emergency room. Early recognition of warning signs, and bringing at-risk patients to ERs is one reason for the low mortality rate in Germany.
Dr. Hank Taliaferro, Duke City Urgent Care: "How To Record Your Symptoms"
Using a Pulse Oximeter To Track COVID-19
In addition to monitoring symptoms like fever and ease of breathing, there is a simple instrument called a pulse oximeter that can help you make decisions about when to seek care.
Pulse oximeters measure blood-oxygen levels. Due to the fact the virus often limits normal breathing, one of the best means of monitoring COVID-19 patients is to track the levels of oxygen in their blood.
Dr. Hank Taliaferro, Duke City Urgent Care: "Learn How To Use A Pulse Oximeter"
These instruments are cheap and easy-to-use, and can help identify patients in need of emergency attention. You can find them for sale at pharmacies, big box stores (like Target), Amazon, or sporting goods stores.
Pulse oximeters use a clip sensor that goes around a patient’s finger. Here’s a presentation from the World Health Organization on how to use a pulse oximeter.
Blood-oxygen levels should be recorded every hour, along with temperature checks. For a healthy person, normal pulse oximeter readings usually range from 95 to 100 percent. Under 90 percent is considered low and warrants contacting a physician.
Pulse oximeters can be used with multiple patients, but must be sanitized effectively. The probe which goes around the finger should be cleaned with an alcohol swab. Dirty fingers, fingernail polish, and bright lights can all make readings slightly less accurate.
Chapter 3. How To Manage COVID-19 Symptoms
Dr. Hank Taliaferro, Duke City Urgent Care: "Strategies To Fight Coronavirus At Home"
Over-the-counter medicines and home remedies may be used to manage discomfort from symptoms.
If you are a caregiver treating someone with COVID-19—or if you have symptoms—you could be confronted with fever, dry cough, shortness of breath, aches, pains, nausea, and dehydration. Many COVID-19 patients report aches and pains, as with the flu.
Dr. Jose Torradas, American College of Emergency Physicians: "How To Check On A COVID-19 Patient Remotely"
Advice for Caregivers
The need to isolate COVID-19 patients is one of the most difficult requirements of treatment. However, if you are careful and listen to the experts, you can improve the chances of protecting yourself and your loved ones.
As outlined in the first section, creating a household plan for treatment that includes an isolation room is an important step in preparing to care for yourself or a loved one with COVID-19 at home.
There are several other decisions to be made and factors to consider when taking on the role of caregiver during this crisis. The guidance below comes from the chairman of the Health Committee of the New York City Council:
Isolation room. Caregivers should limit how much contact they have with those who are sick. Only interact with the patient when necessary. Do not share a bed. Keep windows open to improve ventilation and dilute airborne virus particles. If you have a portable air purifier, run it in the room where the infected person is recovering.
Masks and gloves. Caregivers should at a minimum wear face masks. Even a simple mask makes a difference. Surgical masks are effective, as well as cloth versions. It’s even possible to create your own DIY masks.
Additionally, proper use of gloves can prevent the spread of the disease via household surfaces. But note that gloves need to be worn properly to be effective. And remember to wash hands with soap and water for at least 20 seconds. Further protective equipment such as face shields or bodysuits are not widely available, but can be substituted with clothes that cover exposed areas, which should be frequently washed and disinfected.
Bathroom. If you have more than one bathroom, reserve one for the sick person. If you have only one bathroom, clean it after every use by wiping down all surfaces with a disinfectant. Use the fan to improve airflow and to disperse airborne virus particles.
Disinfecting. Clean your home or apartment daily, at a minimum. Use disinfectant on every surface that is touched often (counter tops, tabletops, light switches, doorknobs, etc.) Wash your cloth mask frequently if you can’t replace it, ideally use a washing machine with hot water.
Clothing. Be ready to do a lot of laundry. Sick people will shed the virus onto their clothing, bedding, blankets, etc. Your clothing will also come into contact with the virus. Wash clothes daily using hot water and if your dryer has an antibacterial setting, use it. Wear gloves while doing the laundry and wash your hands immediately after.
Common COVID-19 Symptom Remedies
Dr. Leigh Vinocur, American College of Emergency Physicians: "Steps To Recover From COVID-19 While At Home"
A common and significant symptom of COVID-19 is fever, although it sometimes is not the first symptom to develop. The body’s normal immune response to fighting a virus is to raise its inner temperature. The best ways to naturally treat a fever are to rest and remain hydrated. Fevers can cause you to sweat more and often diminish your appetite, which can result in not drinking enough water. This combination can lead to dehydration, so it’s important to make an effort to drink plenty of fluids, even if you are not thirsty.
If your fever exceeds 102°F, you should consider using over-the-counter medication such as acetaminophen to help manage your fever and body aches, according to the Mayo Clinic.
Monitor your dosing carefully as taking too much of one drug, such as acetaminophen, can cause liver damage. Adults should not exceed 3000 mg of acetaminophen in a 24-hour period. Be sure to follow dosing guidelines for children.
At one point, official statements from the World Health Organization and governments suggested ibuprofen posed a risk to COVID-19 patients. However, research behind this claim was speculative, and the statements were retracted.
Still, many health care professionals recommend alternating between acetaminophen or ibuprofen to avoid accidentally taking too much of one. Doses of acetaminophen should be given at least four hours apart. Doses of ibuprofen should be given at least six hours apart.
Over-the-counter flu medicines and cough syrups may also help reduce discomfort from symptoms. Read labels carefully for proper dosage, and be careful to not take more than one medication containing acetaminophen.
Dry Cough Remedies
A dry cough is one of the tell-tale signs of the coronavirus (as opposed to other bacterial and viral infections). “Dry” means that the cough produces no mucus or phlegm.
Dr. Hank Taliaferro, Duke City Urgent Care: "Virus Symptoms and Treatment: Dry Cough"
Steam. Another option is inhaling steam from hot tea or a cup of hot water. The humidity from the steam will help open nasal passages and relieve sinus pressure. You could also sit in the shower or the bathroom with the hot water running.
Home remedies. Honey is a remedy recommended by doctors, which may be as effective as cough suppressants. Also, gargling with salt water helps ease irritation from dry cough.
Shortness of Breath Remedies
A major symptom that can be life threatening is shortness of breath. Some patients describe the experience as like someone is “sitting on their chest.”
Body Position. If a patient is struggling to breathe, help them sit upright. This increases lung capacity and can help the patient relax. Lying prone, or face down, can also help with breathing.
Dr. Leigh Vinocur, American College of Emergency Physicians: "Why Breathing Exercises Help Recovery"
- “Take a deep breath in.
- At the end of it, hold your breath for five seconds, then release.
- Do this five times—five breaths total.
- Next, take a sixth deep breath in, then at the end of it cough strongly—covering your mouth when you do so.
- The six breaths plus cough at the end represent once cycle. Repeat this cycle twice.”
Celebrities with coronavirus, like JK Rowling and Chris Cuomo, have reported the process can help address other symptoms resulting from difficulty breathing and low blood-oxygen levels.
A growing number of doctors are prescribing inhalers for COVID-19 to help with shortness of breath and other breathing issues. An over-the-counter option for inhalers is Primatene Mist.
The patient should drink water frequently, as well as fluids that have electrolytes like Pedialyte. Sports drinks and fruit juices are helpful too, but they don’t provide the ideal balance of water, sugar, and salt. Avoid beverages containing caffeine.
Sipping and other alternatives. If a patient is dehydrated, it may be difficult to hold down fluids. Try to give them one sip of water every 5-10 min. Hot decaffeinated tea or hot water with lemon can not only help keep you hydrated but can also loosen chest congestion. Eating fruit and vegetables can also help keep patients hydrated.
But drinking plenty of water should be your top priority, a minimum of 8 cups of fluid each day. If you are experiencing stomach upset, you should drink even more by continuously sipping smaller amounts.
Often nausea may be related to other symptoms, like fever and dehydration. Medical recommendations for dealing with nausea include:
- Drink cold drinks
- Eat light, bland foods (such as saltine crackers or plain bread)
- Avoid fried, greasy, or sweet foods
- Drink beverages slowly
Some health experts recommend eating ginger, or drinking ginger teas. Anti-nausea medication can be prescribed by a physician. Many over-the-counter medicines are also available, including dramamine.
Dr. Jose Torradas, American College of Emergency Physicians: "How Can I Treat Nausea At Home"
When To End Home Isolation
Caring for yourself at home can be an isolating and demoralizing experience. A majority of those afflicted with COVID-19 spend several weeks recovering.
How long must you stay in isolation, and when will it be safe for you to interact with others? The CDC’s official rules for when it is possible to stop self-isolating are as follows:
- No fever. You have shown no signs of fever for 72 hours (without the benefit of fever suppressors). Other symptoms have improved, and at least seven days have passed since onset of first symptoms.
- Negative COVID-19 test. You may also end self isolation if you have tested negative for COVID-19 twice within 24 hours.
Dr. Susan Wilcox, Harvard Medical School, "How Long Should I Self-Isolate?"
Chapter 4. When To Go To The Hospital
Dr. Hank Taliaferro, Duke City Urgent Care: "When Should I Go to the Hospital?"
For most people, COVID-19 does not require hospitalization. If you have COVID-19, you will most likely be able to recover at home and treat your symptoms with over-the-counter medicines and treatments.
In some cases, however, those with the illness will need to seek medical care. The information on this page will help you assess whether and when you should go to the hospital.
When To Go To The Emergency Room
The CDC advises you seek immediate medical attention if you develop any of the following emergency warning signs:
- Trouble breathing
- Persistent pain or pressure in the chest
- New confusion or inability to arouse
- Bluish lips or face
This list is not meant to be all-inclusive, and the CDC recommends that you consult your doctor if you experience any other symptoms that are severe or concerning.
Other symptoms which may be a sign of complications, and cause for urgent treatment include:
- Inability to drink fluids
- Bloody or brown sputum (saliva mixed with mucus and coughed up)
- Worsening fever
- Return of fever, cough, and other symptoms in the second week after the onset of the flu or worsening after symptoms have begun to improve
Recognizing when symptoms are serious enough to seek medical care is critical for patient well-being – but also in order to avoid overwhelming medical professionals and emergency rooms in difficult times.
The CDC has created an easy online “Self Checker” tool that can help you assess the severity of your symptoms, whether they are linked to COVID-19, and when you should seek medical attention.
Particularly high-risk groups include:
- People with obesity (body mass index or BMI over 40)
- Those with brain disorders or peripheral nerves injuries
- People suffering from muscular disorders like cerebral palsy, seizures, intellectual disability, stroke, and spinal cord injury
- Those suffering from weak immune systems due to disease or medication
- Anybody on long-term aspirin therapy
Dr. Hank Taliaferro, Duke City Urgent Care: "What Do I Bring To The ER? – Your Hospital Go-Bag"
Transportation To The Hospital
Moving a person with COVID-19 anywhere requires close contact. When transporting someone to a medical facility or an ER, the caregiver should:
- Wear personal protective equipment (PPE). Both patient and caretaker should wear masks. Caretakers ought to also wear goggles, if they have them, as further protection.
- Grab your hospital go-bag.
- Bring the patient symptom record and medical history information
- The caretaker should drive the patient to the hospital. The caretaker should be the only other person in the vehicle.
Call an ambulance if the patient has difficulty breathing, persistent (or painful) chest pressure, confusion, difficulty waking, or bluish lips or face.
If you do not have access to a car, do not use public transportation. If you are having emergency symptoms like extreme shortness of breath, and low blood-oxygen levels, again an ambulance is the best option.
Dr. Leigh Vinocur, American College of Emergency Physicians: "Can I Bring Loved Ones To the ER"
What To Expect At The ER
Upon arriving at the hospital, go to the Emergency Room. Personnel in the receiving area should be notified before the patient is brought in. (Subject to the severity of the case.) Once the patient has been brought to the medical facility, the vehicle you used for transportation should be disinfected. Wash your clothes and take care to not contaminate other surfaces as you disinfect.
Depending on where you live and the scale of the outbreak in your community, you may experience a long wait in a crowded ER, or even be asked to wait outside or in a temporary facility, like a tent. In New York City, the convention center has been turned into a field hospital. Emergency rooms in cities where the virus is endemic, like New York and Detroit, are seeing their normal daily caseloads double or even triple.
These high numbers of patients as well as staffing shortages are forcing hospitals to juggle doctors’ schedules.
Staff shortages and limited supplies, like a lack of ventilators and PPE, have forced ERs and hospitals to triage patients and ration the care they receive. At the hospital, it is possible that you will not be tested for coronavirus, as the limited supply of COVID-19 tests means that only patients with specific symptoms or histories—like having been in close contact with somebody who has already tested positive—are likely to be tested.
Because there is no cure, yet, for the virus itself, care at the hospital will likely center around the management of the most common complications of severe COVID-19, such as pneumonia, respiratory failure, and complications from prolonged hospitalization including secondary bacterial infections.
Dr. Hank Taliaferro, Duke City Urgent Care, "6 Signs You SHOULD Go To The Hospital"
Time Spent At The Hospital
According to the Center for Disease Control, since March 4.6% of COVID-19 patients are likely to be hospitalized, and 74.5% of those hospitalized are over fifty years old.
If admitted to the hospital, you will likely be placed in isolation to minimize the chances that you infect others. This means the only people coming into your room will be the doctors and nurses who treat you. When you are seen by medical professionals, they will be clad from head to toe in PPE–gowns, masks, goggles, gloves, and facemasks. This might feel impersonal, but it is necessary to help keep them, and their other patients, safe from infection.
You unfortunately will not be allowed any visitors. Be prepared for a lengthy stay. Among those patients who have been admitted to the hospital and recovered, their average length of stay was approximately 10 days.
- If you are experiencing COVID-19 symptoms, this is not in itself an emergency, even if symptoms are unpleasant and uncomfortable. Before going to the ER, in most cases, you can first contact a physician. Many clinics are now practicing telemedicine. Call your primary care provider or an urgent care facility if you would like to talk to a physician and inquire about options.
- If you or a member of your household has persistent shortness of breath, intense chest pain or pressure, bluish lips or face, confusion or unconsciousness, you should seek emergency help immediately.
- Other symptoms which may be a sign of complications, and cause for urgent treatment include: dehydration and inability to drink fluid, bloody or brown sputum (saliva mixed with mucus and coughed up), worsening fever, return of fever, cough, and other symptoms in the second week after the onset of the flu or worsening after symptoms have begun to improve.
- Anyone who is sick or taking care of someone who is sick should wear a mask. Masks can help stop the spread of virus droplets.
There are several kinds of masks:
- N95 respirators. This is the best option for protection. The drawback is that it makes it slightly more difficult to breathe. For a patient who’s having trouble breathing, they might not be the best option.
- Surgical masks. Surgical masks don’t seal tightly around the face. Also, if they get wet, they’re not useful anymore.
- Cloth masks. Cloth masks are the least protective but are better than nothing.
- If you don’t have access to masks, there are ways of making homemade masks. The CDC has step-by-step instructions on how to make one, what materials to use, and how to clean it after use.
- The basic steps you should take include creating a household plan of action. Make sure you are up-to-date with knowledge about how to use medical safety equipment, such as face masks and gloves. If you don’t have these at home, or they are unavailable in your community, it is possible to make your own. (You can make one even if you don’t have a sewing machine.) Be ready to monitor COVID-19 symptoms like fever and breathing (blood-oxygen levels) by having necessary tools, like a thermometer and a pulse oximeter. In case of an emergency, it’s a good idea to make a “Hospital Go-Bag” and put it by your front door.
Those who show symptoms of COVID-19, and are at particularly high risk for complications of the virus are:
- People suffering from chronic diseases of the heart, lungs, liver, blood, or kidneys (any condition that affects a major organ system)
- People with obesity (body mass index or BMI over 40)
- People with diabetes
- People with disorders of the brain, spinal cord, peripheral nerves, or muscles (examples include cerebral palsy, seizures, intellectual disability, stroke, and spinal cord injury)
- Immunocompromised people, or people with weakened immune systems due to disease or medication (such as those with HIV or who are on chronic steroids or tumor necrosis alpha inhibitor drugs)
- People with cancer, including cancer survivors
- People with disorders of metabolism or mitochondria
- Residents of nursing homes and other facilities and those older than 65 years of age
- Fever may last for up to five days, while other symptoms, including weakness and fatigue, may persist for several weeks.
If you have had coronavirus symptoms this poses a serious health risk to others. Even if you have had no symptoms of the virus, it is possible that you could be spreading it.
The rule of thumb for when to stop self-isolating for confirmed and non-confirmed COVID-19 patients is:
- You have shown no signs of fever for 72 hours (without the benefit of fever suppressors). Other symptoms have improved, and at least 7 days have passed since onset of first symptoms.
- Alternatively, if you have been tested, then the rule is 1) no fever (without the benefit of fever suppressors) 2) symptoms have improved, and 3) two negative tests within 24 hours.
- If someone in your household is sick, yes. If there are limited masks available, the priority should be to have the sick person wear the mask. Anyone interacting with the sick person has the next priority. Masks aren’t perfect, but they probably do minimize the spread of the disease.
- If no one in your household is sick, it is probably not necessary to wear the masks while at home.
- Not recommended. Wearing the same mask repeatedly, or wearing the same pair of gloves (after touching many possibly infected surfaces) is not safe.
- However, cloth masks and other fabrics that have been worn over your face can be reused if they are properly cleaned and sanitized.
If you or a household member is showing symptoms of COVID-19, do not take public transportation. Find another option, and think about this in advance when making your household action plan, and gathering lists of organizations and possible resources in your community.
- The Learning Agency pulled together the contents of this site. The American College of Emergency Physicians (ACEP) provided expertise and advice but is not responsible for the content of the website. A number of also doctors helped with this project, including Dr. Hank Taliaferro of Duke City Urgent Care; Dr. Jose Torradas, Board Certified Emergency Physician; Dr. Leigh Vinocur, Spokesperson for the American College of Emergency Physicians; and Dr. Susan Wilcox, Harvard Medical School. The experts provided advice but likewise, they are not responsible for the content.
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The content of this site is for informational purposes only and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition and never disregard professional medical advice or delay contacting a qualified health provider due to information on this site.
If you think you may have a medical emergency, call 911 immediately.