This post was written by Richard Kelty, MD, section chief, PPG – Family Medicine.

As we pass through the COVID-19 pandemic, the news tends to feel mostly grim. If a family member or close friend tests positive for the viral illness, the concern is always what to do next. First, don’t panic. It’s important to remember that, in most cases, if they are generally healthy, it’s possible to nurse a loved one with mild symptoms back to health at home. That said, those with other risk factors or chronic health conditions could very well require hospitalization.

Care at home can help slow the spread of COVID-19 and help protect people out in the community who are at risk for getting seriously ill from the disease. For the in-home caregiver, the goal is to reduce the duration of contact in the environmental space shared with the sick person on a day-to-day basis.

Important guidelines for in-home care

If you are caring for someone at home, there are four important things to remember and monitor.

1. Monitor the person for worsening symptoms and know the emergency warning signs:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face

2. Prevent the spread of germs when caring for someone who is sick

3. Provide symptom treatment

4. Carefully consider when to end home isolation
 

Worsening symptoms

When monitoring the person for worsening symptoms, the emergency signs listed above require further medical attention. Be certain you have the sick person’s healthcare provider’s contact information on hand. Change in condition is the main reason to contact them for further recommendations. For more urgent medical emergencies, you should call 911.

If you have to call 911 for a medical emergency, notify the operator that you (if you’re calling for yourself) or your loved one have, or you think might have COVID-19. If possible, put a cloth face covering or mask over the sick person’s face before medical help arrives.
 

Prevent spread of the virus

A very important part of caring for a loved one at home is to prevent the spread of the virus to other family members. Extra precaution should be taken if anyone in the household is 65 or older or has underlying health conditions, which might make them more susceptible to COVID- 19. Other measures you should take include:

• Designate personal space for the COVID-19 patient. Have the person stay in one room, away from other people, including the caregiver, as much as possible. It is best if they have a separate bedroom, and a separate bathroom that only they use.
   
• Avoid sharing personal items, like dishes, towels and bedding. Serving food to the ill person can be done by leaving it outside the door or left in the kitchen for the sick person to come out and eat. All areas and dishes should be cleaned and disinfected after use. The dishwasher is best for disinfecting dishes.
   
• Have the sick person use a cloth face covering. The caregiver should wear one while in the same room with them. if the sick person needs to be around others, they should wear a face mask. The virus can be released into the environment through coughing or just breathing. The virus can exist on surfaces from the air droplets, though the transmission is very low unless an individual is constantly touching the surface for a long time.
   
• It’s best to wash your hands with soap and water for at least 20 seconds, especially after interacting with the sick person. Hand sanitizer can be used, but it should contain at least 60% alcohol.
   
• All persons in the house, both infected and not, should avoid touching their eyes, nose and mouth.
   
• Clean all the surfaces that are touched often, including counters, tabletops, door knobs, etc. every day. An EPA–registered household disinfectant or a household bleach solution (5 tablespoons of bleach per gallon of water) are necessary to properly disinfect these surfaces.
   
• Laundry should be washed thoroughly. Wear disposable gloves and keep the soiled items away from your body while handling them. Again, the caregiver should wash their hands after removing the gloves.
   
• Strictly avoid having any unnecessary visitors.
   

Symptom treatment

The third important item is to provide symptom treatment for the sick person. This includes making sure that they drink a lot of fluids to stay hydrated, get plenty of rest and keep their nutritional status up by eating as best as possible. Over-the-counter medications may help with symptoms, including Tylenol® or Advil® for fever, Mucinex® DM or Delsym® for cough, and decongestant or antihistamine for sneezing or drainage.

In most mild cases, symptoms will only last a few days and get better in about a week. For more on managing symptoms at home, read Dr. Singerman’s post here.
 

When to end home isolation

The final item to consider is when to end home isolation. People with Covid-19 who have stayed at home can stop home isolation under the following conditions:

If they were not tested to determine if they are contagious, they can leave the home after these three things have happened:

• They have had no fever for at least 72 hours without the use of medication that reduces fevers and
• Other symptoms have improved (shortness of breath, for example) and
• At least 7 days have passed since the symptoms first appeared

If they were tested to determine if they were still contagious, they can leave home after these three things have happened:

• They no longer have a fever (without the use of medication that reduces fever) and
• Other symptoms have improved (cough for shortness of breath, for example) and
• They received 2 negative tests in a row, 24 hours apart

If someone in your household is infected, restrict activities for everyone in the household, except for getting medical care. Do not go to work, use public transportation or other activities outside the home. If anyone else develops symptoms, contact your healthcare provider.  

It is possible to provide effective, healing care to loved ones with COVID-19 at home, if you follow these guidelines. Careful monitoring in isolation will help prevent spread amongst the family members and thereby potentially to others. These mitigation factors are very helpful in controlling the number of people contracting the virus and for the susceptible members of our community becoming seriously ill.