July 13

What to Do if You Come Down with COVID-19


Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Ideally, once you became infected, you would be safely quarantined away from your family in a so-called “fever clinic,” a dedicated facility designed to assess, test, treat, and triage patients, so you wouldn’t put the people you live with at risk. Fever clinics were one of the strategies used to bring the outbreak in China under control by preventing clusters of family infections. In lieu of such innovations, the best choice is to try to recover at home, isolated as much as possible from your housemates. Preferably, you should avoid contact with both people and pets, and be cordoned off in a “sick room” with a separate bathroom, if possible.

Can pets get the disease? In rare cases, dogs have been found infected with the new coronavirus, but the virus replicates poorly in canines. They don’t seem to get sick, and they don’t appear to pass the virus along to others. This is consistent with what we saw in SARS, where a small number of pets tested positive, but they didn’t appear able to infect others.

The COVID-19 virus has been shown to reproduce efficiently in cats, however, who are then able to experimentally transmit the virus to other cats in separate cages, presumably via respiratory droplets, even though they may themselves not become sick. A survey of 102 cats in Wuhan province after the outbreak found evidence of infection in 15 of them––presumed, as with the pet dogs, to be cases of human-to-animal transmission. In the United States, the first confirmed case of animal infection was a sickened tiger at the Bronx Zoo, followed by a few pet cats. There is no evidence to date that pets have been a source of infection of COVID-19 for humans, but rather, we suspect, it’s the other way around.

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To reduce the risk of spreading the disease to those you live with if you are sick, cover your nose and mouth with a tissue when you cough or sneeze, throw the used tissue in a lined trash can, and then immediately sanitize your hands. Don’t share personal household items, such as eating utensils, towels, or bedding. Wash your hands often. Routinely disinfect all high-touch objects, such as phones, doorknobs, and toilet surfaces in your sick room and bathroom yourself, and have someone else clean and disinfect the rest of the house, if possible. Harvard public health experts suggest running the exhaust fan in the bathroom. Opening the windows in the sick room to enhance ventilation may also help.  During the SARS outbreak, hospital wards with larger ventilation windows appeared to harbor significantly lower infection risk for healthcare workers. And finally, based on surrogate coronaviruses, using a humidifier if the air is dry may also cut down on the viral circulation.

Most people who contract COVID-19 spontaneously recover without the need for medical intervention. If you do come down with it, protect those around you, get rest, stay hydrated, and monitor your symptoms. If serious problems arise, such as difficulty breathing or persistent pain or pressure in the chest, seek medical attention—but, notify the 911 operator that you may have the virus, or if less serious, call your doctor or emergency room first for before heading in, since they may have special instructions for suspect cases in your area.

The CDC advises that once your symptoms start getting better, once you’ve been fever-free for three full days (off of fever-reducing medications), and it’s been at least a full week since your symptoms first started, then you can start relaxing your home isolation. The World Health Organization is more conservative, however, recommending self-quarantine for a full 14 days for anyone with symptoms, or anyone living with anyone with symptoms.

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If you’re sick and you must be in the same room with someone else, you should wear a face mask. That’s what masks were originally designed for, so-called “source control,” rather than self-protection. They are meant to protect others from you, rather than you from others. Common cold coronaviruses (as well as flu and rhinoviruses) can be detected in exhaled breath, not just coughing and sneezing, and surgical masks can cut down on the amount of virus you exhale out into in the world. We have yet to know if this is true of COVID-19, but the head of the standing committee on Emerging Infectious Diseases at the National Academy of Sciences told the White House: “Currently available research supports the possibility that SARS-CoV-2 could be spread via bioaerosols generated directly by patients’ exhalation.”

This shouldn’t be surprising. After all, respiratory droplets are not just sneezed gobs of mucus. When your breath fogs when you’re outside on a really cold day, that’s an illustration of respiratory droplets. That plume of vapor coming out of your mouth is made up of tiny droplets of water straight from your lungs. On a warm day, you can imagine yourself breathing out that same cloud—you just can’t see it. Err on the side of caution, and assume the virus is in the breath.

If infected individuals are exhaling virus before they even know they have it, maybe everyone should be covering their face in public. The CDC initially resisted such a measure, a decision the director-general of the Chinese CDC referred to as a “big mistake.” The US CDC relented in April, recommending “wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain,” such as grocery stores or pharmacies. The 180-degree shift is probably best exemplified by the U.S. Surgeon General’s swing from tweeting “Seriously people- STOP BUYING MASKS!” all caps exclamation point, to being featured in a video weeks later demonstrating how to improvise masks out of a bandana and rubber bands. The CDC has easy no-sew instructions at bit.ly/CDCDIY.

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In addition to those who are sick and necessarily exposed to others, surgical masks are advised when disinfecting a residence that may have been exposed to the virus. You should also wear disposable gloves, open all of the windows while mopping the floor and cleaning all surfaces with a disinfectant solution, and wash all linens and the clothes you just wore cleaning with detergent. Make sure to hold soiled linens away from your body, and don’t shake them before they are washed. And, as always, take care to not touch your eyes, nose, and mouth when removing your mask, and carefully wash your hands afterwards. You can find all these instructions at https://bit.ly/COVIDcleaning.

“The suggestion that the public should not wear masks because healthcare workers need them more is [definitely] valid up to a point, but it is surely an argument for manufacturing more masks, not for denying them to populations who could potentially benefit from them. Until such masks are available in sufficient numbers [frequently washed cloth masks are recommended by the CDC].” I’ll talk about what are the best materials to use for them, as well the role of N95 respirators, next.

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