The world is changing fast and to keep up you need local knowledge with global context.
As Covid-19 continues to spread, and with no vaccine yet to prevent contracting the coronavirus, the risk are rising that you will test positive. In this interview with BizNews founder Alec Hogg, Johannesburg-based general practitioner Dr Sheri Fanaroff sets out what to do as soon as you hear this worrying news. She also provides detailed, practical advice so that you can avoid spreading Covid-19 to other members of your household. – Editor
By Dr Sheri Fanaroff
South Africa has now reached the top ten in the world in numbers of confirmed cases and is set to overtake the UK in the next few days. We remain fifth worldwide in terms of active cases and are the 3rd fastest growing country. More than 1/3 of cases are clustered in our smallest province, Gauteng. If it hasn’t already, Covid-19 is coming soon to a person near you. So what do you do when this happens?
1. Don’t panic
- Many people with a positive test will experience no symptoms whatsoever.
- 85% of symptomatic people will experience a flu-like illness which will be manageable at home.
- 10 to 15% of symptomatic people will require hospitalisation and 5% may need ICU.
- The chances of needing to go to hospital increase with increasing age and the presence of another underlying illness (co-morbidities such as obesity, heart disease, lung disease, and uncontrolled hypertension). However, having these risk factors doesn’t automatically mean that you will experience a more serious illness – it just means that you should be monitored more carefully.
- Rest, maintain good hydration and eat healthy food.
- Maintain excellent hygiene.
If you have been diagnosed with Covid-19, either by your doctor (based on symptoms) OR from a positive test result, you need to stay in isolation for 14 days to prevent the further spread of the virus. (I am aware that Prof Karim announced on the news that shorter isolation and quarantine times might be introduced- at the moment, these changes are NOT RECOGNISED by the NICD or any other global authority, and we are still recommending the 14 days).
- Stay home and don’t have visitors.
- Stay in your own bedroom (if possible). Keep the windows open and the room well ventilated.
- Use your own bathroom (if possible) or if you are sharing, then clean the bathroom thoroughly after each use. The toilet seat should always be closed before flushing.
- Rooms that the positive patient is occupying should be wiped down daily with disinfectant (a bleach solution made up of household bleach diluted with 9 parts water can be used). If the patient is well enough, they can clean their rooms themselves. If they are unable to, the person doing the cleaning should wear a mask while doing so and sanitise their hands well afterwards.
- If anyone enters the patient’s room, both people should have masks on and keep a distance of at least 1.5 metres when possible.
- The patient should eat in their own bedroom. Crockery and cutlery should be washed well in hot soapy water. Eating together is not advised as masks cannot be worn while eating.
- When the positive person does interact with the rest of the family, this should ideally be outside, or in a very well ventilated room, keeping a distance of at least 1.5 metres and with all parties wearing masks.
- The affected person’s laundry should be washed in hot water (a washing machine is fine), and preferably ironed afterwards. The person doing the washing should wear a mask while handling dirty laundry and should sanitise their hands well afterwards.
- If the affected patient has young children, children should be told that mom or dad is “sick” and has “germs” for a few days. They should be allowed to interact with their parent but wearing masks and at a distance in a well-ventilated space. (This is obviously challenging!)
Stay in isolation for:
- 14 days from the day the test was done if asymptomatic
- 14 days from symptoms starting if symptoms were mild. (You should feel better and have no fever for at least three days before de-isolating)
- 14 days from coming off oxygen
- 14 days after discharge from hospital
3. Notify your contacts
- Please refer to my update from 19 June for clarity on who your close contacts are.
- You are obliged to inform anyone you have been in contact with for 72 hours before onset of symptoms that they are potentially at risk for contracting the virus.
- Close contacts need to go into quarantine for 14 days – THEY ONLY NEED TO BE TESTED IF THEY DEVELOP SYMPTOMS.
- Your workplace and school need to be informed so that they can follow procedures for disinfecting and notifying contacts.
- The lab who did the test and your doctor are legally obliged to notify your illness as COVID-19 is a notifiable medical condition.
- You need to fill out a “contact line list” and you may be contacted by the Department of Health to check on your symptoms.
4. What medications should I take?
- Please confirm ALL medications with your doctor.
- Do not stop any chronic medications that you are taking (including chronic anti-inflammatories and ACE inhibitors).
- Do not self medicate with cortisone, chloroquine, Zithromax, Ecotrin or any other medication. These can cause complications.
- For fever and headaches, paracetamol is safest and best. You can take two Panados every 4 to 6 hours if needed. If this is not adequate, talk to your doctor to discuss other options.
Recommended vitamins include:
- Vitamin D (50000 units single dose or 1000 to 4000 units daily)
- Vitamin C 500mg 3 times daily
- Zinc 25mg 3 times daily or elemental zinc 20mg daily
- Nicotinamide 25mg daily
- Thiamine 100 mg daily
Do not use a nebuliser (this can aerosylise the virus and spread it in your house). If you feel short of breath, discuss an inhaler with your doctor.
Breathing exercises and steam inhalations may be helpful if you are feeling breathless.
5. How should I monitor myself?
- A symptom monitoring chart is available from your doctor.
- For 14 days, you should monitor yourself for fever, cough, sore throat, shortness of breath, loss of taste or smell, headache, body pains, diarrhoea.
- Try to get a thermometer and monitor temperature twice daily.
- Try to get a pulse oximeter and check oxygen levels and heart rate daily. (Hatzolah and Discovery are providing pulse oximeters to patients at risk. I have a very limited number of oximeters that I can lend out for a week at a time).
- Monitor respiratory rate twice daily (this is the number of breaths taken per minute – it is best counted by somebody other than yourself; your doctor can do this in a video consultation).
6. Do I need to have blood tests or a chest x-ray?
The majority of patients who are able to be treated at home will not need any specific investigations.
If you are over 65 years OR have comorbidities OR your condition is deteriorating, your doctor may decide to send you for blood tests to assess your inflammatory markers, your infection counts and your clotting profile. These tests might help to decide on further management.
If you are experiencing shortness of breath or severe cough, your doctor may decide to send you for a chest X-ray.
7. What would alert me that I need to get more help?
These are things that should alert you to check in with your healthcare provider. He/she can then advise you whether further action is needed.
- Temperature staying above 39 degrees Celsius
- Heart rate staying above 125 beats per minute
- Respiratory rate staying above 25 breaths per minute
- Oxygen saturation staying below 92 % OR a drop in oxygen saturation levels
- An inability to speak full sentences
- An inability to get out of bed and walk to the bathroom
- Chest pain or pressure
- Difficulty breathing
- Development of confusion or decreased level of consciousness
- Inability to stay hydrated
- Diabetics: sugar levels out of control (too high or too low)
8. Have a plan and check-in
- Make sure that you have someone to check in with if you feel like you are deteriorating.
- Have the emergency phone numbers handy.
- Your doctor and/or Hatzollah need to be aware that you are isolating at home with Covid.
- Check in regularly with any change in symptoms or concerns.
9. Ask for help
- You will need help with shopping, meals and other needs while you are in isolation. Don’t be scared to reach out to friends, family and neighbours.
- If you live alone, check-in with a friend or family member daily.
- Call and video call your friends and family regularly so that you don’t feel alone.
10. Stay positive
- Try to stay positive and use your time at home to rest, recuperate and reflect.
- Limit your sources of information to trusted sources and sites eg NICD website, WHO, SA coronavirus website and your doctor.
- If you are unsure of something, rather check.
- Remember that in almost all cases, “This too shall pass” and hopefully you will soon be feeling better and able to get back to work/ school/ normal life.
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