Covid @ Home

A collaborative guide to COVID-19 care

This website was made as a result of the COVID-19 pandemic, but much of the advice may be applicable in other situations. Much of what’s discussed here may be common sense to some, but we felt it’s still good to have some checklists and advice for various stages of illness in one place. While we consulted with nurses and doctors on much of this advice, most of this text was written by the non-medically trained, trying to puzzle together what makes sense in this new situation.

To be clear: LISTEN TO LOCAL HEALTH AUTHORITIES, DOCTORS AND NURSES when given the choice between that and something you found on the internet.

As we started writing for this site in Berlin, Germany in the second week of March 2020, much about the virus was still unclear, but numbers of infected and dead were rising steadily, most recently in Italy. While it is not now - nor is it ever - a good time to panic, we do think it is now time to think and prepare.

This guide is based on the assumption that in the coming months, more people than usual will either become ill or have ill people in their lives. Let’s all hope for the best, but we’re going to assume that doctors and hospitals are going to be very busy if not overloaded. We have to confront the possibility that some of the people who would normally be cared for under medical supervision might need to be cared for at home. We hope some of the information here will give you some confidence in dealing with this disease, which in and by itself will reduce the load on doctors and nurses who, from the looks of it, will be quite busy in weeks and months to come. At the same time, we hope to give you information that helps you tell when it is time to get professional medical help. Getting large amounts of people to get that balance right may make all the difference in the time to come.

This guide contains general advice that should be applicable in many places. We may add information that is specific to certain countries or regions, but you should keep your eyes open for more specific information from other credible sources that is more local to where you are.

Some of the authors of this website are not known as great fans of government and authority, but at this point trust in the public health authorities is vital. Where there are discrepancies, trust reputable sources such as:

Know the Facts:

Remember that there is no difference in potential infectiousness between friends and strangers. There is no race, ethnic group, or nationality that is innately more likely to get or transmit the virus than another. Try to help others when you can without being in contact with large groups of people unnecessarily. There are obvious trade-offs here that everyone has to weigh for themselves. Some people will need to have more contact with other people than others. Slowing the spread is never absolute, but over all of society, our efforts still work when everyone does what they can, within their limits.

At this point the site uses metric units in many places, although sometimes both metric and imperial units are provided. We hope to offer metric and imperial versions of everything in the next few days.

YOU CAN HELP MAKE THIS SITE BETTER. If you see something that could be better, please click here to file an issue. As you can see there the backend of this website is on Github, so if you know that environment you can probably think of other ways to help. To be successful, this will need to be an expanding collaborative effort.

  

Level 1 – Healthy

Don’t Get Infected

(Or infect others should you happen to be asymptomatic / feel fine, but actually have COVID-19… Asymptomatic cases are still infectious.)

Where possible, follow the instructions from authorities. This includes some of the by-now familiar guidelines for social distancing:

Stay Healthy

On top of this, you can do things to stay as healthy as possible:

Psychological well-being

This is going to be rough on all of us at times, and it is going to affect each and every one of us differently. refer to the page with recommandations, hints and tips for psychological well-being.

Prepare

And on top of that, you can prepare so that you are familiar with the things that you will need to do when disease comes knocking. Read the rest of this guide. It is statistically unlikely anyone in your household will develop life-threatening complications, and hopefully there will be plenty of medical care for everyone. It doesn’t hurt to be a tiny bit more ready for the worst-case scenario. But remember at the same time that there is no reason to panic. Take a deep breath and continue your regular life as much as possible.

Get the things you need

We made a shopping page that lists handy things that may help you care for yourself and others.

Existing Medical Conditions

If you or your loved ones have existing medical conditions, now is the time to read up on how these conditions could be made worse by COVID-19 / pneumonia. You / they should make extra sure they have plenty of all of your / their necessary medications. Make sure you have all the information relevant for treatment (contact info of doctors, recent lab results, how much of which drugs the patient is taking). Assume for a moment that your regular doctor isn’t there and you have to explain it all to a new doctor who has very little time. A recent timeline of visits, results, etc would be nice. What should you not forget? Write it down now!

What sorts of existing medical conditions are especially likely to make you / your loved ones vulnerable to more severe COVID-19 problems?

Preventive Care

If the situation is still somewhat normal where you are, this may be good moment to briefly ask your doctor what (if anything) she/he thinks you should do now, and what you should do if you fall ill. If you have not yet been vaccinated for the seasonal flu, pneumococcal pneumonia, or meningococcal meningitis, now may also be a good time to ask your doctor if you are a candidate for those vaccines. Getting these vaccinations now if your doctor advises it could help prevent another infection from compounding problems that may be caused by COVID-19, should you be infected later.

During pandemics, it is typical for childhood immunizations, maternal healthcare, and healthcare for chronic health conditions to get cancelled or delayed because doctors, nurses, hospitals, and the rest of the healthcare system may be overloaded, and because people may be afraid to go in to doctors’ offices or hospitals for fear (sometimes rational) of being exposed to disease. In case your area is not yet greatly affected by COVID-19: Is there any normal childhood vaccination you want to be sure your child gets while he or she can? Any prenatal care or routine care for a chronic health condition you can get now instead of in a month? What about other conditions that are common ailments for you or your loved ones? Anything you can do to prepare to care for yourselves without normal medical care access in the coming months, in case it becomes harder to get time with doctors and nurses because they are overwhelmed? Do it now.

  

Level 2 – Emerging Symptoms

Notice if you suffer from any of the following first symptoms:

Initial symptoms may also include headache, chills, dizziness, nasal congestion, abdominal pain, diarrhea, nausea, and vomiting. Later in the infection, symptoms may include loss of smell and taste lasting for several days.

Is COVID-19 spread in the community where you live? Or have you been to an affected area or been around someone who was in an affected area? Then your symptoms could very well be COVID-19. But remember: In many areas, the odds that it’s something else will still be greater.

Note: Fever is not subjective. You will need a thermometer (or two), and to keep track in a log of at least daily temperature. If you choose to take temperature internally (i.e., in the bottom / rectum), it will be more precise. Be sure you have enough wipes and alcohol to clean the thermometer after each use. If taking temperature orally, don’t eat or drink for 20 minutes beforehand. Either way, note the method in your log so healthcare personnel know which it is. (Around .7 degrees Celsius is often added to oral temperatures.) Here are some good instructions for how to take an oral temperature.

Diagnosis

There will be different policies surrounding testing for COVID-19 based on where you are and what stage of the pandemic your area is in. Check online, call official hotline numbers, follow official guidelines, and consider driving to a drive-through testing center if your area has one and the patient qualifies for testing. You should not just show up at a doctor’s office or a hospital unannounced if you just experience the first symptoms.

Remember: Hospitals are bad places to be until you absolutely have to be there: You and / or the patient run the risk of getting additional infections that, when bacterial or fungal, are much more likely to be resistant to standard treatments due to the nature of the hospital environment. Also: Many hospitals are going to be overloaded.

Don’t Panic - The Worried Well

For most people, this will be as bad as it gets. You’ll be a little sick, and then you’ll get better. Done. At the same time, some people will not be so lucky. Even if only a relatively small percentage of those affected need medical care, this will put a serious strain on doctors, nurses and available medical resources. We can all help. The “Worried Well” are people who visit the doctor when they are not really (all that) sick, because they need reassurance. The coming weeks and months are not a good time for that. This website aims to give you more confidence and preparedness in caring for yourself, friends, and loved ones until you / they actually need professional help.

Self-quarantine

Until tested and depending on where you are and where you have been, it may be prudent to assume the patient (you? a family member?) has COVID-19. That means self-quarantine at home. No more visitors, a sign on the door, and the patient should not go out unless there is no chance of meeting anyone. Different areas have different standards for what it means to self-quarantine when there are other people in the household. If possible, you will want to err on the side of safety and try to get everything delivered for 2 weeks. Things may change, as in some areas the virus will become so common (endemic) that many people will have had it. There is no telling at what point various authorities will stop testing every potential infection, and it will differ from region to region.

Family, flatmates, etc.

Household members of people who are known or suspected to be infected should treat themselves as potentially also infected and self-quarantine too, while keeping the maximum practicable distance from the patient for as long as the patient can take care of him- or herself. This means being in different rooms, sleeping in different beds, eating separately, using different dishes and towels, and when possible, using different bathrooms.

Regularly clean all frequently touched surfaces with household bleach diluted with water: 10 ml / 2 tsp bleach with half a liter / 2 cups of water (carefully washing measurement tools before reuse). You can put that solution in a disused plant sprayer or cleaner spray bottle. You should give the spray a minute to work on surfaces before wiping it dry.

Now at the latest is time to think about Personal Protection Equipment (PPE). If you can get masks AND IF MASKS ARE NOT IN SHORT SUPPLY FOR DOCTORS AND NURSES WHERE YOU ARE, wear one. Depending on your situation, disposable gloves, long-sleeve protective gowns, and eye protection may also be appropriate. The shopping page on this website contains some ideas for personal protection items, as well as important information on when and how to use them. Depending on the stage of the disease where you are, the authorities may provide you with more detailed advice, instructions or even PPE materials if you are caring for a patient.

In most places, there will probably come a time when the number of cases skyrockets, many people have already had COVID-19, and authorities will no longer keep records of who has had it and who hasn’t. The basis then remain the same: Try to protect older people and people with existing illnesses as much as possible, and try to minimize spread whenever you can, as best you can. Remember: The more we can slow down or altogether lessen the disease’s spread, the better it is for everyone. Because by helping to slow or stop the spread, you can help lessen how overwhelmed the healthcare system is going to become. That in turn increases the proportion and number of people who need medical care, who are able to access it. This helps doctors and nurses save more lives.

Diary

When symptoms first start is the right time to start an illness diary.

A few times a day, preferably at somewhat regular hours or points in your normal routines or rhythms (e.g., every morning before making coffee or tea), measure temperature, even if you don’t feel like you have a fever (yet). Weigh once a day if possible. Also note respiratory and heart rates in breaths and beats per minute. It will get you used to doing these things, give you practise, and (if you start early) give you some idea what (more or less) healthy values for you look like. Not necessary, but extra points for blood pressure and oxygenation (Devices to measure those are cheap, see the shopping page).

Then write down any symptoms the patient has. If he or she is in pain, where and when is the pain, and how bad on a scale of 0 (no pain) to 10 (worst pain imaginable)? How bad is the cough? What color if there is mucus being produced? Be sure to note what medication, if any, the patient takes.

Paracetamol (also known as acetaminophen) is a good choice for fever and pain suppression. Keeping an illness diary will also help you to keep track of how much you’ve taken, when, to ensure you treat fever adequately without taking more than the recommended amount in a 24-hour period.

Printable illness diary

We made a printable illness diary that you can use to write down all the information you collect when you take temperature, breathing rate, etc. Please check out the form and our webpage about it via the link above.

Get healthy again

Treat pain and fever with over-the-counter medication at the recommended safe dosages. Use paracetamol (also known as acetaminophen) if you can. Questions are emerging surrounding the safety of ibuprofen / non-steroidal anti-inflammatory medications as well as corticosteroids / steroidal anti-inflammatory medications, in case of coronavirus. If possible, avoid their use if you have symptoms. An additional safe way to treat fever is to take a bath or shower. The water temperature should be comfortable, not cold, because shivering can raise your core body temperature - and the idea is to lower it. When you get out of the bath or shower, the leftover water evaporating like sweat from your skin can help lower your temperature.

Try to keep eating nutritious food. Nothing too heavy, not too much at the same time. Lots of vitamins and fresh produce. Adequate carbohydrates (potatoes, rice, pasta, etc). Inhale steam 3+ times a day. Go for a daily walk when possible, while keeping distance from other people. If your throat is irritated, avoid acidic drinks (such as soda and juice) as they can be further irritating; water and teas are better choices then.

Notice the color and amount of your urine. If it is dark (more colored than clear), or there is not a lot, drink more water. It is very important to avoid and treat dehydration by drinking enough, even though it can be hard to drink enough when you have a fever / are sweating a lot, and are suffering from fatigue and discomfort due to illness. If you are struggling to drink enough and beginning to show signs of dehydration like darker urine, you might also try eating foods containing more water (e.g., cucumber, oranges, apples), sipping on boullion or soup, or setting a small goal for yourself (e.g., every time you get up, drink a glass of water).

Coughing can be an important, healthy effort on the part of the body to clear the lungs of fluid so you can breathe easier. Do not suppress a productive cough all the time / just because you don’t want to be coughing. However, if you want to try to suppress your cough enough to get a good night’s sleep so your body can better heal itself, then over-the-counter cough medications, herbal teas such as anise / chamomile, cocoa, and lozenges can help. Some over-the-counter cough medications contain ingredients like guaifenesin or NAC, generally considered safe mucolytics that relieve coughing by helping your body get rid of mucus (usually by making it thinner and so easier to cough up); your pharmacist can help you find one that’s right for you.

Feeling better?

Before you break your quarantine, health authorities may want to (re)test you to see you are really not contagious anymore. But maybe the number of cases is already so high that people will have to make their own decisions. Err on the side of safety and try to stay home for a little longer than officially indicated. The World Health Organization recommendation is to continue isolation for at least two weeks after symptoms disappear, even if you are no longer feeling sick.

If you managed to get tested, yay! You now know that your body (presumably, keep watching the latest science on this) has built immunity. Which means that this thing is over for you, and also that you are a more logical choice to help your family and friends when they get sick. Depending on what state the world is in, you may want to inform your employer and others that might depend on you that you’ve had it, so they know you’re immune.

  

Level 3 – Bedridden

All the good care in Level 2 has not worked and things are getting worse. Doesn’t mean you did anything wrong, just keep going. Except now the patient is getting weaker. He or she is often too weak to get out of bed and may need extra encouragement to eat and drink.

If the patient is you

This is when you start telling other people around you that you are really ill and are mostly in bed. Talk to someone you trust about how they may have to take care of you. Have this person or these people read this document. If you have people in your environment who have already had COVID-19 (something that will be increasingly common as time goes on), such people would naturally make the best caregivers as they presumably will be COVID-19-immune. Otherwise try to judge what is wisest in your circumstances. By all means do not wait with this until the very last moment, because if the disease progresses, you will get short of breath which inevitably will also affect your ability to talk and to think clearly.

In any case

At this point, read ahead for all the signs that indicate Level 4. The purpose of care in Level 3 is also to monitor the patient more and more closely so as to catch early any signs that the patient is moving to Level 4. For instance: If the patient is not able to drink at least 2 liters of fluids per day, you should (kindly) insist. Dehydration is a medical condition, and without this daily bare minimum you’re quickly in Level 4.

In most cases, however, the patient will improve after a few days or at most a week. Just stay with it. Once the patient gets a little better, care may be done by the patient him- or herself again. Make sure the illness diary and quarantine are kept up until the patient has been completely well for a while. If you have been caring for the patient, your own two-week self-quarantine period now begins.

Care work

A large part of the work you are doing at this stage is care work, which may overlap with nursing but does not require specialized training. Remember that people who need help with basic self-care due to illness may be embarrassed to ask for or accept it. Be gracious. Everyone needs help sometimes. Think how to make the patient physically, mentally, and emotionally more comfortable and well; you might do this by asking yourself what you would need in their position, by watching for cues about discomfort (e.g., shivering, sweating), or by asking how you can help.

Some possibly useful behaviors include:

Illness diary

As mentioned in the previous section, you might want to use this printable form, or make your own.

At this stage, watch out especially for and note symptoms that might suggest worsening. Read the next section for more detail, but these include dizziness or rapid heart rate (drink more and eat something if you can), rapid breathing (elevate head while lying down or lower it to the table while sitting up for easier breathing), and a blue tint to fingertips or lips (cyanosis - get fresh air, get warm, and check blood oxygenation if possible). Also consider using relaxation techniques to slow a rapid respiration or heart rate that may be partially due to anxiety: Listen to soothing music, check in with a friend electronically, or see if you can slow your breathing and bring down your heart rate by counting longer for forceful exhaling than for gentle inhaling. (Some people use 4-7-8 and others prefer 5-2-5 to try slowing down their inhale-hold-exhale patterns.)

If you think the patient’s condition might be worsening, your illness diary might expand to include the following:

If the patient’s condition seems to be worsening, skip to the next section.

A typical day

At this stage, a typical day might look something like this:

You (or the patient) get up, weigh, and note weight in illness diary. You might also want to take your temperature first thing, before eating or drinking, especially if you are taking temperature orally - and note it in the illness diary, too.

Then, start drinking fluids. Not too much caffeine or sugar. As much water and herbal tea as you like. Remember you want to drink at least 2 liters and up to 5 liters a day.

Air out your home as much as possible, perhaps while the water for your morning tea or coffee is boiling. If you have the energy (and enough sheets), consider changing your bed linens if they got sweaty / otherwise soiled. Next, have a quick shower if you’re able. Staying clean can help you feel better mentally and emotionally, as well as physically.

Eat a small, nutritious meal (piece of fresh fruit? handful of salted nuts?) - something that sounds good to you. This is also a good time to take paracetamol (also known as acetaminophen) for fever / pain if you need it, and note the dose and time in your illness diary.

If that was already enough exertion, take a rest. Nap whenever you can - sleep is crucial for healing. If you’re not sleepy but need to rest, then try to rest sitting up to give your lungs a better chance to drain. If you’re still upright, now is a good time to steam to help your sinuses / airways open and mucus to drain.

Keep drinking throughout the day. Some people find it helpful to empty and refill a liter bottle of water or a teapot that holds approximately a liter, so that it’s easier to keep track of roughly how much you have drunk. This also makes it easier to keep water by the sofa or bed while you are resting.

Throughout the day, check in with yourself about fatigue (sleep as much as possible), hunger (eat small, nutritious meals), thirst (drink whenever you feel like it), and temperature (take care to keep warm enough). If you feel up to it, and only if you feel up to it, move (e.g., go for a short walk as long as it’s still permitted where you are, or get up and dance to a favorite song).

Finally, you want to be alert to signs that your condition may be worsening and you may need more care. So after taking basic care of yourself, then check in with other people around you who know that you are really ill. Let them know how you are doing - and if you need help, ask. Especially let someone know if you start experiencing more severe symptoms (see the next section).

  

Level 4 – Professionals Take Over

As symptoms get worse and the patient deteriorates, the frequency with which measurements are taken should go up. At this point, your log should contain temperature, respiration, and heart rate every few hours.

You should interpret any of the following as a medical emergency:

Loss of consciousness

There’s different levels. When patient loses consciousness, make a note of whether the patient responds when you call their name (Voice), when you pinch the shoulder forcefully (Pain) or whether he/she does not respond at all (Unresponsive)

If loss of consciousness is brief, you might (if patient quickly recovers and is fully awake again!) encourage the patient to eat and drink a bit, and freshly ventilating the room. But loss of consciousness is serious, get help.

Cognitive problems / confusion

You probably know the patient, so you should be able to tell without any fancy tests if and when he/she is not with it anymore. Sudden onset of confusion is trouble. Seek medical help.

Too high or too low respiration rate

Count respirations per minute by holding your hand close enough to feel the patient’s breath, watching his or her chest, and / or watching his or her abdomen, while holding a clock with a second hand or a digital watch / phone stopwatch. Respiration rate (RR) should be between 12 and 20 breaths per minute.

Immediate home care for respiratory problems may include ventilating the patient’s room and propping him or her up so that he or she can be in an upright but comfortably resting position. It is also a good idea to elevate the head of the bed for sleeping if possible, and there are some sleeping positions that can make breathing easier, too (see Level 3, Care work).

If you or the patient are experiencing shortness of breath / labored breathing, seek medical advice.

Low oxygen saturation

If you have an oxymeter (see shopping page), any oxygen saturation lower than 95% may indicate a respiratory problem. If at any stage the patient’s lips or fingertips turn blue (or even mildly blue) (called cyanosis), call an ambulance! Anything less than 96%, get fresh air into the patient’s room, and get him or her warm.

(Also call a doctor if the fingers, toes or lips turn less blue than this…)

If the patient’s skin gets a lacy purple overlay (also called livedo reticularis) like below (and that’s not normal for the patient), that is also a reason to call for help.

Very low blood pressure

Blood pressure lower than the bottom of the normal range (90 mmHg systolic, 60 mmHg diastolic) is cause for concern. Note that blood pressure comes as two numbers, the systolic and diastolic pressure. If you have a cheap automatic device it should tell you both these numbers. If you have a device, note the systolic pressure on the diary form.

If you do not have a device to measure blood pressure or have trouble getting a reading, then try testing the patient’s capillary refill time instead. Check by placing his or her fingers flat on a hard surface. Use your finger to press down on one of his or fingernails from the top. The fingernail should lose color. Check how long it takes the fingernail to turn its normal color again. It should take 1-2 seconds. Longer than that may indicate low blood pressure. It could also be a symptom of dehydration.

Dehydration is a common cause of low blood pressure, so immediate home care may include encouraging the patient to eat and drink, especially foods or beverages containing essential electrolytes like potassium and sodium. Dizziness is a common symptom of low blood pressure, so the dizzy patient will want to be careful while changing positions (laying to sitting up, sitting to standing); fainting may occur. But really, once again, if things do not look right somehow - if blood pressure is very low, or if the patient normally has high blood pressure and it’s looking much lower than their normal - again, get help.

Too high or too low heart rate

Heart rate is easier to measure than blood pressure, and usually high heart rate (above 100-110 beats per minute for an adult) goes with low blood pressure. Smaller people and children often have normally higher heart rates. High heart rate alone may not be cause for alarm, as it may indicate anxiety or dehydration. Relaxation techniques and drinking / eating something might be appropriate. But once again, values outside the normal range here should cue you to seek medical help immediately. This is especially true if you see rapid breathing along with low blood pressure or high heart rate and / or confusion.

Very high fever that comes (back) suddenly

If you check temperatures regularly, you will want to be aware that the trend can reverse suddenly, even when the patient seemed to be doing better earlier. Regular measurements are important. A fever that is very high (> 39° Celsius) is a cue to seek medical help. So is a fever that goes away and then comes back suddenly.

Call for help

When any of the above symptoms occur, things are serious! If at all possible, this is the point where you should not be taking any decisions based on a guide from the internet anymore. Do not wait for things to get worse. Call a doctor, or call the emergency number and get the patient in an ambulance pronto. Stay calm and report the situation as it is. Your job is done: You have kept a patient out of the medical system while he or she was just sick. Now it’s time for professionals to handle it. The data you have been gathering should hopefully help you convince the operator, ambulance people, and doctors that you are not merely panicking for no reason and will likely help get the patient the care he or she needs sooner.

  

Level 5 – System Overload

What if the official channels are overloaded?

What we’re unfortunately seeing in some areas is that the system becomes stressed to a breaking point if too many people become sick at the same time. Either you cannot get through, you are told the ambulance is going to take a while, hospitals are not taking new patients at all, or some hospitals prioritize treatment of certain groups of patients (such as the relatively young and healthy) over other groups (such as the elderly and / or people with existing illnesses).

In the event that official means of getting medical help are unavailable, you might want to try to get hold of that doctor you know, the nurse down the street, anyone with medical training and / or experience. If that doesn’t work, depending on the urgency, you might want to mobilize your and the patient’s wider circle know you have a patient who is not doing well and that you cannot get help. Ask around for doctors or nurses. Use Facebook? If you have any spare time after that, organize your diary pages, making sure any doctor who has time for the patient can immediately see temperature records, etc. Try not to seem too worried around the patient, because at this point there likely isn’t anything he or she is going to be able to do.

If you do get through (by phone?) try to stay calm and help the doctor / hospital assess the situation quickly.

In cases where ambulances are the bottleneck and you feel you need one, you will have to make your own judgement whether you want to try and drive to the emergency room or wait and hope to get through. Plan which hospital you go to first and maybe have someone who is not driving with access to the internet, either in the car or on the speakerphone. Please drive safely in any case, the last thing you want is a sick patient in a car accident.

 


 

For now let’s all hope our medical professionals can cope with the case load that is coming to them. Do your part in slowing the disease down as much as possible. Let’s try to all still be there at the other end of this.