29/06/2020
Great advice from my colleugues in the GGPC
So you have COVID, now what?
Dr Karin van der Merwe and Dr Varanna Dogan
COVID numbers are increasing in South Africa and it is inevitable that many of us will get infected. Some will be diagnosed by having a positive COVID test while others may have typical symptoms and a false negative test or no test at all. What should you do if you are pretty sure you have COVID?
1. Keep calm
Most people will be asymptomatic and at least 95% of those infected will recover completely. Only 10-15% of symptomatic people will need hospitalisation, which means 85% of symptomatic people will experience a mild flu-like illness at home. The chance of hospitalisation increases with age and in those with chronic medical conditions like diabetes and high blood pressure, particularly if these are poorly controlled.
Avoid information overload by limiting the number of articles and posts that you read on the internet about COVID. Not all of these will be from reputable sources and many will cause undue fear. Some trusted sources include the Department of Health (sacoronavirus.co.za); NICD (National Institute of Communicable Diseases) and WHO (World Health Organisation). If in doubt, ask your GP which sources you can trust to give reliable information.
2. Monitor yourself
Take note of how you are feeling daily and what symptoms you experience. Symptoms you may experience include loss of taste or smell, fever, sore throat, dry cough, muscle aches, headache, abdominal cramps, diarrhea and fatigue. It may be useful to take your temperature daily. If available, you could measure your oxygen saturation using a pulse oximeter. This is a handy device which clips onto your finger, telling you the percentage of oxygen in your blood. The level should be more than 90%. These are available at pharmacies and are covered by some medical schemes.
The natural progression of COVID is that the first week of illness generally presents with flu-like symptoms and from about Day 6 respiratory symptoms may start. In patients at risk for complications, the doctor will probably order blood tests on Day 6 or 7 to monitor inflammation levels and risk of clotting and add medications like cortisone or anticoagulants according to the results.
3. Check in
Make sure you have a GP or clinic that you can check in with - preferably by phone. It is especially important to contact a doctor or go to hospital if you have any of the following - difficulty breathing, persistent chest pain, new confusion, inability to stay awake, bluish lips or face or oxygen saturation less than 90%. Do not hesitate to contact your doctor if you have any concerns. The doctor will ask you questions about how you are doing and decide whether you need to be admitted to hospital or continue to recover at home. Treatment at home may include supportive measures such as paracetamol and supplements such as Vitamin B3, VitaminC, Vitamin D and Zinc. Please discuss any other treatments with your GP and do not stop any chronic medications.
4. Self-isolate
Be responsible. Isolate yourself from others. This includes your family members. Isolation refers to separating people with a contagious disease from those who are well. You need to stay in a separate room and use a separate bathroom if possible. If you are sharing a bathroom it needs to be disinfected after use. Eat your meals in your room and when having any contact with others, including your close family members, wear a mask and keep 1.5m away. The person handling your laundry and dirty dishes should wear gloves or thoroughly wash their hands afterwards. For very detailed information on how to self-isolate see
https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/care-for-someone.html
How long do you need to isolate for?
If you were asymptomatic, you need to isolate yourself for 10 days from your positive COVID test. If you have a mild infection, you need to isolate yourself for 10 days from the start of your symptoms. If your infection was more severe, you need to isolate for 10 days from the time you no longer needed oxygen. You do not need to have a negative COVID test to come out of isolation. If any doubt exists, discuss when you can come out of isolation with your healthcare provider.
5. Enlist help
Ask your family and friends to assist you with your physical needs whilst you are self-isolating. Getting food, medicine and other essentials delivered is advisable. If you live alone, ask a friend to call and check in with you daily.
6. Notify your contacts
Anyone who has had recent contact with you without a mask OR at a distance of less than 1.5m for longer than 15 minutes is called a contact.
For instance, this may include those living with you, work colleagues in the same office space and classmates of scholars. Contacts need to quarantine themselves for 10 days from their last contact with you to make sure they don’t spread the infection. Quarantine is different from isolation because it refers to separation of well people exposed to a contagious disease to see if they become sick. It is important for limiting transmission as some contacts may be asymptomatic carriers of COVID.
Contacts only need to be tested for COVID If they become symptomatic. At this stage a positive test would mean a definite COVID infection but a negative test does not mean the contact is clear of infection so quarantine must continue until 10 days after the start of symptoms.
If contacts have no symptoms they do not need a COVID test but even if they were to test negative for COVID, they would still need to complete the 10 days of quarantine as false negative tests are common.
The above rules apply whether the contact has been vaccinated against COVID or not.
Update or Sign up for the COVID alert App which will notify those people who came within a certain distance of your phone thereby alerting them of possible exposure:
https://apps.apple.com/za/app/covid-alert-south-africa/id1524618326
Or
https://play.google.com/store/apps/details?id=za.gov.health.covidconnect
In closing
We hope these guidelines will help you to remain calm and know how to handle getting a diagnosis of COVID. By monitoring yourself and keeping lines of communication open, your recovery can be optimised. Once you have recovered it is likely that you will have a measure of immunity from the virus. The exact extent of this protection is still under study.
On the other hand, If you know someone who has been diagnosed with COVID, hopefully these guidelines will help you empathise with them and prompt you to be kind and offer to assist in whatever way you can. Be one of the voices that care!
NOTE: At the initial time of writing this post the isolation and quarantine times were 14 days. These have subsequently been reduced to 10 days.
