En español | The coronavirus, it appears, will be with us for some time. And that means many Americans will be caring for family members with COVID-19 at home — attempting to meet their needs while trying to avoid contracting the disease themselves.
"You want to be there for them physically and emotionally, but it's important to protect yourself, too,” cautions Jacqueline Winfield Fincher, M.D., an internal medicine physician in Thomson, Georgia, and president of the American College of Physicians (ACP).
Whether your family member has tested positive or you simply suspect that your loved one has the disease, it's important to notify her health care provider early on and then stay in close contact with the doctor for the duration of the illness, Fincher says. From there, physicians and caregivers offer the following tips for how to handle everything from fever to monitoring breathing.
Isolate the patient
The Centers for Disease Control and Prevention (CDC) recommends having the patient stay in a separate bedroom or area of the house and having him use a separate bathroom. If you have no choice but to share a bathroom, experts advise opening a window or turning on a fan to increase air circulation. Clean all surfaces after the sick family member uses it, but wait as long as possible before going in, because particles could still be airborne. (If the patient is up to it, she can minimize the risk of spreading the illness by doing the cleaning.)
Daniel Lewis, a family physician in Greeneville, Tennessee, who recently recovered from COVID-19, says he moved into his home's “fairly finished basement” while he was sick. “My wife would sit food at the top of the stairwell and throw me items that I needed,” he says.
Treat their rising temperature
Take the patient's temperature at least twice a day, once right when the person wakes up and then again in the afternoon or early evening, when it's likely to be slightly higher.
A regular digital thermometer under the tongue works, but if your family member is too weak to take his own temperature, you may want to consider getting an ear thermometer or an infrared forehead type, suggests Jessica Sima, a registered nurse in McHenry, Illinois. Though expensive ($35 to $100), this type provides a reading with a quick swipe across the forehead, lowering your chance of exposure.
If your loved one has a fever (defined as a temperature of 100.4 °F or above), you can offer acetaminophen (brand name Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Anaprox). Early reports that taking an NSAID could lead to a more severe coronavirus infection did not bear out, and the CDC now says either is safe.
Many doctors recommend starting with acetaminophen, especially older adults, because NSAIDs can raise blood pressure and increase risk of bleeding, stomach ulcers and heart failure.
Lewis notes that Tylenol didn't work to bring his fever down when he had COVID-19, so he tells his patients to use ibuprofen if acetaminophen isn't working. Fincher typically recommends alternating acetaminophen with an NSAID. But make sure you don't exceed the daily limit of each medication listed on the package, Fincher warns.
Offering a slightly warm bath or sponge bath can also help a feverish patient feel better, the CDC says.
Make sure they're hydrated
Dehydration is a risk when you have a fever, and that's especially true for COVID-19 patients, who may have a high fever for days at a time. If your family member also has the gastrointestinal issues sometimes associated with the coronavirus (such as vomiting and diarrhea), he is at even greater risk.
Make sure the patient is urinating regularly, Fincher says. Dark-yellow urine is a sign that the person may be dehydrated.
Sima recommends packing a cooler of drinks and leaving it bedside. If water isn't appealing, offer tea, juice, energy drinks or soda, she says. Jell-O, applesauce, popsicles and soup boost hydration, too. When Sima nursed her mother through a recent bout of COVID-19, popsicles “were the only way to get fluid in her,” Sima says. “She went through boxes and boxes of popsicles.”
Consider getting a pulse oximeter
A pulse oximeter (or “pulse ox") is a device that clips onto a patient's fingertip and measures her heart rate and the oxygen saturation level of her blood.
Fincher says it can be a useful tool for COVID-19 caregivers because a falling oxygen level can be an early sign that a patient's health is deteriorating.
Raymond Casciari, M.D., a pulmonologist at St. Joseph Hospital in Orange, California, also recommends pulse oximeters for coronavirus patients, as long as they use it in consultation with their physician.
He says an oxygen level of below 94 percent is concerning, but it's also important to notice the trend over time. “If it's dropping a little each day, then the trend is going in the wrong direction and you want to call the doctor,” Casciari says.
Joe Grillo, 58, of Oradell, New Jersey, says he and his wife bought a pulse oximeter from a local drugstore for $40 after they both came down with COVID-19, in March. They checked their oxygen levels once a day while they were ill and shared the results with their doctor.
"It's about as simple of a device as you could possibly use,” he says.
Home pulse oximeters aren't as rigorously tested as medical-grade ones, so doctors caution that it's crucial to watch for other symptoms, too, and not to rely on the device too heavily.
Help ease their cough
The dry cough that accompanies the coronavirus is hard on many patients and is particularly difficult to suppress, Casciari says. Unfortunately, studies show that over-the-counter cough suppressants aren't any more effective than a placebo and doctors do not recommend them for COVID-19 patients in particular. “What does seem to work is anything that lubricates the throat,” he notes, “like sucking on eucalyptus cough drops.” Prescription medicines with codeine may also provide relief, Casciari adds.
Sima says hot tea with honey helped her mom when her cough was really bad: “It soothed and coated her throat.”
To reduce nighttime coughing, elevate your family member's head with extra pillows or a foam wedge. Or try this trick from Stella Nsong, a registered nurse in northern New Jersey: Put a couch cushion under the head of the mattress (on top of the box spring).
Coach them through this breathing exercise
Casciari and Fincher both say a breathing technique touted by celebrities with COVID-19, including J.K. Rowling and CNN broadcaster Chris Cuomo, could be helpful for your loved one.
In a video demonstrating the technique, British doctor Sarfaraz Munshi tells viewers to take a deep breath, hold it for five seconds and then release it. Patients should repeat this five times, then take a sixth breath in and cough strongly while releasing it. Afterward, they should lie flat on their stomach for 10 minutes, taking slightly deeper breaths than normal.
The exercise pushes air deep into the lungs and opens air pockets that otherwise might be collapsed, helping to prevent mucus buildup, Casciari explains. It also increases the amount of oxygen the patient is getting. “We've used it for years with respiratory illness,” he says.
Lying facedown afterward takes advantage of gravity to redistribute the air and fluid in the lungs, improving oxygenation, Casciari says. Called proning, the technique is being used by hospitals across the country on severely ill patients. Physicians have found it to be helpful.
Casciari was quick to point out that the exercises are no substitute for going to the hospital if your loved one is having trouble breathing or if his symptoms are getting worse.
Take steps to protect yourself
Both you and the patient should wear a mask if you are within six feet of each other. You should also wear a mask and gloves when you collect and wash the individual's dishes and do her laundry (in hot water, separately from yours).
Wash your hands frequently, using disposable paper towels to dry them, instead of a hand towel.
The CDC recommends cleaning and disinfecting frequently touched items and surfaces, such as doorknobs, light switches, handles, faucets and electronics, at least once a day. Make sure you read the directions on household cleaners. Many sprays recommend leaving the product on hard surfaces for a few minutes to effectively kill germs, Fincher says.
Sima wasn't able to find sanitizing wipes or sprays, so she mixed bleach with water (using the formula provided on the back of the bleach bottle) and put it into a spray bottle. She also bought a paint suit to wear when she was in the same room as her mom and asked a friend with a 3D printer to make her a plastic face shield to wear over her surgical mask. “I wanted as many extra layers of protection as possible,” she says.
Watch for signs of worsening
Although about 80 percent of COVID-19 patients recover at home without medical care, it's essential to watch for signs that your loved one needs to go to the hospital. In many patients, symptoms peak on days eight to 10, Lewis says.
"For a lot of illnesses, you are out of the woods after about a week, but with COVID-19, that's when you need to be extra vigilant and watching for any worsening,” Lewis says, noting that he went on a ventilator on day 10.
Grillo had a similar experience."A week went by, I thought I turned a corner, and then, all of sudden, it came back with a vengeance,” he says. “I ended up having fevers for 15 days straight."
Go to the hospital or call 911 if your family member exhibits any of the following warning signs: trouble breathing; persistent pain or pressure in the chest; bluish lips or face; fainting; or stroke symptoms such as confusion, weakness on one side or trouble focusing.
"The number one red-flag symptom is shortness of breath,” says Fincher, who notes that if your loved one feels like she can't get a deep breath — or can't get a full sentence out without taking a breath — you should insist on taking her to the hospital.
Sima recommends putting your family member's medication list and documents such as a living will into an envelope and keeping it where you can grab it quickly. “I taped it to the back of the front door so I wouldn't be scrambling if things turned to the worst.” You may also want to keep cellphones, chargers and face masks handy in case of an emergency.