Home Isolation monitoring during COVID-19
The pandemic really hit the globe hard since its arrival in December of 2019. The first initial months of it were brutal, destroying countless lives as it advanced. Almost 2 years into the pandemic, many countries particularly those with low national GDP have faced a humanitarian crisis. However as they show in the movies, a ray of hope emerged with the introduction of vaccines for combating the disease. Even so, the basics of infection prevention still hold the primary line of defense against combating the disease.
The science behind the prevention of the spread of virus still remains very basic, you need to keep a safe distance, wear a protectable filter to cover the virus entry points, and wash away the potential viral load you might encounter in your day to day life; the now-famous S-M-S (Social/ physical distancing, putting on your Masks and Sanitizing your hands). But even with the vaccines and S-M-S the disease still has the potential to spread, however with these precautions we have seen the severity of the disease drastically fall down.
Now let’s say you do contract the disease even being doubly vaccinated and adeptly performing the S-M-S. So, what to do next?
As a Doctor, I would definitely advise you to take the next step in understanding the disease. I like to understand it as The WHAT? - What is the disease, what to know about it, and The HOW? - How did I potentially come across it, How to monitor my progression. I would suggest all to bring it down to these questions whenever you fall sick or have a family member who has fallen sick.
So we know that COVID-19 is a viral illness and spreads via respiratory droplets; the entry and exit point of which is your nose and mouth. It mainly affects our respiratory system hence the coughing, sore throat to the much serious Viral Pneumonia along with other range of symptoms. The disease has an incubation period (the time period between entry of the virus in your body to start of the symptoms) of about 2-10 days with maximum people experiencing symptoms by the 7th day. So it is very important to keep yourself in quarantine if you feel like you've been exposed and monitor for any development of new symptoms. If you have developed the symptoms, you need to keep yourself isolated and have your family members and close contacts get themselves quarantined and tested on the 7th day from the development of your symptoms or as soon as they themselves start developing symptoms. The isolation period for COVID-19 is 10 days starting from the day of your symptom onset.
So, How to monitor yourself during these 10 days? What things to not miss out on and when to definitely seek hospital care?
When you do develop your symptoms, you need to get promptly checked for COVID-19 by RT-PCR. Rapid Antigen Test (RAT) can be an alternative but RT-PCR is still the test of choice. However if you are shown positive by RAT, you need not hassle to get a PCR if PCR is not readily available in your locality. Following your diagnosis, it is recommended that you start keeping in touch with a medical professional (preferably a licensed medical doctor) for treatment. At Danphe Care, we monitor you for 10 days, with Doctor consultation and nurse follow-up every day along with specialist backup. We keep track of your records in our EMR (electronic medical record) and help with referrals if needed as well. Not all who develop the disease need hospital admission. Roughly speaking, out of 1000 infected people, 800-850 develop mild to moderate disease, which is self-limited. The rest 100-150 might develop severe to critical COVID but these are usually patients with underlying comorbidities, weakened immune responses, or ones whose disease progression was not monitored and developed into severity.
What you need to do is to monitor your symptoms. COVID progression is tracked clinically, meaning you should not overlook your symptoms. You may categorize your symptoms broadly into two categories; Major symptoms (if these symptoms are seen to increase your treatment will change promptly along with necessary investigations) and Minor Symptoms (these definitely will be a burden but usually subside by the course of the isolation period). The Major symptoms you should monitor are FEVER, COUGH, CHEST PAIN, AND SHORTNESS OF BREATH.
We say you have a fever if your core body temperature exceeds 38C or 100.4F (at home the closest measurement of core body temperature is your oral temperature) or if your surface temperature exceeds 99.5F (measured in our axilla/armpit or by means of a non-contact thermometer measuring the temperature of your forehead). Some people might have fever up to 102F, however, if you don't have exacerbations of other symptoms and your oxygen level is above 94%, you might be prescribed a stronger medication to control your fever, but if you have continuous fever for more than 5 days with an increasing pattern, with the addition of other symptoms you need to consult a physician and need a baseline investigation for possible complications.
People usually tend to develop dry cough (i.e. with no production of sputum), which could be continuous for some people or might be limited to a few occasional episodes and/or also with a predilection to a certain time of the day (i.e. either the morning or the evening). If you do have a productive cough, you will need to note the color of the sputum, if other than white need to consult your physician. The important point in cough is to note the progression. An occasional cough might be present even after your isolation is overextending up to a month or so (a possible long COVID symptom). If you start coughing, you need to note the progression, if it looks to increase in frequency or you start developing deep coughs you need to consult your physician.
You might notice chest pain (slight or maybe a discomfort) when you take in a deep breath and your chest starts to expand. Usually, people tend to complain of chest pain more over their lower chest (i.e. the bony border that separates your chest and your abdomen). If this occurs you will need to contact your physician.
Shortness of Breath
To understand this, you could consider an example. Imagine climbing a flight of stairs and reaching the second floor from the ground floor. When you reach the second floor you start effort breathing, you need a pause to take in your breath. Now picture a similar scenario when you are in your isolation. If you start developing effort breathing while doing minor activities, walking casually to take in the fresh air in your terrace during your isolation, You MUST contact your physician. This is a very alarming sign that you SHOULD NOT overlook by any means.
However, one should also understand that due to the pandemic a lot of people have started developing Anxiety which also triggers shortness of breath. To clear the confusion as to which is the cause of your Shortness of breath, you HAVE to measure your OXYGEN SATURATION (SPO2). Anxiety attacks do not cause a drop in saturation. If you see a drop in your saturation that is an ALARMING SIGN that your COVID is increasing in severity. If you are not a patient of any underlying chronic lung diseases such as Asthma or COPD your SPO2 should be 94% or above. If at any time you do see a drop below 94% you HAVE TO CONTACT YOUR PHYSICIAN IMMEDIATELY.
Monitoring your Oxygen level
You will need to keep a device called a Pulse Oximeter with you at all times during your isolation. Before using it you need to checklist a few things i.e. You should be on rest (10-15minutes), your hands should not be wet, cold, or shaky. You will need to stabilize your hand either by resting it on the table/bed surface or by placing it against your chest (like during the national anthem). You will also have to remove any nail paint and long nails. Following these, place the device on your finger (any finger works, commonly done on the thumb or index finger) and measure it for ONE MINUTE by placing a watch nearby. You will appreciate 2 readings, one which shows your heart rate, labeled as PR (pulse rate) which should be between 60-100 bpm (beats per minute) and the other shows your oxygen saturation i.e. SPO2 which should be 94% and above. The SPO2 tends to fluctuate for the initial few seconds as it is dependent on our chest physiology, so you need to only document the number which does not fluctuate, which usually comes at around 15-20 seconds of keeping the device. That is also to say, do not document the number which you see immediately after you put on the device as it may fluctuate thereafter for a few more seconds. Also, you should remember that some people might get faulty devices when they buy them, a manufacturing defect. If you are in doubt that your device is faulty you need to sanitize the device with an alcohol-based sanitizer, wipe it and give it to your caretakers (who should not have been infected with COVID or have diseases such as Asthma, COPD). IF their reading comes below 94% the device can be labeled as faulty. If you are still in doubt, I would suggest you visit the nearest Hospital and get checked there. Your oxygen level will be documented as per the one which the hospital shows.
IF AT ANY TIME YOUR MEASURED OXYGEN LEVEL DROPS TO 90% OR BELOW YOU WILL NEED HOSPITAL OBSERVATION MOST LIKELY WITH OXYGEN SUPPORT AND OTHER INVESTIGATIONS TO RULE OUT COMPLICATIONS.
Apart from these four mentioned above other symptoms (such as weakness, lethargy, loss of smell/taste, headache, loose stools) have a tendency to subside during the course of your disease with the help of nutrition, hydration, and if needed supportive medications (such as multivitamins). However, if you do start developing excruciating headaches or multiple episodes (>3) of loose stools you definitely need to consult your physician.
I usually advise my patients to keep a track of their symptoms. You should monitor yourselves every 4 hours and write down the measured data (at least Temperature and SPO2) wherever you feel comfortable (in a tabulated form either in your computer, mobile, or even your copy/notebook). This helps decrease your anxiety as you can see your clinical progression as well and also you will not have to be in doubt regarding your clinical status a day or two days before. You may chart it as :
Lastly, I would like to say that you need not worry if you get infected with COVID-19 but definitely be vigilant in monitoring your symptoms. I would advise all who stay in home isolation to get connected with a physician so that you can be promptly referred for hospital admission and monitoring if need be.
-Dr. Suyash Timalsina, Medical Coordinator, Danphe Care. (@drsuyasht.wordpress.com)