If you have a cough, fever, or shortness of breath, how can you tell if you’ve got Covid-19, a common cold, the ordinary flu, or a bad case of the worries? Should you get tested? When should you seek medical care —and when should you just stay home?
Two of us (M.H. and M.W.) are primary care doctors who have received numerous calls from concerned patients with symptoms such as cough, fevers, or shortness of breath. Those calls prompted us — with the help of several colleagues — to develop a simple self-triage tool to help individuals decide when to treat their symptoms safely at home and when to seek medical help. One of the most important things each of us can do during the ongoing pandemic is to free up medical providers to concentrate on the seriously ill.
First the good news: The vast majority — perhaps 80% or more — of people who come down with Covid-19, especially those under 50, will suffer symptoms that are no more serious than a bad cold or a mild flu and will be better within two weeks. There is no need to seek testing or go to a doctor’s office. A test result won’t change your medical care because there is no treatment at this time other than the usual recommendations for any cold or flu: drink plenty of liquids, rest, stay home, and try over-the-counter remedies. (A test will, however, alert you to be extra careful not to infect others.)
In some people, though, Covid-19 is a more serious illness, particularly among the elderly and those with chronic conditions. That’s why the current outbreak must be taken so seriously.
Our team at the Gehr Family Center for Health Systems Science and Innovation at the Keck School of Medicine of USC, in partnership with Akido Labs, developed a triage tool to help guide patients. It’s available online for anyone to use. This tool will help most people effectively manage mild and moderate symptoms of Covid-19 at home.
We have also compiled the general advice and tips for self-care at home below.
Caring for yourself at home with Covid-19
Although the news reports about Covid-19 are alarming, reports from China, Italy, the U.S., and elsewhere indicate that for most people, infection with the novel coronavirus is on par with getting the flu. These steps can help you know if you need formal medical care and, if not, how to care for yourself safely at home.
Know when to seek medical care. The reasons to seek immediate care today are no different than they were before the Covid-19 outbreak. The severe symptoms listed in the table below suggest that you need medical attention. Otherwise, if you have a fever and cough or other cold or flu symptoms, but are otherwise healthy, are under age 60, aren’t having difficulty breathing, and don’t feel seriously ill, you’re better off caring for yourself at home.
Severe symptoms that suggest the need for medical attention (please note that this is not intended to be a comprehensive list, but provides general guidance)
|Consider calling an expert (e.g. your primary doctor) for guidance if you:||Considering seeking urgent medical attention (call 911 if appropriate) if you:|
|Feel dehydrated or produce little urine even though you are drinking plenty of fluids||Experience shortness of breath (difficulty breathing) at rest or with simple activity|
|Experience symptoms associated with Covid-19 like cough and fever AND you are over age 60 or have a chronic medical condition like diabetes, heart disease, or lung disease||Have chest pain|
|Have symptoms and were in direct contact with someone known to be infected with Covid-19 (you might be a candidate for Covid-19 testing)||Become confused or light-headed|
|Have any other worrisome symptom for which you typically would call 911|
Don’t go straight to a doctor’s office or urgent care. Start by calling a medical advice line or a telemedicine option instead. It’s wise these days to stay away from crowded places, and that includes emergency departments, hospitals, doctors’ offices, urgent care centers, and clinics — unless you are seriously ill. These are places where you could pick up the coronavirus if you don’t have it, or spread your batch to other people.
Many health plans have 800 numbers with nurses or doctors on call to answer questions by phone, as do some doctors’ offices. Look at your insurance card and make the call. Some clinics are conducting video visits, also known as telemedicine. If you call an advice line first, you can often get the guidance you need without spreading infection or unnecessarily exhausting yourself.
Save testing for those sick enough to need hospitalization. Testing for Covid-19 will not change your medical care because there is no treatment available or necessary for mild symptoms. (People with serious symptoms, such as difficulty breathing, should get supportive care in the hospital.) Tests are currently in short supply and are being prioritized for those who have severe symptoms or who have been exposed to someone diagnosed with Covid-19. If you do not fall into one of those two categories, resist the urge to request testing unless public health officials encourage you to get tested for tracking purposes. (We know as we write this that the indications for testing may loosen in the days ahead as testing supplies increase.)
Practice self-care. Viral infections are dehydrating. Drink plenty of liquids. Pedialyte and soups that contain salt are helpful, as are plain water, tea, juice, and soda. Drink enough so your urine is its normal pale color and you produce as much urine as you usually put out. Note: Not urinating normally is a sign you may need medical attention. If you have special dietary restrictions due to diabetes, kidney disease, heart failure, or other condition, get medical advice by phone or email about the fluids that are best for you.
Some over-the-counter medications may help. As anyone who has experienced a cold knows, over-the-counter remedies tend to provide only limited relief, and some may have side effects such as dry mouth, drowsiness, and raised blood pressure. Try flushing out your nose and sinuses with saline solution. Fever-reducers and pain medications such as Tylenol (acetaminophen) can help, and honey can be an effective cough remedy. There is anecdotal evidence that non-steroidal anti-inflammatory medications like ibuprofen or naproxen may make Covid-19 worse, though more research is needed.
If you have one or more chronic medical conditions, seek telephone advice from an expert to make sure you choose a treatment that is safe for you.
Don’t ask for antibiotics. Antibiotics do not work for viral illnesses like Covid-19. They also often cause side effects such as nausea, diarrhea, and rashes.
Get plenty of rest. Infections stress the body. Lots of rest — including sleep — will help keep your immune system strong so it can devote itself to ridding your body of the virus.
Separate yourself from others to prevent the virus from spreading. If you have the symptoms of a cold or the flu, play it safe and act as if you have Covid-19. Wear a face mask when in a room with others and if you must leave the house. Avoid close interactions with others for 14 days.
Follow the advice of public health authorities. Even for those who aren’t ill, social distancing will avoid fueling this pandemic. Please heed the advice of your local officials.
This is a scary moment in history. No one should be faulted for feeling anxious. Most people with viral illnesses — including Covid-19 — can be cared for effectively in their own homes without seeking formal medical care and will recover within two weeks. But it’s also important to know when to seek expert care.
We hope that our simple tool for self-triage and general advice and tips for self-care at home can ease some of the anxiety. and help you take the best care of yourself and your loved ones without putting yourself or others at unnecessary risk.
Michael Hochman, M.D., is a primary care physician, associate professor of clinical medicine at the Keck School of Medicine of USC, and director of the Gehr Family Center for Health Systems Science and Innovation at Keck. Michael D. Wang, M.D., is a professor of clinical medicine at Keck and director of inpatient programs for the school’s Department of Medicine. Katy Butler is a journalist, essayist, and author who writes extensively about health topics. The authors acknowledge the essential contributions of Arek Jibilian, M.D., Carolyn Kaloostian, M.D., Anjali Mahoney, M.D., Rishi Mehta, M.D., Pieter Cohen, M.D., and Chris Hendel for reviewing this material and helping develop the triage tool.