Episode #37 - Treatment and care at home

VGS   If you're caring for a COVID patient at home, what is the treatment protocol?

Hello, I'm Vismita Gupta-Smith and this is Science in 5, talking about how to care for a patient at home. The treatment protocol for COVID-19 care at home is Dr Janet Diaz. Welcome, Janet.

JD   Thanks for having me on this important session.

VGS   Janet, please explain the treatment protocol for COVID care at home.

JD   So, if a patient with COVID-19 is going to be cared for at home, there are a few important things to consider. One is, the patient should be in isolation – meaning that we don’t want that patient to transmit the virus to other people. Number two is, you may have a fever. So, if you have a fever, you can take symptomatic treatments or antipyretics or drugs that reduce fevers to keep you comfortable. The third is, to eat and drink sufficiently. So, make sure you stay hydrated, make sure that you maintain some good eating habits, eat what you like, but ensure to keep yourself well-nourished and well-hydrated. Most patients who get COVID-19 will have no complications from it acutely. They may not develop severe pneumonia and may not need to go to the hospital and that's good. But we do know there are a few patients – mostly those who have risk factors for severe disease – these patients are at risk for developing severe disease. So these patients, if they're being monitored at home, need to carefully watch your symptoms. There's one thing I do want to emphasize: SARS-CoV-2 we know is a virus. So, if you have COVID-19, then in patients that are being managed at home, we don't recommend the use of antibiotics. That means medicines that treat bacterial infections, because it's a virus infection so it won't respond to an antibiotic.

VGS   Janet, we are seeing an increased demand of medicines like Remdesivir and also increased appeals for plasma therapy in the treatment of COVID-19. Please tell us what the evidence is telling us about the effectiveness of both Remdesivir and plasma therapy.

JD   At this moment in time, we have a recommendation against the use of Remdesivir for patients with COVID-19 because there was low certainty in the evidence that it had any benefit in mortality. For convalescent plasma, we don't actually have a recommendation in that guideline specifically yet, but what we do have in the clinical management guideline is also against its use, unless under clinical trials as evidence is accumulating on those interventions. So we also do not recommend its use other than under clinical trials which are continuing and ongoing.

VGS   Janet, let's talk about oxygen now. How to monitor oxygen at home. What are the red flags? And also, please explain the wider red flags beyond oxygen when a person should get alert that now is the time to call your health care provider.

JD   Remember that all care at home should be done under clinical supervision, which means the decision for when you decide to do home care or you decide to be hospitalized really should be done under the supervision of a health care provider, according to the national protocols for COVID-19 care pathways. The pulse oximeter can be used at home. Pulse oximeter is a simple device. It's a fingertip device that can just be a small device put on your index finger. It is relatively inexpensive and simple to use. We do have a recommendation saying that if you are at home and especially if you're from a high risk group – so you're a person that may have the risk of developing severe disease – that monitoring your pulse ox, your oxygen saturation at home could be useful because you can detect, hopefully early, if your oxygen saturation starts to fall and then get the right intervention and care pathway started. So 94 to 90 is a little bit low. However, it's not below 90 percent, which is the warning sign.

So if your number is 90 to 94, then you have to make sure that you call your clinical provider and you tell them, this is my number, this is how I'm feeling. What should I do? So, you can get some advice on what to do next. The warning symptoms to consider when you're at home are: shortness of breath or difficulty breathing. That can imply that you're having a pneumonia and the pneumonia is progressing. Another one is chest pain. That can imply that your pneumonia is there and it's progressing. Another one is change in mental status. Sometimes that can be like confusion, like your thinking is unclear or that you're dizzy or that you're sleepier than usual.

VGS   Janet, can oxygen therapy be used at home?

JD   For an acute case of COVID-19 where we don't know if the pneumonia is going to be mild, if it's going to be severe, if you're going to progress to respiratory failure –  that is the concern. So, if oxygen is going to be used at home, it has to be done under a monitored setting, meaning that your clinician, under clinical supervision, that it's prescribed to you because oxygen is a medicine.

VGS   Thank you, Janet. That was Dr Janet Diaz explaining the protocol for caring for a COVID-19 patient at home. Until next time then. Stay safe, stay healthy and stick with science.