COVID-19 Aftercare Inst NARH

Home Care Instructions for Patients with Mild Respiratory Infection

Most people with respiratory infections like colds, the flu, and Coronavirus Disease (COVID-19) will have mild illness and can get better with appropriate home care and without the need to see a provider. People who are elderly, pregnant, or have a weak immune system, or other medical problem are at higher risk of more serious illness or complications. It is recommended that they carefully monitor their symptoms closely and seek medical care early if their symptoms get worse.

TREATMENT AND MEDICAL CARE
Treatment
There is no specific treatment for most viruses including those that that cause the common cold and those that cause COVID-19. Sometimes there is treatment for the viruses that cause influenza if given early. Antibiotics treat infections caused by bacteria, but they do not work against viruses.
Most people recover on their own from these viruses, including COVID-19. Here are steps that you can take to help you get better:
• Rest
• Drink plenty of fluids
• Take over-the-counter cold and flu medications to reduce fever and pain. Follow the instructions on the package, unless your doctor gave you instructions. Note that these medicines do not “cure” the illness and therefore do not stop you from spreading germs.
• Children should not be given medication that contains aspirin (acetylsalicylic acid) because it can cause a rare but serious illness called Reye’s syndrome. Medicines without aspirin include acetaminophen (Tylenol®) and ibuprofen (Advil®, Motrin®). Children younger than age 2 should not be given any over-the-counter cold medications without first speaking with a doctor.

Seeking Medical Care
You should seek medical care if you are not getting better within a week, or if your symptoms get worse. If you are elderly, pregnant, have a weak immune system, or other medical problems, call your doctor right away.
It is best to call ahead of time to discuss your symptoms, if possible. This may allow you to receive the advice you need by phone. By avoiding a visit to a healthcare facility, you protect yourself from getting a new infection and protect others from catching an infection from you. If you do visit a healthcare facility, put on a mask to protect other patients and staff.
It is recommended that you seek medical care for serious symptoms, such as:
People with potentially life-threatening symptoms should call 911. If possible, put on a facemask before emergency medical services arrive.
PROTECTING OTHERS
Follow the steps below to help prevent the disease from spreading to people in your home and community.
Stay home when you are sick
• Stay home – do not go to work, school, or public areas.
• Stay home for at least 24 hours after your symptoms have gone away without the use of fever-reducing medicines.
• If you must leave home while you are sick, try to avoid using public transportation, ride-shares, and taxis. Wear a mask if possible.
Separate yourself from other people and animals in your home
• Stay in a specific room and away from other people in your home as much as possible.
• Use a separate bathroom, if available.
• Try to stay at least 6 feet from others.
• Do not handle pets or other animals while you are sick.
Cover your coughs and sneezes
• Cover your mouth and nose with a tissue when you cough or sneeze. Throw used tissues in a lined trash can; immediately wash your hands.
Avoid sharing personal household items
• Do not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home. Wash them thoroughly with soap and water after use.
Clean your hands often
• Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Use soap and water if your hands are visibly dirty.
Clean all “high-touch” surfaces every day
• High touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Also, clean any surfaces that may have body fluids on them. Use a household cleaning spray or wipe, according to the product label instructions.

Updated 3/14/20

COVID MDM – Test/No Test (3/20)

This patient presents with symptoms concerning for viral syndrome including flu and SARS-nCoV-2019.

WELL-APPEARING/DISCHARGE

YES: Patient meets criteria to test for COVID-19. Doubt PNA, sepsis, other serious bacterial infection or acute emergent condition. Is otherwise well-appearing with acceptable vitals, a reassuring physical exam, and is safe to discharge home following NP swab. Will add to follow-up list to call with results after. Will provide strict return precautions and instructions on self-isolation/quarantine and anticipatory guidance.

NO: Patient does NOT meet our current criteria to test for COVID-19, although coronavirus infection is certainly on the differential. Doubt PNA, sepsis, other serious bacterial infection or acute emergent condition. Is otherwise well-appearing with acceptable vitals, a reassuring physical exam, and lacks serious medical comorbidities that would require admission. Patient is nontoxic-appearing and although symptomatic, otherwise safe to go home. Will provide strict return precautions and instructions on self-isolation/quarantine and anticipatory guidance.

ADMITTING (testing)

Patient presentation suspicious for COVID-19 infection. Patient requires admission for their symptoms given ***_. Differential diagnosis includes other viral causes of LRTI, pneumonia, less likely PE, PTX, primary cardiovascular causes, bacterial sepsis, or other severe metabolic/ischemic derangements. Will swab for SARS-nCoV-19, place in enhanced precautions, admit to medicine.

COVID HPI – No Risk Factors 3/20

This patient presents with fever and cough for ***_ days.

Risk Factors:

-Denies HCW status
-Is not immunocompromised
-Denies close contact with suspect or confirmed COVID-19 patient
-No cluster status (SNF, group home, etc)

COVID-19 DC INSTRUCTIONS AND FAQ

COVID-19 (Novel Coronavirus) FAQs for Inquiring Patients

What do you do if you are worried that you have been exposed to COVID-19 but are without any symptoms?
If you develop symptoms that may indicate an infection, contact your physician. These include fever, cough, and shortness of breath.

Testing is not available for asymptomatic individuals, regardless of travel history.
To reduce the chance of getting sick use general infection prevention measures such as hand washing, covering your mouth and nose when you cough or sneeze and discarding any tissues carefully, and staying home when you are sick. Wear a mask.

Should patients cancel or postpone an upcoming trip?
The decision about travel is personal and should be made in the context of a person’s underlying health conditions, reason for travel and necessity of travel.
Travel insurance generally does not cover cancellations due to concerns of infectious disease outbreaks.

The Center for Disease Control has a section on travel notices. Situations are changing frequently and you should monitor the site for updates.
Should situations change rapidly in a foreign country while they are traveling, you could be subject to quarantine or restrictions upon return to the United States. It is best to have a plan on how to return urgently if needed during a trip abroad.
Because of how air circulates and is filtered on airplanes, most viruses do not spread easily on airplanes. CDC does recommend use of facemasks during air travel.

Should facemasks be routinely worn?
Yes.

What other general precautions are advised?
Patients should be instructed to:
Avoid close contact with people who are sick.

Wear a mask whenever you are indoors (except within your home), within 6 feet of others, or if you are outdoors and cannot maintain distance.

Avoid touching your eyes, nose and mouth.
Stay home from work or school when they are sick. If you have a fever, you should remain home until 24 hours after fever resolves.
Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
Sneeze/cough into their elbow, not your hand.
Practice frequent hand hygiene with soap and water (at least 20 seconds) or alcohol-based hand rub.
Avoid crowded places or mass gatherings, especially if you are immunocompromised or have chronic lung disease.

Are there any special precautions that are recommended if I am pregnant?
There is not yet any information available about the susceptibility of pregnant women to COVID-19. As a general rule, pregnant women may be more susceptible to viral respiratory infections and at risk for more severe illness.
The CDC guidance for COVID-19 and pregnancy has answers to questions about transmission during delivery, breastfeeding as well as other situations.

Should food, water, or medications be stockpiled? Should people telecommute?
The CDC has excellent information on this. Please visit the CDC’s guidance for getting your household ready for COVID-19.

What do I do if I’ve been exposed to a known confirmed COVID-19 case?
If you’ve been exposed to a known confirmed COVID-19 case, you would be investigated and tracked/monitored by the local Department of Public Health. The Department of Health will have jurisdiction and will provide you with specific instructions on what to do if they develop symptoms.

What should I do if I start feeling sick at work? And what should the workplace do for anyone exposed?
Anyone who is sick with a fever and cough should stay home from work until at least 24 hours after resolution of fever, regardless of concerns for COVID-19. It is still influenza (flu) season and influenza remains far more common.

MDM – 1st Trimester Bleeding

This pregnant patient presents with vaginal bleeding in the first trimester. DDX includes ectopic, IUP, threatened/inevitable abortion, along with completed abortion. Patient is HDS and without a history of coagulopathy or infectious symptoms. Doubt alternate acute emergent pathology.

Plan: bHCG, +/- basic labs, type and screen, TVUS, reassess

DC Inst – Palpitations

You were seen today in the emergency department for palpitations. Your evaluation, which included a history and physical, an EKG and ***chest x-ray, and blood work, showed no emergency cause for your symptoms.

You need to follow-up with your primary care doctor or cardiologist within 3 to 5 days. If you continue to have palpitations, sometimes the next step is to perform continuous monitoring of your heartbeat while you go back to day. This is called a Holter monitor or a ZIO Patch, and needs to be arranged by your PCP or cardiologist.

Please return to the emergency department for chest pain, shortness of breath, lightheadedness or dizziness, or other symptoms that are concerning to you.

MDM – Peds Fever (Low Risk)

This well-appearing child presents with fever, likely secondary to a urinary source vs viral syndrome. No localizing symptoms of URI or intraabdominal pathology, low suspicion for serious bacterial infection given nontoxic appearance and otherwise healthy child with no major medical problems. Doubt pneumonia or pyelonephritis. Doubt meningitis or appendicitis.

Plan: ***straight cath for urine, antipyretic instructions, reassurance and reassessment, discharge with pediatrics f/u

MDM – Peds Head Trauma

LOW RISK, <2 y old

This pediatric patient presents with head trauma. Given mechanism, history, and physical exam findings, we have a low probability of serious injury to include intracranial bleed or skull fracture, DAI, or high risk of decompensation. Given lack of a severe mechanism, GCS 15 or lack of AMS, no occipital/parietal scalp hematoma, and no LOC, risk of obtaining a CT scan outweighs the potential benefit. Will observe patient, PO challenge, reassurance and reassessment, anticipating discharge with PMD follow up.

LOW RISK, >2 y old

This pediatric patient presents with head trauma. Given mechanism, history, and physical exam findings, we have a low probability of serious injury to include intracranial bleed or skull fracture, DAI, or high risk of decompensation. The patient has a GCS of 15 and is not altered, and has no or minimal LOC history. The mechanism is of low energy. In this group, PECARN rules demonstrate an exceptionally low risk of serious intracranial injury and obtaining further imaging is likely to be of little or no benefit.

Plan: observation, pain control, PO challenge, reassurance/reassessment, likely discharge

HIGH RISK: 

This pediatric patient presents with a history concerning for a serious intracranial injury. Unable to clear patient with PECARN rules given ***. Will obtain CT imaging to rule out intracranial injury or skull fracture. Patient is protecting airway and otherwise has an unremarkable secondary trauma survey.

Plan: CT scan head/neck, pain control, reassess

MDM – AKI/Dehydration

Mild, Discharge: 

This patient presents with generalized weakness and fatigue likely secondary to dehydration. Suspect acute kidney injury of prerenal origin. Doubt intrinsic renal dysfunction or obstructive nephropathy. Considered alternate etiologies of the patient’s symptoms including infectious processes, severe metabolic derangements or electrolyte abnormalities, ischemia/ACS, heart failure, and intracranial/central processes but think these are unlikely given the history and physical exam.

Plan: labs, ***fluid resuscitation, pain/nausea control, reassessment

MDM – Diarrhea (Low Risk)

This patient presents with diarrhea consistent with likely viral enteritis. Doubt acute bacterial diarrhea. Considered, but think unlikely, partial SBO, appendicitis, diverticulitis, other intraabdominal infection. Low suspicion for secondary causes of diarrhea such as hyperadrenergic state, pheo, adrenal crisis, hyperthyroidism, or sepsis. Doubt antibiotic associated diarrhea.

Plan: PO rehydration, reassess, discharge with OTC antidiarrheal meds//short course antibiotics