Coronavirus (COVID-19) is generating a lot of panic at the local, state and national level, with good reason, because this is an unpredictable situation for the general public and healthcare officials alike. With some common sense, a good measure of social distancing and a whole lot of handwashing, the everyday person can have a huge impact on the potential outcome. Here’s what you need to know and what you need to do.
Three Patient Types of COVID-19 Patients
According to Nacogdoches Memorial Hospital emergency department physician, Dr. Eduardo Wilkinson, there are three basic presentations of COVID-19 patients and each level of illness has different needs and a different impact.
Presentation One – These individuals will probably cause the most problem because they’re the silent carriers spreading coronavirus far and wide. They may never even know they’ve got the virus, because they’ll experience no evidence of illness or extremely mild symptoms. Their super speedy recovery will be over in seven days or less and they may not feel bad enough to slow their activity. These silent carriers are the ones who really need to self-isolate, but there may be no way to know who they are. That’s why everyone is being asked to practice social distancing. We need to slow the spread and flatten the curve, so the healthcare system has time to get ahead of the virus or, at the very least, not be overcome by it.
Testing these asymptomatic patients isn’t really a viable option. It would serve no useful purpose and would instead diminish critical supplies needed to protect healthcare workers as they treat seriously ill patients in other categories.
Presentation Two – These patients may feel pretty bad to downright awful, with fever, severe dry cough, shortness of breath and fatigue, but with no underlying threats to their general health should be able to manage on their own with support at home. Most of these patients will stop shedding virus and will recover in about 14 days. Of course, if symptoms worsen at any point, patients or their caregivers shouldn’t hesitate to contact their primary care provider by phone to be screened for testing or to make arrangements to be seen.
These are the patients who will most likely need to self-quarantine, staying away from the rest of the family with a room and bathroom to themselves, if at all possible. The goal is to decrease fever, prevent dehydration and promote comfort in the patient while being diligent in preventing the spread to anyone else in the household. Anyone caring for a second level patient will need to be extra careful with home-based infection control efforts, cleaning high touch surfaces frequently, while also protecting themselves. Just like healthcare workers, home caregivers should assume that their patient has an infection that is contagious and act accordingly. For information on what to do to protect your family if you or a loved one are sick, check out the CDC’s guide on the subject.
At this time, the supply of test kits is still extremely limited. These second tier patients could be infected with either COVID-19, strep or influenza (flu is still in East Texas). Home treatment is going to be almost the same for all three illnesses, so this level of illness may not be tested for COVID-19 until tests are more readily available, explains Dr. Wilkinson. That will be soon, but it’s not quite here yet.
Testing for flu and strep for all appropriate patients is definitely helpful. According to Dr. Irma Sainz, Memorial Hospital pathologist, if a person tests positive for flu or strep, they do not have COVID-19. “Viruses are not friendly to each other,” she explains. “So you won’t have two micro-organisms in your body at the same time, with the exception of some hepatitis viruses. Unless you are dying of sepsis, you won’t have more than one micro-organism causing disease in your body at once.”
Let’s repeat that, because it is somewhat reassuring. If you test positive for flu or strep, you do not have coronavirus.
Knowing a patient has flu or strep will also be helpful in determining whether it is safe to take aspirin and Ibuprofen pain reliever products to help reduce fever. Doctors recommend not taking anti-inflammatory medications or steroids with COVID-19. Stick with acetaminophen instead. Other over-the-counter medications, like cough medicines and decongestants, are also fine in treating coronavirus.
The worst of the worst – The last group of patients will be the sickest of the sick. They’ll be ill well beyond 14 days and will need hospitalization. Many, but not all of them will have serious underlying threats to their general health, such as diabetes, heart disease or lung disease.
Testing is being reserved by state officials for the patients that are most at risk because of underlying conditions, age, travel or exposure. Because these patients are the most likely to become dangerously ill from exposure to the disease, critical resources are best expended where they’ll have the most impact. Since approximately 80% of COVID-19 deaths have been in people who are 65 and older, testing the compromised populations makes the most sense because the knowledge gained will allow for the fastest, most aggressive response.
“We’re only going to test you if you meet the criteria or if you haven’t tested positive for flu or strep and we feel like you’re so sick that we need to admit you. That’s the point when it’s critical to know what we’re dealing with,” said Dr. Wilkinson. “If we’re not testing you, it isn’t because we don’t believe you and it’s not because we don’t worry about you.”
Exceptions – Though huge emphasis has been given to protecting the elderly population, there have been cases of younger victims, so no one should assume anything, even the healthcare providers. If you or a loved one is seriously ill, seek medical attention by calling a primary care provider or the emergency department immediately.
Some emergency warning signs for COVID-19 are difficulty breathing or shortness of breath, persistent pain or pressure in the chest, new confusion or inability to arouse, bluish lips or face. Understand that this list is not all inclusive and you should consult your medical provider for any other symptoms that are severe or concerning.
Dr. Wilkinson said there are changes to the coronavirus picture every day, with potential new treatments on the horizon and important medical discoveries being shared between colleagues in the trenches. “As testing improves, we’ll be able to provide a more precise answer,” he said. “It’s just a matter of time.”
The symptoms. Here are the specific symptoms of coronavirus, flu, strep and allergies, so you’ll know the difference.
Severe Dry Cough
Shortness of Breath
Red, Swollen, Painful Tonsils
Tender lymph nodes