If you have COVID-19 symptoms, it is important to delay and prevent the spread as much as possible within the home and the community – this reduces the burden on the healthcare system, allows time for appropriate treatments, and means vaccines can be developed, tested and mass produced.
Coronavirus is thought to spread between people in multiple different ways – and we need to address all these routes to minimise infection and spread. If someone’s symptoms are mild, it is prudent to care for them at home – and you can reduce the infection risk to the carer and other family members by following simple guidelines.
Three things are important up-front:
- Start isolation at the first sign of symptoms – this is when the person is most likely to spread infection. This means they should remain in a room alone and if possible have their own bathroom. They will have to eat, sleep and generally carry on life in this room.
- Quarantine of the whole household must be done rigorously, as coronavirus spreads very easily.
- Be prepared. Know what to do and have basic items already available at home.
How can I minimise the risk of infection?
If you live in a family, the whole group should consider themselves to be under quarantine, that is, in lockdown and no longer leaving the house, because there is a risk that other family members have already become infected.
Minimising the transmission of the virus within the home means addressing all the known routes – so use a mask or a P2 respirator to protect you from droplets and practise thorough hygiene against virus on items. This would include cleaning surfaces daily, wearing gloves and washing your hands. Research has found a combination of these measures is most effective.
1) Wear a surgical or P2 mask
Surgical masks – originally designed to prevent doctors infecting their patients – are good for filtration of large droplets and less useful for filtering small aerosols. Respirators (called P2 in Australia) are made with a thicker filter and are standardised to provide very good protection against inhaling small aerosols. However, to work properly the respirators needs to seal tightly to the face, if not, they will leak, particularly around the nose and chin. For example, more than two days’ beard growth can be enough to cause leakage.
If surgical masks or respirators are not available, it is not clear what the best advice is. Where nothing else is available, people have used scarves, shawls, masks made from several layers of gauze or t-shirts. Any of these will stop you touching your face and will capture at least some droplets – so better than nothing.
2) Wear a gown
In a hospital context, medical staff would put on a gown before entering the room and remove it on leaving and then washing their hands. You will have to use your imagination here – perhaps a cotton coat, slippers or thongs and a headscarf that can be easily laundered as it will become contaminated. Use only for this purpose and preferably store in an enclosed space close to the entry door.
3) Thoroughly clean surfaces
In the only study so far, coronavirus was shown to survive for up to three days on plastic, two days on stainless steel and one day on cardboard – so clean flat surfaces in the room regularly. The WHO recommends cleaning with soap (or detergent) and water and then decontaminating with an agent such as freshly prepared diluted bleach (a 0.1% solution of ordinary household bleach will suffice. Household bleach comes in a range of strengths. If the concentration on the bottle says 5% sodium hypochlorite, then four teaspoons of bleach per 1 litre of water is fine), or 0.5% hydrogen peroxide solution or 70% alcohol solution. Wear gloves and ensure the area is well ventilated.
4) Wear gloves
It is normal in infection control to use disposable gloves when handling any potentially infectious material to reduce virus transfer and exposure. If not available, use washing-up gloves. Treat the outside of the gloves as potentially contaminated after using, requiring disposal or cleaning with soap and water or disinfectant.
5) Wash your hands
In the case of influenza and colds, handwashing at least 10 times per day typically provides around 20% reduction of disease, and this effect is likely to be greater for coronavirus. Wash your hands frequently and for at least 20 seconds each time using warm water and vigorous hand-to-hand action. Dry your hands on a clean paper towel and dispose of. Wash your hands after any possible exposure to contamination, visiting the person or shared bathroom, handling objects they have handled, before preparing foods, after mask removal, and in many other situations – you will have to use common sense based on activities.
If soap and water is not available, alcohol sanitiser is a good alternative. This should contain at least 60% alcohol to be effective.
6) Handle contaminated material carefully
Because the infected person will be generating virus aerosols through coughing, talking and blowing their nose at least, it is important that these are safely collected at the source. The simplest way is for them to wear a surgical mask if available. They should also cough into the crook of the arm.
Surgical masks may be in short supply, so coughing into a disposable tissue is a substitute.
The infected person should use tissues in a lined container and dispose of them in the garbage. If no tissues are available, use soft toilet paper (if you have spare) and flush down the toilet, or bag and put in garbage. The infected person should wash their hands in warm soapy water or use an alcohol sanitiser after each handling of tissues.
Wear a mask and gloves while handling contaminated clothing and bedding in a plastic bag. Laundry with normal detergent is said to be effective at removing virus; wash in the hottest setting that can be used with the items and dry in the sun. Preferably wash clothes at home, not a laundromat.
Food should be left at the infected person’s door (knock and leave, don’t greet). Afterwards, the plates and utensils, if not disposable, should be treated as infectious and put through the dishwasher.
7) Increase ventilation
Open windows in all rooms as frequently as possible. There are numerous studies showing lower rates of virus and bacterial transmission in well-ventilated hospital wards, dormitories and houses. It’s likely that good circulation of outside air flushes out the important droplets and aerosols as well as providing cleaner air for anyone else present in the household.
8) Protect your eyes
There is some data that some viruses can enter the body via droplets sprayed into the eyes, as well as by wiping fingers on the eyes. In hospitals, some form of goggles or eye shields are frequently used. Try and find an equivalent, like wrap-around sunnies or goggles when direct exposure to an infectious person is likely.
9) It’s tough, but avoid contact
It may sound harsh, but, where practical, members of a family should avoid all direct contact with an infectious person, that is, being in the same room. If people do want to talk and socialise at home, do it in the backyard or on an open balcony, maintain a two-metre distance between people and wear masks. Pets should not be allowed in the person’s room as they may transport virus on their fur.
These restrictions could be distressing and a challenge to family dynamics and it will raise anxiety for everyone. Try using a phone/online communication at other times and try to find other ways to keep spirits up, entertain, make the time useful and provide reassurance.
10) Maintain a healthy diet
There are many articles in the popular media about boosting your immune system or particular foods with health-giving properties. There is not much in the medical literature about this, other than the obvious advice about the extra importance of a healthy well-balanced diet at times like this.
How long should all this go on for?
These measures should be continued until the risk of secondary transmission to others is thought to be low – that means two to three weeks. This means the person with the infection should remain in isolation in their room, and, if possible the other family members remain in quarantine within the home until then. The decision to discontinue home precautions should be made on a case-by-case basis, in consultation with your doctor or whoever is providing professional advice.
Finally, support medical research and evidenced-based experts, not what anyone says on the web. We have had five near-miss respiratory viral epidemics in the last 20 years, it will happen again, there is a lot to learn, so start planning now. In this evolving situation, you should also check the website of your state health department, for up-to-date on advice on diagnostic testing and disease management in the home (e.g. NSW Health guidelines).
Shopping and action list
- Disposable gloves or, failing that, dishwashing gloves
- If available, disposable surgical masks, P2 respirators, (if not available, then P1)
- Bleach, cleaning detergent and disinfectant, bucket and mop, cleaning cloths
- Laundry liquid
- Thermometer to check temperatures
- Hand moisturiser
- Dishwashing detergent
- Soap for handwashing
- A plan to provide food, medical communication and other necessities over a period of three weeks
- Discuss with family and friends and agree to check on each other regularly.
Sacha Stelzer-Braid is a senior postdoctoral scientist in the Virology Research Lab at UNSW Sydney/Prince of Wales Hospital with special interests in surveillance of enteroviruses, and the transmission and role of respiratory viruses in chronic airways disease.
Euan Tovey is an associate professor, honorary affiliate senior research fellow at the Woolcock Institute, University of Sydney, with special interests in virus transmission and sampling biological aerosols.
An extended version of this article first appeared on The Medical Republic.