What to do if you've got covid
A compilation of official and unofficial advice to help you recover
I was going to send out a long email digging into the research on some long-term complications of covid, but given the case curve right now, I decided to compile some advice for all the friends and friends of friends who are looking at a positive test. If you don’t have covid, you probably know someone who does or will soon. If you’re new here, the intro post has some context about who I am what you’re reading.
Very first thing, if you have covid, I am so sorry you’re sick. There are a million ways to get covid right now, and a much smaller number of ways to not. The good news is that if you’re fully vaccinated (ideally with a full initial vaccine series plus an mRNA booster), you’ve already won the first round of the severity lottery. More good news: There are a lot of big and small things you can do to make this easier on yourself and help keep others safe while you’re ill.
Before I jump in, Vox has a great piece on handling covid right now, although it’s angled toward people who don’t already feel terrible. Lots of humane, practical notes on preparation, rest, feelings, and more. For a general update on the state of the covid, the first segment of This Week In Virology #850 is great for getting up to speed on known knowns while not looking at a screen (there’s video but I just listen to the podcast while I do dishes). There’s also a great KQED Forum segment from earlier this month with my former COVID Tracking Project colleagues Alexis Madrigal and Jessica Malaty Rivera and UCSF’s Dr. Bob Wachter that remains a useful overview of the Omicron (and CDC) situation that you can listen to in about 15 minutes.
Should you get a PCR test? ¯\_(ツ)_/¯
The CDC has advice for you, including a testing quiz to try to help you figure out what to do in various testing/exposure circumstances. To this I will only add that if I had a positive antigen test and Omicron symptoms today, I would get a confirmatory PCR test only if I could do it safely and without exhausting myself. If you’re symptomatic and have a positive antigen test result, you probably have covid. So a PCR test will mainly do two things: Get your case officially recorded and give you a definite* diagnosis, which might be needed later to guide treatment for long-term effects. At the moment, with so many people stuck with only at-home tests (or no tests at all), those benefits have to be weighed against the need to rest up and get better. I’ve been continuing to see reports of people standing outdoors in winter weather for 6-8 hours to get PCR tests and that sure seems like a terrible idea if you have a respiratory infection of any kind.
I’m not even going to get into the new isolation advice from the CDC except to say that if I had covid, I wouldn’t be leaving self-isolation before 10 days without a negative antigen test, assuming I could find a test. (Reminder that antigen tests are great at lighting up when you’re infectious but have a higher false-negative rate, and are best used frequently and repeatedly, not just as a one-and-done test. PCR tests are likely to find even low levels of viral RNA even after you’re no longer likely to transmit the virus, so they’re not a good way to test out of isolation.) ¯\_(ツ)_/¯
If you’re in the US and get a positive result on an at-home test, you can call your county (or equivalent) health department for information on testing and reporting at-home tests, but as far as I can tell, almost no one is currently accepting reports of at-home tests because they’re overwhelmed. ¯\_(ツ)_/¯
If you’re in the UK, the NHS says if you have a positive antigen test, don’t bother with a confirmatory PCR test, stay home and self-isolate. I would probably ask for a confirmatory PCR anyway because asymptomatic people are statistically more likely to get a false positive than symptomatic people are. But if you have symptoms, the official UK advice is don’t take a lateral flow test, call for a PCR test instead. This is despite the fact that lateral flow tests are better at spotting infections among symptomatic than asymptomatic people, so IDK, use your best judgment. ¯\_(ツ)_/¯
(*) PCR tests do produce false negatives, at rates we don’t really understand but which may be quite high. Also, much more rarely, false positives, heavily concentrated among asymptomatic people without covid exposures. None of our tools are perfect. ¯\_(ツ)_/¯
Stay home, keep your air separate, get help if you need it
The WHO has solid, simple advice for self-isolation:
Stay home and self-isolate for 10 days from symptom onset, plus three days after symptoms cease. Call your health care provider or hotline for advice. Have someone bring you supplies. If you need to leave your house or have someone near you, wear a properly fitted mask to avoid infecting others.
The Mayo Clinic has good advice for protecting people who live with you while you’re isolating. I think the main thing to keep in mind is that the same rules we all know about covid still apply: If you have limited energy, I would put it toward keeping your air separate from the air your family or roommates are breathing, then on things like handling laundry separately. This may involve opening windows, installing HEPA filters in whole-house air systems, wearing high-filtration masks—only you know your situation. But if you have covid and you’re trying not to spread it, keep those airborne virons away from others.
If you need food or medication you can’t get delivered or afford while you’re isolating, call your local mutual aid organization—or, if you prefer, your local church—and see if someone can help. This is a good starting point for finding mutual aid in the US. In the UK, NHS volunteers may be able to help.
Please remember that this is not the time to feel weird or guilty about asking for help. Humans are social animals and you don’t have to get through everything on your own. (And if you feel like returning the favor, I promise you that the organizations that help you now will welcome a gift of your time, expertise, or money later on, once you’re through this.)
Lastly, this is a great short explanation about why it’s useful to track your symptoms and be vigilant even after the first round of symptoms is over. We don’t know that much about Omicron yet, but we do know that previous flavors of covid can worsen after the first five or so days of infection, so please be careful with yourself.
If you have existing health problems
Your first move should be a call to your doctor’s office, if you have one. If you have health problems that put you at additional risk from covid, you may qualify for monoclonal antibody treatment or other forms of medical care, and your physician’s office can give you guidance on what to do. If you have complex chronic conditions and your primary care doctor isn’t helpful, try speaking with your specialist physicians (again, if you have them).
US folks, if you don’t have a primary care doctor but you’re covered by some form of insurance, call your insurance org very first thing in the morning when they open and ask about a hotline to speak with a nurse, or for advice on where you can get help. If you have no insurance and no primary care doctor, call your county-level health department or your city’s health authority if you live in a major city and ask for advice on getting guidance and care.
Know what a covid emergency looks like
Emergency lists are kind of alarming, and again, if you’ve had the good fortune to be able to get 2-3 shots of an mRNA vaccine, you’re probably going to experience infection with Omicron as a flu-ish virus. But not everyone has had that good fortune and many common health problems can make covid infections harder to deal with, so let’s go over the emergency stuff anyway.
The CDC considers the following (non-comprehensive) list of symptoms reason to seek emergency care:
Persistent pain or pressure in the chest
Inability to wake or stay awake
Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
“Trouble breathing” is obviously subjective and covers a very wide range of symptoms, as any asthmatic person can tell you. The NHS has a more specific list of emergency symptoms that seems helpful although it’s also just upsetting.
They recommend going to a hospital or calling for emergency help if:
you're so breathless that you're unable to say short sentences when resting
your breathing has got suddenly worse
you cough up blood
you feel cold and sweaty, with pale or blotchy skin
you have a rash that looks like small bruises or bleeding under the skin and does not fade when you roll a glass over it
you collapse or faint
you feel agitated, confused or very drowsy
you've stopped peeing or are peeing much less than usual
Covid can cause harmfully low oxygen levels without making you feel like you can’t breathe, which is why I also strongly recommend getting a pulse oximeter if you don’t have one yet, and learning how to use it in a way that takes your skin color into account, as noted in this (paywalled) NYT article, important part excerpted here:
A normal reading on a pulse oximeter typically ranges from 96 to 100. Because patients with Covid-19 can quietly develop low oxygen levels without realizing it, patients are advised to monitor their oxygen levels at home. If the oxygen reading dips to 93 or 92, patients are advised to check in with their doctor. But if, as the Michigan study suggested, a pulse oximeter sometimes overstates the oxygen saturation level, the worry is that a patient with dark skin who is self-monitoring at home might delay getting care if the monitor incorrectly reads 94 or 95, when the patient’s actual oxygen level might be 92 or 93.
The solution, Dr. Sjoding said, is for patients to know their baseline reading on the home device and to pay attention to downward trends. If you’re sick at home with Covid-19 and your normal reading drops by four points or more, that’s a good reason to call your doctor.
The NHS also has some good advice on easing shortness of breath that doesn’t rise to the level of an emergency.
Caring for others
If you’re caring for a child or someone else who has covid and needs assistance and you’d prefer not to get covid, you can ventilate everything, wear high-filtration masks (mash them down around your nose, do whatever you need to do to make them fit), wear eye protection, and don’t despair. The household “secondary attack rate” with Omicron appears to be well under 50%.
Other things worth considering
The usual note: I am not a doctor. I am not a public health specialist. I do have a ton of experience dealing with respiratory infections, plus more experience reading covid data than I would really like to have. Please take the following as notes from a concerned friend who wants you to feel better soon.
We all know that stress, lost sleep, and burnout are all physically bad for us. And they’re not great for covid odds, as shown in this wrenching review of insomnia, burnout, and covid among healthcare workers. I hesitated even to mention this because so many of us are so strung out and the last thing I ever want to see is another exhortation to practice self-care during a systemic clusterfuck. But especially if you’ve managed to claw back some normalcy over the last few months, this is the time to slash your expectations of yourself, including any work, household, and family stuff that doesn’t rise to the level of an actual necessity. Even if you don’t have covid, tbh, especially if your life includes taking care of other people.
Relatedly, the early research on covid and melatonin is super interesting and suggestive of a protective effect. If you tolerate melatonin well and it’s available in your area, this is maybe a good time to look at the research and consider taking some.
Don’t exercise if you’re sick. The British Medical Journal has a long article with a good flowchart about when you can start physical activity after a covid infection. The upshot is no exercise for at least a week since your last symptom and then start up stretching and low-intensity work for another week or so—and don’t do anything that feels like too much. Millions of people will be unable to do this because they have to work, raise children, care for elders, and lots of other physical things. But intense resting should be the goal.
There is no ~holistic wellness thing~ that is going to work like a good vaccine series, but I think food-based care can be great for helping you feel better, which isn’t nothing. I really like a thyme-rosemary tea for non-covid lung grossness, plus ginger when I’m ill and shivering. Evidence on these herbs’ antiviral effects in human body remain unclear, but kitchen herbs can be really comforting and supportive, and thyme seems to clear up my throat and lungs when I’m particularly asthmatic or have bronchitis, so I use it all the time. Grocery store dried herbs and ginger root are great—throw ‘em in hot water for ten or twenty minutes and drink them with honey if you like honey. Bon Appetit has a food-centric guide to getting through covid that is a kind of eye-rolly but also has some good tips. I am not myself above gargling thyme tea and saltwater alternately to deal with a sore throat.
If you’re having miserable non-emergency respiratory symptoms, here’s what I do when I’m down with bronchitis: Use a cool-mist or warm-mist vaporizer (you do have to keep it clean) at a low level all the time, and at a higher level in a sheet-tent or small room you can ventilate afterward for short periods when you’re at your worst. Turning on the shower and hanging out in the steam can also help a lot. (Don’t let high humidity hang out on your walls, though—it encourages mold, which you definitely don’t want.) Mucolytics like Mucinex can help, taken with absolute tons of fluids. If you have asthma, even a little, you’ll want to be on your full preventive regimen, including the steroids. Try sleeping or resting propped up with lots of pillows or an extra fluffy blanket, and make sure you’re getting fresh air intake in the room(s) where you’re recovering. Lastly, I am a big original-nasty-flavor Ricola fan and find that along with ice chips, they sometimes temporarily relieve a persistent cough. (But don’t lie on your back while sucking on a cough drop, I speak from experience.)
Admin note: I’ve been doing these emails starting with just close friends since early December and will keep sending them for as long as we’re dealing with the big Omicron surge, but I make no promises about how often I will send them or whether they will continue in the longer term. Our kid is home from school for the next few weeks, so I might not get the next one out as soon as I would like to.