Patient discussions

General prevention measures

  • Wash hands often with soap and water for at least 20 seconds or an alcohol-based hand sanitiser (that contains at least 60% alcohol), especially after being in a public place, blowing your nose, or coughing/sneezing. Avoid touching the eyes, nose, and mouth with unwashed hands.

  • Avoid close contact with people (i.e., maintain a distance of at least 1 metre [3 feet]) including shaking hands, particularly those who are sick, have a fever, or are coughing or sneezing. Avoid going to crowded and poorly ventilated places. It is important to note that recommended distances differ between countries (for example, 2 metres [6 feet] is recommended in the US and UK) and you should consult local guidance.

  • Practice respiratory hygiene (i.e., cover mouth and nose when coughing or sneezing, discard tissue immediately in a closed bin, and wash hands).

  • Stay at home if you are sick, even with mild symptoms, until you recover (except to get medical care)

  • Clean and disinfect frequently touched surfaces daily (e.g., light switches, door knobs, countertops, handles, phones).[378][379]

  • BMJ Learning: Covid-19 – handwashing technique and PPE videos external link opens in a new window

Face masks

  • Despite the lack of good-quality evidence, the World Health Organization (WHO) advises that in areas of known or suspected community or cluster transmission, people should wear a non-medical mask in the following circumstances: indoor or outdoor settings where physical distancing cannot be maintained; indoor settings with inadequate ventilation, regardless of whether physical distancing can be maintained; and situations when physical distancing cannot be maintained and the person has a higher risk of severe complications (e.g., older age, underlying condition). Carers and those living with suspected or confirmed cases should wear a medical mask when in the same room, regardless of whether the case has symptoms. Children aged up to 5 years should not wear masks for source control. A risk-based approach is recommended for children aged 6 to 11 years. Special considerations are required for immunocompromised children, or children with certain diseases, developmental disorders, or disabilities. The WHO advises that people should not wear masks during vigorous-intensity physical activity. Use of a mask alone is insufficient to provide adequate protection, and they should be used in conjunction with other infection prevention and control measures such as frequent hand hygiene and social distancing.[88]

  • WHO: coronavirus disease (COVID-19) advice for the public – when and how to use masks external link opens in a new window

  • Public Health England: how to make a cloth face covering external link opens in a new window

  • CDC: use of masks to help slow the spread of COVID-19 external link opens in a new window

Pulse oximetry

Travel advice

Pets and animals

  • At this time, there is no evidence that companion animals (including pets and other animals) play a significant role in the spread of COVID-19, and the risk of animals spreading COVID-19 to people is considered to be very low. There is no evidence that the virus can spread to people from the skin or fur of companion animals.[1093]

  • A very small number of pets have been reported to be infected with the virus after close contact with people with confirmed COVID-19; however, thousands of pets have been tested in the US with none testing positive. There is evidence that cats and ferrets are highly susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while dogs and other livestock have no or low susceptibility. Large cats in captivity (lions, tigers, and a puma) and domestic pet cats have tested positive after contact with symptomatic humans. Transmission between cats has also been reported. The virus has been reported in mink on farms, and once the virus is introduced on a farm, can spread between mink, and between mink and other animals on the farm. There is also the possibility that mink may transmit the infection to humans in these environments.[1094][1095][1096][1097][1098] Gorillas in a US zoo have tested positive. It is suspected that the gorillas acquired the infection from an asymptomatic staff member.[1099]

  • Advise patients to limit their contact with their pets and other animals, especially while they are symptomatic. Advise people to not let pets interact with people or animals outside the household, and if a member of the household becomes unwell to isolate them from everyone else, including pets.[1100]

  • CDC: coronavirus disease 2019 (COVID-19) – pets and other animals external link opens in a new window

Return to physical activity

  • Recommend a phased return to exercise only when the patient has been symptom-free for at least 7 days. Advise patients to begin with at least 2 weeks of minimal exertion, and to use daily self-monitoring to track progress and decide whether to move up or drop back a phase. Patients who have a history of severe disease, cardiac involvement, ongoing symptoms, or adverse psychological symptoms require further clinical assessment before returning to physical activity.[1101]

  • Guidance on return to sports after COVID-19 in children is available from the American Academy of Pediatrics:

Suggested return to physical activity after COVID-19: risk stratification to exclude features suggestive of myocarditis or post-acute COVID-19 and phased resumption of physical activity after 7 days without symptoms[Figure caption and citation for the preceding image starts]: Suggested return to physical activity after COVID-19: risk stratification to exclude features suggestive of myocarditis or post-acute COVID-19 and phased resumption of physical activity after 7 days without symptomsBMJ. 2021;372:m4721 [Citation ends].

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