Communicate with patients and their families and carers, and support their mental wellbeing to help alleviate any anxiety and fear they may have. Signpost to charities and support groups.
Explain that symptoms may include cough, fever, and loss of sense of smell or taste. Patients may also experience breathlessness (which may cause anxiety), delirium (which may cause agitation), fatigue, headache, myalgia, sore throat, drowsiness (particularly in older people), poor appetite, and chest discomfort/pain. Additional symptoms in children may include grunting, nasal flare, nasal congestion, poor appetite, gastrointestinal symptoms, skin rash, and conjunctivitis. The presence of fever, rash, abdominal pain, diarrhoea, or vomiting in children may indicate paediatric inflammatory multisystem syndrome (PIMS). Reassure the patient that they are likely to feel much better in a week if their symptoms are mild.
Discuss who to contact if their symptoms get worse, or if PIMS is suspected. Offer telephone or video consultations as appropriate.
Discuss the benefits and risks of hospital admission or other acute care delivery services. Explain that people may deteriorate rapidly, and discuss future care preferences at the first assessment to give people who do not have existing advance care plans an opportunity to express their preferences.
Patients may be required to use a pulse oximeter in the home setting. Patient education and appropriate follow-up are required.
Many countries have implemented international travel bans/closed their borders, have issued advice for domestic travel. Some countries are restricting entry to foreign nationals who have been to affected areas in the preceding 14 days, or are enforcing quarantine periods (e.g., at home or in a designated facility such as a medi-hotel) where the person’s health and infection status are closely monitored. Some countries are requiring a negative test before departure and after arrival, and are implementing travel measures to protect against new international variants of the virus. Masks may be mandatory on flights.
Consult local guidance for specific travel restriction recommendations in your country:
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.
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 may be more susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while dogs and other livestock have no or low susceptibility. Non-human primates (gorillas) and large cats in captivity (lions, tigers, pumas, cougars, snow leopards) and domestic pet cats have tested positive after contact with symptomatic humans. 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.
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.
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.
Guidance on return to sports after COVID-19 in children is available from the American Academy of Pediatrics:
Clinical or subclinical myocarditis has been reported in competitive athletes with recent infection that restricts them from training and competitive play.
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