Communicate with patients and their families and caregivers, 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, diarrhea, or vomiting in children may indicate pediatric 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.
General prevention measures
Wash hands often with soap and water for at least 20 seconds or an alcohol-based hand sanitizer (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 3 feet [1 meter]) 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, 6 feet [2 meters] 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)
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 nonmedical 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). Caregivers 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 ages up to 5 years should not wear masks for source control. A risk-based approach is recommended for children ages 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.
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 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. Gorillas in a US zoo have tested positive. It is suspected that the gorillas acquired the infection from an asymptomatic staff member.
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.
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:
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