Patient discussions
General discussions
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 multisystem inflammatory syndrome in children (MIS-C). Reassure the patient that they are likely to feel much better in a week if their symptoms are mild.[397]
Discuss who to contact if their symptoms get worse, or if MIS-C is suspected. Offer telephone or video consultations as appropriate.[397]
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.[397]
Pulse oximetry
Patients may be required to use a pulse oximeter in the home setting. Patient education and appropriate follow-up are required.
Pets and animals
Advise people with suspected or confirmed infection to avoid contact with animals, including pets, livestock, and wildlife. The risk of animals spreading severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to people is low. However, there is limited evidence that the virus can spread from people to certain animals (e.g., dogs, cats, mink, hamsters, ferrets, nonhuman primates, big cats and other zoo animals, some wildlife) during close contact.[1162] Cats showed a greater susceptibility to infection compared with dogs.[1163]
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.[1164]
Guidance on return to sports 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.[1165] However, available evidence does not confirm a causal relationship between COVID-19 and myocardial involvement in athletes.[1166] Early recognition and continuous assessment of cardiac abnormality in competitive athletes is important to prevent cardiac complications.[1167]
General resources
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