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Suzanne Myers was sick, concerned and a little confused. Myers, a 55-year-old who lives in Brooklyn, N.Y., and her husband are both vaccinated and boosted against COVID, and in early spring they went to a weekend party with about 20 other people at the home of friends. On the Monday morning after the party, Myers woke up with a sore throat.
“I thought maybe it was spring allergies,” she says. “Then I thought I should test.” Her first at-home COVID test was negative. But by Wednesday, she felt worse—in addition to a sore throat and congestion, she had a bad headache. She tested herself again and was positive.
Myers had questions about how to take care of herself. She wondered if over-the-counter (OTC) cold medicine would help. Because she has type 1 diabetes, an added risk factor for severe COVID, she wanted to know if she should try to get a prescription antiviral. There are more and more people with such questions as case numbers and test positivity rates climb again. The situation is leaving thousands at home as they try to figure out how best to get themselves over an illness that could be moderate but could also take a serious turn and that has killed about one million Americans.
To answer questions about self-care for COVID and about when you should seek medical help, Scientific American called physicians across the country who are treating COVID patients. We also reviewed recommendations from the U.S. Centers for Disease Control and Prevention, as well as several public health experts, to gather the most up-to-date advice for people who think or know that they have the disease.
Note Your Symptoms
All current cases in the U.S. are caused by the Omicron variant, and, in particular, a lineage of Omicron known as BA.2. The good news is that “Omicron seems less likely than Delta to cause serious disease,” says Timothy Brewer, a professor of medicine and epidemiology at the University of California, Los Angeles. Omicron also tends to cause symptoms a little sooner than Delta did—about two to three days after infection rather than four or five.
The range of possible symptoms is wide but centers on the upper respiratory system. Because BA.2 replicates more in the airways above the lungs rather than deeper inside those organs, physicians are seeing less chest and lung inflammation and more sore throats and congestion. Achiness, coughing, shortness of breath and fever are also common.
Take a Test
Between 48 and 72 hours after potential COVID exposure or at the first sign of any symptoms, people should take either a rapid antigen or PCR test. “There should be a very low threshold for testing yourself to see whether you have COVID or whether you have something else,” says Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. COVID can look very like a cold, influenza or allergies, but the treatments for each are different.
PCR tests are more sensitive but harder to get, and taking a rapid antigen test at home usually suffices, the experts say. If the first test is negative, people should wait two days (behaving cautiously in the meantime) and take another one as Myers did. If it is COVID, the viral load will increase in that time. “Nothing in life is perfect, nor are the rapid antigen tests, but they’re pretty darn good at picking up contagious levels of virus,” says Lucy McBride, a practicing primary care doctor in Washington, D.C. (Lists of free test locations are available on the Test to Treat locator Web site provided by the U.S. Department of Health and Human Services.)
When people test positive, it is a good idea for them to call a primary care physician if they have one. Doctors can provide guidance on treatment and update medical histories. They will also report the result to public health authorities so that it is included in case counts. At a minimum, people should track the date that symptoms began and the date of a positive test.
Most people who get COVID will be just fine at home. “If you’re vaccinated and boosted and generally healthy, people do very well,” McBride says. Over-the-counter medications will not treat COVID directly but can help manage symptoms. Doctors recommend acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil or Motrin) to bring down fevers and relieve achiness. Early in the pandemic, there were reports that ibuprofen made COVID worse, but those have not been substantiated. NSAIDs are only intended to be taken for short periods, however, because they have more side effects than acetaminophen, and they are not safe for everyone. People who take other medications should consult with a doctor before taking NSAIDs. Antihistamines or cold medications such as DayQuil can be used to relieve congestion and cough.
All over-the-counter medications should be taken as needed and not beyond recommended dosage instructions (some cold medicines already include acetaminophen). “The dose and frequency really depend on the patient’s underlying health conditions and should be discussed with the person’s doctor,” McBride says.
TLC is as important as over-the-counter medications. Getting enough rest is critical, as is drinking enough fluids, which prevent dehydration and reduce cough. Classic remedies such as hot tea with honey alleviate sore throat and cough, too.
Time to Isolate
Even if people feel only mildly ill, they should isolate for at least five days. That means eating and sleeping alone and not sharing a bathroom. If that level of isolation is not possible, experts say to focus on ventilation (opening windows where possible) and careful and consistent use of masks by everyone in the household. N95 and KN95 masks are most protective, and it is important that they fit well. “Try minimizing time spent together and maximizing [physical] distance,” Brewer says. “Transmission is a function of time, proximity, viral load and mitigating factors.” Regular handwashing is also key.
While she was sick, Myers and her husband slept in separate bedrooms, but they still had to share a bathroom. She avoided the living room and the kitchen and ran an air purifier on that floor. Her husband and 18-year-old son stayed healthy, but after her 15-year-old daughter got sick within a few days, they hung out together. That is generally fine, Adjala says. There is little benefit in isolating from other people with COVID when you have it yourself.
Using Prescription Drugs
One of the most significant recent changes in the COVID landscape is the wider availability of authorized outpatient treatments. The antiviral drug Paxlovid reduced risk of hospitalization and death by 89 percent in a clinical trial, and it is a pill, which makes it relatively easy to take. The drug cannot be taken with many common medications such as statins or blood thinners, however. Monoclonal antibodies also significantly reduce the risk of severe disease, but they require an injection or infusion. And not every patient is eligible to get these treatments. Both have been authorized for people who are at higher risk of severe illness because of age (65 and older) or underlying health conditions such as high blood pressure or lung disease. To date, there is no evidence that these treatments benefit people who are young or otherwise healthy. Either treatment is available by prescription or at Test to Treat sites nationwide for people who are eligible.
To be effective, these medications must be started soon after symptoms begin (within five days and seven days, respectively). “[People who might be eligible] should call their provider right away,” says Raymund Razonable, an infectious disease specialist at the Mayo Clinic. “These treatments work best when the patients are not feeling so bad.” Side effects of Paxlovid are uncommon but include diarrhea and a metallic taste in the mouth.
If You Live Alone
Anyone with COVID should watch for signs they are getting worse. “People can feel fine for a while and then go downhill quickly,” Brewer says. When that happens, it is often about eight to 10 days into the illness. If an infected person lives alone, Brewer says, “having someone be able to call you once a day to check up would be a really smart thing to do.” Regular check-ins can also reduce anxiety and the loneliness that isolation can bring. And while friends and family should not get physically close to someone who is isolating, they can—and should—help out by providing meals, Tylenol and other OTC medications if needed and perhaps books and magazines to fill the hours.
When to Worry
Doctors say their biggest concern that the disease is turning serious occurs when a patient has any trouble breathing. If people get easily winded while moving about the house, they should call a physician. A pulse oximeter, available at most major pharmacies, can be a useful noninvasive way to test oxygen levels in the blood—it’s like a hi-tech clothespin that clamps on your fingertip—but the device is not necessary. Other worrisome symptoms that should send someone to urgent care or the emergency room are chest pain, blue lips, unremitting fever or “inability to take in liquids and get in enough food and water,” says Rasika Karnik, medical director of the post-COVID recovery clinic at the University of Chicago Medical Center.
When Are You Safe Again?
If someone is feeling well enough and has been fever-free without medications for at least 24 hours, it is usually safe to reemerge after five days of isolation. But the CDC recommends wearing a mask for another five days. Ideally, people should retest at home beginning five days after the first positive test until they get a negative one. Altogether, this could take 10 days or more. (Myers was negative on day nine.) “Using antigen tests to rightsize or precision guide isolation periods is probably the best thing to do,” Adjala says.