Level 2 – Emerging Symptoms

Notice if you suffer anew from any of the following, most common first COVID-19 symptoms:

• Fever
• Fatigue
• Dry (unproductive), persistent cough
• Shortness of breath
• Gastrointestinal symptoms

Fever seems to be the most common symptom – but it’s not universal. Early data showed that gastrointestinal symptoms (diarrhea, nausea, vomiting, abdominal pain, loss of appetite) were uncommon. But more recent evidence suggests that they are common, and can even precede respiratory symptoms. Initial symptoms may also include joint / muscle pain, headache, chills, dizziness, nasal congestion, and sore throat. Loss of smell and taste lasting for several days can start early or later in the infection. So can skin symptoms like a rash on the back, chest, or stomach (in about 20% of cases in one sample), or small red or purple-colored lesions around the tip of the toes (especially in children and adolescents).

However, common colds, flu, and allergies can also cause many of the same symptoms. In fact, nasal congestion, itchy eyes, and sneezing most likely indicate a condition other than COVID-19, such as allergies. There is no single, unique COVID-19 sign or symptom. There is no way to know for sure whether you have COVID-19 without testing for it.

Is COVID-19 spread in the community where you live? Or have you been to an affected area or been around someone who was in an affected area? Then your symptoms could very well be COVID-19. But remember: In many areas, the odds that it’s something else will still be greater.

Note: Fever is not subjective. You will need a thermometer (or two, in case one breaks), and to keep track in a log of at least daily temperature. If you choose to take temperature internally (i.e., in the bottom / rectum), it will be more precise. Be sure you have enough wipes and alcohol to clean the thermometer after each use. If taking temperature orally, don’t eat or drink for 20 minutes beforehand. Either way, note the method in your illness diary (more on this below), so that healthcare personnel know which it is. (Around .7° Celsius or 1° Farenheit is often added to oral temperatures.) Here are some good instructions for how to take an oral temperature.

If you don’t have symptoms

Some people may be exposed to, carry, and infect others with the virus – without ever showing symptoms themselves. These people are asymptomatic carriers. They seem to be common; they may even number around one in four of those infected. Unless widespread testing is available where you are (which is currently a small minority of places), it may not be possible to determine if you are one of them. This is one of the reasons why everyone should currently be following the advice of public health authorities that generally includes social distancing measures covered in Level 1.

If you have symptoms

The single most important thing once you have symptoms that might be COVID-19 is to stay at home, or to go home if you discover them while not at home. Call in sick. Stay away from people as much as possible and go to a separate room if you live with others. If you live alone, let someone (friend, family) know that you are ill and will keep letting them know how you’re doing.

Symptoms? Maybe you need to register…

As this point you need up-to-date local information. Your health authorities may want to know if you have symptoms. Reasons for this may include population monitoring to see where the virus is, planning the government’s response as well as opening a channel to follow up with you personally. There may be a phone number to call if you have symptoms, or a website to visit, or an app to download. Just figure out what the authorities in your area want you to do as soon as you have isolated yourself from others.

Diagnosis

You will want to know whether what you have is just a cold, a flu or actual COVID-19. There will be different policies surrounding testing for COVID-19 based on where you are and what stage of the pandemic your area is in. Check online, call official hotline numbers, follow official guidelines. If testing capacity is limited, you may not qualify for testing, even if you have all the symptoms of COVID-19.

You may find that the official information on getting tested doesn’t always match the reality on the ground. It may be impossible to get through, the lines may be way too long, the waiting conditions may be unsafe. (You don’t want to get COVID-19 from trying to find out if you have it.)

In some cities, your regular doctor will come to your home in full gear to swab your throat. In other places, there are drive-throughs. There are also Do-It-Yourself test kits you can order by mail where you perform your own throat swab and send it to the lab for testing. The availability of all of these methods will differ depending on where you are, who you are, what stage the pandemic is in and many other factors. We cannot possibly help you further than to tell you to inform yourself as soon as you have isolated yourself.

Under no circumstances should you just show up at a doctor’s office or a hospital unannounced if you experience symptoms.

Remember: This is for your own protection as well as that of the other patients. Hospitals are bad places to be until you absolutely have to be there: You run the risk of getting additional infections that, when bacterial or fungal, are much more likely to be resistant to standard treatments due to the nature of the hospital environment. Also: Many hospitals are going to be overloaded, so waiting times may be astronomical.

Don’t Panic

For most people, this will be as bad as it gets. You’ll be a little sick, and then you’ll get better. Done.

At the same time, some people will not be so lucky. Even if only a relatively small percentage of those affected need medical care, this will put a serious strain on doctors, nurses, and available medical resources. We can all help them by staying home whenever possible.

The “Worried Well” is a medical term for people who visit the doctor when they are not really (all that) sick, because they need reassurance. The coming weeks and months are not a good time for that. This website aims to give you more confidence and preparedness in caring for yourself, friends, and loved ones until you / they actually need professional help.

Consider using relaxation techniques to slow a rapid breath or heart rate that may be partially due to anxiety (or just to chill out):

• Listen to calming music.
• Check in with a friend electronically.
• See if you can slow your breathing and bring down your heart rate by counting longer for forceful exhaling than for gentle inhaling. Some people use 4-7-8, and others prefer 5-2-5 to try slowing down their inhale-hold-exhale patterns. Use what feels best for you.

Self-quarantine

Until tested and depending on where you are and where you have been, simply assume the patient (you? a family member?) has COVID-19. That means self-quarantine at home. No more visitors, a sign on the door, and the patient should not go out unless there is no chance of meeting anyone. Different areas have different standards for what it means to self-quarantine when there are other people in the household. If possible, you will want to err on the side of safety and try to get everything delivered for 2 weeks. Things may change, as in some areas the virus will become so common (endemic) that many people will have had it. There is no telling at what point various authorities will stop testing every potential infection, and it will differ from region to region.

Garbage

During this time at least, err on the side of caution when it comes to trash. Used tissues, paper towels, and other possibly contaminated disposable items should be bagged in disposable trash bags, tied securely, and put aside for 72 hours prior to external disposal. Some places also recommend putting these items in a second disposable trash bag. If you use communal garbage bins, disinfect the handles when possible before and after use. Wash your hands after handling trash and bins.

PPE

Now at the latest is time to think about Personal Protection Equipment (PPE). If you can get masks AND IF MASKS ARE NOT IN SHORT SUPPLY FOR DOCTORS AND NURSES WHERE YOU ARE, wear one outdoors. You are not supposed to be outdoors when you have symptoms, we know. But we mean even just when taking out the trash. If you have no mask, at least do something. Make your own using our mask-making template. Wrap a towel around your nose and mouth, breathe through a scarf, anything is better than nothing. Here are a few recommendations for PPE in the context of the COVID-19 pandemic, summarized and expanded on briefly below:

• Use PPE if you are sick and have to be around other people, or if you feel well but have to be around someone who is sick (e.g., caring for someone).
• Use a high-filtration respirator like an N95, FFP2, or FFP3 if you can. Next-preferred would be a regular medical face mask (surgical or procedural). Then a home-made or improvised mask. Just use something.
• Use disposable gloves to take out the trash when you are ill, or when caring for someone who is ill.
• It may make sense to also use a cap, gown, and eye protection if you are caring for someone with COVID-19 at home.
• Fitting respirators properly is hard and important; look up some videos and mold it to your face with your fingers without squeezing the bridge.
• Take care putting it on. Start in a clean zone with clean hands and keep your PPE as clean as possible.
• Take care taking it off. First remove gloves and wash hands, then remove mask and wash hands, then remove any other PPE or dirty clothes and wash hands. Then put on clean clothes and get back to a clean zone.
• Dispose of used gloves in a disposable trash bag, double-bagging and / or placing the trash aside for 72 hours before external disposal.
• Although this is not normal, you probably want to reuse masks since they are already in short supply globally (and the same may become true for other PPE). The best way to reuse PPE is to mark seven sets – one for each day of the week. Rotate them after wearing to sit in a clean place for a week. If you need respirators / masks decontaminated faster, bake them in the oven at 70° Celsius (around 160° Farenheit) for 30 minutes.

Family, flatmates, etc.

Seek up-to-date local information if you live with others. The authorities may provide you with different or more detailed instructions, advice, or even PPE materials.

Here are some general suggestions and tips for dealing with family and flatmates if you have or suspect you may have COVID-19:

• Self-quarantine from the outside… Household members of people who are known or suspected to be infected should treat themselves as potentially also infected and self-quarantine, too.
• … and distance on the inside. They should also keep the maximum practicable distance from the patient for as long as the patient can take care of him- or herself. This means being in different rooms, sleeping in different beds, eating separately, using different dishes and towels, and when possible, using different bathrooms. (If that’s not possible, at least keep contaminated toilettries like the patient’s toothbruh in a separate space such as the patient’s room for now.) We know, distancing in your own home and possibly from your own family, is weird and sometimes heartbreakingly hard. But this is a potentially lethal disease and the people close to you will (hopefully) understand.
• Clean the kitchen faucet. Regularly clean all frequently touched surfaces (doorknobs, light switches, table surfaces, keyboards, phones, toilet handles if in shared bathrooms, kitchen faucet handles if in shared kitchens – you get the idea) with a regular household cleaner (e.g., Lysol, Windex), hydrogen peroxide solution, or diluted bleach (10 ml / 2 tsp bleach with half a liter / 2 cups of water; carefully washing measurement tools before reuse). You can put that solution in a disused plant sprayer or cleaner spray bottle. Give the cleaner a minute to work on surfaces before wiping it dry.
• Consider PPE. Your housemates might want to wear masks indoors, too. When they handle your trash or laundry, disposable gloves are also a good idea.

In most places, there will probably come a time when the number of cases skyrockets, many people have already had COVID-19, and authorities will no longer keep records of who has had it and who hasn’t. The basics then remain the same: Try to protect other people, especially those middle-aged or older and people with existing illnesses, as much as possible. And try to minimize the spread whenever you can, as best you can. Remember: The more we can slow or stop the disease’s spread, the better it is for everyone. Because by helping to slow or stop the spread, you help lessen how overwhelmed the healthcare system is going to become. That in turn increases the proportion and number of people who need medical care (for any reason), who are able to access it. This helps doctors and nurses save more lives.

Diary

When symptoms first start is the right time to start an illness diary.

A few times a day, preferably at somewhat regular hours or points in your normal routines or rhythms (e.g., every morning before making coffee or tea), measure temperature, even if you don’t feel like you have a fever (yet). Weigh once a day if possible. Also note respiratory and heart rates in breaths and beats per minute. It will get you used to doing these things, give you practise, and (if you start early) give you some idea what (more or less) healthy values for you look like. Not necessary, but extra points for blood pressure and oxygenation (Devices to measure those are cheap, see the shopping page).

Then write down any symptoms the patient has. If he or she is in pain, where and when is the pain, and how bad on a scale of 0 (no pain) to 10 (worst pain imaginable)? How bad is the cough? What color if there is mucus being produced? Be sure to note what medication, if any, the patient takes.

Paracetamol (also known as Tylenol or acetaminophen) is a good choice for fever and pain suppression. Keeping an illness diary will also help you to keep track of how much you’ve taken, when, to ensure you treat fever adequately without taking more than the recommended amount in a 24-hour period.

Printable illness diary

We made a printable illness diary that you can use to write down all the information you collect when you take temperature, breathing rate, etc. Please check out the form and our webpage about it via the link above.

Contact lenses

Even when you are not that ill yet, it is much better to use glasses if you have them, and stop routinely putting in contact lenses in the morning. You do not want to touch your eyes more than you have to because they may get infected. If and when you do get more ill, you do not want to risk forgetting that you have them in.

Get healthy again

• Rest as much as you need to. Tiredness is a common symptom. Let your body use its energy to fight for health. Do the bare minimum of everything else.

• Treat fever with care.
  • Treat pain and fever with over-the-counter medication at the recommended safe dosages. Use paracetamol if you can.
  • Fever is part of the body’s natural defenses. Research suggests medicating fever less rather than more aggressively is safer. This means medicating a temperature of over 40° Celsius (104° Farenheit) – and not medicating a lower fever.
  • Questions are also emerging surrounding the safety of ibuprofen / non-steroidal anti-inflammatory medications (NSAIDs), as well as corticosteroids / steroidal anti-inflammatory medications, in case of coronavirus. If possible, avoid their use if you have symptoms.
  • An additional safe way to treat fever is to take a bath or shower. The water temperature should be comfortable, not cold, because shivering can raise your core body temperature – and the idea is to lower it. When you get out of the bath or shower, the leftover water evaporating from your skin can help lower your temperature.

• Keep eating. Try to keep eating nutritious food. Nothing too heavy, not too much at the same time. Lots of vitamin-rich, unprocessed food like fresh vegetables and fruit. If you’re not eating, maybe drink one of those big multi-vitamin pills that fizz into water.

• Steam. Inhale steam daily. The best way to do this is with a steam inhaler, a device that outputs steam that is not too hot to breathe. A humidifier or shower also works. The older method many people know is to boil water in a pot and then put your head over it, under a dishtowel; just make sure you don’t do damage with hot water or steam that’s too hot to breathe. There are no miracle cures and this is no exception; it just helps your airways open and drain a bit better.

• Keep moving. Go for a daily walk in the fresh air and sunlight when possible, while keeping your safe distance from other people. Exceptions: You’re too tired – then rest! You’re symptomatic and can’t get out of your apartment building without coughing in the shared elevator – stay home!

• Keep drinking.
  • This is really key. Drinking enough fluids helps the lungs produce secretions, and helps those secretions it does produce be thin enough to potentially cough up.
  • If your throat is irritated, avoid acidic drinks (such as soda and juice) as they can be further irritating; water and teas are better choices then.
  • How much is enough? Notice the color and amount of your urine. If it is dark (more colored than clear), or there is not a lot, drink more water.
  • It is very important to avoid and treat dehydration by drinking enough, even though it can be hard to drink enough when you have a fever / are sweating a lot, and are suffering from fatigue and discomfort due to illness. If you are struggling to drink enough and beginning to show signs of dehydration like darker urine, you might also try eating foods containing more water (e.g., cucumber, oranges, apples), sipping on boullion or soup, or setting a small goal for yourself (e.g., every time you get up, drink a glass of water).
• Encourage coughing.
  • Coughing can be an important, healthy effort on the part of the body to clear the lungs of fluid so you can breathe easier. It’s also exercise for your lungs.
  • Do not suppress a productive cough all the time / just because you don’t want to be coughing. However, if you want to try to suppress your cough enough to get a good night’s sleep so your body can better heal itself, then over-the-counter cough medications, herbal teas such as anise / chamomile, cocoa, and lozenges can help.
  • Some over-the-counter cough medications contain ingredients like guaifenesin or NAC, generally considered safe mucolytics that relieve coughing by helping your body get rid of mucus (usually by making it thinner and so easier to cough up); your pharmacist can help you find one that’s right for you.
• Get up, stand up. Other simple ways to try to prevent pneumonia and other lung complications from developing typically include:
  • Sitting upright as much as possible to help fluids drain. Do not lie flat in bed all day.
  • Getting up and moving periodically. Although you may be very tired (malaise) due to your illness, being upright and moving around can similarly help fluids drain.
  • Expanding your lungs by breathing deeply (in and out), and raising your arms (up above your head and down again).
  • Opening the window and breathing the fresh air, especially if breathlessness is bothering you.
  • Exercising your fuller lung capacity by blowing up a balloon every hour, using a peashooter, or using any other toy you might have on hand that exercises lung capacity. This is a particularly good idea if your breathing is fast and / or you are feeling breathless. Be gentle and patient with yourself. Focus on taking slow, deep breaths all the way in and all the way out, and remember lung capacity is like muscle strength: You can build it up by repeated exercise. Do 10 deep breaths every hour you’re awake.

Feeling better?

If your symptoms go away, that doesn’t mean you should end your quarantine immediately. You need up-to-date local information again to see whether the authorities want you to register as healed, especially if you tested positive earlier. Depending on availability and local policy, you may need to be tested again. Your local health authorities may provide you with specific advice on what to do next. If so: Follow it.

Absent of up-to-date local instructions from authorities, you should err on the side of safety and try to stay in isolation for a little longer than officially indicated. The World Health Organization recommendation is to continue isolation for at least two weeks after symptoms disappear, even if you are no longer feeling sick.

If you managed to get tested, yay! You now know that your body (presumably, keep watching the latest science on this) has built immunity. Which means that this thing is over for you, and, if you are young and healthy, also that you are a more logical choice to help your family and friends when they get sick. Depending on what state the world is in, you may want to inform your employer and others who might depend on you that you’ve had it, so they know you’re immune.