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Health & Wellness

What Doctors Have Learned During The Pandemic Has Changed How COVID-19 Is Treated At Home

A man wearing a mask while sick with coronavirus looks through a window
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Dr. Gotttlieb says COVID patients allowed to stay home should try to determine if they're eligible for monoclonal antibodies that decrease the risk of hospitalization.

The delta variant has sharply increased the number of COVID hospitalizations. It’s still possible to nurse milder cases of COVID at home. But the standards are higher than when the pandemic first began.

Dr. Robert Gottlieb, an advanced heart failure and transplant cardiologist for Baylor Scott & White who has led clinical trials on COVID treatments, explained why to KERA's Sam Baker.

INTERVIEW HIGHLIGHTS:

General Rule Of Thumb:

If you're worried about how you're doing always seek medical attention, and if you ever can't breathe, you should be dialing 911 or seeking emergency room attention.

Your Oxygen Levels Matter:

If your oxygen levels are above 88%, sometimes we say you're safe to stay at home. But this is a condition where the name says it all: sudden acute respiratory distress syndrome. This can get bad in a hurry and the oxygen levels do not fully reflect that.

So if someone has an oxygen level of 92 or 93% persistently at rest that would be criteria that I would send someone to the emergency room for an evaluation and consideration of admission for things such as remdesivir, as well as potentially steroids if they have relative hypoxemia.

Therapies Needed For Home Care:

March of 2020, we told patients who didn’t require the hospital to stay at home and passively self-quarantine. We now have the benefit of a year and a half of better understanding of the virus and new therapeutic agents.

The question now is: Are they eligible for neutralizing monoclonal antibodies to further decrease their risk of progression to hospitalization or worse? It's an outpatient antiviral that's an infusion in some cases, even an under-the-skin injection, that's a one-time dose. The earlier you can get an antiviral, the better.

What Else is Needed:

A COVID-19 test is still the core of this. So it's important to get yourself a test. If it's positive, reach out to your healthcare provider and ask if you’re eligible for the neutralizing monoclonals.

After That:

  • Obtain a pulse oximeter, basically a finger measurement of your oxygen levels.

Symptomatic care: For example, if you have a fever, Tylenol is certainly a tried-and-true method. Maybe some ibuprofen. Some people use over-the-counter decongestants for sinus symptoms.
When You Can Return To Normal Life:

Current CDC guidelines suggest that if ten days have passed since your initial diagnosis and you don't have a reason to shed the virus at high levels for longer, ten days may be sufficient.

Personally, I tell a lot of my patients that might be a little bit too short. I asked for 14 days for some patients. For those with something that decreases their immune response, the virus can take longer to clear. The CDC guidelines in those cases are generally 20 days.

RESOURCES:

Steps to help prevent the spread of COVID-19 if you are sick

Caring for Someone Sick at Home

Interview highlights were lightly edited for clarity.

Got a tip? Email Sam Baker at sbaker@kera.org. You can follow Sam on Twitter @srbkera.

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