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Living with an Essential Worker When You Are High Risk for COVID-19

By now, you’ve heard the guidance for protecting yourself from COVID-19 so much that it’s ingrained in your brain and daily habits: Wash your hands often and thoroughly, put at least six feet between yourself and others, stay home as much as possible, wear a cloth mask if you need to be out in public.

If you live with an autoimmune disease like rheumatoid arthritis or lupus, you know how important these steps are. After all, health issues such as having an inflammatory condition — or undergoing chemotherapy or being an organ transplant recipient — may make you more susceptible to experience severe illness from COVID-19, according to the U.S. Centers for Disease Control (CDC). And chronic underlying health issues such as heart disease, diabetes, and lung disease have been linked to more hospitalizations, intensive care unit admissions, and deaths, recent CDC data show.

“People who are immunocompromised may not be able to fight off the infection as well as someone with a functioning immune system, and that increases their risk of complications,” says Nieca Goldberg, MD, medical director of the Women’s Heart Program and senior advisor for Women’s Health Strategy at NYU Langone Health.

However, even if you’re being strict about staying home, it’s not always easy to keep the outside world out — especially if you live with an essential worker.

This is even more important to think about right now, as many states are starting to loosen stay-at-home orders and allow more types of businesses to slowly reopen.

Regardless of what kind of job your loved one has, it is important to assess their risk of being exposed to the virus. This, in turn, can affect your own risk and determine which measures you follow to stay safe within your home.

“Essential workers should touch base with an occupational health office where they work, their public health department, or a primary care provider to get specific guidance,” says David Aronoff, MD, director of the Division of Infectious Diseases at Vanderbilt University School of Medicine in Nashville, Tennessee. “Depending on their risk, there are then various levels of household infection protection that can then be used [to protect high-risk loved ones at home].”

Here are seven strategies to help you stay healthy at home when people in your household are working outside of it. They should be used along with guidance from your health care provider.

1. Ask your loved one to switch into ‘inside’ clothes when they get home

Your loved one should wash their hands immediately before leaving work and then again when they come home. If possible, they should remove their shoes and change out of clothes in an isolated space (say, in a designated bathroom or even in the garage) before entering other parts of your home. This reduces your risk of exposure to their clothing and other items like jewelry that may have come in contact with the virus.

“We don’t know if people are likely to transmit the virus because their clothes are contaminated, but it’s reasonable to try to reduce even a small risk,” says Dr. Aronoff.

That said, keep in mind the virus won’t “jump” from someone’s clothes to you — direct contact would be needed.

2. Share less and disinfect more

Depending on your loved one’s risk of exposure to COVID-19, you may need to take heightened precautions, such as temporarily sleeping in separate rooms, says Dr. Aronoff (more on handling sex and intimacy below). Some employers and hotels have even arranged for essential health care workers, for example, to stay in hotel rooms or apartments for a period of time, but this may not be possible for everyone.

Physically separating from your loved one may not be the best option for you, so make the decision with guidance from your health care provider. “Depending on someone’s personality, being void of all human contact might be too stressful, so you have to find a balance,” says Robert Keenan, MD, a rheumatologist at Duke Health in Durham, North Carolina. “If a patient has an additional stress burden, that’s going to make them more susceptible to infections and flares.”

Another strategy: Do not share items such as food, drinks, or silverware.

Make sure to frequently clean commonly used surfaces, says Dr. Aronoff. “Disinfect commonly used surfaces at least once a day or more, depending on how often they’re used,” he adds. Those may include TV remotes, light switches, sinks, countertops, refrigerator handles, keyboards, doorknobs, or car handles.

Preliminary research published in the New England Journal of Medicine showed that the coronavirus remains infectious in aerosols (a mist of tiny droplets) for up to three hours, on copper for up to four hours, on cardboard for up to 24 hours, and on plastic and stainless steel for up to two to three days.

The CDC recommends cleaning frequently touched surfaces with disinfectants registered by the Environmental Protection Agency for use against COVID-19.

3. Closely assess the risk of physical intimacy with your partner

Holding hands, kissing, sex — where do you draw the line during the age of COVID-19?

While COVID-19 has not yet been found in semen or vaginal fluid, it has been discovered in the feces of infected persons, which may pose a risk for those who partake in anal sex.

Experts still have much to learn about its potential to spread through sex in general, according to materials from the New York City Department of Health and Mental Hygiene. But we do know the virus can spread through direct contact with an infected person’s saliva or mucus, and that kissing is an easy way to pass along the virus.

Because of this, those at high risk may need to take extra steps to reduce their risk of contracting the virus from a partner who works outside the home, which may include sleeping in separate bedrooms or avoiding sex and kissing. Call your doctor for guidance based on your specific situation.

4. Make sure your loved one wears a mask at work

Even if it’s not required in their workplace, make sure your loved one wears a mask when they are outside your home. The CDC recommends wearing cloth face coverings in public settings where it is difficult to maintain social distancing measures, especially in areas where there is significant community-based transmission.

This helpful CDC guide shows how your loved one can make their own cloth mask, even using a simple T-shirt that does not require any sewing.

“The biggest benefit of masks is to prevent people from unexpectedly transmitting the virus,” says Rachel Bender Ignacio, MD, assistant professor of infectious disease at UW Medicine in Seattle, Washington. When your loved one wears a mask, it provides social modeling for others, who may then follow suit and protect your loved one from exposure the virus as a result.

“A lot of the public health recommendations are about social order and best practices as a community,” says Dr. Bender Ignacio. “If six people in an office all wear masks in solidarity, that means someone at home living with an immunocompromised person is safer.”

5. Keep up your regular healthy habits

Let’s be clear: “Immune-boosting” habits are not necessarily going to prevent you from getting the coronavirus. But it is very important to maintain such healthy habits as getting enough sleep, eating an anti-inflammatory diet, and exercising. These habits can help you continue to feel healthy, prevent disease flare-ups, and help manage stress, depression, and anxiety. They are also key for managing chronic conditions like diabetes and heart disease.

“Aerobic exercise is particularly important for maintaining your heart health and improving your mood, and there is plenty of online exercise content to stream at home,” says Dr. Goldberg. “You need to get enough sleep too, which can be difficult when you’re stressed, and make sure you’re following a healthy diet.” Check out these anti-inflammatory meals that use mostly shelf-stable ingredients.

6. Keep taking your routine medications

We’ve been fielding many questions from patients about their prescribed medications and how they may or may not impact risk for COVID-19 complications.

People want to know whether they should stop taking immune-suppressing medications such as biologics. There have been concerns about certain types of blood pressure drugs called ACE inhibitors. And some people who take hydroxychloroquine for lupus, rheumatoid arthritis, or other rheumatologic conditions have been forced to make tough choices about drug rationing if their medication is in short supply and cannot be refilled.

The general consensus among medical experts is that you should not make any changes to your medication regimen without talking to your doctor. Unless you have COVID-19 symptoms or a likely exposure to COVID-19 (say, because someone in your household has symptoms), a change in your medication regimen is likely not needed.

The American College of Rheumatology just issued new clinical guidance for what people with inflammatory arthritis should do in these situations. Generally speaking, there is no need for medication changes if patients are healthy. If people become sick with infection symptoms, they and their doctor can decide whether to hold certain immune-suppressing medications until they recover.

If you have questions about your medications, talk to your doctor, and consider taking advantage of telehealth services as an alternative to in-person visits.

“I’m telling my patients to stay on their current medications right now, because we don’t want them flaring, which may require a doctor visit,” says Dr. Keenan. “Staying on your therapy will allow you to hopefully remain at home as much as you can.”

7. Take extra precautions if your partner isn’t feeling well

The COVID-19 virus is primarily transmitted through respiratory droplets spread through coughing, sneezing, and other direct contact. That is why it is most important to isolate yourself from your loved one if they’ve been directly exposed to someone with a COVID-19 diagnosis or have COVID-like symptoms themselves.

If someone you live with is sick, they should use a separate bedroom and bathroom from you if possible. If you must share a bathroom, the person who is sick should try to disinfect it after each use, or you should wait as long as possible before entering to clean it, according to the CDC. Your loved one should eat their meals in their room and use a dedicated, lined trash can for tissues and other garbage. Don’t share personal household items such as dishes, cups, eating utensils, towels, or bedding.

Ideally, a high-risk or immunocompromised person would assign someone else in the household to be the sick patient’s caregiver during this time. If you’re the only option, however, the CDC recommends wearing disposable gloves when handling dirty laundry and dishes or when disinfecting frequently touched surfaces, and washing your hands often for at least 20 seconds with soap and water.

Here is more CDC guidance for cleaning your home when someone you live with is infected with COVID-19.

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Cleaning and Disinfection for Households. U.S. Centers for Disease Control and Prevention. March 28, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cleaning-disinfection.html.

Cleaning And Disinfecting Your Home. U.S. Centers for Disease Control and Prevention. April 2, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/disinfecting-your-home.html.

COVID-19 Clinical Guidance for Adult Patients with Rheumatic Diseases. American College of Rheumatology. April 11, 2020. https://www.rheumatology.org/Portals/0/Files/ACR-COVID-19-Clinical-Guidance-Summary-Patients-with-Rheumatic-Diseases.pdf.

Interview with David Aronoff, MD, director of the Division of Infectious Diseases at Vanderbilt University School of Medicine in Nashville, Tennessee

Interview with Nieca Goldberg, MD, medical director of the Women’s Heart Program and senior advisor for Women’s Health Strategy at NYU Langone Health in New York City

Interview with Rachel Bender Ignacio, MD, assistant professor of infectious disease at UW Medicine in Seattle, Washington

Interview with Robert Keenan, MD, a rheumatologist at Duke Health in Durham, North Carolina

List N: Disinfectants for Use Against SARS-CoV-2. U.S. Environmental Protection Agency. https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2.

Sex and Coronavirus Disease 2019 (COVID-19). NYC Health Department. March 27, 2020. https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-sex-guidance.pdf?referringSource=articleShare.

Use of Cloth Face Coverings to Help Slow the Spread of COVID-19. U.S. Centers for Disease Control and Prevention. April 13, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html.

van Doremalen N, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. The New England Journal of Medicine. April 16, 2020. doi: http://dx.doi.org/10.1056/NEJMc2004973.

What You Can Do if You are at Higher Risk of Severe Illness from COVID-19. U.S. Centers for Disease Control and Prevention. April 3, 2020. https://www.cdc.gov/coronavirus/2019-ncov/downloads/COVID19-What-You-Can-Do-High-Risk.pdf.

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