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When you’re immunocompromised or at a high risk for COVID-19 complications and a loved one you live with gets the coronavirus, you feel a flurry of anxiety and helplessness. You’re worried about their well-being and want to help them in every way possible, but you also know you have to protect yourself and avoid getting infected.
Household transmission of COVID-19 is common. In fact, those with the coronavirus tend to infect about half of their household, according to a November 2020 study published in the U.S. Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report.
However, there are strategic steps you can take if you’re immunocompromised and someone you live with gets COVID-19, while still caring for your loved one (if you’re the only one who can do so).
Here’s exactly what doctors want you to do if you’re immunocompromised and sharing a home with someone who has tested positive.
1. Quarantine right away and get tested
Although you’ll be strictly quarantining if someone in your home gets COVID-19, you should get tested so you can alert anyone you’ve been in contact with if you’re infected, says Elana Oberstein, MD, an internist with a subspecialty in arthritis and autoimmune disease at The Lennar Foundation Medical Center in Coral Gables, Florida, and Senior Medical Director of Musculoskeletal at Modernizing Medicine.
“I encourage it because I think it’s important for the greater good of the community,” says Dr. Oberstein. “If you test positive and you’ve been, say, going to work or attending in-person religious gatherings, it’s important to contribute to the process of informing close contacts who may need to quarantine.”
Besides getting tested for COVID-19, you should strictly be staying at home if you’re a close contact of someone who is positive for COVID-19.
If you live with someone who has been diagnosed with COVID-19, you should isolate from them for 14 days after your last contact with them or their positive test — whichever comes last, says Dr. Shah. Watch yourself closely for common symptoms like fever, cough, and shortness of breath.
The infected individual in your home should not be around others until all three of these criteria are met, per the CDC:
- It’s been 10 days since symptoms first appeared
- They’ve gone 24 hours with no fever (without the use of fever-reducing medications)
- Other symptoms of COVID-19 are improving
People who get severely ill with COVID-19 may need to stay isolated for up to 20 days after symptoms first appear, and those who are severely immunocompromised may require testing to determine when they can be around others. It’s best for the infected individual in your home to contact their doctor for the appropriate next steps.
2. Connect with your own doctor through telemedicine
As soon as you know that someone in your household has COVID-19, get in touch with your doctor through a telemedicine visit. Your physician may recommend alterations to your disease-modifying antirheumatic drugs (DMARDs) or biologic medications based on your level of contact with the infected person and your personal health history.
Some doctors may recommend pausing immunosuppressive medications if you have a high likelihood of being infected with COVID-19. “That decision is going to be made on a case-by-case basis,” says Dr. Oberstein. “It also depends on if you are the actual caregiver for the sick person, or if you’re just sharing a roof.”
“If you’re able to really isolate yourself in a separate part of the house, your doctor may not need to change anything about your treatment regimen — but if you are at higher risk and caring for a sick loved one when nobody else can, your doctor may want to make an alteration,” she adds.
Do not make any changes to your medication without consulting your doctor first. That’s especially crucial when it comes to steroids like prednisone, which can cause withdrawal symptoms like severe fatigue, weakness, body aches, joint pain, nausea, loss of appetite and lightheadedness when not slowly tapered off, according to the Mayo Clinic.
When you take prednisone for more than a few weeks, your adrenal glands produce less cortisol (a hormone that’s similar to prednisone). It takes time for your adrenal glands to return to their normal function once prednisone dosages are reduced.
Ask your doctor if you should taper off oral corticosteroids like prednisone when you’ve been exposed to someone with COVID-19, but don’t stop taking them — or any other medication — without your doctor’s guidance.
3. Isolate yourself as strictly as possible from the infected individual
Put as much space as possible between you and the infected person in your home. That means sharing different rooms, bathrooms, and items (including towels, dishes, etc.) if possible.
“The infected individual should not have any contact with you, and they should be using separate utensils, clothes, and items like combs, and avoiding surfaces that everyone may touch as a family,” says Aditya Shah, MD, an infectious disease consultant at the Mayo Clinic.
When possible, people who are at higher risk for severe illness should not be the designated caregivers for those with COVID-19, per the CDC. If you’re able to pass along the responsibilities to someone in your household who is not immunocompromised, that is your best option.
If that’s not possible or if you can’t isolate from the infected person, still try to stay at least six feet away from them and make sure you’re both wearing face masks whenever you’re in a shared space, says Dr. Shah.
The CDC also recommends making sure any necessarily shared rooms have good airflow by opening a window to increase air circulation.
4. Maintain your normal healthy lifestyle habits
At this time, it’s more important than ever to maintain your own healthy habits like eating well and staying hydrated — and avoiding alcohol and smoking.
“Adapting a normal healthy lifestyle is important, as is following your doctor’s recommendations for how long you should be isolating depending on your risk factors,” says Dr. Shah. “Good nutrition and hydration will help your body recover if you get infected.”
It’s also important to track your health and log any potential symptoms in a journal or an app on your phone. “Note anything out of the ordinary and call your physician if you notice any changes,” says Dr. Oberstein.
The CDC outlines common symptoms of COVID-19, which may appear two to 14 days after exposure to the virus:
- Fever or chills
- Shortness of breath or difficulty breathing
- Muscle or body aches
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
“If you get COVID-19 as an immunocompromised patient, worrisome symptoms include difficulty breathing, pain and pressure in the chest, any alteration of mental status like confusion or increased sluggishness, and any discoloration of skin or a new rash,” says Dr. Oberstein. You should seek immediate medical attention if you have any of these symptoms.
5. Take time for yourself if you’re the caregiver
Most people who get COVID-19 usually feel better after a week; symptoms last a few days for most people.
If you’re the only caregiver available for someone who has COVID-19, make sure you’re both wearing face masks and maintain as much distance as possible while covering these basic needs outlined by the CDC:
- Help the sick individual follow their doctor’s instructions for care and medicine
- See if over-the-counter medicines for fever help them feel better
- Make sure the sick person drinks plenty of fluids and rests
- Help with filling prescriptions and getting food or any other items they may need. (You and the rest of your household contacts need to stay in quarantine, so use delivery services to obtain products and necessary goods, adds Dr. Oberstein.)
- Take care of the sick individual’s pets, limiting contact between your loved one and their pets when possible.
As stressful as it is when a loved one gets sick, it’s also important to make sure you don’t overstretch yourself as you care for them. That includes staying in touch with your doctor, continuing to take your medications unless otherwise directed by your physician, and getting enough sleep and optimal nutrition.
“Ask a caretaker, you can neglect your own self-care, and we certainly do not want that to happen in this case,” says Dr. Oberstein. “You have to take care of yourself during this time.”
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Caring for Someone Sick at Home. Coronavirus Disease 2019 (COVD-19). U.S. Centers for Disease Control and Prevention. December 2, 2020. https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/care-for-someone.html.
Grijalva CG, et al. Transmission of SARS-COV-2 Infections in Households — Tennessee and Wisconsin, April–September 2020. Morbidity and Mortality Weekly Report. November 6, 2020. doi: http://dx.doi.org/10.15585/mmwr.mm6944e1.
Interview with Aditya Shah, MD, an infectious disease consultant at the Mayo Clinic
Interview with Elana Oberstein, MD, an internist with a subspecialty in arthritis and autoimmune disease at The Lennar Foundation Medical Center in Coral Gables, Florida, and Senior Medical Director of Musculoskeletal at Modernizing Medicine
Prednisone withdrawal: Why taper down slowly? Mayo Clinic. June 19, 2020. https://www.mayoclinic.org/prednisone-withdrawal/expert-answers/faq-20057923.
Symptoms of Coronavirus. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. May 13, 2020. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html.
When to Quarantine. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. December 4, 2020. https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html.
When You Can Be Around Others After You Had or Likely Had COVID-19. Coronavirus Disease 2019 (COVD-19). U.S. Centers for Disease Control and Prevention. December 1, 2020. https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/end-home-isolation.html.