Doctor says pulse oximeter is good to have at home with COVID-19 patients
There is some perhaps well-intended, but mostly inaccurate information being copied and pasted on social media about how to care for people who have the coronavirus and are experiencing symptoms while isolating at home.
After reading a social media post titled, “How to Fight COVID at Home,” Dr. Shephali Wulff, sSMHealth System director of infectious disease, pointed out more than a few inconsistencies in the post, some of which could cause other medical issues.
Wulff noted that SARS-CoV-2, which causes COVID-19, is a respiratory virus, and the care would be what is recommended for a person with any respiratory illness — addressing the symptoms.
“You certainly want to make sure they are hydrated and that you support their fever with Tylenol and ibuprofen products. If they have a terrible cough, you can get an over-the-counter cough medicine,” Wulff said.
However, there is a critical distinction with COVID-19.
“The difference with COVID is that while the majority of people get better, certainly in the second phase of illness, around Day 7, 8, 9, 10 — it’s sort of this critical window where people, if they’re not going to get better, that’s when they start to get sick and they get into what we call the pneumonic phase of illness, where they develop inflammation in their lungs, and that’s when they have trouble breathing and present to the hospital,” Wulff said.
In the aforementioned social media post, the unnamed author claims, “The doctor sent me home to fight Covid with two prescriptions — Azithromycin 250mg & Dexamethasone 6mg.”
COVID-19 is caused by a virus, and antibiotics, like Azithromycin, do not kill viruses. They destroy bacteria and other microorganisms in infectious disease.
“There’s no role in antibiotics being used to treat COVID,” Wulff said. “In addition to that, Azithromycin has as one of it’s side effects … people can develop arrhythmias.”
“Dexamethasone” is a corticosteroid used to reduce the swelling,heat, redness and pain of inflammation. Wulff said while steroids may be indicated for a hospitalized patient, for COVID at home, it has an opposite effect.
“We see this happening from time to time that some of the outpatient folks will send patients home with steroids, and that’s what they are saying in this article … and that’s really not indicated for people who are at home,” Wulff said.
“Dexamethasone was studied in this huge trial — 6,000 patients … but what they found was while there was 12% mortality benefit for inpatients, it actually had the opposite effect on outpatients.”
For persons who experience leg cramps, Wulff said the posting incorrectly suggests taking Pepcid, which is an antacid used to treat heartburn.
“I honestly would not advise people, if they don’t otherwise need an acid blocker for their stomach, I wouldn’t have them start taking one when they have COVID,” Wulff said. “I also wouldn’t advocate somebody start self-medicating with aspirin. If they have a question about that I would have them talk to their primary care doctor.”
Thermometers are useful tools to have at home to check for fever. Wulff said there is another device, also available for use at home, the fingertip pulse oximeter, that can help make a crucial decision on whether to call the doctor or go to an emergency department.
“For patients who are at that critical point where they are starting to have worsening cough, worsening shortness of breath, it would be helpful for people to have a home pulse oximeter,” Wulff said.
“If they are caring for a loved one, they can keep their eye on what their oxygen saturation is, especially in that critical window between Day 7 and 10. And if they’re noticing that their loved one is getting really short of breath and their oxygen saturation is less than 92% — then they need to come in and get care.”
Getting rest and walking around is important, she said — but not in two-hour intervals, as the posting suggested. “Certainly, while you are sick, we want you to get your rest, so I would not set my alarm and wake up every two hours,” Wulff said. “If you are sleeping peacefully without coughing and feeling short of breath — get your sleep.”
What did the social media post get right? A couple of items.
“I agree with ‘get up and walk around.’ That’s good advice, but not while you’re sleeping,” Wulff said. “During the day, certainly make yourself get up and walk around so you don’t develop a blood clot.”
Also right was the advice for COVID patients to sleep on their stomachs or sides to keep pressure off their lungs. Wulff said that’s what they tell patients in the hospital as well, to sleep on their stomach or side as long as they can tolerate it.
“It works by recruiting the lung tissue in the back of your lungs that otherwise collapses a little bit if you’re flat on your back all the time,” Wulff said. “It helps you oxygenate better.”
It is also accurate to drink fluids to hydrate and to restore electrolytes. While this posting in question specifies items to eat, drink and what to avoid, the real recommendation from Wulff is to stay hydrated and try to eat a balanced diet, which is what you are supposed to do anyway.
“You want a balanced diet with some fat, Vitamin C and some protein. That’s probably fine,” she said.
Wulff said she and other health workers, who have had a steady stream of COVID patients in their hospitals for the past couple of months, are optimistic, now that vaccines are being distributed. But all the health precautions most people have taken for most of 2020 — wearing masks, frequent handwashing, and maintaining a social distance — must continue, at least for the foreseeable future, she said.
“We do feel like there is an end to this coming, I would want people to remember that,” Wulff said. “As much as this is awful and having to quarantine, especially over the holidays, I am really hopeful that the next six to nine months will look a lot better.”
The Centers for Disease Control says a health professional should determine whether the patient is stable enough to recover in a residential setting. Other considerations include whether there is a bedroom, and preferably, a separate bathroom where the person with the virus can recover without sharing space with healthy members of the family. Shared bathrooms must be disinfected after each use.
The CDC says appropriate caregivers should be available, as well as access to food and other necessities. For more information, visit https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-home-care.html.