This was originally a Twitter thread, reproduced here so it can reach a wider audience.
For most people, Covid-19 will pass without event. It will feel like a cold or self-limiting viral illness. Typically symptoms peak on day 2 or 3 and then improve thereafter. While a cough can persist for a couple of weeks, it should not worsen after the first few days.
For some, Covid progresses. Despite the rumours floating around, Covid does not solely progress in the elderly or vulnerable. Indeed, the increase in risk of severe disease, death, and disability is thought to be the same for all adults.
Disease progression can take many forms. At the very least you should use the same judgment you did before the pandemic to decide when to seek medical care. If you’re worried, then make contact. And you should stay vigilant for the possibility of Silent Hypoxia (see below).
PCR test is best
But first, you need to know when and how to test. Too many people are presenting to a medic late due to not getting the right test at the right time. This is not helped by reduced access as many governments surrender to Covid. If you have any ‘viral’ symptoms you should consider undertaking a Covid PCR test at the moment. In many countries just now, cold or flu-like symptoms is quite likely to be Covid, so do seriously consider a PCR.
Antigen (lateral flow) tests are not good enough for symptomatic infection. Over a quarter of Covid patients will test negative on antigen tests. This is crucial for decisions around self-isolation, but is more important for those eligible for anti-viral and antibody therapies. Timing is key.
We have a number of treatments available for the early phase of Covid. Paxlovid is an antiviral and looks to reduce hospitalisation by 80 percent, and mortality by at least that too. Its side effect profile is good, but it is still a serious drug with complex interactions. It can only be used when supervised.
There are a number of other treatments available. In those countries wealthy enough to access them there tends to be criteria for usage. In the UK, it is generally the immune vulnerable. As for the US, they have broader criteria, but it is prioritised. You need to find out if you are eligible.
It is most unfortunate when a patient who is eligible for these treatments either realises too late, or has tested negative on antigen tests for some time and then a PCR confirms Covid too late for these treatments. Typically these treatments must be taken by day 5 from symptom onset.
Please note: it’s currently unclear how worthwhile taking these medications are if fully vaccinated (all three), young(ish) and not in an at-risk group. I strongly advise against trying to source these medications yourself.
Silent hypoxia
Once you get Covid it is important to be aware of signs of complications or disease progression. You may have heard of Silent Hypoxia. It is another feature of Covid that makes it NOT like the flu. Silent Hypoxia is where your blood oxygen level is low but you don’t feel it. Normally when oxygen levels fall, you become short of breath and your respiratory rate increases. For a small but significant number of people with Covid, they develop lung inflammation, drop their oxygen levels, but don’t feel it. Although they do feel unwell.
Typically, severe fatigue predominates. For example, walking from the bathroom or up a flight of stairs makes you knackered, when it didn’t before (see animation at the end for more detail). Pulse oximeters can measure your oxygen, are cheap and can be shared between communities. For this reason we advise measuring oxygen levels at home. Remember, worsening can come on at any time, from Day 1 through to Day 14. It is a bit more common in those who feel worse around Day 5 to 10. Urgent medical care is needed if your oxygen level drops.
We are getting really good at treating patients who develop Severe Covid. But the earlier you get to us if you have lung inflammation (Covid pneumonitis) or Covid pneumonia, the easier it is to treat and the less likely you will get longer term complications.
After Covid care
Risks also remain after the Covid infection passes, especially for those more unwell. After any viral illness, I think it is useful to take it easy for a couple of weeks (no bungee jumping!), eat well (lots of veggies), and stay active. Any new symptoms of concern, please do seek advice.
In some countries, all adults over 35 with Covid are clinically assessed, in others it’s over 65, and others all clinical vulnerable cases are assessed and followed-up. Sadly, some countries kind of leave you to get on with it and offer no assessment. Certainly those over the age of 35 and definitely those over the age of 50 OR those with clinical risks, should maintain a lower threshold for seeking medical care.
I know it may feel like a burden on an already overburdened health service, BUT if you delay care, then that will overburden healthcare much more. So:
- Get vaccinated.
- Try to avoid getting infected
- If you have any viral symptoms get tested. PCR is better than a lateral flow, and is a must for high risk people.
- Know if you are eligible for antivirals/antibody therapies.
- If you get Covid, don’t panic. For most it will just resolve – even high risk people.
- Get a pulse oximeter. Keep an eye on your oxygen levels (and helps you sleep better knowing you are OK too).
- Seek help early. Better for you and better for us.
- Finally, the GOLDEN RULE: if you are worried and would normally make contact with your healthcare provider, then do it. We can’t help you if we don’t know you are unwell.
And finally…
You might want to save this animation and watch it when you get Covid.
The advice given to me was – get prepared for #OMICRON wave.
— CJones (@CJJones16829986) December 27, 2021
1. Thermometer
2. Pulse oximeter (oxygen monitor)
3. Watch 2 min vid.
And remember, don’t delay contact. If you are worried get in touch with your healthcare provider!#CareForCovidpic.twitter.com/rQ6M96LMnU
16/16
And this is a great App developed by a British GP. ⬇️
And this is a great App developed by a British GP. You can monitor loved ones from a distance and yourself. Results can be emailed to your care provider.https://t.co/oXz1RHoWT9
— Dr Dan Goyal (@danielgoyal) March 20, 2022
For clinicians, this review is helpful for identifying the deteriorating community covid patient.
Many politicians have given up, and a lot of people are pushing the ‘it’s over’/’it’s like the flu’ narrative. It isn’t. And it’s not. It is a lot less severe if you’re fully vaccinated and if you have access to treatment when needed. We don’t have to give up – just take a bit extra care.
