What are the recommended management and treatment options for a patient with a recent diagnosis of Covid-19, presenting with symptoms of a cold and cough, but no fever, following a recent cruise where other passengers tested positive for Covid-19?

COVID-19 Management for Mild Symptoms

For a patient with confirmed COVID-19 presenting with cold symptoms and cough but no fever, implement home isolation with symptom monitoring and avoid routine antibiotics unless bacterial superinfection is clinically suspected. 1

Immediate Isolation and Monitoring

Your patient should begin strict home isolation immediately given the confirmed positive test and recent cruise exposure:

• Isolate in a well-ventilated single room with windows open for air circulation 1
• Maintain at least 1 meter distance from other household members 1
• Restrict activity and limit all visitors 1
• Monitor temperature daily and track symptom progression 1

Critical warning signs requiring immediate medical evaluation include: development of fever, worsening cough, shortness of breath, difficulty breathing, chest pain, or inability to maintain hydration. 1 Patients can deteriorate rapidly, typically around day 5-7 after symptom onset, so daily monitoring is essential. 1

Symptomatic Treatment

For Cough Management

• Use honey (for adults) as first-line simple measure for cough suppression 1, 2
• Avoid lying flat on back as this makes coughing ineffective 1
• If cough becomes distressing, consider short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution 1

For Fever (If It Develops)

• Paracetamol (acetaminophen) is preferred over NSAIDs until more evidence is available regarding NSAID safety in COVID-19 1, 3, 2
• Use paracetamol only while fever and symptoms are present, then discontinue 1, 2
• Maintain adequate hydration with regular fluid intake (maximum 2 liters per day) 1, 2

Antibiotic Considerations

Do NOT prescribe routine antibiotics at this time. 1 The evidence strongly recommends against empiric antibiotics for mild COVID-19:

• Antibiotics should only be prescribed based on clinical justification such as high fever, significantly elevated inflammatory markers (WBC, CRP, procalcitonin >0.5 ng/mL), or radiographic evidence suggesting bacterial superinfection 1
• Bacterial coinfection at initial presentation occurs in <5% of COVID-19 cases 1
• Your patient currently has no fever and only mild symptoms, making bacterial coinfection unlikely 1

However, maintain close surveillance: If the patient develops high fever, feels significantly worse, or symptoms progress rather than improve after 48 hours, bacterial superinfection should be reconsidered and empiric antibiotics covering community-acquired pneumonia pathogens (amoxicillin, azithromycin, or fluoroquinolones) may be warranted. 1

Infection Control Measures

Personal Protection

• Wear a medical or surgical mask at all times when in shared spaces or within 1 meter of others 1
• Cover coughs and sneezes with tissue or bent elbow, never hands 1
• Wash hands with soap and water for at least 20 seconds frequently, especially after coughing or sneezing 1
• Use alcohol-based hand sanitizer when soap unavailable 1

Household Measures

• Clean and disinfect high-touch surfaces daily with 500 mg/L chlorine-containing disinfectant 1
• Do not share toothbrush, towels, tableware, bed sheets, or other personal items 1
• Caregivers should be healthy individuals without underlying medical conditions 1
• Caregivers must wear N95 masks (preferred) or surgical masks when in the same room 1

Follow-Up Protocol

Establish daily communication (phone or video) to monitor symptom progression: 1

• Track temperature, respiratory symptoms, and overall clinical status daily 1
• Assess for development of dyspnea, chest pain, or confusion 1
• If symptoms worsen or fail to improve after 5-7 days, arrange for clinical evaluation 1
• Consider testing household contacts if they develop symptoms 1

Duration of Isolation

Continue isolation for at least 5 days from symptom onset, and until fever-free for 24 hours without antipyretics and other symptoms are improving. 4 The patient can be infectious during the incubation period and early symptomatic phase. 1

Common Pitfalls to Avoid

• Do not prescribe antibiotics "just in case" - this contributes to resistance and provides no benefit for viral illness 1
• Do not wait for severe symptoms to develop before establishing monitoring - patients can deteriorate rapidly and unexpectedly 1
• Do not use chlorhexidine for disinfection - it is ineffective against SARS-CoV-2 1
• Do not assume absence of fever means low risk - some patients progress to severe disease without initial fever 1