What are the immediate steps and follow-up recommendations for a COVID-19 positive patient to manage their condition, considering potential variations in age, medical history, and symptom severity?

COVID-19 Positive Patient Information and Follow-Up

Immediate Isolation Requirements

Isolate immediately for a minimum of 5 days from symptom onset or positive test date, and end isolation only when you are fever-free for 24 hours without fever-reducing medications AND your symptoms are improving. 1

• You can end isolation after day 5 ONLY if ALL of the following are met: 1

  • No fever for at least 24 hours without taking Tylenol, ibuprofen, or other fever reducers
  • Your symptoms are getting better or gone
  • Ideally, a rapid antigen test is negative

• Extend isolation to 10 days if: 1

  • Your symptoms persist or worsen
  • You still have a fever
  • Rapid antigen tests remain positive

• Important caveat: PCR tests can stay positive for weeks even when you're no longer contagious—do not use repeat PCR testing to decide when to end isolation 1, 2

Home Isolation Setup

Stay in a well-ventilated single room separated from other household members. 1

• If you cannot have your own room, maintain at least 3.5 feet (1.1 meters) distance from others 1
• Wear a medical mask (N95 preferred) whenever you are around other people, including household members 1
• Keep your door closed when possible to prevent airborne spread to other rooms 3
• Open windows to improve ventilation if weather permits 3

Symptom Management at Home

For Cough

Avoid lying flat on your back as this makes coughing less effective. 3

• Try honey first (for anyone over 1 year old) 3
• If cough is distressing, short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution can suppress coughing 3

For Fever

Take paracetamol (acetaminophen/Tylenol) for fever and body aches—this is preferred over NSAIDs like ibuprofen. 3

• Drink fluids regularly to avoid dehydration (no more than 2 liters per day) 3
• Do not take fever reducers just to lower temperature if you have no other symptoms 3
• Continue only while fever and other symptoms are present 3

For Shortness of Breath

Use controlled breathing techniques and positioning to manage breathlessness. 3

• Pursed-lip breathing: Inhale through your nose for several seconds with mouth closed, then exhale slowly through pursed lips for 4-6 seconds 3
• Sit upright to increase lung capacity and reduce airway obstruction 3
• Lean forward with arms bracing a chair or your knees—this improves breathing capacity 3
• Relax and drop your shoulders to reduce the hunched posture that comes with anxiety 3

When to Seek Immediate Medical Attention

Seek emergency care immediately if you experience worsening symptoms, especially: 3

• Increasing shortness of breath or difficulty breathing
• Persistent chest pain or pressure
• New confusion or inability to stay awake
• Bluish lips or face
• Inability to keep fluids down

Contact your healthcare provider, pulmonologist, internist, or infectious disease specialist if mild symptoms worsen 3

Protecting Household Members

Household contacts have a 29% overall risk of infection, with higher risk (42%) for children of the COVID-19 patient. 4

• Household members should monitor for symptoms for 14 days 3
• They should wear masks and get tested if they develop symptoms 5
• Household contacts with diabetes or if you have immunocompromising conditions face significantly higher infection risk 4

Special Considerations for Certain Patients

If You Take Immunosuppressive Medications

Do not apply standard isolation criteria—you require individualized assessment and likely longer isolation. 1

• Discuss medication management with your rheumatologist or specialist 3
• For most immunosuppressive medications (except IL-6 inhibitors), temporarily stop them if you have COVID-19 symptoms 3
• You may need test-based strategies rather than time-based strategies to end isolation 1

If You Are at High Risk for Severe Disease

Contact your healthcare provider immediately about antiviral treatment options. 6

• High-risk factors include: age ≥65 years, obesity, diabetes, hypertension, chronic lung disease, cardiovascular disease, cancer, or immunocompromising conditions 3, 7
• Remdesivir (VEKLURY) is FDA-approved for non-hospitalized patients with mild-to-moderate COVID-19 who are at high risk for progression to severe disease 6
• Treatment should be initiated as soon as possible after diagnosis 6

Return to Normal Activities

Most patients can return to work and normal activities after meeting the 10-day criterion plus symptom improvement and 24-hour fever resolution without medications. 1

• You are unlikely to be infectious once these criteria are met 1
• Never end isolation before day 5 regardless of how good you feel 1
• After hospital discharge (if applicable), remain in isolation for at least 2 weeks from first positive test 1

Follow-Up Testing

Do NOT routinely retest with PCR to determine when to end isolation—you can remain PCR-positive for weeks without being contagious. 1, 2, 8

• Rapid antigen tests are more useful for determining when you're no longer infectious 1
• If symptoms persist beyond 10 days, contact your healthcare provider for guidance 3

Key Points to Remember

• Never end isolation before day 5, even if you feel completely better 1
• Fever must be gone for 24 hours WITHOUT taking fever-reducing medications 1
• PCR tests staying positive does NOT mean you need longer isolation 1, 2
• Household transmission risk is substantial (29%)—protect your family members 4
• Contact your doctor immediately if you're high-risk or symptoms worsen 3, 6