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Recommendations for people with acute upper respiratory infections (colds or flu) regardless of test availability or even negative test results (a brief explainer)

2020-04-08

SARS-COV-2 virions by EM: JAMA Open Network

 

There has been a lot of publicity surrounding the new test for SARS-COV-2: a point-of-care test that gives you results while you wait (positive in five minutes, negative in fifteen minutes).  This test is not yet widely available, and until it is, people who have symptoms should not wait but should isolate themselves.  Even if you have had tests for influenza, strep throat, and other respiratory infections that show another condition, you could still be co-infected with the novel coronavirus.  Self-isolation will prevent transmission of all types of infections.

Patients with typical symptoms of dry cough, fever, headache, and possibly sore throat, loss of sense of smell (without a stuffy nose) or upset stomach, vomiting, or diarrhea: assume that if there is novel coronavirus circulating in your community, you have it.  A SARS-COV-2 test may not be available due to shortages of supplies, and even if you have had the test, you may not get results for some days.  So isolate yourself, don’t go to work, and notify all your contacts that you are sick.  You don’t have to tell them that you have the novel coronavirus; you might have a cold or flu.  Regardless of your actual type of infection, you will prevent passing it on to others if you isolate yourself until you feel better.

Treatment is another issue.  Most infections of this type (upper or lower respiratory) are caused by viruses that cannot be killed any known medications.  You should take a cough medicine, a decongestant, and acetaminophen (paracetamol).  If the acetaminophen doesn’t help, then you should take ibuprofen for fever, aches, and pains.  International medical organizations have stated that there is no evidence that ibuprofen makes your illness worse, despite theoretical considerations that have been widely aired.  Always take ibuprofen with food to prevent upset stomach.  Never exceed the recommended total daily dose of acetaminophen of 3,000 milligrams, as your liver could be affected.  Check the ingredients of combination medicines for colds and flu, as they often contain acetaminophen with other ingredients.

If you are given hydroxychloroquine (HCQ) (and you can get it by prescription if the pharmacy has any), you should start taking it as soon as possible, and never exceed the prescribed dose.  Overdoses of HCQ can be fatal, and the difference between the potentially effective dose and the toxic dose is small.  We do not yet know whether HCQ is helpful in treatment of COVID19, but if you can get it, you can take it and keep in mind that it is an experiment, not a cure-all.

If you are given an antibiotic, you should take it at the recommended dose (several times every day in most cases) and at recommended times (some are taken on an empty stomach and others with food).  Read the label, please.  Be sure you take your antibiotic with or without food exactly as the doctor or pharmacist tells you.  Some antibiotics don’t work unless they are taken on an empty stomach; others may cause severe stomach upset if not taken with food (some will cause diarrhea by killing beneficial bacteria in your intestines).  Take your antibiotic for five to seven days, or at least three days after you start to get better.  Do not stop the antibiotic too early, nor should you take it off and on, as any possible effect will not happen unless it is taken regularly.  Whether an antibiotic will do you any good is an entirely open question.  Most likely it will not make any difference, but if you take it, you should take it as recommended.

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