COVID-19 Outpatient Management Guidelines

Updated July 31, 2021

Originally published April 4, 2020

This management guideline is to aid patients in the outpatient setting who are exposed to COVID-19 and/or are newly diagnosed with COVID-19.

Once a patient has found themselves positive for COVID-19 or exposed to someone COVID-19 positive, the first step is not to panic. The vast majority of COVID-19 positive patients do not require medical intervention in a hospital setting, and can be managed at home.

Help! I’ve been exposed to someone who has COVID-19. What should I do?

-       Wait 48-72 hours before getting yourself tested regardless of symptoms. Getting tested too early may not yield accurate results, as a potential viral load may not have reached a threshold to detect the genetic material tested by nasal swab.

-       Quarantine yourself. Stay home and wear a mask around family members. You should stay in a separate bedroom alone, and if possible, use a separate bathroom.

-       Monitor for symptoms. Symptoms such as a fatigue, weakness, body aches, fever, cough or chest congestion may indicate a viral infection.

-       If you develop symptoms, wait 24-48 hours from your first symptom onset before getting tested. Getting tested too early may yield a false negative result.

I am symptomatic, have been tested and found positive for COVID-19. What is my next step?

-       COVID-19 is caused by the SARS-CoV-2 virus. This virus induces a viral syndrome that is similar to influenza or other common, communicable viruses. Symptoms such as fevers, body aches and a dry cough are typical symptoms of a viral syndrome and should improve within 5 days. Fatigue and weakness may last 4-6 weeks. Some of the methods used to treat typical viral syndromes can also apply to treating COVID-19 while at home.

-       Isolate yourself at home and from your family members for 10 days from your first day of symptoms. You should stay in a separate bedroom alone, and if possible, use a separate bathroom. This is different from quarantining, as isolation requires physically staying away from family members. Being in common home areas should be avoided as much as possible while in isolation.

-       Hydrate yourself. Drinking fluids such as water, electrolyte-rich drinks, and chicken noodle soup help keep your body hydrated while it fights the virus.

-       Get plenty of rest. Your body needs more sleep than a typical night in order to help your body stay energized enough to fight the virus.

-       Medications: Taking immune-supporting vitamins such as Vitamin C, Vitamin D, and Zinc should help boost your immune system. Supportive acetaminophen and alternating NSAIDs may also be taken for symptomatic relief of fever and body aches. Famotidine and/or melatonin and other medications have been discussed in anecdotal reports but there is no strong support in the literature regarding its efficacy.

I’m considered high risk for complications of COVID-19. In addition to the above, what else should I be doing if I’m COVID-19 positive?

-       For patients in a high-risk category, days 3-5 from symptom onset are essential for close monitoring. Patients should monitor their blood oxygen saturations at rest and on exertion for drops below 94%.

-       If your oxygen level dips below these levels, then seek medical attention from your physician.

- These patients should also seek early evaluation for receiving outpatient infusion of the monoclonal antibody (see below).

I’ve had symptoms longer than 5 days, I’ve seen no improvement, and/or I’m getting worse. What’s going on?

-       Symptoms such as shortness of breath, chest tightness, difficulty breathing or lower blood oxygen levels after day 5 of symptom onset are concerning and should be taken seriously. You should seek medical attention and get evaluated by your personal physician. Your physician, taking into account your medical history, can personalize these next steps for you. They may obtain a chest x-ray and routine laboratory tests with specific inflammatory markers in order to better evaluate your case.

What about antibody therapy as a way to fight the virus? Is this an option for me?

-       Monoclonal antibody IV infusions approved for COVID-19 positive patients are a valuable tool in the fight against a COVID-19 infection. These are available for outpatient management as single dose IV infusions, but supplies are limited to specific locations. Patients should contact their physicians for the nearest location to receive this therapy. With the spread and uncertainty surrounding the emerging Delta variant, antibody therapy should be considered for high-risk patients and is likely more beneficial towards reducing the likelihood of progression to severe disease, especially when given during the earlier stages of the disease.

-       Convalescent plasma is the only widely-available option in antibody therapy for COVID-19 patients in a hospital setting as a compassionate use. This therapy uses antibodies from recovered COVID-19 patients in order to help bolster the patient’s immune system to fight the virus.

I had a COVID-19 scare, but it turned out negative and I am asymptomatic. What can I do to protect myself and my family?

-       It is important to get the annual influenza vaccine in order to protect yourself against influenza. For patients above the age of 65, it is also recommended to check with your physician to ensure your pneumonia vaccinations are up to date, including the Prevnar-13 vaccine and Pneumovax 23 vaccine.