Know the 3 feet + 15 minute rule
Talking to someone – just like breathing, sneezing etc. – is one of the ways by which virus particles are released into the environment. However, the no. of virus particles (vp) that come out of one’s mouth/nose would vary with the activity – breathing, speaking, sneezing or coughing etc.
Breathing: ~20 vp/minute
Speaking: ~200 vp/minute
Coughing: ~200 million vp/minute
Sneezing: ~200 million vp/minute
If you have had a chat with a COVID-19 positive patient, you should know that the infection can be transmitted only when you inhale 1000 viral particles– called ‘infectious viral dose’. Inhaling a smaller number of viral particles will not transmit the infection. Having said that, if you have been in close proximity (within 3 feet) of your neighbour, without precautions, and have had more than 15-min face to face interaction, then you would be at high risk of getting the infection.
In conclusion, the formula for successful infection (without precautions) = Exposure to Virus X Time.
A close contact is defined as being within 6 feet of someone who tested positive for COVID-19. Based on this, there can be two types of contacts: High risk and low risk.
High risk contact
- Person living in the same household as a confirmed COVID-19 patient.
- Passenger in close proximity (within 1 meter) of a symptomatic person who later tested positive for COVID-19 for more than 6 hours.
- A person who touched body fluids of the patient (respiratory tract secretions, blood, vomit, saliva, urine, faeces).
- A person who touched or cleaned the linens, clothes or dishes of the patient.
Low risk contact
- Person who has shared the same space (same class in school/worked in the same room) and not having a high-risk exposure to a confirmed case of COVID-19.
- Person who has travelled in the same environment (bus/train/flight/any mode of transit) didn't have high-risk exposure (within 6 feet distance) to a confirmed case of COVID-19.
If you are a high-risk close contact, you must get tested between the 5th and 10th day of coming in contact with a COVID-19 patient, even if you do not have symptoms. This is because if you have been exposed to the virus, it is likely that you will develop symptoms after an average 5 days of exposure.
However, if you do have symptoms, you should get tested at the earliest.
Take care of yourself & protect your loved ones
Though it is natural to feel worried after testing positive, you should be rest assured that the infection is mostly mild, and self-limiting, especially in young, healthy adults. However, in some people, it may turn serious, requiring hospital care
At this time, your priority should be to look after your own health, while preventing the spread of infection to those in your vicinity. You should first isolate yourself from your family members and limit yourself to one room. Thereafter, assess your degree of symptoms, and take action accordingly.
The revised guidelines by MoHFW state that very mild/pre-symptomatic patients having the requisite facility at their residence will have the option for home isolation.
|Case severity||Type of containment recommended|
|Isolation at home|
I tested positive for COVID-19 but am not showing symptoms.
While you may feel fine, it is important to inform your doctor about your test results. Remember the following:
- Without symptoms too, you can transmit infection to others. Therefore, isolate yourself in a separate room. If you do not have a separate room, you will be shifted to a nearby COVID Care Center.
- Take special care not to come in contact with elderly or those with co-existing disorders such as diabetes or high blood pressure.
- Keep a watch on your symptoms; and check your oxygen levels twice a day. If you develop any symptoms or your oxygen levels fall below 95%, contact your doctor.
You can end the quarantine period 10 days after testing positive, if you have not had symptoms for the last 3 days. There is no need for testing after the home isolation period is over.
I tested positive for COVID-19 but my symptoms are manageable.
In case of mild symptoms too, you can isolate at home, if you have a separate space to isolate effectively. Remember the following:
- Get plenty of rest, drink lots of water and take medicines prescribed by the doctor to relieve symptoms such as fever or cough.
Keep a regular check (twice daily) on the following:
- Any new symptoms that may have developed
- Any other parameter as advised by doctor or health worker
You can end the home isolation period after 10 days of symptom onset, if there has been no fever for 3 days. Thereafter, you will be suggested to continue to stay at home and self-monitor your health for further 7 days. There is no need for testing after the home isolation period is over.
I tested positive for COVID-19 and my symptoms are bothersome/serious.
If your symptoms become so severe that you are unable to take care of yourself then you should immediately reach out to your doctor. Especially if you are experiencing:
- High fever for 3-4 days
- Have comorbidities like diabetes, hypertension, cancer
- >65 years of age
- Or are pregnant
Report to a nearby hospital to find out about vacant beds; or simply call an ambulance at 102.
Patients or their caregivers should keep monitoring their health throughout the isolation period. If any of the following warning signs are noticed, immediate medical help should be sought:
- Difficulty in breathing
- Dip in oxygen saturation (SpO2 < 95%)
- Persistent pain/pressure in the chest
- Mental confusion
- Slurred speech/seizures
- Weakness or numbness in any limb or face
- Developing bluish discolorations of lips/face
Even if your symptoms are mild or you test negative, you may need to self-quarantine until your symptoms have disappeared because the symptoms may be due to another respiratory infection. If you’re not sure what to do, ask a registered medical practitioner about how long you need to be in self-quarantine.
If you have been identified as a high risk contact:
Continue to monitor your health for up to 14 days. If you have any new or returning symptoms, inform your doctor about it.
In addition to keeping a track of your temperature, the Ministry of Health & Family Welfare (MoHFW) recommends regular monitoring of blood oxygen levels even in mild, very mild, pre-symptomatic cases. If during the course of your home quarantine, you experience shortness of breath, calling your nearest general physician is the safest course of action. However, in several cases, despite the drop in oxygen levels in blood, you may continue to breathe comfortably, until pneumonia progresses to an advanced stage. The condition is called a ‘happy hypoxia’.
Shortness of breath due to COVID-19, may not be easy—or even possible—for a person to self-assess. That’s where a tiny, self-monitoring device called pulse oximeter can serve as a tool for early detection of oxygen deficiency. Using this, you can track your oxygen levels early on, similar to how a thermometer can track body temperature. A drop in the levels can signal for seeking prompt treatment, before breathlessness becomes evident or serious.
Learn to use a pulse oximeter correctly following the below simple steps:
- Place the pulp of the finger falling the light and the fingernail on the other side.
- Insert the finger and switch on the device
- Wait for a few seconds until a reading is displayed
- Pull out the finger
- Turn off the device, or it will be switched off automatically if it has that feature.
NOTE: A pulse oximeter does not detect COVID-19. If your device tells you that your oxygen level is low, it could be due to chronic lung diseases (such as COPD), lung infections or other factors. Low oxygen levels are usually NOT the sole indicator of COVID-19.
|With washing machine||Without washing machine|
|Use warm water at 60−90°C, along with any laundry detergent, and wash thoroughly.||Use a large drum having warm water at 60−90°C & any laundry detergent. Use a stick to stir; avoid splashing. Empty the drum and soak clothes in 0.05% chlorine for ~ 30 minutes.|
|Rinse the laundry with clean water and allow it to dry fully in sunlight.|
Always use gloves when handling any dishes, cups/glasses, or cookware used by a COVID-19 patient. Wash all utensils with soap and hot water or in a dishwasher.
Wash hands with soap and water after taking off gloves or handling used items. Make sure these utensils are not used by any other family member.
There is no need of testing prior to discharge from a COVID care centre or home quarantine as per the revised discharge policy on the MoHFW.
Mild or pre-symptomatic cases admitted to a Covid Care Facility can be discharged after 10 days of symptom appearance and no fever for 3 days. At the time of discharge, the patient will be advised to continue to follow the home isolation for further 7 days and monitor their health.
What’s the logic behind this?
- Via sneezing or coughing, the shedding of virus begins to decline after onset of symptoms.
- Ten days after the illness begins, recovery of live virus almost approaches zero.
- Many patients show no viral shedding in their secretions following the disappearance of symptoms.
- Others who do show such shedding, would not have live viruses after another 3 days. The RT-PCR test may still come positive during this period, but the virus is not live or infectious.
Hence, if you or your friend undergo a test, there is a fair chance that the result may come out positive, as the RT-PCR test would detect the dead/inactive viruses present in your sample. But in reality, you are neither yourself infected, nor can you transmit it to people around you.
Resolve. Restraint. Remove.
- The Risks - Know Them - Avoid Them. https://www.erinbromage.com/post/the-risks-know-them-avoid-them
- COVID-19 Containment & Response Measures. https://www.mohfw.gov.in/pdf/2COVID19PPT_25MarchPPTWithAnimation.pdf
- Strategy for COVlDlg testing in lndia (Version 5) https://www.mohfw.gov.in/pdf/Revisedtestingguidelines.pdf
- Detail Question and Answers on COVID-19 for Public. https://www.mohfw.gov.in/pdf/FAQ.pdf
- Revised guidelines for Home Isolation of very mild/pre-symptomatic/asymptomatic COVID-19 cases. https://www.mohfw.gov.in/pdf/RevisedHomeIsolationGuidelines.pdf
- The mystery of the pandemic's ‘happy hypoxia’ https://science.sciencemag.org/content/368/6490/455
- Caution about early intubation and mechanical ventilation in COVID-19. https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-00692-6
- Pulse Oximeter Not a Substitute for Talking to Healthcare Providers. American Lung Association. https://www.lung.org/media/press-releases/pulse-oximeter-covid-19
- Water, sanitation, hygiene and waste management for the COVID-19 virus. https://apps.who.int/iris/rest/bitstreams/1271257/retrieve
- Q&A: Infection prevention and control for health care workers caring for patients with suspected or confirmed COVID-19 https://www.who.int/news-room/q-a-detail/q-a-on-infection-prevention-and-control-for-health-care-workers-caring-for-patients-with-suspected-or-confirmed-2019-ncov
- Revised Discharge Policy for COVID-19. https://www.mohfw.gov.in/pdf/ReviseddischargePolicyforCOVID19.pdf