• Dr Jonathan Fluxman

Covid-19: A detailed guide how to isolate at home

Updated: Nov 14



Isolating in the home can be difficult, especially if the home is overcrowded and vulnerable people live with you. Try to follow this advice to reduce risks of transmission


SUMMARY

1. Isolate straight away if you are sick or a contact of someone who has Covid-19, don’t wait. 2. Wear a mask whenever you are in the same room with other people; they should also wear a mask. 2m distancing without masks is not enough. 3. Keep the windows open as much as possible. 4. Keep your distance from everyone else (no hugging or kissing) and keep interactions short. 5. If it is possible to have your own room, stay in it all the time, except for using the bathroom/toilet. 6. Use the kitchen and bathroom on your own; open the windows when you are there. 7. Wash hands regularly, clean surfaces and handles regularly 8. Consider going to stay somewhere else if there are vulnerable people in the home. People over 60 are a lot more at risk of getting infected in the home than those under 20. 9. Call your GP or 111 at any time if you are unwell or need advice.


Contents


1. Introduction

2. How does Covid-19 spread?

3. Make an isolation plan before anyone in the house is infected

4. Act straight away if you think you have coronavirus or are told you need to isolate

5. Things to do to everywhere to reduce spread of the virus in the home

6. Caring for people in the home and running the home

7. Overcrowding and multigenerational homes

8. The importance of ventilation

9. The importance of face masks

10. How long do I have to isolate? How long do other people in the house have to isolate?

11. Using the kitchen, living room and bathroom

12. Essential visitors to your home

13. Getting financial help while isolating



1. Introduction


If you have coronavirus, or you have been on contact with someone who has it, staying away from other people is very important to stop the virus spreading. This means not only isolating from people in the community or at work, but also from people in your own home. This is important because spread of the virus to other people in the same household occurs very often. We are in close contact and spend a lot of time together with people we live with. As many as 1 in 3 people at home can get infected when someone brings the virus home, [1] and many families have elderly people or those with medical conditions which makes them vulnerable to the virus. People over 60 are four times more likely to get infected in the home than those under 20. [2]


The most effective way of preventing spread in the home is for the infected person to isolate somewhere else. Many countries have set up isolation facilities in local areas, paid for by the government [3], but the UK government has not responded to calls for this to be done here. For some families isolating outside the home may not be possible, due to caring responsibilities and the need to run the home.


Isolating within the home can be difficult; the suggestions and ideas in this article should help. Even if you can’t manage to do everything suggested here, you will still reduce the risks of transmission. Please also look at official advice on the NHS website about this and related topics. Germ Defence is also a very helpful website with lots of information about how to self-isolate.


Before looking at what to do in the home, it is worth looking at how the virus is transmitted, so we know how we need to isolate from each other. Its also helpful to think about a plan how to isolate a member of the family before anyone has to do it for real.


2. How does Covid-19 spread?


The virus spreads the same way in the home as everywhere else:

  • Through the air by aerosols and droplets. It is really important to understand that the virus can float in the air indoors (like cigarette smoke) and we can breathe it in even if we are more than 2m away. Airborne spread is the most important way the virus spreads.

  • By direct contact with someone who is infected, eg hugging, kissing or shaking hands and then touching your eyes, nose or mouth.

  • By touching a surface which has virus on it, and then touching your eyes, nose or mouth.

  • The longer the time you spend in the same room as an infected person the greater the risk.

  • Enclosed indoor spaces with poor ventilation are high risk for spread.

  • Remember people without symptoms can spread the virus.

  • Talking loudly, singing and shouting produce a lot more virus, try and avoid this.



3. Make an isolation plan before anyone in the house is infected


Try and make a plan with your family and others you live with, how you will manage if you have to isolate. Try and do this before anyone gets the virus so you all know what to do. These are some of the things you could think about and discuss:

  • Is there somewhere else you could stay if you had to isolate? This is the safest option but it may not be possible, eg if you run the home or are caring for someone.

  • If you have to isolate is there a room where you can stay on your own?

  • Can you stay in only one part of the house if you have to isolate?

  • If you usually share a bed with someone else, can you sleep alone?

  • Do you and everyone else in the house have your own face mask? Face masks should never be shared.

  • Can someone prepare food for you and leave it outside your door?

  • Do you have friends, neighbours or family who can help with shopping, or buying medicines? There are also community groups helping people in most areas. The local Council will also have information of local support groups.

  • Think about what to do according to who gets ill and has to isolate. Who will provide care for elderly or disabled family members, or look after the children for example.

  • Who will you talk to, do you have a TV you could use, books or a computer to help manage the isolation. Stay in touch with people on the phone, by text or social media.

  • Do you have a garden or a private outdoor space – its safe to use this but only if this is not shared with other people.

  • Are there clinically vulnerable or older people in the house? Anyone over 60 and people with severe heart or lung disease, obesity, diabetes, or reduced immunity is at higher risk, so it is especially important to stay away from them.

  • If the house is crowded and you can’t stay in a room on your own, is it possible for anyone who is vulnerable, especially elderly family members to have a room on their own? If not is it possible for them to go and stay with someone else?

  • Agree on how to use shared spaces like the bathroom. You should use it alone and make sure the windows are open.

  • Is it possible to move seats or chairs further apart to try and socially distance, if people have to share the same space.

  • Are there cleaning materials to wipe down surfaces, handles and taps when you are finished. Don’t share towels with anyone else.

  • Are you registered with a local GP surgery? Do you have their phone number?

  • Find out what help the local Council can offer you and your family.

  • Talk to your employer and your trade union at work about your rights if you have to isolate, especially concerning pay and guaranteeing your job is secure while you are isolating.



4. Act straight away if you think you have coronavirus or are told you need to isolate


If you feel unwell and think you might have Covid-19, or if you are told you have been in contact with someone who has Covid-19 and need to isolate, don’t wait, act straight away. People are most infectious early on, just before and at the start of their symptoms, so put on your mask, stay away from other people and isolate yourself as quickly as possible. If you are at work, inform your manager and go home, do not finish your shift – you could infect your fellow workers in that time. Avoid using public transport if you can. If you take a cab to get home, open the windows. Keep your mask on all the time. Tell other people at home you might have the virus and are coming home, they should open the windows and put on masks before you come in. Go straight to your room, close the door and open the window. Call 111 and get advice, including about how to get a test.


If you are a contact of someone who has Covid-19, you will be advised what to do. Again, don’t delay, go home and isolate as soon as you can, you could be infectious even though you feel well. You should be told how long you need to isolate, but if you want advice, call 111.


IMPORTANT: You can infect other people, including family at home, even if you don’t have symptoms. So if you have been told by a doctor, nurse or the Test and Trace service that you need to isolate, please do it, even if you feel fine. The most infectious time is just before symptoms start and for the next few days. Studies have shown that early isolation by asymptomatic people is very effective in preventing household spread. [4]



5. Things to do everywhere in the home to reduce spread of the virus


  • Open the windows to improve ventilation. If its cold then open the windows for a few minutes every half hour or so to flush out any airborne virus.

  • Keep your distance from other people. This is very important; the closer you are, the more risk there is of breathing in virus. But remember it can travel more than 2m, so social distancing on its own is not enough. So no hugging or kissing until isolation has ended.

  • Wear a face mask – this will protect other people as well as you. Always wear a mask indoors if there are other people in the same room, even if you are more than 2m away.

  • Wash your hands every few hours, and after using any shared space in the house, like the kitchen or the bathroom.

  • Cover your mouth and nose if you cough or sneeze; with a tissue or your elbow. Throw away used tissues and wash your hands.

  • Buy some household cleaner to wipe down touch surfaces, especially in bathrooms.

  • Clean surfaces and floors with household cleaner. Avoid using vacuum cleaners and brooms if you can – they may kick up virus on the floor or carpet and re-suspend it in the air. If you do hoover or sweep, wear a mask, close the door of the room and open all the windows, and leave them open for a while afterwards.



6. Caring for people in the home and running the home


The work of running the home, caring for children, elderly relatives or people with disabilities will still need to be done if someone has the virus. This work often falls to women, and it may not be possible to get someone else to help, so you may need to continue to do this even though you are ill with the virus. These are some things to think about:


  • Many people with Covid-19 are not seriously ill, but some have severe fatigue, high fever and breathlessness. If you are severely affected you must look after yourself and rest. Get help from friends or relatives, or contact Social Services for help if there is no-one else to help. The infection can be unpleasant and very tiring, even if you are not serioulsy unwell, so get help if you possibly can.

  • Open the windows before you come in, or as soon as you enter the room;

  • Avoid close face-to-face contact if you can, or keep this to a minimum.

  • Do not talk loudly, sing or shout and keep talking time to a minimum; this will reduce the amount of virus produced. [5]

  • Both people should wear face masks, unless this is not possible due to medical reasons or causes distress. It is safe for children to wear face masks as long as they are aged three or older. [6]

  • Try not to cough or sneeze while you are in the room. If the person being cared for has the virus and coughs or sneezes, hold your breath and leave the room for a few minutes, and make sure the windows are open.

  • Wipe down any surfaces you may have touched, like rails, tables, etc. Leave the windows open for a while afterwards. Put on the heater if this makes the room too cold.

  • Cooking is safe, there are no reports of spread of Covid-19 from food. Wash your hands before preparing food as usual. If you have to eat together do not share plates or bowls.



7. Overcrowding and multigenerational homes


Many people live in overcrowded accommodation and this makes isolating a lot more difficult, especially in multi-generational families. Older family members, especially people over 70, are much more at risk of serious illness if they get infected. The same applies to people who are clinically vulnerable; keeping these two groups safe is very important. Try to do the following:

  • Allocate one room to the person who has to isolate if you can.

  • If you have to sleep in the same room, try not share a bed with anyone else.

  • Avoid close contact and keep some distance away from others in the room.

  • Avoid talking loudly, laughing and singing if you are sharing the room. These activities release much more virus into the room.

  • Limit the time you spend with each other as much as possible, other people should leave the room during the day.

  • Open all the windows in the room. If it gets cold, close them, but open them again 30 mins later. Put on the heating if it gets cold.

  • Wear a face mask – everyone should do this.

  • Elderly and vulnerable people could occupy one room, where others should not enter.

  • Consider moving out to somewhere you could isolate more safely, where you could have your own room. Think about this carefully and take advice from your GP or the Council public health department – remember you are infectious and you do not want to put anyone else at risk.

  • Consider moving out elderly relatives or those who are vulnerable – could they stay with family or friends while you are isolating?



8. The importance of ventilation


Because Covid-19 spreads through the air, ventilation is important to reduce risk. Good ventilation with outside air can be very effective. Try and do the following:

  • Keep the door closed in the room you or someone else are isolating in.

  • Open the windows fully to get good air flow before anyone else enters the room. Try and get a “cross draft”, i.e. open windows on different sides of the room, this will remove virus more effectively.

  • A fan in the room with an open window is helpful, but don’t use a fan without an open window – all it will do is circulate virus throughout the room.

  • Open other windows in the house and any outside doors if this is safe. Do this regularly. The more people there are in a room and the smaller the room is, the more frequently it should be ventilated.

  • Ventilate the whole house or flat three to five times a day for between five and ten minutes. [7, 8]

  • Ventilate any rooms where people spend a long time (e.g. work rooms, living rooms, home-office rooms) every one to two hours for between five and ten minutes.

  • If it gets cold, close the windows, but try and open them again as often as you can if you are in the same room as other people. Turn on the heating if it gets cold.

  • Open windows in the bathroom, toilet and kitchen – small, enclosed spaces are more risky.

  • If you have air conditioning in your home, adjust the setting for maximum outside air exchange. Check with the supplier or building maintenance how to do this if you need to, and also check if the system has air filters, which can be effective in removing virus aerosols from the air.

Important: Good ventilation on its own cannot prevent infection if you are in close contact with other people. Keeping your distance, wearing a mask and observing the rules on hygiene are also essential.



9. The importance of face masks


Face masks can be very effective in reducing risk of Covid-19. If everyone in the home wears one, there is two-way protection [9]: the amount of virus released into the air is reduced and the amount breathed in is also reduced. Important things about face masks:


  • Try and use cotton for the material for home made face masks. Two or three layers are best. Take care when buying face masks, some of them are poor quality and do not filter out the virus very well.

  • The mask must fit as well as possible, round the sides, above your nose and under your chin. If air leaks round the edges, it is less effective.

  • The mask must cover your nose and your mouth.

  • Always keep it on when there are other people in the room, even if you are more than 2m away from each other.

  • Don’t take off your mask when talking – you produce more virus when you talk, so keep it on.

  • Masks with valves will not protect people around you – the virus will escape into the room through the valve.

  • A face shield on its own is poor protection for you and the people around you. They only protect against “spray” of large droplets, but not against the fine virus aerosols which float in the air and move with air currents. They will move under the edge of the face shield and be drawn in to your mouth and nose as you breathe in, just as cigarette smoke would.

  • A face shield does protect the eyes from droplet spray from someone else, but it must be worn with a face mask to give effective protection.

  • Similarly if you are infected, wearing just a face shield on its own will not protect people around you in indoor spaces. It will stop any spray from coughing or sneezing but not the fine virus aerosols which will float through the large gap at the bottom of the face shield. This video shows this very well: https://aip.scitation.org/doi/suppl/10.1063/5.0022968 (copy and paste link into google and click on movie 1 or 2)

  • Perspex screens work in the same way as face shields. They will stop large droplets but not the fine aerosols, so you need to wear a mask as well if you have a screen at home or work.



10. How long do I have to isolate? How long do others in the house have to isolate?


This depends on your symptoms and your test results. It can be complicated so if you are not sure what to do, call your GP or 111 for advice; its important to isolate for the right period of time. These are the basic rules:


  • You need to isolate for 10 days from the day your symptoms start.

  • If you don’t have any symptoms, and you have had a positive test, isolate for 10 days from the day the test was taken. If you get symptoms after the test, isolate for 10 days from the day your symptoms start.

  • Other people in your house must isolate for 14 days from the day you get symptoms or 10 days from the date of your positive test.

  • If you have typical symptoms of Covid-19 and you have had a negative test result, you may still have the virus. Call your GP or 111 for advice, do not assume you don’t have it.

  • If you are still sick after 10 days you may need to isolate for a longer period. Call your GP or 111 for advice.



11. Using the kitchen, living room and bathroom, and washing clothes


Kitchen - it is better for other people to prepare food for you and bring it to your bedroom if possible. If you do use the kitchen, make sure no-one else is in there, open any windows, and wear your face mask. Wipe down surfaces with household cleaner when you are finished. Leave the windows open. Covid-19 is not transmitted in food.


Living room – open all the windows before you enter the living room, and wear your mask. Other people in the room should also wear their masks. Keep at least 2m away from people. Do not spend a long time together; even with masks there is still a risk of passing on the infection. Do not occupy the same room with anyone who is vulnerable if you can avoid it.


This is a good animation of the importance of masks and ventilation in the home (as well as for a pub and a classroom): https://english.elpais.com/society/2020-10-28/a-room-a-bar-and-a-class-how-the-coronavirus-is-spread-through-the-air.html


Bathroom and toilet – make sure no-one else is there, open the window and close the door. Bring your own towel, toothbrush etc from your bedroom. When you are finished, wipe down surfaces, and handles eg taps, toilet handle and door handles, inside and out. Leave the window open and close the door when you leave. Take your towel, toothbrush etc with you.

When using the toilet, close the lid before you flush the toilet. While there are no proof of spread through faeces, flushing does create aerosols so it is safer to close the toilet lid before flushing.


Washing clothes and bedding - there may be virus on these so don’t shake them out which might disperse virus into the air. They do not need to be washed separately from other items, and ordinary household washing powder will kill the virus.



12. Essential visitors to your home


No-one outside your household should visit the home while you are isolating, except for essential visits from carers and maintenance workers.


  • Tell them someone is isolating in the home before they come.

  • Open the windows before they arrive.

  • Spend as little time together as you can. Keep 2m away from each other.

  • Wear a mask, and the visitor should also wear a mask all the time.

  • For carers coming in to the home, they will be wearing PPE, including a mask. If the person needing care is able to s/he should also wear a mask.

  • Wipe down surfaces after they leave, leave the windows open for a while after they have left.

  • If you or someone else in the house cannot wear a mask (for example if it causes severe anxiety), spend as little time as possible in the same room as other people.


13. Getting financial help while isolating


Many people struggle to isolate because they do not have the security of a proper contract with their employer which will pay them full wages. The government will pay people £500 to isolate for 2 weeks (you need to claim the money from the local Council), but this is much less than what people on low wages need. The government urgently needs to increase support for people needing to isolate.



References


1. https://science.sciencemag.org/content/370/6515/406.full

2. https://www.medrxiv.org/content/10.1101/2020.04.11.20056010v1

3. https://www.theguardian.com/world/2020/jun/07/cuba-coronavirus-success-contact-tracing-isolation

4. https://wwwnc.cdc.gov/eid/article/26/8/20-1274_article

5. https://www.sciencedirect.com/science/article/pii/S1473309920308331

6. https://ihv.org.uk/news-and-views/news/phe-statement-face-coverings-for-babies-and-very-young-children/

7. https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/so-schuetzen-wir-uns.html

8. https://www.schulen-lueften.ch/de 9. https://www.cdc.gov/coronavirus/2019-ncov/more/masking-science-sars-cov2.html


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