UNOFFICIAL GUIDE

By Abigail Joyce from Singapore

AN UNOFFICIAL GUIDE ON WHAT TO DO WHEN THERE IS A COVID POSITIVE PATIENT IN YOUR HOUSE! (BASED ON MY PERSONAL EXPERIENCE)

Note: This is not intended to substitute the comprehensive information set out in the various Government websites which are easily accessible. Rather this is intended to be a primer/”thought-starter” document summarizing the considerations (non-exhaustive) you may want to take note of in light of such a situation. Learning points were gathered from personal experience! And perhaps most importantly, to note that while these are all pragmatic tangible “solutions” to also rely on guidance and healing from God which is – irrefutably the most important. Prayer both prayerparation (prayer + preparation) and prayer for healing in combination with sensible practical measures, is (in my opinion) the best way to go!

https://worldcouncilforhealth.org/resources/early-covid-19-treatment-guidelines-a-practical-approach-to-home-based-care-for-healthy-families/

Phase 1: Someone tests positive in your house (Day 0) Someone tests positive in the house! First step DO NOT PANIC! Get the individual to do another ART test (twice) and if both are clear positives, then you can safely assume that he/she has COVID. Under the previous Government measures, the infected individual would have to go to the nearest testing clinic to get a PCR test for more definitive confirmation, but (as of today) such PCR confirmation is not necessary.

Phase 2: Containment and identification of full scope of infection (Day 0) The most crucial thing to do in this instance is to get EVERYONE ELSE WHO LIVES IN THE SAME HOUSE, TESTED as soon as practicable. The objective of this is to ascertain who is HEALTHY (and so can be a caregiver) and who is INFECTED (hereinafter referred to as the “home patient”). Note that, even if the other individuals in the house test negative on the first day, this is not to say that they may not test negative in the subsequent days as the virus (as I understand) takes awhile to incubate in the body. Mandatory declaration to MOH that you are “COVID Positive” or a “Close Contact of a COVID Positive patient” to MOH – once everyone has undertaken their ART test and obtained their results, please disclose your results to MOH on the Government portal. Do note to take pictures of all ART tests and to take note of the date and time you took the test. An easy trick to do this is I would hold my test up against the bottom right-hand corner of my computer so that I instantly knew from each picture the corresponding date/time I took the test.

Do note that there are ONGOING reporting obligations for the COVID Positive Patient and the Close Contact of the COVID Positive Patient. For Close Contacts specifically – under the current Government regulations you can still resume your daily activities i.e. go out as long as you test NEGATIVE for that day. Each negative test is only valid for 24 hours (and you have to submit this daily to MOH for 7 days). Please refer to MOH website for more details. 

  Immediately, contain the infected individual to a room. If you have the privilege of a multi-storey house, you may quarantine the individual to a single floor. If like me you have only a typical 4 room flat with the master bedroom as the only en-suite room, then the infected individual should be isolated in the en-suite room. 

Phase 3: Stabilization and recovery (Day 1 – 7) Deep clean the house – After the COVID Positive patient has entered into the isolation room, immediately kickstart a deep clean of the entire house. The purpose of this is to ensure that every other space in the house which all the unaffected family members will be staying in, is clean and they will not be infected by any residual virus that is lingering in the air/on surfaces. How I did this (with my brother) is we sprayed a Dettol dilution mixture over the floors and all surfaces before wiping it down, thereafter we vacuumed all areas, and finally (an idea I came up with which has 0 scientific basis – purely from my days studying biology as a kid) I would suggest using a HAIR DRYER to heat up all areas which are commonly used e.g. the sofa – the rationale being the heat from the hair dryer would denature the virus (simply due to heat). We put the hairdryer on the highest setting and aimed directly on the sofa (very close contact) for maximum heat exposure.

Protocol for all unaffected family members – the first 5 days (Day 1 – Day 5)post identification of COVID patient, is the most crucial as during this time, while the other family members may have tested negative, they COULD be COVID positive (just the virus is still incubating and has not fully expressed itself yet). As such, for the first five days, AS FAR AS POSSIBLE ALL UNAFFECTED FAMILY MEMBERS SHOULD SOCIALLY DISTANCE AND STAY IN THEIR OWN ROOMS/CONFINED AREAS as though the other person WERE positive. This includes wearing masks when leaving your personal room/area to common areas e.g. toilet/kitchen. We only lowered our guard after all other family members continued to test negative 5 days in a row and had no other visible symptoms!

Common areas should be routinely sanitized. If you are as particular/anal as me – this means 3 times (morning/afternoon/night) everyday – by common areas I don’t just mean the toilet/kitchen but also routinely touched items like taps, faucets, knobs, fridge handles. Anything you can think of which you touch at least 2 – 3 times in a day – SANITIZE IT!

Other things you may consider which we implemented are: • Toothbrush leave it in your personal room, not the communal toilet • Do not take ice using your hands!! Make sure you use a scoop • Everyone had a defined set of cutleries which we stuck to everyday (to minimize cross contamination) • Routine spraying of aerosol disinfectant on sofas • Eating separately in our individual rooms for all 3 meals

Caregiving preparations – after the house is deep cleaned the second priority is to make caregiving arrangements for the home patient. This means thinking how to provide food/water/medication without coming into direct contact with the home patient. • To avoid contamination – use disposable cutlery e.g. we serve food to the home patient on paper plates with paper forks and spoons. Food is left on the door. Then we go back to the room and only after we are away from the door do we send a text message to the home patient that he can collect the food by the door.

• We had a big water tumbler which we would refill 3 times a day. Each time the tumbler is left outside the door it indicates the patient has ran out of water. Individuals responsible for refilling water will be fully masked up with rubber gloves as the tumbler would be contaminated (as it is touched by the patient). • We give the patient trash bags so that he/she accumulates all the disposable cutlery from all 3 meals and we dispose the trash bag once at the end of every night.

As patient may feel uncomfortable during their recovery process, things that can help to ease discomfort include having losengez, honey water, apple cider vinegar, and numbing throat spray Most importantly, ensure that patient has an oximeter so they are closely monitoring their O2 levels

Phase 4: Preparation for re-entry (Day 15 onwards) Assuming the patient tests negative after 2 weeks, arrangements have to be made before the patient leaves the isolation room WHY CLEANING IS IMPORTANT: As the virus can survive on surfaces of different materials for at least 2 to 3 days, surfaces potentially contaminated with the COVID-19 virus (e.g. commonly touched surfaces, surfaces which may have been exposed to respiratory droplets such as sneezes or coughs, and floors) should be sanitized! We don’t want to risk a healthy family member entering the isolation room and falling ill

Before you start cleaning, put on a pair of gloves, N95 mask, eye goggles and a disposable gown Avoid using a spray pack to apply disinfectant on potentially highly contaminated areas (such as toilet bowl or surrounding surfaces) as it may create splashes which can further spread the virus. Also, alcohol-based disinfectant is flammable, do not spray it into the air! I would also suggest setting out a table to document every element of the isolation room which needs to be cleaned to leave nothing to chance, a sample table which we put together in my family is set out below for reference:

THINGS TO BE DISINFECTED IN THE ROOM 

Proposed Cleaning Solution – Note most of the solutions we extracted from NEA’s guidelines:

Toilet • Toilet bowls • Toilet fixtures/fittings • Uncovered items • Clean toilets with a separate set of equipment (disposable cleaning cloths, mops, etc) using disinfectant or bleach solution. Use an appropriate disinfectant and note that different active ingredients require different periods of contact time to be effective.

• Clean all accessible surfaces (sinks, taps, soap dispensers, toilet roll dispensers, walls, cubicle doors, cubicle locks, handles, flush buttons, etc).• Urinals and toilet bowls can be disinfected by pouring disinfectant into the urinal/toilet bowl. Allow for an appropriate contact time. Clean urinals and toilet bowls with a brush and use a separate cloth for seat covers. Brush and cloths used for these should not be used for other surfaces.• Consider disposing/replacing cheap toiletries (soap bottles, etc)• Replace toothbrushes and toothpaste

Bed – Mattress – Cushion • Arrange for a cleaning contractor to properly disinfect the mattresses, pillows, cushions or carpets that have been used by the person who has been confirmed to have the COVID-19 (NEA guidelines) • Throw away the old bedsheet/pillow cases which was in the isolation room used by the covid positive home patient

Clothing • Use the warmest appropriate water setting and dry items completely (CDC guidelines)• Put clothes in boiling water, sun it, before putting into the washing machine• Send to third party clothes cleaning laundry location. Floors and walls – Fan? • Mop floor with prepared disinfectant or bleach solution, starting from one end to the other

Aircon • Get aircon company to do a chemical wash of the unit connected to the isolation room. Other surfaces• Wipe all frequently touched areas (e.g. doorknobs, arm rests, seat backs, tables, air/ light controls, keyboards, switches, etc.)

Miscellaneous • Things you should have stored in the house: • Sufficient ART kits • Dettol • Disposable gloves (we preferred rubber gloves over plastic gloves) • A huge water tumbler • Disposable plates and cups • Big trash bags • Hand sanitizer • Aerosol disinfectant sprays • Oximeter (collect the free one from Temasek holdings) • Povidone-Iodine Mouthwash or spray (e.g. Betadine)