All the good care in Level 2 has not worked and things are getting worse. Doesn't mean you did anything wrong, just keep going. Except now the patient is getting weaker. He or she is often too weak to get out of bed and may need extra encouragement to eat and drink.
This is when you start telling other people around you that you are really ill and are mostly in bed. Talk to someone you trust about how they may have to take care of you. Have this person or these people read this document. If you have people in your environment who have already had COVID-19 (something that will be increasingly common as time goes on), such people would naturally make the best caregivers as they presumably will be COVID-19-immune. Otherwise try to judge what is wisest in your circumstances. By all means do not wait with this until the very last moment, because if the disease progresses, you will get short of breath which inevitably will also affect your ability to talk and to think clearly.
- Stay in bed. At this point rest is very important. The patient should sleep as much as possible. At least in the beginning, patients will still be able to get out of bed for limited amounts of time. Toilet, a quick rinse-off shower, weighing once a day (note in diary). Put new sheets on the bed as often as possible and wash the old sheets at 60 degrees Celsius or warmer.
- Ventilate the room as often as possible.
- Drink more water! (more than 2 liters and less then 5 liters a day).
- Try to eat vitamin-rich foods, but multi-vitamin drink is also ok.
- Inhale more often.
At this point, read ahead for all the signs that indicate Level 4. The purpose of care in Level 3 is also to monitor the patient more and more closely so as to catch early any signs that the patient is moving to Level 4. For instance: If the patient is not able to drink at least 2 liters of fluids per day, you should (kindly) insist. Dehydration is a medical condition, and without this daily bare minimum you're quickly in Level 4.
In most cases, however, the patient will improve after a few days or at most a week. Just stay with it. Once the patient gets a little better, care may be done by the patient him- or herself again. Make sure the illness diary and quarantine are kept up until the patient has been completely well for a while. If you have been caring for the patient, your own two-week self-quarantine period now begins.
A large part of the work you are doing at this stage is care work, which may overlap with nursing but does not require specialized training. Remember that people who need help with basic self-care due to illness may be embarrassed to ask for or accept it. Be gracious. Everyone needs help sometimes. Think how to make the patient physically, mentally, and emotionally more comfortable and well; you might do this by asking yourself what you would need in their position, by watching for cues about discomfort (e.g., shivering, sweating), or by asking how you can help.
Some possibly useful behaviors include:
- Getting at eye level and at a distance that is large enough for comfort but small enough that they do not have to strain speaking loudly to talk to you.
- Simple encouragement to drink and eat. (E.g., "Drink, honey.")
- If the patient is not drinking or eating adequately, offer alternatives. (E.g., if solid food is unappealing, what about soup, bouillon, or electrolyte solution? If hot drinks are unappealing, what about something cold, or vice-versa?)
- Checking that the patient is warm enough in the extremities (e.g., cold feet?) and at night.
- Reassure the patient that it is likely that he or she will make a full recovery.
- If breathing is labored, try breathing techniques (e.g., pursed lips or diaphragmatic breathing techniques) and positional changes (e.g., leaning your chest forward a little or putting your arms and head down on a table while sitting with feet flat on the floor; or sleeping on your side with a pillow between your knees, or on your back with your head elevated with a pillow or two).
- Keeping the illness diary (see below).
As mentioned in the previous section, you might want to use this printable form, or make your own.
At this stage, watch out especially for and note symptoms that might suggest worsening. Read the next section for more detail, but these include dizziness or rapid heart rate (drink more and eat something if you can), rapid breathing (elevate head while lying down or lower it to the table while sitting up for easier breathing), and a blue tint to fingertips or lips (cyanosis - get fresh air, get warm, and check blood oxygenation if possible). Also consider using relaxation techniques to slow a rapid respiration or heart rate that may be partially due to anxiety: Listen to soothing music, check in with a friend electronically, or see if you can slow your breathing and bring down your heart rate by counting longer for forceful exhaling than for gentle inhaling. (Some people use 4-7-8 and others prefer 5-2-5 to try slowing down their inhale-hold-exhale patterns.)
If you think the patient's condition might be worsening, your illness diary might expand to include the following:
- more frequent temperature readings
- respiration rate (breaths per minute)
- heart rate
- onset of new confusion
If the patient's condition seems to be worsening, skip to the next section.
At this stage, a typical day might look something like this:
You (or the patient) get up, weigh, and note weight in illness diary. You might also want to take your temperature first thing, before eating or drinking, especially if you are taking temperature orally - and note it in the illness diary, too.
Then, start drinking fluids. Not too much caffeine or sugar. As much water and herbal tea as you like. Remember you want to drink at least 2 liters and up to 5 liters a day.
Air out your home as much as possible, perhaps while the water for your morning tea or coffee is boiling. If you have the energy (and enough sheets), consider changing your bed linens if they got sweaty / otherwise soiled. Next, have a quick shower if you're able. Staying clean can help you feel better mentally and emotionally, as well as physically.
Eat a small, nutritious meal (piece of fresh fruit? handful of salted nuts?) - something that sounds good to you. This is also a good time to take paracetamol (also known as acetaminophen) for fever / pain if you need it, and note the dose and time in your illness diary.
If that was already enough exertion, take a rest. Nap whenever you can - sleep is crucial for healing. If you're not sleepy but need to rest, then try to rest sitting up to give your lungs a better chance to drain. If you're still upright, now is a good time to steam to help your sinuses / airways open and mucus to drain.
Keep drinking throughout the day. Some people find it helpful to empty and refill a liter bottle of water or a teapot that holds approximately a liter, so that it's easier to keep track of roughly how much you have drunk. This also makes it easier to keep water by the sofa or bed while you are resting.
Throughout the day, check in with yourself about fatigue (sleep as much as possible), hunger (eat small, nutritious meals), thirst (drink whenever you feel like it), and temperature (take care to keep warm enough). If you feel up to it, and only if you feel up to it, move (e.g., go for a short walk as long as it's still permitted where you are, or get up and dance to a favorite song).
Finally, you want to be alert to signs that your condition may be worsening and you may need more care. So after taking basic care of yourself, then check in with other people around you who know that you are really ill. Let them know how you are doing - and if you need help, ask. Especially let someone know if you start experiencing more severe symptoms (see the next section).