It is important to control the symptoms from the fifth to the tenth day.

When a relative of mine became seriously ill with what appeared to be an infection from coronavirusMy first question was about when it manifested. How many days ago did the first symptoms appear?

Keeping a calendar of the first signs of the disease and controlling fever and oxygen levels are important steps in controlling this type of infection. A covid-19, the disease caused by coronavirusIt has been unpredictable in the variety of symptoms it can present. But when it gets worse, it follows a persistent pattern.

Although most patients are hospitalized within a week, a sizable minority enters a “second, tremendously uncomfortable” phase of the disease, according to Ilan Schwartz, assistant professor of infectious diseases at University of Alberta. “After the initial symptoms, the situation stabilizes and maybe even a little better, then an acute second phase follows.”

Although one patient is different from the other, doctors say that the fifth to tenth day of illness is the most worrying time, often due to respiratory complications, especially for elderly patients and people with pre-existing health problems, such as discharge pressure , obesity or diabetes. Younger patients who have complications often begin to have difficulties a little later, from 10 to 12 days. Most people who arrive on the 14th day without troubling symptoms (just extreme weakness) are likely on their way to recovery.

“For other illnesses, most people, after a week of symptoms, start to feel better,” he said. Leora Horwitz, assistant professor of health and medicine of the population in NYU Langone Health. “With the greedyI tell people that after a week I want them to really pay attention to how they feel. Don’t be complacent when you think it’s all over. ”

It is important to call a doctor if breathing becomes difficult or if other troubling symptoms appear, regardless of the day on the disease program the patients are on. And don’t panic and still feel horrible after a week. It is common for greed symptoms to persist, and feeling sick for more than a week does not always mean that people need medical treatment.

But controlling symptoms and paying attention especially as the disease approaches the second week will be an urgent measure because doctors see patients arriving at the hospital with an insidious form of pneumonia.

On radiographs, those with pneumonia of the greedy they have “ground glass-like opacities,” a haze at the bottom of both lungs. Oxygen levels drop so slowly that the patient doesn’t even notice the so-called silent hypoxia. Often, it is only after oxygen saturation reaches dangerously low levels, causing severe difficulty breathing, that patients finally seek medical attention.

The best way to monitor your health during this period is to use the pulse oximeter, a small device that holds the patient’s finger and measures oxygen levels in the blood. (There are cell phone apps that do this, but their tests have been found to be inaccurate.) Normal oxygen saturation varies from approximately 96% to 99%. If your oxygen level drops to 92%, it is time to call a doctor.

While the person is still at home, he can also increase the flow of oxygen in the lungs by not lying on his back. Resting on your stomach, in the prone position, you can open the parts of the lungs that compress when you are lying on your back. You can also lie on your left or right side, or sit upright in a chair.

Anna Marie Chang, an assistant professor of emergency medicine and director of clinical research at Thomas Jefferson University, became ill for about a week before her oxygen levels dropped to 88% on the ninth day of the illness. She went to the hospital where she was treated with oxygen and lay mainly on her stomach for four days to recover.

It is unclear why relatively young patients like Chang, 38, sometimes get worse.

“The first part is a viral illness and everything,” said Chang. “Your body develops an autoimmune inflammatory reaction and tries to fight the infection. This system can be over-stimulated, and this appears to be causing the worsening. We see this reaction around day 7-10.”

She recommended that patients pay attention to what their bodies are saying and not follow symptoms closely. “The human body does not follow the perfect manual,” he said.

The problem, according to doctors, is that so far the general medical advice has been to recommend that patients treat the disease at home and seek medical attention or return only if they experience severe respiratory failure. This is why so many patients wait too long to see a doctor.

“From a public health point of view, we were wrong to tell people to return only if it is very difficult for them to breathe,” said Richard Levitan, a well-known New Hampshire emergency room physician, who called for the extensive use of oximeters for pulse at home in the first two. covid-19 weeks. “Holding on tight is not a good strategy.”

Levitam notes that while many patients’ conditions may worsen from the fifth to the tenth day of illness, they hesitate to be too specific about the time period because not all patients have a clear idea of ​​when their illness began.

“Sometimes patients set a different disease term than might be expected,” Levitan said. “When asked how long he has been ill, a patient will say a few days and his wife will say no, that she has been ill for a week.”

But what if you don’t have a pulse oximeter to monitor your health? These devices are currently in short supply on the market or delivery takes weeks.

Some doctors send kits that include pulse oximeters to their home patients, so ask your doctor if you should be monitored. Ask your friends if they have an oximeter to borrow for two weeks in case they get sick (the device can be easily cleaned).

If you still feel unwell a week after the start of your illness and don’t have an oximeter, you can also go to an emergency clinic and ask them to check your oxygen level. If you are concerned, talk to your doctor about the need to see an emergency medical center or emergency room.

In the absence of an oximeter, a rough measure of respiratory function is through a test called the “Roth score,” which you can do yourself. For this you must inhale and hold your breath for a count of 30.

If the patient cannot count to 10 (or seven seconds) without breathing again, their oxygen level may be below 95. If the patient cannot count to 7 (five seconds), their oxygen level may be below 90% The test is not perfect, nor has it been studied in covid-19. A team at Oxford University said the Roth score should not be used because it has not been validated and could give false hope.

Another physical but subtle symptom of oxygen drop is when patients begin to breathe quickly and with a short inhalation to compensate, albeit without realizing what they are doing. Patients with low oxygen levels may also have bluish lips or skin. This is why a video conference with your doctor can help if the person is not sure if they need to go to the hospital.

Below is the covid-19 symptom schedule. Although this can serve as a general guide, symptoms can appear at any time. Always pay attention to what your body says and consult a doctor to find out how to orient yourself in your specific case.

DAY 1 TO 3

The first symptoms of covid-19 vary considerably. They can start with an itchy throat, cough, fever, headache, shortness of breath, or light pressure on the chest. Sometimes it starts with diarrhea. Some people just feel tired and lose their taste and smell. Many have various symptoms, but no fever. Some patients with gastrointestinal symptoms will experience respiratory symptoms, others will not.

DAYS 4 TO 6

Some patients never show more than mild symptoms, or none at all. Others start to feel terrible, with constant fever, body aches, chills, cough, and cannot feel comfortable.

Some children and young adults with a mild form of the disease may experience skin rashes, such as itchy red patches, swelling, or blisters on the toes or hands, similar to cold burns.

The exact time is not clear and the symptom may appear at the beginning of the infection or after it has passed. It happened with Schwartz, who had respiratory symptoms and then blistered feet. “It appears that many of these people, including me, are negative” on the coronavirus swab tests, he said. “I suppose it is a false negative. Perhaps what we are seeing is an immunological phenomenon that occurs after the initial infection begins to heal.”

DAY 7 TO 8

For some patients who are lucky enough to have a mild form of the disease, the worst ends after a week. According to the guidelines of the Centers for Disease Control and Prevention, patients whose symptoms have improved and who have not had a fever for three days may abandon isolation.

But others who have felt very bad will continue to feel bad or even worse. Still others may start to feel better for a short time and then get worse.

Patients should monitor their oxygen levels and consult a doctor to see if they start to get worse. “We should advise patients not to wait too long to see a doctor,” said Levitan. “I think they should see the doctor for supervision when they find that they are getting worse.”

DAYS 8 TO 12

Monitoring should continue in the second week of illness. Patients may feel better sleeping on their stomach or on their sides.

“It is from 8-12 that we really have a way of knowing if a person is getting better or worse,” said Charles A. Powell, director of the Mount Sinai National Institute of Jewish Respiratory Health. “Our biggest concern is an aggravation from 8 to 12: increased difficulty breathing, an increasingly worse cough.”

Powell said a home oxygen monitor can indicate if someone needs to go to the hospital. Otherwise, patients should speak to their doctors.

“It is difficult for the person at home to feel comfortable, and it is difficult for the family to think that they can handle it, and this will cause the doctor to suggest that the patient come to him for an evaluation,” Powell said. “We don’t want to wait too long until oxygen levels drop too low and get worse.”

DAYS 13 TO 14

At this time, patients who have had a mild form of the disease should be well recovered. Those who had more severe symptoms but maintained normal oxygen levels should feel quite recovered after two weeks.

However, patients with severe symptoms and those who needed additional treatment due to low oxygen levels may still feel sick and fatigued and may take longer to recover. / Translation by Anna Capovilla