If you are not already self-isolating, or considering it, there is a high chance you will be in the coming months. The government’s advice is that people who live alone and have a fever or a continuous cough should be completely isolated for seven days, while 14 days of “whole household isolation” is recommended where anyone has those symptoms. This means not even going out for a walk or opening the door to receive a delivery directly.
This extreme state is ringed by the equally novel and perhaps more poorly understood concept of “social distancing”. At its most basic, this means trying to drastically reduce the amount of contact you have with other people, especially if you are 70 or older. If your average day features 1,000 interactions – public transport, the office, the shops, the pub, the cinema – then reducing that to 500 interactions will have a material effect on your chances of contracting the coronavirus and on the speed of transmission overall.
It sounds simple, but both concepts throw up multiple practical follow-up questions – to which the answers are often unclear. Prof Tom Jefferson, a British epidemiologist based in Rome with the medical research group Cochrane, is an expert in reducing the spread of respiratory viruses. He says that we may have to tolerate this lack of clarity. “There is no certainty in science,” he says. “Uncertainty is the engine of science.”
Here, though, is what we do know.
How do you decide whether or not to self-isolate?
Public Health England’s guidelines list the most common symptoms as a fever and/or a continuous cough. The policy was originally to test returning travellers or anyone who had had contact with someone known to have the virus. Geography-based testing has now stopped. Testing was limited to hospitals, briefly, but will be rolled out more widely, in the first instance to frontline healthcare workers.
Greg Fell, a director of public health in Sheffield, says: “Were it me and I’d come down with fever and a cough, I’d assume it was Covid-19,” he says. “I’d encourage a really low threshold for ‘persistent cough’,” which is to say any cough. Similarly, you should count any raised temperature as a fever.
How long should you self-isolate?
Even if you live alone, there is considerable debate about this. Jefferson says: “I would self-isolate for 15 days to make sure.” The reasoning behind this lies in the evidence of countries where testing is more widespread. In South Korea, considerable numbers of people who tested positive were asymptomatic; likewise, on the cruise ship Diamond Princess, where the whole passenger list was tested, half of those with the disease had no symptoms. Charles Chiu, a professor of laboratory medicine at the University of California, San Francisco, has said that coronaviruses generally have an incubation period of two to 10 days and that “it is extremely unlikely to be longer than two weeks”.
Prof Carl Heneghan, the director of the Centre for Evidence-Based Medicine at the University of Oxford’s Nuffield Department of Primary Care Health Sciences, who is also a practising GP, is blunt about this: “You can still be shedding virus fragments beyond the infectious phase. If you want to be ultimately safe in this period, you go to the 14-day measure. If you want an economy to work, you go for the seven-day measure – remembering that austerity killed 40,000 people on average, every year for five years after 2009. If we kill the economy, we’ll end up with austerity again and about 200,000 deaths. This is a real balancing act.”
What does self-isolation entail?
It really is as it suggests: go nowhere, see no one. Have deliveries left on the doorstep. Don’t see other self-isolating people. The PHE advice is to sleep alone and to keep two metres away from those you live with. But having spoken to a number of people who are self-isolating, this is simply not realistic. It is very hard to prevent transmission between flatmates. The stress of trying to preserve a physical distance with your children, particularly if they are small, probably outweighs the benefit.
Should you visit older relatives?
“Anybody who has any sniffle should not visit their elderly relatives until they are completely well,” Heneghan says. “Particularly keep an eye on young children, whose symptoms can be incredibly mild.”
However, complete isolation also has drawbacks for our health, he says: “It is not a good strategy to isolate people completely. If you do that, you’ll create more problems. Isolation itself weakens immune systems. We are a social species.”
Instead, observe social distancing when you visit: wash your hands as soon as you arrive; don’t hug, shake hands or otherwise embrace; sit well apart; make sure older relatives use hand sanitiser; and try to keep the room ventilated (while the virus is not believed to be airborne, better circulation will reduce the contact risk).
What can you do for elderly or vulnerable relatives besides visiting?
Make sure they have supplies of any regular medication, since it is possible that core health services will start to break down in the near future. Book online deliveries for these drugs.
What can you do for older and immunocompromised people in your community?
Many boroughs have a dedicated Facebook page – search for your area plus “Covid-19 Mutual Aid”. Iona Lawrence, a community organiser, says thinking hyperlocal is the best way to help. “It falls on us all to work out who on our street is old or particularly vulnerable. A good place to start is putting notes through neighbours’ doors and doing small things such as helping people to set up Skype or video-calling, if they don’t already have it.”
This, she says, will help to build relationships before the government instructs older people and other vulnerable people to stay at home.
Heneghan points out that nursing homes are particularly at risk. She makes a case for building a volunteer army, as there are no measures in place to provide cover if staff become ill.
How should you talk to children about coronavirus?
The advice is always to start with an open question – How much do you know? How do you feel about it? – but I would preface that with some expertise drawn from experience: if you talk to your kids in an unfamiliar register, that alone will freak them out.
Don’t use stock lines you have read; adapt the language so it sounds like something you would normally say. Fortunately, you can reassure them while staying factual: the disease does not tend to cause serious symptoms in children. “We don’t yet know why not,” Jefferson says. “Were they exposed to something in utero? Or is it that the micro-organism itself needs a certain habitat to reproduce quickly?”
Furthermore, unlike flu – which children experience mildly, but “spreads like nobody’s business”, as Fell puts it – coronavirus does not seem to spread through children in the same way.
How do you keep kids entertained if you are all self-isolating?
Outside of homework and home learning, there are some basic principles: give a bit of structure to the day; divide it into a timetable and share that with them. If they are young (under eight), you can probably build in some exercise: mini-circuits, bear crawls, dancing. If they are older than that, they will laugh you out of town.
Focus on five skills you want them to master by the end of quarantine – making pancakes, learning poker, knitting, touch-typing, learning Uma’s dance routine from Descendants 3 – and do a few minutes on it each a day. Build in some time for them to Skype their friends. Watch box sets.
How should you seek reassurance about your health worries?
“What matters here is how people use health services,” says Heneghan. “If they use them like they use Tesco and toilet roll, we’ve got a problem.” In other words – be considerate and sensible. “Be aware that any health centre, any hospital, is a potential source of infection. It’s incredibly difficult for it to be a clean place – it’s the last place you want to be unless you’re seriously unwell. If you feel OK, you need to look after yourself at home.”
Video consultations with GPs will be stepped up, but even these will be overstretched. The constant advice, from everyone, is that the worried-well, or the worried-infected-but-surviving, need to find sources of reassurance other than from health professionals – friends, family, neighbours.
If you are not self-isolating, or you have emerged from self-isolation, one way to take your mind off your anxieties is by trying to unearth the presently invisible need in your community. Will Higham, the associate director of programme innovation at the charity Rethink Mental Illness, says: “There’s a huge community of very vulnerable people who rely on trusted relationships to get through their day. If you are living with severe mental illness, there’s a high chance that the mood music of this crisis will be deeply worrying to you.”
Again, even though the infrastructure for volunteering is unclear or underdeveloped, think about what capacity you have and research ways to use it.
What should you do if you get an illness that isn’t coronavirus?
If you feel unwell at all, even without a fever or a cough, “just take a pause, reflect, stay home and see where it develops”, says Heneghan. “In that two- to three-day period, when you have what you might think is just a bit of a cold – and might be just a bit of a cold – the way people behave could have an incredible impact on rates of transmission.
“That’s the principle of social distancing. The government strategy, from my perspective, is spot on. If you put draconian measures in place, people lose their trust. Asking people to act responsibly and use their judgment is an incredibly useful public health method.”
If you have an existing condition, or one that develops during this crisis, the broad principles are the same as for the coronavirus: seek medical attention if it is serious, but do everything you can not to put undue stress on services.
What should you order in, whether for yourself or others?
There is a huge amount of righteous wrath about supermarkets’ empty shelves and the evils of stockpiling. In fact, it is not necessarily that we are all antisocial. This is just what shops look like when everyone has been encouraged to have enough food in to last for a week or two. However, do not hoard toilet roll or hand sanitiser, especially given that the protective effects of hand-washing appear to be as much related to the abrasion as the substance. Nor should you stockpile ibuprofen: although it reduces fever, it also dampens down the immune system and can increase blood pressure; it should be used only if you have an intolerable headache.
Nobody serious is suggesting that eating more blueberries and kale will protect against the virus, but there is evidence that alcohol depletes immunity. Make sure older relatives have food and drink that is appetising; they often become dehydrated because their thirst response has diminished, so they need things that are enticing.
Try to use local shops, which are likely to suffer more from an economic downturn than large chains. You can pack a freezer full of Chinese dumplings, which you will thank yourself for when you don’t feel like cooking. If you are not self-isolating, choose click-and-collect over deliveries, to leave the slots for people who need them.
How can you stay cheerful?
Don’t be too hard on yourself. Watch trash if you want to. Read Hilary Mantel’s The Mirror & the Light: it is so long that it feels as if it could have been written just for this moment.
Anecdotal evidence suggests that having a pet is a boon, although whether you should buy a dog in anticipation of self-isolation is moot, given that someone has to walk it. In Italy, where even the asymptomatic are asked to remain at home, “there’s dog sharing going on among neighbours”, says Jefferson, “because people are climbing the walls, and one way legally to get out is to walk the dog. The dogs are absolutely exhausted.”
How can you stay fit at home?
There is a good chance, if you have symptoms, that you will not feel very energetic, so I reiterate the point above: be kind to yourself. It is not the end of the world if your fitness slides a little during a national emergency.
However, it seems likely that gyms will close, at least for a time, and social distancing will ramp up, so even if you are quite well and boisterous you will need other outlets for your energy; I can’t see many people doing hot yoga or using a climbing wall in a month’s time.
I strongly recommend doing 30 minutes a day of online yoga; it is very calming, apart from anything else. Look on YouTube for an old Cindy Crawford workout, or a Mr Motivator; these are extremely cheering and date from an era before anyone was expected to have any equipment – not even a mat. It is amazing what Crawford can get up to using only a chair. Canadian airforce exercises – also on YouTube – are extremely fun, although they make your whole house shake.
