OT&P Advice for patients who think they may have Covid-19

The current situation in Hong Kong is evolving rapidly. As anticipated, this is associated with mixed messaging. We will continue to update this page as the situation evolves. 

Our first advice is ‘Don’t Panic’.   

We are not in any way diminishing the importance of Covid. In the rest of the world the greatest impact from Omicron was the impact caused by illness and isolation in healthcare and other key workers. This threatened to overwhelm health and supply systems. The public health restrictions are designed to flatten this wave, in order to protect the health system.

Omicron is a highly infectious disease. In our opinion the majority of people in Hong Kong are likely to be infected over the next 2 - 3 months. A recent review in the Lancet suggests that up to 90% of these cases will have no symptoms^[1]. For the majority of the rest, especially the vaccinated, it will be somewhere between a mild cold and a bad flu.  

What do I do if I think I may have Covid?  

Anyone who has symptoms or has been a contact of a known case should be tested. We have written a previous article explaining the different tests available. In Hong Kong there is a legal obligation to comply with government testing orders. Anyone who is subject to a testing order must be tested with a PCR test via a designated government testing centre and it is free through the government system. Anyone who is not subject to a government testing order should take a rapid test. 

Rapid tests are available here. It is likely that the government will release free rapid tests to the population within the next few weeks. This is likely to be associated with instructions (advised or mandated) in the event of a positive result. Currently there are no such mandated instructions. Our advice is that anybody who tests positive with a rapid test should isolate at home for a minimum of seven days* or until a subsequent rapid test is negative whichever is the latter. Ideally, all household contacts should also remain isolated and all test negative on rapid test at the end of the isolation period. If household contacts need to leave isolation, for example, key workers or shopping, they should have a negative rapid test before leaving the house and wear a mask at all times.  

What symptoms may I expect? 

Statistically it is most likely that you will experience no symptoms. For this reason, we also advise rapid testing before potential exposure to other vulnerable people or groups. 

The typical symptoms of earlier variants were cough, fever and/or change in the sensation of taste.

For Omicron the commonest symptoms are:

• runny nose 
  
• headache 
• fatigue (either mild or severe) 
• sneezing
• sore throat 

In other words Omicron is commonly experienced like a ‘cold’.

What medications may I use?

As with a cold you may choose to not take any medication. Stay well hydrated and rest. For nasal obstruction or congestion consider hot soaks or steam inhalations.  

You can of course take paracetamol or ibuprofen. Ibuprofen tends to be a bit better for relieving muscle aches or the ache of a sore throat although it can cause indigestion and side effects are a little more common. Take it on a full stomach or at least with some food. 

For children, you can reduce temperature by controlling the ambient temperature. You can use paracetamol or ibuprofen in suspension or paracetamol by suppository. If you have any concerns about your child you should contact your doctor. 

What symptoms should I worry about? 

This is by no means an exhaustive list and if you have any concerns you should contact your doctor. 

• Feeling gradually more unwell  
• Feeling more breathless 
• Having difficulty breathing when you stand up or move around 
• Feeling very weak, achy or tired 
• Shaking or shivering 
• Significant loss of appetite
  

One particular concern with Covid is respiratory problems. In assessing potential severity of shortness of breath, the measurement of oxygen saturation through a pulse oximeter can give vital information. In general oxygen saturations above 95% are normal. We consider admitting to hospital at and below 92%. Between 92-94% patients should ideally be assessed. Some modern smart watches have pulse oximeters. We will keep some that we can use for urgent assessment. It may be worth considering within organisations or social groups a provisional plan such that they can be shared with people who may need them.

In summary we are likely to see a significant number of infections within our community over the next two months. The vast majority of these infections will be asymptomatic or mild but the sheer number means that there will be some people who experience more important symptoms. We will continue to be available and all our clinics will remain open as they have throughout the pandemic. If you have any concerns we can arrange telephone or telemedicine consultations.

Finally we anticipate that some of our doctors are likely to be spending time volunteering in the government system in the coming weeks. All our clinics will be staffed. We appreciate your understanding that your normal doctor may not always be available immediately but we will ensure that all patients who are concerned and especially children will be dealt with promptly.

*In the original version of this article we recommended five days or a negative rapid test. This was compatible with international experience. We have changed this advice to 7 days. This is because the Hospital Authority have chosen seven days as the time before medical staff can return with a negative rapid test. This is also the time used in Singapore. It seems most likely that this will eventually be the advice in Hong Kong.

Reference

1. Murray, C. J. L. (2022, January 19). COVID-19 will continue but the end of the pandemic is near. The Lancet. Retrieved February 16, 2022, from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00100-3/fulltext