Summary
Two things COVID patients at home should consider doing:
1. Use an oximeter to monitor blood oxygen levels - it can make a 50% difference to survival
2. Prone - instead of lying on your back, do 30 minute rotations with cushions to lie semi-upright, on both sides and on your stomach. Repeat regularly.
To help remote carers (family/friends) systematically manage your care, use:
1. SMS Sinch for monitoring oximeter readings, and
2. Presence, a remote-controlled system that uses old phones or tablets to manage awake proning. Both systems are free to use.
Get an Oximeter - Fast
With Dr Richard Levitan @airwaycam saying that “mortality from Covid halved with post-diagnosis pulse oximetry monitoring” according to a 38,660 Sth African study, getting an oximeter is a no-brainer!! [1] A New York study confirms pneumonia + hypoxia is not good. (1a)
Don’t wait until you test positive as oximeters are in short supply, and delivery systems are not what they used to be.
So get an oximeter before you need it to manage COVID. In fact, it can even alert you that you might have COVID, and should get tested. [2]
Prone
Awake prone positioning of COVID patients allows the lungs to provide more oxygen. For those who are having trouble breathing it reduces incidence of treatment failure and the need for ventilators without any signal of harm. Essentially, it involves 30 min rotations of the patient lying half upright, on their sides and stomach on cushions rather than just flat on their back all the time.
Note that extensive proning is not for everyone. For example, if you are more than 24 weeks pregnant or have major cardiac, spine or pelvic issues. Be sure to read this article to check the “do’s and don’ts”.
For those who want more science: Meta-trial from the Awake Prone Positioning Meta-Trial Group
Use SMS Sinch
Over the last year, Sinch Health has developed a free system to support people at home alone with COVID. It allows a remote carer (this could be family or a friend) to monitor the oxygen levels from the Patient’s oximeter. The Patient takes a reading hourly of their oxygen levels, and then manually sends that reading to the phone number we have set up. That is, they send a SMS that simply is, e.g. 98
Remote carers are alerted automatically if the patient's readings drop too low. This takes some of the stress out of the illness as both patient and carer are monitoring the oxygen levels together. It also acts as a training and morale-boosting tool with one of around 100 oximeter use, self-care and recovery tips sent to the patient when confirming receipt for each reading.
At any time, the remote carer can check to see what are the latest readings, and importantly how the numbers are trending, without constantly disturbing the patient. This can supplement stretched government-provided support.
SMS Sinch
Presence
A problem with remote care is that most tech requires the recipient of a call to answer the phone. If a patient doesn’t/can’t answer their phone, a remote carer needs a backup. That could be a video call. But like phone calls, the recipient of a video call needs to at least touch and sometimes, understand the tech.
That can be too challenging for many older, or otherwise unsophisticated COVID patients. We found that a quick fix to the remote monitoring challenge can be to use an app called Presence, from US company called PeoplePower Co.
Apart from the software being free, another plus is that it can use old smartphones/iPhones and tablets/iPads which are sitting in drawers unused.
With Presence, a patient needn’t be disturbed constantly by a remote carer checking on whether they are using their oximeter correctly, or if they have done their 30 minute prone rotation. With this being recommended for up to 16 hours per day, multiple carers using Presence for each patient might be needed. With Presence, remote carers can share support shifts from any location, even their workplace, via their smartphone.
Below is a PDF on how to setup up someone for remote support. It was adapted from a guide we produced for monitoring Seniors pre-COVID. This continues to be a growing need in lockdown.