Illustration of medical professionals treating sick people
Illustration: JOSEPH CARRINGTON

In mid-March of 2020, soon after the World Health Organization declared the coronavirus a pandemic, U.S. hospitals began to fill with gravely ill people. As cases surged, stores, schools, and businesses went remote. Healthcare professionals across the country worked feverishly to save lives but had no road map to help them handle the new threat.

“We didn’t know how COVID-19 was spread,” recalls Pieter Cohen, MD, an internist at Harvard Medical School and author of a set of medical guidelines for doctors treating COVID-19 patients. “We had absolutely no idea what to do in terms of treatment. We were in totally uncharted territory.”

But they learned, day by day. “Remarkable advances have been made in a short period,” a group of Cleveland Clinic physicians wrote in a review of treatment studies for severe COVID-19, published recently in the journal BMJ.

More on Covid-19

Now vaccines, developed in record-breaking time, are widely available. Health experts know how COVID-19 spreads, and doctors have a more precise understanding of which groups are at highest risk for severe illness and the therapies that may help them avoid hospitalization. They also have effective treatments for those who are hospitalized, and have clarity on what good care looks like for people managing the illness at home.

Still, the coronavirus is likely to be with us for a while. Infection rates remain high, though the rapidly growing numbers of vaccinated people will ultimately help drive those down. And variants are emerging. Also, while most people are on the mend in a few weeks, some are ill for months or longer.

Many of us are still unsure what to do if we contract COVID-19: how to control fevers and aches, when to call doctors, and when to head to the emergency room. To help, Consumer Reports gathered the most recent evidence on how to manage and recover from an infection, whether it’s mild, moderate, or severe.

First, find out what to do you if you have COVID-19, then learn about what to do if you need more care and when you’re on the road to recovery.

You’re Sick. Now What?

With proper care, most people with mild to moderate COVID-19 recover well at home. But let your doctor know if you suspect you have it, so they can determine whether you’re at greater risk for severe illness: This includes those who are older than 65, are immunocompromised, or have preexisting conditions such as heart disease, diabetes, obesity, cancer, and chronic obstructive pulmonary disease.

Get Tested
If you’ve been exposed to someone who has or may have COVID-19, or you start to develop symptoms such as fever or chills, cough, shortness of breath, fatigue, or body aches (headache, loss of taste or smell, sore throat, congestion or runny nose, nausea, and diarrhea are also common), isolate yourself and get a COVID-19 test.

Tests are free and available at doctor’s offices, hospitals, and pharmacies—where you can often be tested via drive-thru. Call first; you may need an appointment. PCR tests, the most accurate, usually produce results within 48 hours. With a rapid test, you’ll have an answer in minutes to hours, but it’s less precise than a PCR. Your doctor might also direct you to take an at-home test. If a test is negative but you have symptoms, talk to your doctor and continue isolating—you may need to take another test.

“I took acetaminophen and ibuprofen for fevers, had Gatorade, water, and Pedialyte next to the bed. My wife would leave crackers and toast next to the door. It was the basics: rest, hydration, acetaminophen, and ibuprofen.”

Sean McGann, MD, Philadelphia

Use the Right At-Home Treatments
Rest and hydration are key—drinks with electrolytes, such as Gatorade and Pedia­lyte, may help if you are having trouble keeping food down. (Many people lose their appetite.) It’s fine to use over-the-counter medications to relieve fever and aches.

COVID-19 can make you feel pretty knocked out, but some movement is important—such as walking around your home for 5 minutes every hour or two. Along with staying hydrated, this can help prevent COVID-related blood clots, which have been linked to potentially fatal strokes, says Jacqueline W. Fincher, MD, president of the American College of Physicians (ACP). Plus, movement can help you evaluate your lung function: If it’s harder to breathe after a brief walk at home, contact your doctor. (See “Keep Track of Symptoms,” below, for what to check while you’re sick.)

In certain cases, doctors might prescribe an infusion of monoclonal antibodies—which are similar to the antibodies your immune system makes to fight infection. These may help keep COVID-19 from worsening, according to the Infectious Diseases Society of America. Such treatments are available to those older than 65 and to younger people with more serious preexisting conditions. (Ask your doctor whether you qualify.) The IDSA recommends a “cocktail” of bamlanivimab and etesevimab for people in those groups who have mild to moderate COVID-19 and are at risk of progressing to severe disease but are not hospitalized.

Starting to feel better? You can stop isolating 10 days after you first felt ill—as long as you’ve been fever-free for at least 24 hours without medication and other symptoms are improving.

Skip What’s Questionable
Over the past year, a number of supplements and drugs have been touted as COVID-19 remedies, often with little proof. People’s interest in vitamins C and D and zinc, for example, has surged. But National Institutes of Health treatment guidelines say there’s no evidence any of these help with COVID-19—and taking more than the advised amounts of zinc can be harmful.

Early in the pandemic, some people hoarded hydroxychloroquine (Plaquenil), based on the theory that this malaria drug might prevent COVID-19. Later, the Food and Drug Administration reported serious adverse effects for some users, and randomized trials showed that people who received the drug had longer hospital stays and were more likely to be intubated or die.

There’s no harm in taking hot showers to ease congestion or lying on your stomach to open your lungs, though there’s not much evidence of benefit while ill at home. But if you’re trying these strategies because you’re struggling to breathe, you need to see a doctor, Cohen says.

Smart Steps: Keep
Track of Symptoms

It’s wise to monitor yourself while sick. And if possible, do the following before contacting the doctor or urgent care, or even summoning emergency help.

1. Take your temperature.

Fevers are common during COVID-19, but a lingering high fever can alert your doctor to worsening illness.

2. Check your oxygen and respiratory rates.

If you have a pulse oximeter, assess your blood oxygen levels (see “How to Use a Pulse Oximeter,” below). For your respiratory rate, count your inha­la­tions for a minute: About 12 to 18 times is normal; 22 or greater is high and concerning, says Jacqueline W. Fincher, MD.

3. Record other key measurements.

If you regularly monitor your blood pressure, blood sugar, and/or heart rate, a current reading can reveal how much stress your body is under. For people with diabetes, “a big change in blood sugar is a sign of overwhelming sickness,” Fincher says.

4. If you are going to be seen in person, wear a mask.

And if you can, bring your insurance info and a list of your current medications.


ILLUSTRATION: JOSEPH CARRINGTON

If You Need More Care

Some people with COVID-19 need to see a doctor or be treated in a hospital. There are now some effective therapies for these patients, and doctors know at what stage each may be particularly helpful, says Adarsh Bhimraj, MD, an infectious disease doctor at the Cleveland Clinic and lead author of a set of treatment guidelines for COVID-19. “There’s a Goldilocks zone, a timing for each of these agents in the disease process,” he adds.

Know When to Seek Help
Contact your doctor or urgent care right away if you have a fever over 102° F that won’t ease with acetaminophen or ibuprofen, have a falling blood oxygen level (healthy people should be above 95 percent), or are taking more than 20 breaths a minute and/or feel increasingly short of breath. (Breathing difficulties and other problems can ebb and flow: For some people who go on to develop complications such as pneumonia, symptoms often worsen four to eight days after they first appear, says Harvard’s Cohen.) Your doctor will probably want to evaluate you to see whether you should be in the hospital.

Call for emergency help immediately if you experience significant trouble breathing (22 breaths or more per minute, or a pulse oximeter reading of 90 percent or below, based on two readings taken 5 minutes apart), persistent chest pain or pressure, confusion you didn’t have previously, an inability to stay awake, or pale, gray, or blue-tinged skin, lips, or nail beds. Although breathing trouble might worsen gradually, some of the other problems above might develop suddenly if your lungs have been working poorly for a while, says Sean McGann, MD, an emergency physician at Thomas Jefferson University Hospital in Philadelphia.

What to Expect at the Hospital
In the ER, you’ll be checked for lung damage and other pulmonary problems, and your oxygen levels will be monitored. If you’re found to need supplemental oxygen—or doctors think you might require it in the next 24 hours, perhaps because X-rays suggest pneumonia—you’ll probably be admitted. The same will happen if you seem to be getting significantly sicker overall and have a risk factor for severe COVID-19, such as diabetes or heart disease.

If admitted, you’ll continue to receive oxygen for as long as it’s needed. Mechanical ventilators, which essentially breathe for patients, were used extensively in hospitals early in the pandemic. Now, for most patients, doctors have less-invasive options, such as high-flow nasal cannulas that can deliver more than 10 times the oxygen of standard cannulas.

Placing people on their stomachs, known as proning, also helps curb the need for ventilators. In fact, this strategy is so effective that it has been widely adopted for those who are hospitalized with COVID-19, says Greg Martin, MD, a professor of medicine at Emory University in Atlanta and president of the Society of Critical Care Medicine.

As for medications, if you are receiving oxygen, you may also be given dexametha­sone, a steroid that reduces inflammation and has been found to improve survival rates. In addition, you might be given remdesivir, an antiviral shown to shorten recovery time. If your immune system overreacts to the coronavirus, causing extreme bodywide inflammation, the IDSA recommends the monoclonal antibody tocilizumab along with steroids to help tamp down that inflammation. And now that it’s known that hospitalized COVID-19 patients are at high risk for blood clots, doctors use blood thinners when needed to reduce the blood’s ability to clot.

“Having a pulse oximeter was the best suggestion someone gave me . . . since I could monitor and track my oxygen levels and heart rate and share with my doctor or check before virtual visits. [The] thermometer was also helpful.”

Kristen Tjaden, Indianapolis

The Lowdown on Discharge
Once doctors are sure you no longer need help breathing, you’ll be sent home if you can care for yourself, or to a rehabilitation facility, typically for a short stay, if the healthcare providers think you’ll need more help. This may be the case if you were hospitalized for an extended time or were on a ventilator.

You could be prescribed certain medications for use at home: an inhaler to reduce the lung inflammation that can make taking full breaths challenging, for example. Many COVID-19 patients are also sent home with pulse oximeters for monitoring blood oxygen levels, McGann says.

Once home, you may need to take precautions to avoid infecting others—unless it has been at least 10 days since your symptoms started and you’ve gone 24 hours without a fever. Immunocompromised people may remain contagious longer, so check with doctors if you’re in that group.

Smart Steps: How to Use a Pulse Oximeter

1. Test regularly.

Do it every morning and evening, or as your doctor directs.

2. Make sure fingers are warm and dry.

Then place an index finger in the fingertip monitor, with the fingernail facing up, below heart level. Hold still until the device screen shows a blood oxygen level.

3. Check the screen for 1 minute.

Normal is usually 95 percent or higher (around 90 percent for those with chronic lung disease). If a low number appears, cough three times and take three deep breaths. If the number fails to rebound or you’re having trouble breathing, call your doctor.


ILLUSTRATION: JOSEPH CARRINGTON

On the Road to Recovery

Give yourself time: While most mild cases subside in two to three weeks, fatigue may linger, and more severe cases may take up to three months to resolve. Also, a significant percentage of people have health problems related to COVID-19 for many months. Experts are making progress in helping “long-haulers” but say there’s more work to do.

Build Back Your Strength
After COVID-19, it’s wise to return to physical activity slowly. Don’t be surprised by weakness: Most people lose a good bit of muscle and cardiovascular strength after a couple of weeks in bed.

If you’ve had COVID-19, the American College of Sports Medicine recommends slowly resuming exercise after talking with your doctor. Try starting with an activity such as a brief walk, at a pace that allows you to hold a conversation, and ramp up as you can.

You’ll probably need to go quite slowly if you were in intensive care—because each day there typically translates to at least a week of recovery, says the ACP’s Fincher.

Anyone who spent a month in the hospital may require inpatient or outpatient rehab, a program of exercise that is supervised by an occupational or physical therapist.

And whether your COVID-19 was mild, moderate, or severe, stop any activity right away and call a doctor if you have chest pain or abnormal shortness of breath.

Deal With Other Health Problems
If you have a condition such as asthma or diabetes, work with your doctor to make sure it’s well-controlled. Otherwise, recovery will be far more difficult, Fincher says. And because COVID-19 can have residual effects on organs and systems such as the heart, nervous system, and lungs, tell your doctors about any new problems you notice during recovery, so you can be monitored or treated for them.

For instance, if a cough won’t quit after COVID-19, your doctor might prescribe an inhaler to reduce airway or lung inflammation. Some people who develop myocarditis—the heart inflammation that can cause chest pain, heart rhythm and breathing problems, and swelling in the extremities—may need to have a cardiologist check their heart health during recovery and prescribe medications if needed. An antiseizure drug such as gabapentin (Neurontin and others) or pregabalin (Lyrica) may be prescribed for numbness, tingling, or burning pain in the hands or feet, which are signs of nerve damage.

“I attempted to work out, but 10 minutes on the elliptical was like running a marathon. It was the same the next day. I waited a week before trying again. Finally, at two months out, I feel all better. I’m up to 35 minutes on the elliptical and no more naps.”

Cary Fappiano, Watertown, Conn.

Reach Out If Symptoms Last
It’s no surprise that a nagging cough might persist for a while after a viral illness or that someone hospitalized with severe COVID-related pneumonia might need several months to feel fully recovered. But doctors say they’ve seen many people—often young and previously healthy—struggle with sometimes debilitating shortness of breath, racing heart, brain fog, extreme fatigue, or mood issues for many months after even mild to moderate COVID-19. Known as long-haul COVID, long COVID, or post-COVID syndrome, these problems affect 10 to 35 percent of people, by some estimates. “This is the shadow pandemic,” says Diana Berrent, founder of Survivor Corps, which connects people who’ve had COVID-19 with one another and supports research on potential treatments.

We’re still learning exactly what symptoms may be part of long-haul COVID, but if you had a mild to moderate case and don’t feel mostly recovered a month later, alert your doctor or look into getting checked out at a post-COVID care center.

Many medical centers are launching these outpatient facilities, where highly individualized treatments are based on each person’s symptoms, says Zijian Chen, MD, medical director of the Center for Post-COVID Care at Mount Sinai in New York City. Some people might need physical therapy to build strength; pulmonary rehabilitation, which typically involves cardiovascular and breathing exercises; or an inhaler to bolster lung function. Others might require medication to normalize a rapid heart rate or speech therapy for cognitive problems. (Find a list of centers on the Survivor Corps website. If you’re considering such a program, check your insurance coverage.)

And note: Some people report that their long-haul symptoms have improved after receiving the COVID-19 vaccine, and at least one small preliminary study suggests that’s possible, but more research needs to be done.

Harvard’s Pieter Cohen and other doctors who have treated long-haulers say that in most cases, they see improvement, gradual though it may be. And they are hopeful that with time, they’ll be better able to help these patients. “Now that we realize this is long COVID, or post-COVID syndrome, that’s the next frontier everyone is diving into,” says Emory University’s Greg Martin.

Smart Steps: Take Deep Breaths Again

People with COVID-19 often take rapid breaths while they are ill and may have difficulty breathing fully during recovery as well. Breathing exercises can help you retrain your body to breathe properly, says Josh Duntz, CEO of Stasis, which teaches breath work and has partnered with Mount Sinai’s Center for Post-COVID Care. Long-haulers—people with long-lasting symptoms after COVID-19—who have done breathing exercises have found that they’re helpful for their recovery, according to David Putrino, PhD, of the Icahn School of Medicine at Mount Sinai. If you’re interested, you can try the two exercises below, for 10 minutes each morning and 10 each evening. At first, do them lying on your back while relaxed. After two weeks, try them while sitting up. See how you’re feeling after several weeks.

1. 4-6 breathing.

Breathe in through your nose for 4 counts and exhale through your nose for 6. Your goal is six full breaths per minute.

2. Box breathing.

Breathe in for 4 counts, hold your breath for 4, exhale for 4, and hold your breath with no air in your lungs for another 4.


ILLUSTRATION: JOSEPH CARRINGTON

Editor’s Note: This article also appeared in the June 2021 issue of Consumer Reports magazine.