What you can do if someone you know gets a COVID-19 infection or exposure

Update August 21, 2021

Since the article below was originally written, we've learned a lot about what works against COVID, and there are now a number of far better options for preventing and treating it. Here's what you should know and do (as of August, 2021):

Get vaccinated. Vaccines are extremely safe and work very well at reducing your chance of getting really sick if you get exposed to COVID. This is both because they reduce your chance of getting infected, and because they allow your body to respond more quickly to kill off the virus before it causes severe disease.

Wear a mask in indoor public places or anywhere others might not be vaccinated, even if you are. The Delta variant can infect and spread between vaccinated individuals, usually causing cold or flu-like symptoms, but if you're sharing air with people who are unvaccinated, the risk of eventually causing severe disease goes way up.

Get tested with a rapid antigen test if you have any cold-like symptoms, and before spending time unmasked with people outside your household, even if they're vaccinated. BinaxNOW tests are available for $13 each at pharmacies for home use. These tests are very effective at telling you whether you're infectious right now. If you are vaccinated and test negative, being around other vaccinated individuals that same day is quite safe, even if you're unmasked.

If you get infected, ask your doctor about monoclonal antibodies. For individuals at higher risk of developing severe disease, such as the elderly, those with other health issues, and those who haven't been vaccinated, these antibodies help reduce the chance of needing to be admitted to the hospital. They have to be infused with an IV, so ask your doctor what the options are.

If you get infected, ask your doctor about fluvoxamine. Recent randomized trials, while still ongoing, show promising interim results indicating a 30% reduction in disease progression.

Don't bother with ivermectin. The same studies that confirmed an effect for fluvoxamine (and other recent ones) did not find any evidence of benefit for ivermectin in patients from wealthy countries. One possible reason for that might be that the early indications of effectiveness, mostly from developing countries, were due to high levels of undiagnosed parasitic infection in the populations studied there, and ivermectin helped improve COVID outcomes by killing off the parasites and letting patients' immune systems focus on the virus. Whatever the reason, it's probably not worth getting an ivermectin prescription at this point. And you definitely don't want to be going anywhere near any veterinary formulations (which are often unsafe for humans). If you happen to have some ivermectin (prescribed for humans) in your medicine cabinet, it's still very safe to use it in the event of an infection, but it's not likely to help much relative to vaccines, masks, monoclonal antibodies, or fluvoxamine.

Original article

(Written by Scott Leibrand, Dana Lewis, and Dr. Howard Leibrand, MD in 2020. Last updated Feb 20, 2021.)

With 1 in 4 Americans having been infected with COVID at some point, most of us know someone who’s been infected. And with the prevalence of more-transmissible variants still growing, we likely all know someone who hasn’t gotten infected yet, but will be before we’re all vaccinated.

What do you do when someone gets COVID symptoms, tests positive, or has an exposure? In most cases, all we’ve been doing is asking the infected person to self-isolate, and have their close contacts self-quarantine. If their case gets bad, we send them to the hospital, hope there’s still a bed available, and that the healthcare professionals can find a spot for them in the ICU if they need it.

But there’s more that we can be doing. The science is clear to anyone reading it - as we have been - that there are quite a few things we can all be doing earlier to improve our odds of having a mild case instead of a severe or fatal one if we do catch COVID.

Here’s what you should be doing. It includes things you can start doing preventatively today, and things you can prepare to help all your family and friends do after an exposure or as early as possible after symptom onset or a positive test.

Getting vaccinated

If you haven’t already had a positive COVID test, get yourself vaccinated as soon as you’re eligible. The mRNA vaccines (Pfizer and Moderna) are currently authorized to be given as two shots: the first is over 80% effective after about 2-3 weeks, and effectiveness rises to 90-95% two weeks after your second shot.?

The COVID vaccine is nearly 100% effective at preventing you from getting seriously ill or dying from COVID if infected 2+ weeks after your second shot. We don’t yet know how effective it is at preventing a minor infection in your upper airway, but early indications are that it’s about 70% effective at preventing transmission. Until we get enough people vaccinated that COVID becomes rare, we’ll all need to keep wearing masks, avoid sharing air, and try to keep our distance.

(While official guidance hasn’t been updated yet, studies indicate that individuals who’ve already had COVID likely only need one shot of mRNA vaccines (the original infection serves as the other one). By the time healthy young and middle-aged adults are eligible for vaccination, it’ll likely also be clear that it’s more important to get everyone vaccinated with their first dose first, and then come back and get everyone their second dose after 6-12 weeks, as the UK has been doing. We’re also on track to finally have the J&J vaccine authorized by early March, starting as a single-shot vaccine.)

Preventing infection

Avoiding inhaling COVID is the first line of defense:

• Avoid sharing air with anyone outside your household.
• Wear a mask that protects you against airborne transmission, such as a KN95, valved N95, KF94, or similar.?
• KN95s and KF94s are widely available on Amazon etc. To get valved N95s for general use or unvalved N95s for use in healthcare, use a site like CovCare. For more details on what’s most appropriate for whom, see this Twitter thread I wrote on the topic a month ago.
• If you work in healthcare and your employer won't fire you for protecting yourself, start wearing an N95 all the time, not just when performing AGPs or treating known COVID cases. If necessary, buy your own and reuse them, or buy your own KN95s. A reused N95 or a KN95 is far better at blocking aerosols than a surgical mask.
• Make sure all indoor spaces are well-ventilated (even if it makes them a bit cold), or well-filtered through HEPA air purifiers (see suggestions here) or high-MERV filters. If you can’t ensure 5 complete air changes per hour, and anyone outside your household is sharing the space, you need to assume that there are enough COVID aerosols floating around to make you sick.

Preventing viral replication

If you do inhale any particles containing live COVID virus, your next line of defense is your upper airway. Your body’s innate immune system can do a lot, and there are things you can do to ensure it’s operating at top speed.

• Take Vitamin D. Unless you’re out in the sun every day, your levels drop in winter, which (along with being inside more with others) is a big part of the reason influenza and now COVID spread so much more easily in the winter. If you don’t know your vitamin D levels, EVMS recommends 1000-4000 IU/day.
• Get a flu shot if you haven’t already. If you’ve already gotten a flu shot, get an MMR booster. Both are available from the pharmacy without a prescription. Observational studies show that the flu vaccine reduces risk of hospitalization or ICU admission from COVID. Plus, it helps prevent the flu. Similarly, there is significant evidence that recent MMR vaccination augments innate immunity in such a way as to reduce the severity of COVID if you get infected.
• Take other useful vitamins and minerals: Zinc 30-50 mg/day, Vitamin C 500 mg twice a day, and B complex vitamins at their normal recommended doses (EVMS). Some forms of zinc can cause minor stomach upset (be cautious especially about zinc sulfate), so I take my chewable zinc citrate together with my chewable Vitamin C and one of my chewable multivitamins after a meal to avoid that. Zinc gluconate is another good option.
• Take quercetin, a plant pigment (flavonoid) found in onions, green tea, fruits, etc. It’s long been known to boost immune activity, and EVMS recommends 250 mg per day. Some studies have shown it works best paired with bromelain, a pineapple extract, so I now take a pill that has both. (If you have hypothyroidism, talk to a doctor first.)
• Gargle with a mouthwash containing CPC (cetylpyridinium chloride), or LAE (ethyl lauroyl arginate). If you end up with viruses in your upper airway and throat (oropharynx), those compounds have been shown to kill COVID virus they come in contact with. It may also help address any sore throat symptoms.
• (Section removed: ivermectin is no longer recommended.)

Preparing for an exposure or an infection

Most likely, someone you know is going to be exposed to someone with COVID or get it themselves. If that happens, you don’t want to be scrambling to find the medications that they need. To be ready for that eventuality:

• (Section removed: ivermectin is no longer recommended.)

What to do when someone gets exposed to someone with COVID

When someone finds out they’ve been exposed to a contact who likely has COVID, they need to immediately start quarantining (from everyone, including your household) in case they become infectious themselves. They should also make sure they have a pulse oximeter to measure blood oxygen levels, and immediately start taking “post-exposure prophylaxis” doses of:

• (Section removed: ivermectin is no longer recommended.)
• Melatonin (slow release): begin with 0.3mg at bedtime, and increase to 2 mg per night as tolerated (EVMS; mechanism details here)
• Aspirin, 80-100 mg/day (unless contraindicated)
• Vitamin D, Zinc, Vitamin C, Quercetin, B vitamins, and CPC/LAE mouthwash as described above
• Famotidine (Pepcid). This is an antacid that studies show might slightly reduce COVID severity and mortality. Evidence for effectiveness against COVID is mixed, so it's probably not necessary to take it if you don't need it for another reason, but if you need an acid reducer for any other reason, it’s probably the best one to take. If you're on a PPI like Prilosec, switching to an H2 blocker like Pepcid reduces risk significantly according to several studies.

And closely monitor your sense of smell. Not everyone who gets COVID will be affected, but if you lose your smell after an exposure, that’s a very strong sign of infection (far more so than fever, cough, or anything but a positive test). When you wash your hands using an aromatic soap or alcohol-based hand sanitizer, make sure you can smell your fingers.

What if someone gets symptoms or a positive test?

If someone develops symptoms after a known exposure or tests positive for COVID, they need to immediately begin self-isolating, as they’re likely to be actively contagious. They should also do a bit more to help their immune system stop viral replication as soon as possible.?

Ask your doctor about the availability of the Eli Lilly or Regeneron antibody drugs. As HHS Secretary Azar was quoted in this NYTimes story, they “could help keep you out of the hospital” if given within 10 days of symptom onset. “Please, talk to your health care provider.”

Consulting with a doctor is a good idea as soon as you can, as every case is a little bit different. But generally, for symptomatic patients at home you’ll want slightly higher doses of many of the same things as for exposure, and also consider bromhexine / ambroxol:

• (Section removed: ivermectin is no longer recommended.)
• Vitamin D 2000-4000 IU/day, zinc 75-100 mg/day, Vitamin C 500 mg twice a day, quercetin 200-500 mg twice a day, and B vitamins (normal dose)
• Aspirin 81-325 mg/day to reduce platelet activation, one of the primary causes of severe COVID symptoms
• Melatonin 6-10mg at night (the optimal dose is unknown)
• Bromhexine / ambroxol (available over the counter in Europe, or by mail) to relieve cough by helping lungs break up and clear mucus faster. In RCTs, Bromhexine (which the body metabolizes to ambroxol) has been shown highly effective against COVID.
• Make sure they have a pulse oximeter and regularly check their blood oxygen levels (SpO2). If it drops below 94% and doesn’t immediately come back up with repeat testing, call a doctor immediately: EVMS recommends hospital admission below 94%, but a doctor will be best positioned to decide what’s needed in any given situation.
• Talk to your doctor about getting vitamin D levels checked: up to 87% of COVID-19 deaths may be linked to low vitamin D levels, and RCTs have shown significant benefit of early high-dose vitamin D in deficient individuals (for example, 60,000 IU/day of cholecalciferol until 25(OH)D>50 ng/mL).
• Talk to your doctor about fluvoxamine. It’s a commonly prescribed antidepressant and antianxiety medication (SSRI), and in this RCT, it completely prevented clinical deterioration (shortness of breath or needing supplemental oxygen), which occurred in 8.7% of the control group.

Summary

As you can see, there’s a lot that we can do to help reduce the likelihood and severity of COVID infection. If you’re willing to help get what you need to help your family and friends when one of them eventually gets exposed or infected, here’s what you’ll want to buy if you don’t already have it. We’ve linked to several examples of things we have tried and use (and those are Amazon affiliate links, but you can buy them anywhere), or to an example search if it’s something generic and most options will do.?

• Masks such as KN95 (example KN95 option or another KN95 option on Amazon) or valved or unvalved N95s from CovCare
• Vitamin D, that can come in tablets (and in different packaging sizes, such as this) or gummies (example)?
• Zinc citrate chewable (example)?
• Vitamin C chewable (example)
• Quercetin w/ Bromelain (example)?
• B complex vitamins (example search)?
• Mouthwash with CPC (example)
• Aspirin (example search)
• Famotidine (Pepcid) (example search)?
• Melatonin (slow release) (example search)
• Pulse oximeter (example)?