Counselling the untested: 5 tips for helping patients who can't get a COVID test

As Canada grapples with a shortage of COVID-19 test kits—and people to administer them—pharmacists in much of the country are fielding calls from patients worried they may have COVID but can't find a test. These patients want to know what to do in the meantime, some with symptoms suggesting a high likelihood of COVID-19, while others feel it may just be cold or flu. Then there are those exhibiting no symptoms but who've had close contact with a positive COVID-19 case. Here are five tips to help you help your patients in these scenarios: Relieving fever and headaches Some of the symptoms of COVID-19 can be addressed using the same approaches for flu and cold symptoms, said Jeff Taylor, a pharmacist and professor at the University of Saskatchewan’s College of Pharmacy and Nutrition. Antipyretics—such as Advil and Tylenol—could be recommended to relieve fever and headaches. According to the latest advice from the University of Toronto’s Department of Family and Community Medicine and the Ontario College of Family Physicians (OCFP), acetaminophen such as Tylenol is the best choice for patients who can take it. It’s not always necessary to address these symptoms with medication, said Evan Froc, a pharmacist and manager of a Walmart Pharmacy in Saskatoon. “In a lot of cases we would only treat a fever if a person was visibly uncomfortable as a result of the fever,” he said. “Even with children, if they’re not really behaving differently then the need to treat is not necessarily there.” Read: Provinces clamour for rapid tests while feds struggle to deliver millions promised Managing a patient’s ‘COVID cough’ When patients who may have COVID complain of cough, it’s important for pharmacists to understand the nature of their cough and assess their ability to breathe, said Froc. “Are they coughing but can breathe well, or do they have to in-draw and actively recruit other muscles to cough and breathe?” he asked. “To what degree are they short of breath?” A key consideration to make before recommending medication for cough is the presence of conditions such as asthma or chronic obstructive pulmonary disease. For these patients, treating with medications intended to suppress cough would not be a good thing, said Froc. “We don’t want to reduce their capacity to respond—we want them to be able to cough and get that stuff out of there,” he said. Another tip from UofT and OCFP: For a cough, try a teaspoon of honey—unless the patient has diabetes or is under 12 months of age). Or turn on a humidifier. The importance of hydration and diet Resting and staying hydrated is key, said Timothy Smith, a pharmacist and co-founder of Simplicity Wellness in Winnipeg. “Water is the best place to start with staying hydrated,” he said. “If there are signs of dehydration—such as weakness, urinating or sweating less than usual, dry skin, headache—patients can consider an electrolyte product, for example, Pedialyte or Gatorade/Powerade. Soup or broth can be consumed, if desired.” Patients should also be advised to eat when they get hungry, said Froc. Maintaining a healthy and well-rounded diet is important, even when patients feel less inclined to sit down to a meal. Read: Testing symptomatic patients for COVID? If you're in Ontario here's what you need to know Escalating from self-care to professional care Is a patient having difficulty breathing? Time to recommend taking the next step, such as a virtual appointment with their doctor, who might prescribe an inhaler, said Froc. When breathing seems impossible—described by some COVID patients as trying to suck air through a straw—pharmacists should advise patients to go to their nearest emergency department. Smith lists other symptoms that should prompt a visit to ER: chest pain or pressure, fainting, dizziness or weakness, severe or persistent diarrhea, vomiting or coughing up blood, fever that doesn’t respond to medication, changes in vision, confusion or changes in mental status, sudden or severe pain, and blue lips. Froc pointed out that as a general rule, a fever registering at over 38 degrees celsius would be considered by doctors as an indicator of a probable COVID case. However, he cautioned that home-use thermometers don’t always give accurate readings. Forehead thermometers, in particular, tend to be inferior to rectal, ear, sublingual or in-armpit gauges. Emphasize the need to self-isolate and protect others Even if a patient is unsure whether or not they have COVID, patients who have symptoms of the virus or have been in contact with someone confirmed with COVID should be reminded firmly not to go to public places, said Smith. Remind them that they can ask their pharmacy to help them get their medications delivered. Taylor at the University of Saskatchewan said patients self-isolating in a home occupied by other people should be reminded to wear a mask when they need to leave their quarantine space, such as when they need to use a bathroom. It’s also important for patients to know the latest public health guidelines for in-home COVID care, especially as new variants continue to emerge, added Taylor. He encouraged pharmacists to have on hand the website address of their provincial public health department, ready to give out to patients. Read: ER tales: Deciding who is swab-worthy during COVID-19

Counselling the untested: 5 tips for helping patients who can't get a COVID test

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