Autoimmune conditions, fibromyalgia, Hashimoto's disease, invisible illness

COVID-19 Guidelines for Vulnerable Groups & Caregivers

Initiative by Dr. Anubha Mahajan, (General Dentist & Founder, Chronic Pain India) in collaboration with Dr. Piyush Goel (Senior consultant Pulmonogy & Critical care, Columbia Asia Hospital,Gurgaon), Dr. Parul Prinja (Internal Medicine & palliative/supportive care specialist, Columbia Asia Hospital, Gurgaon), Dr. Khan Amir Maroof, (Associate Professor, Community Medicine, UCMS & GTB Hospital, Dilshad Garden, New Delhi), Dr. Abhilasha Kapoor (Junior Resident, Community Medicine, UCMS & GTB Hospital, Dilshad Garden, New Delhi), Dr. Santhosh Kumar Sundaram (Junior Resident, Community Medicine, UCMS & GTB Hospital, Dilshad Garden, New Delhi).

(March, 2020)


1. Community preparedness towards prevention of COVID-19 among people with disabilities, chronic illnesses, autoimmune diseases and rare diseases.

2. Preventive measures to control the spread of COVID-19 infection among their family members and care givers.

Community preparedness towards prevention of COVID-19 among people with disabilities, chronic illnesses, autoimmune diseases and rare diseases:

1. All social gatherings must be avoided – in public or at home.

2. Work from home options must be exercised.

3. Awareness on precautions, prevention and treatment must be created through digital platforms in accessible formats (following Government guidelines).

4. Awareness about nearby health facilities available for lab testing. (Link to helpline numbers)

when to get tested for COVID-19?
if you have cough, fever or difficulty in breathing.
call on the 24 x 7 helpline : 

5. Follow up visits for medical consultations on minor issues must be avoided and where possible, communication must be through phones and/or e-mails.

6. Physiotherapists and Occupational therapists can do home visits with proper Person-al Protective Equipment like apron, masks, gloves, proper hand washing. Symptoms like cough, fever, cold must be reported to the nearby health care facility immediate-ly.

7. Regular medications must be continued and those with symptoms of nCoV infection should avoid nebulization and taking steam at home when not isolated.

8. In case of a mild symptoms, quarantine yourself at home and inform the nearby health care facility.

9. Stock up essential drugs and all other necessities you may require.

10. Muscle fatigue or chronic fatigue must not be confused with symptoms of COVID-19 unless the person has fever, cough, breathlessness, diarrhea.

11. Talk to family doctors to take a call prior, about what should be done in case of an emergency and preparatory measures should be taken.

12. Frequent hand washing with soap and water or alcohol-based sanitizer and surface cleaning with disinfectants like sodium hypochlorite is required around people with autoimmune diseases.

13. In case of unforeseen emergency, contact the doctor and ask what for further advise. If the doctor feels a home-visit is needed, consider that. Try to avoid visits to the hospitals as much possible.

14. If you are a wheelchair user, sanitize your wheelchair daily, especially clean the wheelchair rims and wheels.Canes  and  crutches  must  be  sanitized  too,  especially  after walking around.

15. Grab rails & hand rails need to be sanitized.

16. Social distancing can be frustrating and boring which is understandable, especially in a pandemic scenario. There are simple things that you can try to help yourself:

   · Spend time doing things you enjoy doing at home, which might include reading books, indoor activities, watching a movie or a tv show, listening to a podcast, sketching or painting
· Eating healthy – have a balanced diet and drink enough water.
· Try some exercises that you can do at home.
· Meditation and deep breathing exercises
· Listen to relaxing and calming music
· Mindfulness and coping activities

17. Leverage technology: stay in touch with your friends and family through phone calls, video chats or various online platforms.

protective measure against coronavirus.
A distance of at least 1 meter is necessary to ensue safety for all.
wash your hands with soap and water regularly.
if soap and water is not available, use hand sanitizer with at least 60% alcohol.
wash hands before touching eyes, nose and mouth.
Throw used tissues into closed bins immediately after use.
cover your nose and mouth with tissue while sneezing and coughing.
avoid mass gathering and crowded places.

Preventive measures to control the spread of COVID-19 infection among their family members and care givers:

1. Provision of Personal Protective Equipment to the family members and care givers (e.g., gloves, surgical or washable masks, household available sterile cloths as apron).
Healthy people need to wear mask only when they are:
· Taking care of suspected patients
· If you have symptoms like cough/ cold

Note: This is effective only if you combine it with frequent hand washing. Hand washing with soap and water (soap/ water or alcohol-based hand rub) for at least 20-30 seconds before and after taking care of the affected person.

When to use a mask.  for healthy people wear a mask only if you are taking care of a person with suspected COVID-19 infection.  wear a mask, if you are coughing or sneezing when outside.  masks are affective only when used in combination with alcohol based hand rub or soap and water.  if you wear a mask then you must know how to use it and dispose of it properly.

2.Social distancing of at least 1 meter has to be practiced.

3.Minimum direct physical contact like hand shaking, touching eyes, nose and mouth

4. Sanitizing hands before wearing mask. Masks must be changed if used beyond 6 hours or if its moist/wet.

5. Touch only strap/ elastic and immediately throw in a closed bin. Wash hands again.

6. Sneeze in elbows/ tissue paper. Dispose in a covered bin.

when coughing or sneezing, cover your mouth & nose with flexed elbow or tissue. dispose in a covered bin immediately

7. Cloth masks are not recommended under any circumstances.

8. Health education on cough etiquettes and disposal of infected materials like tissue paper, disposable masks, etc. for the community.

9. Care givers and attendants must avoid travelling and visiting places where mass gathering occurs.

10. People with diseases like Diabetes mellitus, Hypertension and other chronic illnesses and immunocompromised states along with elderly people have to take extra precautions while coming in contact with affected/suspected individuals.

11. Provide support to your affected/suspected family member or a neighbor as isolation may further lead to mental stress to the person.

For Home Quarantine

During home quarantine, separate rooms preferably with an attached toilet if possible, should to be provided for the affected/suspected individuals if feasible, otherwise social distancing has to be practiced.

1. Stay in a well-ventilated room with separate toilet.

2. If caregiver has to stay in same room maintain 1-meter distance.

3. Only one family member to take care of quarantined person.

4. Avoid shaking bedsheets/ linens etc.

5. To dispose masks/tissue : Dispose the tissues in a closed bin and pour ordinary bleach solutions (5%) or sodium hypochlorite solution (1%), and later burn them (easier meth-od) or deep burial. Sodium hypochlorite solution can be found in bathroom cleaners.

6. People who are living alone and maintaining self-isolations at home, can move around in home.

7. Discrimination and neglect of the affected/suspected individuals should be avoided and reassure them that COVID-19 is a curable condition with proper management.

If one household member has flu like symptoms or is being quarantined for likely exposure :

1. Do not panic
2. Call your doctor, fix tele-consultations
3. Drink lots of liquid to stay hydrated as is done in other common viral illnesses.
4. Take medicines as advised
5. Take proper meals at regular intervals. Avoid fasting.
6. Stay confined to a single well-ventilated room
7. Go to a hospital only if you are having breathing difficulty, are unable to have oral in-take or have not been passing urine every 2 hours.

Environmental Sanitation

1. Surface cleaning of quarantined person’s room/ table top/ bed frame/ floors with 1% sodium hypochlorite solution.
2. Wash clothes separately with common detergent.
3. Clean toilet seat surface with phenolic disinfectant daily
4. Washable masks and aprons have to be disinfected with Sodium Hypochlorite before washing and it has to be dried in the sunlight.

Advice for People at High Risk

1. Stay indoors in well ventilated room open windows/ doors.
2. Caregivers to wear masks and sanitize hands prior to handling them.
3. Maintain a 1-meter distance if another member of the household is infected.
4. If a person with co-morbidities develops symptoms, call and visit the doctor after wearing mask and applying hand sanitizer.

Some advice regarding bringing items/ household goods :

1. For packets/ nonperishables, let them sit in the packet for 24 hours, nearest to entry door. Next day, open packet, take out item, sanitize hands – take items inside the home. Dis-pose packing straight away.

2. For perishables: Milk packets – clean with soap & water. Vegetables – wash thoroughly with water

3. Keep a fixed pair of footwear to be worn outside and take off at the door before entering the house.

4. Similarly, clothes worn outside should be taken off and put in hamper. Change into an-other pair at home after cleansing yourself thoroughly .

5. Sanitize the cloth hamper also daily.

Important Links: Corona Virus Helpline Numbers | Basic FactsMyth busters by WHO |WHO Link for COVID-19 Info

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