Author’s note: Please share this guide. It’s what I wish I had when I got COVID, and it’s even more important now that hospitals are turning away patients. It has been checked and verified by two specialist doctors who work with COVID patients in hospitals, and includes information that not all GPs have.
Even with so-called “mild” symptoms, getting through COVID was worrying and challenging. Between predictions, theories, and politics, everyone’s a COVID expert. But when you contract it, you realise that nobody talks about the practical stuff that can save your life (and help you feel better about managing your way through it).
While I’m now in better shape, I’m recovering with a lingering cough and some lung “spots” which I need to treat to avoid becoming fibrosis. That said, I consider myself lucky. Not due to pure chance, or my age, fitness level, good health. Not because I’m a tough guy that does push-ups every day. I’m lucky because I got sick just before the second wave, when front-line doctors in hospitals could advise me. That allowed me to take the right actions,
So I’d like to share all that advice with you.
DISCLAIMER: Consult a doctor for your treatment, especially regarding any medication. There are lots of complications that only a physician can help you avoid, and self-medicating can easily do more harm than good. For example, my antibiotics turned me purple, and it could have been worse.
Giving yourself the best chances means starting preemptive treatment so that you don’t need hospital care. So start treatments as soon as possible.
A big risk with COVID-19 is that you feel okay, or only have mild symptoms, but then after a while, it develops quickly into critical lung problems. So wait and see is a bad approach, since the worst cases are often simply because treatment wasn’t started in week 1. Be safe, not sorry.
Covid cases generally become critical in 3 ways:
The sooner you start on these treatments the better. The following treatments, done several times per day, also help make sure you get through:
Symptoms change quickly and often. It’s normal to experience some really rough days, and then some good ones, then bad again. For me, the fever was followed by strong nausea, which was the worst part, then a week of low and high body temperature. Do not assume a good or bad few days is a meaningful change in your overall recovery.
Rather that worry about every little change in symptoms, the key things that you want to measure are:
These will give you more certainty if you’re okay or need to call an ambulance.
Get tested early so you can act early. Get a PCR test after 2 days of symptoms, not longer than 5 days after.
You need a doctor to prescribe some key medicine, and to make sure you’re avoiding complications. Unfortunately, lots of Bulgarians find their GPs unresponsive or dismissive. But in COVID times, the good GPs are willing to guide you even if you aren’t their patient. So ask your friends and colleagues for recommendations.
Your goal is to keep your immune system calm so it doesn’t overreact and cause swelling in your lungs. Do NOT use immuno-boosters.
You’re aiming for 5 straight days of no strong symptoms. This is a sign you’re on the path to recovery. If you keep resting and keep on with the treatments, you can rest easy. You’re now on the path to recovery.
If you’re stuck in quarantine with others who don’t have COVID, stay very isolated from them in your own room, keep fresh air circulating, and disinfect the bathroom sink and counter after every use.
Get a CT scan afterwards, even with no lung problems. Lung damage often occurs quietly and without symptoms, and is likely to become permanent if untreated.
Get everyone you were quarantined with you to get an antibody test, to be sure who had it and didn’t.
Give yourself a few weeks off after you feel better, to get back to normal.
I’ll describe these in more detail in the following sections, but to get you started quickly, here’s what I recommend you do:
These are what you’ll need right away:
These reduce the viral load in your body, giving it an easier fight:
One doctor explained that the worst COVID cases (the lethal or long ones) were usually because the patient had waited too long to start treatment, which gave the virus time to work quietly. This was typically because the person waited too long to get tested. I imagined all the conspiracy theorists and tough guys in the covid ward at the hospital, feeling embarrassed.
So, getting practical, the things you can do to give yourself the best changes are things that remove any delays and start your treatment:
The sooner you start on countermeasures, the more likely you are to survive, and to have only “mild” symptoms. The virus is in your body and has a head start, but if we start our medicine on time, we’ll make it much less likely to take hold later.
The first step to getting prescription medicine is a PCR test. (If you can’t get a PCR test, tell the doctor that and they will help you with the next steps.)
Even though I got my results on day 6 of my symptoms, I was later told by a doctor that this was early enough in my case.
Another doctor explained that the PCR tests are most accurate 1 or 2 days after symptoms start, when the virus is still active in the sinuses and trapped in mucus. One of the problems with PCR tests is that a negative result isn’t always reliable, so it’s worth getting tested again if you get a negative.
If you don’t have symptoms, but are worried because you’ve had contact with COVID, the doctors advise you to isolate for 2 weeks and wait for symptoms to get tested. A PCR test can show a positive result after around 5 days with no symptoms, but again, they’re not too reliable so even with a negative, you stay in isolation and get tested again at the end, since there are many cases where the symptoms only started 2 weeks after contact.
An important note: I was rejected for being tested by a major public Sofia hospital, being told I am too young (they didn’t even ask my age, maybe because I am so beautiful) and because my fever had gone down that morning. They just heard a few of my symptoms, and simply told me it probably wasn’t COVID. At first, I was relieved to hear this! The person doing triage at the main emergency hospital in the capital city is telling me I’m just being a scaredy cat! But they were wrong and that mistake could have cost my life, and caused spreading to so many others. Luckily, I checked symptoms online and because I was losing my sense of taste (things started to taste metallic), I went to get a private test the following day, just to be sure.
Do not accept their apathy or excuses. Get tested early. It could save your life, and it will at least save you a lot of misery. Not to mention the people around you.
That said, I had a quick, comfortable and painless experience getting tested at Ramus Lab in Sofia. No line. Friendly people. Didn’t feel a thing. Got my results online the next morning.
While 100 leva may feel a lot, and it might feel unfair that the government isn’t paying, in the long run it’s worth it for the benefit of your own safety and calm mind.
You will need a doctor to prescribe you medicine, firstly because the standard medicines require a prescription, and secondly because there are lots of pre-conditions they need to check to prescribe the right things (allergies, spider veins, and many more conditions need specific attention.)
The official support channels provided me with no medical support, so the first thing I recommend is to find yourself a doctor with COVID experience, or at least up to date on the latest developments.
Don’t waste time. Start letting people know you have COVID, and ask around for people who have had COVID, or have a good, responsive GP. Get their phone numbers and call them. Ask casually what COVID papers they’ve found useful lately, to see if they’re on top of things.
My symptoms started with the light-headed feeling of a fever, but other people start with a cough or a sore throat. In my case, the symptoms came on fast and strong. Just after lunch, I could feel a cold starting in my sinuses. Four hours later, I was sweating into my bedsheets with a 38-degree temperature and full fever symptoms. This virus moves fast. It took me straight to bed without saying a word.
What’s considered “mild” COVID was actually really intense for me, as far as the common flu goes. It is certainly worse than any flu I’ve had, and I’d compare it more to when I had mono and salmonella. High fever, body aches, strong headaches and ear aches, sweats, vomiting, diarrhea, sometimes all at once. It was like a disgusting endurance sport that nobody should ever have to watch on TV. Seriously, it was tiring. I just wanted it to stop. A few times, I would walk into the bathroom, get dizzy and just lie down on the cool tiles for a bit.
The high fever came with strong dreams and delirium. Sometimes I couldn’t tell what I had dreamed and what had actually happened. I noticed I started to have stressful dreams (which hasn’t happened in a few years, since I started meditating regularly). That was my mind making sense of the stress my body was under. I vaguely remember starting to watch Star Trek, and developing critiques comparing Deep Space Nine to Discovery. I was clearly losing it.
My highest fever broke after 2 days, but fevers kept coming back. I was told these starts and stops were normal. For about a week, my temperature oscillated from 35.5 to 39, but every day, I’d have at least a few hours break where I felt mostly better.
I lost a noticeable amount of muscle mass over the first few weeks - people commented on how skinny I’d become afterwards. (And just when I’d finally become strong enough to do the upside-down yoga things from the Youtube videos!)
I slept a lot. For the first week, I slept 14-18 hours per day, and over the second week, even when I felt better, I was still sleeping around 12 hours per day. My body was still fighting something, and I could feel how important sleep was because I’d feel stronger when I first woke up in the mornings.
Things seemed to get better for a few days, then worse for a few days.
At first this was all very worrying. Did the good days mean I was getting better, or did the bad days mean the virus was winning? Viruses do sneaky virus things, I thought, especially this one.
What made me feel better was when one doctor explained a rule of thumb: after 5 days of being “stable” without any active symptoms, then you’re on track for recovery.
By now, it might have crossed your mind that COVID can be really bad for you. If you have it, it might have also crossed your mind that even though the odds are very good that you’ll survive, maybe not. Maybe this is it. For me, it took a few days to get used to that idea, but I noticed lots of people around me were quite uncomfortable learning I got COVID.
I think everyone deals with the idea of a serious sickness in different ways. Some people were encouraging. stepped up and offered help. Some people close to me reacted with the emoji equivalent of a pat on the back, or said awkwardly polite things and took some distance. You’ll probably be surprised. Your neighbourhood arch-enemy might start bringing you fresh tomatoes and taking out your trash.
But this is serious. It’s literally life or death. So its understandable when people talk around the statistics and medical stuff with indirect language, even doctors sometimes. I felt better knowing what I was up against, so found it useful and refreshing to talk about it directly. So that’s what I’ll do here.
The typical path of COVID is it starts with flu-like symptoms (or sometimes just a cough, sometimes just fatigue or dizziness, sometimes low blood pressure and the feeling of wanting to pass out) in the first week, and towards the second week, progresses into your lungs, where it can be lethal. In your lungs it can block your ability to intake oxygen in a few ways: exhaustion, ARDS and thrombosis.
Your only job now is to not let those things happen. Here’s how.
After I wrote this article and asked my doctors to review it, one pointed out that exhaustion is actually a really serious path to critical symptoms:
“I saw many people with COVID-19 who were tested early but due to the home treatment (sometimes even in the hospital) they deteriorated pretty fast and the worst part is that the level of hypoxia and respiratory failure does not always correspond to the symptoms. Sometimes the only symptom of a serious respiratory failure in COVID-19 patients is the extreme fatigue and exhaustion and there is no cough, fever, dyspnea or other symptoms of respiratory distress.”
Having been through it, I realised that older people and less healthy people have a harder time with this because it’s so tiring.
I also understand now why the doctors told me to stop working and just relax all day. Even when I felt relief from symptoms on good days, my body was still fighting. I was only a little tired, or light-headed, so I felt I could do something, like help clean, or answer some emails. But doing even those little things completely floored me a few hours later. Just because symptoms improve and you feel better doesn’t mean your body isn’t working hard.
It’s important to take things that help your body work less. Paracetamol is a key medicine, because it actively keeps your fever low. Avoiding fever helps you save energy, and keeps your immune system from going into turbo.
In retrospect, I can see that my morning routine of forcing myself to drink water and cold towels to break the fever gave me some rest, and helped me stay strong to fight.
You need to help your body have less to do, because this could be a long marathon. Take a deep breath and accept that, then be happy that you don’t have to deal with errands, or your boss, and can finally watch all those shows on your Netflix list.
ARDS is fancy doctor-speak that basically means your lungs get swollen, making it hard for you to breathe in and out, and hard for oxygen to pass through your lung membranes and into your blood.
If you ever had a swollen elbow or fingers, you remember how hard it was to bend them. This happens with the ‘balloon’ of your lungs, so imagine fighting that swollen resistance with every breath. Well actually your lungs aren’t so much like a balloon, they’re full of little folds inside, which is where oxygen passes through to your blood on the other side. But if they’re swollen, they swell shut.
The problem is that the swelling is actually caused by your immune system fighting the infection, not the virus itself. So it’s the immune system reaction which causes the critical breathing problems. (This is one of the reasons men are more affected. Like some other parts of our body, our immune system can overreact to things at inconvenient times.)
So this immune system reaction of swelling up the lungs is what we want to avoid, therefore the typical treatment for COVID (as of October 2020) is to preemptively reduce the chances of this swelling happening. To stop it, we need to keep our immune response “calm.” A typical treatment is to start a particular antibiotic that reduces the immune system response. In my case, it was Azithromycin. After a few days, I started to have an allergic reaction to the antibiotic, so I was prescribed corticosteroids instead. (My doses were also based on a bunch of questions the doctor asked: weight, height, age, level of fitness, what I was wearing, etc. This is why you need to talk to a doctor for your prescription!)
A radiologist working on COVID cases explained that “spots” can appear in CT scans in the lungs that get worse within hours. These spots are glue-like secretions that block oxygen intake. So best to be safe, and get to a hospital or call for an ambulance before things get serious, or there might not be enough time.
When you read the statistics about ‘critical’ cases, these are cases where the patient needs assistance for breathing.
The worrying aspect of this, while you’re at home, is that the lung symptoms can show up suddenly, and you can go from having no breathing problems to needing an ICU (intensive care unit) within hours - something they call “crashing.”
This is why there’s some debate around the number of people being hospitalised. In many cases, the patient needs to be watched more carefully, and to be near an intensive care unit if they need it suddenly. This is why some people are in the hospital but not in the ICU or on a ventilator.
Another doctor advised me:
“In general, care should be taken and shouldn’t be delayed even with a slight respiratory distress. The moment you have certain aches or itches in the trachea you should go to the hospital.”
This kept me second-guessing every time I had a pain or itch in my throat. What an emotional roller coaster!
I was later advised to get a device called a pulse oximeter, which gives a clear reading of blood-oxygen levels within seconds, and gives you peace of mind. I wish I had this device from day 1, since I would have been much calmer knowing I can constantly check my blood oxygen levels to know for sure if I should be calling an ambulance, or not.
I was told that if after some deep breaths, my oxygen (VO2) can’t rise above 94%, it’s time to call emergency and go to a hospital.
The other way COVID blocks your lungs from getting oxygen into your blood is thrombosis. These are little blood clots in your veins, and in the case of COVID, in the small capillaries of your lungs. Blood clots block them from taking oxygen into your blood through the walls of your lungs.
Turns out this is much easier to counteract. The typical treatment for this is to take a full dose of aspirin every day, starting as soon as symptoms start. Aspirin thins your blood and breaks up blood clots. It’s even a good idea to start with aspirin before you’ve had your PCR test, just to be safe and get an early start.
You want to watch out for joints swelling here. If you have that, it’s a sign of thrombosis and you should call a doctor.
A lot of countries have reservations about their healthcare system. I got COVID while living in Bulgaria, which has a healthcare system highly affected by corruption, lack of funding, and apathy.
It took a while for me to find access to good medical guidance. Good thing is there are plenty of good doctors here. Just a matter of finding them yourself.
From my experience, no medical support was available from the official COVID channels. A few days after I got my positive PCR test, I was phoned by a municipal administrator who was responsible for enforcing quarantine. (I was told from the lab that they would call, but mistakenly assumed that would be to offer medical support.) They didn’t speak English so they spoke to my wife. I have to say they were the nicest and most polite bureaucrats I’ve encountered in 7 years in Bulgaria. They were the first I’d even describe as being caring. But - they were still bureaucrats tasked with enforcing quarantine, which basically meant getting you to sign a document explaining basic hygiene and that you understand the penalty for breaking quarantine. For medical support, I was on my own.
The public COVID support phone numbers were either busy, or answered by administrators who would give the phone number of an epidemiologist, which was always a busy signal and didn’t return calls.
My wife’s GP was my only option at first. We contacted her before my PCR test, and she seemed quite unconcerned, only offering a prescription for antibiotics “if I felt like acting early”. Also, it became clear once I talked to other doctors that not all GPs in the country are keeping up to date with COVID treatment.
There are good doctors out there, you just have to be proactive and look for them yourself. The bureaucracy is overwhelmed, and apathetic as you’d expect any government office here. It was the classic case: “that’s not our responsibility here, why don’t you try this other department.”. So, I think it’s up to you to find a good doctor through your own network. The good news is that the doctors who are actively reading and keeping themselves up to date are usually quite open to helping people through COVID even if they aren’t officially their patients.
For monitoring your condition, you’ll want 2 devices:
A pulse oximeter. There are so many times when you will be worried that things are getting worse, and not sure about this or that itch or pain and if you should call an ambulance or go to the hospital. A pulse oximeter gives you an instant reading of your blood-oxygen levels so is the best, clearest - and earliest way to know if things are going downhill and you need to get professional hospital attention. Good ones (meaning accurate ones) are about 80-120 leva. We got ours from a medical supply store near Pirogov, but you can get them online too. I was told if my reading drops below 94%, it’s time to call 112.
Thermometer. It was helpful to have a thermometer to check my constantly changing temperature and react accordingly.
If you want to be extra careful, you can get a blood pressure meter too. (I didn’t, but the doctor said to keep an eye out for symptoms of high or low blood pressure.)
I had fevers starting and stopping for about a week. Again, doctors explained that keeping the fever low was important, to keep energy to power through. But also the high fever meant a strong immune system reaction, and too strong means swelling can start.
I used Fervex or paracetamol whenever my fever got above 38. In between, ibuprofen was helpful for reducing sinus swelling and with the headaches, sore throat and ear aches.
I kept a wet hand-towel in a plate by the bed, and cooled my head and neck with it. Once a day, forcing myself to sit up and drink a good amount of water would break the fever for a bit.
My medicine prescriptions and daily routines got a bit complicated to remember while in a hazy, fever state, but I made a few checklists to remind me: one for when I wake up, another after lunch and one for sunset. (Sleeping so much, sun-up and sun-down are easier to orient around.)
Ibuprofen (not taken within 2 hours of paracetomol) is an anti-inflammatory, and was useful for the headaches and sinus swelling.
Also, daily stretching, even for a minute or two, really helped reduce the aches in my legs and lower back. While standing or sitting with softly stretched legs, just reaching for my toes and bending my knees to move the stretch to my lower back or hamstrings as needed,. I really wish I’d figured that out sooner. It really helped reduce the pain.
I would rinse my sinuses manually 2 or 3 times per day. They call it “reducing viral load” which basically means cleaning out the mucus containing the virus so there’s literally less of the virus for your body to kill off. I guess it breeds in your nose and mouth at first.
Three times per day, I’d spray isotonic water up my nose and into my rear sinuses, blow my nose and then inhale the nasal gel and massage it in. This helps soothe your sinuses after you clean them, and also captures and kills some of the virus.
Then, I’d brush my teeth and gargle with mouthwash to clean the back of my throat.
Drinking herbal tea was good for my lungs. Also taking cough syrup preemptively kept my cough from starting the first 2 weeks.
I’d also do steam inhalations, with chamomile, pine and baking soda. The first week, twice per day and once my symptoms lightened, once per day. (A month later, I still do them to treat my cough and lungs.)
Be careful not to burn yourself. Let the water cool a little because even a mild burn in your lungs is going to make you unsure if the pain is from COVID or the burn. The idea is just to keep your airways clear and help release mucus build-up in your lungs.
Amazingly, my wife didn’t get COVID, even though she was quarantined with me in a small apartment and took care of me. (Confirmed with a negative PCR test and antibody test.) Maybe she was somehow resistant. Maybe it’s because she’s a strong Bulgarian woman who doesn’t take shit from anyone, especially not COVID from her husband. But it’s possible this was also because of how thoroughly we cleaned and managed our space.
I stayed in the bedroom, and she stayed in the living room, sleeping on the couch. We spent maybe 15 minutes at a time in the same room, a few times per day. No physical contact. Very romantic.(My wife suggested we watch the same movie from our different rooms, but for some reason, I had to watch Star Trek.)
Windows stayed open to keep fresh air circulating. This meant sleeping with the window open and heater on sometimes.
Every two days, we fully cleaned all floors and surfaces in the apartment, changed the sheets, and did all the laundry.
Used tissues were thrown directly in a plastic bag by the bed, and thrown out daily.
We kept a bleach-based cleaning spray on the bathroom counter, so I could disinfect the sink and counter every time I used the bathroom.
We have 3 cats. A nurse had told my wife, “you have cats? There’s no way in hell you won’t catch it then.” And yet, we managed somehow. We kept the cats separated. I had the kitten with me, because it decided I was its mama, and my wife had the other two. We didn’t let them move between rooms very much, even setting up separate litter boxes. I think cleaning the bathroom surfaces and bathroom sink and counters helped prevent the cats from stepping in some covid and tracking it around the apartment.
We read somewhere that I could be contagious up to 8 days after my last active symptoms, so we stayed living like this until then. Two weeks.
Pick one or two reliable people to help you. Ask them to be available to help you through the whole quarantine. When you’re stuck at home, and worried about things, you don’t want to constantly ask different people to fit in an errand for you, and worry when they forget.
We were lucky to have 2 reliable friends in the neighbourhood. We asked one to handle our pharmacy trips (short trips, but often urgent since we didn’t know what we needed at first) and one to handle our food shopping (longer trips, but not urgent once we were well stocked.)
I also found it hard to start planning ahead. I was so used to just popping into the store when I needed something. So to save time, we ended up asking for a big shop, and got loaded with weeks of food and bathroom stuff, like extra toilet paper, toothpaste, shampoo, soap… an extra bottle of everything just so we wouldn’t have to ask for a shopping trip for something we forgot we were running out of.
Doctors recommended ‘strong’ foods that are packed with nutrients, typical stuff for when you’re sick.
I craved high-protein foods, and fresh vegetables and salads.
A useful tip - get foods that are easy to prepare. Things that you can just throw in the oven, like frozen fish, potatoes etc. or easy stuff like omelettes, sandwiches and soups. With all the extra cleaning and chores, and the emotional aspects tiring you, you’ll want easy, pre-made meals.
Make sure you drink a lot of water. I found I had to force myself to drink water sometimes, but was happy I did because it helped break the fever. At least for me, my daily breaks from the fever often came after waking up and drinking 500ml of water.
I ate lots of fruit. Peaches, apples, anything with water and fructose will help keep you hydrated, energized and help your digestion.
Feeling better was such a relief, both physically and emotionally. So I was keen to start my life again, to get back to my morning yoga routine and back to my projects.
But the doctors told me to take it very easy, and not start again. I didn’t realise how much weight I’d lost at first, and how much sleep I still needed. Getting back to work was slowing my recovery, so I stayed in bed and went back to a routine of books, films and naps. Even then, it took another few weeks for me to regain my normal physical strength and capacity. Give yourself time.
In my case, I developed these lung spots without ever feeling breathing problems - just a mild cough that started at the end of week 2.
One friendly doctor convinced me to get a CT scan. I thought the cough was very mild so I didn’t think it was necessary, but he pointed out that doesn’t mean anything. When you take a look inside, it can be a totally different story. And it was. I had lots of spots. He pulled me out of the CT scanner and said, “you are not clean, my friend.”
So, I continued with the steam inhalations every day.
Even after a month, I notice if I miss a day, a lot of secretions build up – and this is bad because they can become permanent fibrosis if not treated.
After quarantine, I had an antibody test, and was told from the result that I should have some months of immunity. I just need to check my antibodies somewhat regularly to be sure. I’m told this number changes a lot depending on the person, so it’s a good idea to get tested. (It’s a standard blood test, not a PCR test, and costs 21 leva.)
My wife also got tested just to be sure. Given we’d shared a small apartment for the whole quarantine, we were pretty sure she must be asymptomatic, or resistant somehow. Good thing she got tested, since we now know she doesn’t have antibodies and is still at risk. (So now I do all the shopping.) Anyway, everyone you quarantined with should get an antibody check to know if they were exposed or not.
I’m looking into donating blood plasma, since it can be used to create prophylactic medicine for doctors and front-line workers. I’m also looking into volunteering in places where people with immunity can be useful.
It’s a bit strange to walk back into the world and experience the pandemic with immunity. While it’s calmer and less threatening, one of the nicest things is to meet up with friends, and instead of elbow bumping, to give each other hugs!
The doctors who helped me, and who read this guide, wish to remain anonymous because I am also speaking so candidly about the official response and management problems. Still, thanks to Dr. I and Dr. P for their care and advice, and for reviewing this before publishing, and for taking the time after long days at work to see me through this.
I’m not a doctor, but if you have any questions (and speak English) , please try me on email and I’ll do my best to answer them. My email is me@salim virani .com (remove all the spaces).
If you have any corrections or anything to add to this guide, please get in touch too.
I wish you strength, luck and a steady recovery.
I’m on the Kernel Stewards team, where we help ~2,000 fellows understand the what the development of blockchains mean to humanity on anthropological scales. I’m particularly interested in enabling fellows to build things with blockchains that are altruistic and prudent.
I’m also building a communication tool for community groups and unconferences. It focuses on autonomising teams rather than “coordinating”.
In the past, I've designed peer-learning programs for Oxford, UCL, Techstars, Microsoft Ventures and The Royal Academy Of Engineering, careering from startups to humanitech and engineering. I also played a role in the Lean Startup methodology, and the European startup ecosystem. You can read about this here.
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