COVID-19 updated guidelines

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01 Team

• MEDICAL
• Sajan Nakka
• Angela Stoffel
• Jody Knowlton
• Dr. David Emerson (on consultation basis)

• STUDENT BODY REPRESENTATIVES
• David Hernandez
• Amir Davis
• Cathreen Minja

• ADMINISTRATION
• Julia Moodie
• Norbert Restrepo
• Dr. Andrew Smith
• (Others will be invited or requested to be part of as necessary)

02 COVID-19 General Education

General: 

The virus spreads from the eyes, nose, and mouth. Once the virus is contracted it takes 48+ hours to up to 14 days with a median of 5.1 days to start experiencing symptoms. The days prior to the appearance of symptoms is called the incubation period. During this time a person can be infectious as the virus is hijacking the body’s immune system and actively replicating. The risk of infecting others (spreading) increases proportionally from the time of contracting the virus until symptoms are noticed. For example, one will be more infectious on day 2 than on the day (day 0) when they contracted the disease. So, when someone tests positive or has symptoms, we must identify where and who they were in contact with within at least the last 2 days.  

Self-identification: 

All individuals must be made aware of the seriousness of this disease and how cumbersome and expensive this process can be. In other words, more caution early on can make a big difference. If anyone feels different from normal or sick (any suspicion) make sure you start isolating yourself and report to the deans or Ms. Julie Moodie. Stay in your room and contain yourself until further instructions are given. Outside activities are limited to walks in the open away from others to get fresh air. Please keep in mind that the whole idea is to contain the spread. We also request you to turn in the names of people you interacted with (15 minutes within 6 feet) and places you have been to in the previous 2 days. Contact the deans and/or Ms. Moodie to make them aware. Those who were exposed to someone with a positive test must quarantine for the next 5–7 days.

Valuable resources:

Time, money, and health are valuable resources. Covid infections can be expensive, It costs money and work hours to track, assess, monitor, test, treat, discuss in team meetings, etc. If someone contracted Covid that could not be avoided, then using these resources are justified. If someone contracts the disease due to the neglect of proposed guidelines, then even though resources will be rightfully used for their care, it would be at the expense of resources that could have been used elsewhere. For example, a single individual Covid positive or Covid exposed who disregards the guidelines adds the burden of tracing, assessing, testing, etc. Furthermore, a 5-day quarantine would be required for those who were exposed which will cause a loss of work, an inconvenience for those whom they live with, and more testing at the end of quarantine. Collectively this is a loss of valuable resources that would have otherwise been used productively if guidelines were adhered to. Guidelines followed will effectively save resources and lives if possible.

Close Contact/Exposure: 

Someone who was less than 6 feet away from a Covid-infected person (laboratory-confirmed or a clinical diagnosis) for a cumulative total of 15 minutes or more over a 24-hour period (for example, three individual 5-minute exposures for a total of 15 minutes). An infected person can spread SARS-CoV-2 (Covid) starting from 2 days before they have any symptoms (or, for asymptomatic people, 2 days before the positive specimen collection date). Those providing treatments for Covid patients with appropriate protection gear (N95 mask, face shield, gloves, and disposable gowns) are not considered exposed.

Vaccination/Prior infection: 

Someone who is vaccinated or had a prior Covid infection has an immune system that is better prepared to handle the virus should they contract the virus, but it does not necessarily protect them from contracting the virus. If they contract the virus, they will most likely experience a shorter course of illness that is less severe and decreases their chance of having serious complications because the body is better prepared to fight the infections. Again, it does not mean that they cannot contract the virus. Therefore, individuals who are vaccinated or received natural immunity from a previous infection will follow the same quarantine rules unless recommended otherwise by the medical assessor.

03 COVID-19 Containment

Identifying those who are sick with Covid

• Covid symptoms: Anyone not feeling well or has a fever
• Covid exposed: Anyone with or without mask that has been within 6 ft for more than 15 mins of some who has tested positive from 2 days prior to having symptoms or testing positive to the end of their quarantine/isolation. (15 mins or more exposure, with or without mask, 6 feet or closer to someone 2 days before testing positive or having symptoms up until that person discontinued their isolation)

Three categories of individuals

• Covid Positive – Tested positive with or without symptoms or at medical personnel’s discretion.
• Covid Exposed – Exposed to someone positive
• General/Normal Risk – General exposure, not exposed to anyone who tested positive

General rules

• 6 feet distancing
• Masking indoor (use your judgment, must mask if 6 feet or closer)
• Handwashing and hygiene
• Daily temperature checks

Isolation/Quarantine rules

04 COVID Positive

• 10 –14 days. 
• For symptomatic patients, 10 days after symptoms’ onset, 24 hours of no fever (should not be on antipyretic medications such as Tylenol), and an improvement of other symptoms
• For asymptomatic patients, isolation can end 10 days after an initial covid positive test. (In either case, a medical assessment is necessary before ending isolation)
• No contact with anyone except the designated associate assigned to help
• Outside activities are limited to walks in nature (including sitting outside in grass or chairs, etc.) close to your place of isolation for those that are feeling well enough. Sunlight and fresh air will help but ensure you are away from others.
• Have an exit that is separate for those that are positive so that they can go for a walk outside.
• The isolation rooms should be on separate levels and if possible separate buildings.
• No sharing bathrooms with those that are well.
• Before the end of your quarantine, the Health Office will assess and test you if necessary and make a recommendation to be cleared or continue isolation and be reassessed later. When cleared you will be exempted from isolation and join the general risk group.

COVID Exposed 

• 5–7 days observatory quarantine.
• Same rules as those that are Covid positive, except that this group is quarantined in a separate place from the COVID positive and the General risk groups.
• Before the end of your quarantine, the Health Office will assess and test you and make a recommendation either to be cleared if negative or continue to isolation if positive and be reassessed. When cleared you will be exempted from quarantine rules and join the general risk group. If you have symptoms, you will be given instructions on what to do.

Designated helper (Someone who has had Covid before)

• Food delivery: Will wear a mask, ideally N95, if not at least a double mask. Leave the food outside. Sanitizing or washing your hands after coming back and moving in with the general public.
• Treatment/Therapy: Need to wear an N95 mask, face shield, gown. Once treatment is over the designated helper will discard his/her gown or put away his/her clothes. This person preferably must be living alone and using a separate bathroom.

Elect not to get tested

• If you have any symptoms suggestive of a viral/Covid infection (fever, headache, runny nose, cough, sore throat, fatigue, weakness, etc.) you will be expected to take necessary precautions and self-quarantine yourself for 10 -14 days.
• Before the end of your quarantine, the health office will assess and test you. If you test negative, you will be exempted from quarantine rules and join the general risk group.

Noncompliance

• If during the assessment it is discovered that the infection was the result of someone not following guidelines, we will ask that individual who did not comply to take responsibility and share a small part of the burden as a result of their actions. For example, if someone was supposed to be in isolation or quarantine but did not follow guidelines and exposed others, we will charge individuals the cost of the tests for those that they exposed.

04 COVID Testing

Rapid test: 

Nasal swab test. The swab is inserted 1 inch into your nose and no further. It detects the viral antigen. If you test positive, there is small chance that you may be negative. If you test negative, you practically don’t have the virus.

RT-PCR: 

Nasal swab test. It detects viral RNA. If you test positive, there is an even smaller chance that you may be negative. If you test negative, you practically don’t have the virus. This test, taken after the Rapid test, makes the positive result more certain.

Antibody test: 

Blood test. It detects the antibodies that were made by your body in response to an infection you had in the past or from being vaccinated. The level of antibody titers tells you how well you are protected. Based on this information booster shots are determined that help bring up the antibodies.

05 COVID-19 Communication

Daily briefings will be conducted during outbreaks to manage the disease on our campus. 

06 COVID-19 Assessment

Designated contacts –Angela Stoffel (Primary), Jody Knowlton (Secondary)

Helpful list of signs and symptoms to look for (when calling for medical help)

• Abnormal vital signs in comparison to admissions physical assessment
• Severe Headache
• Fever above 103^o F that is rising.
• Shortness of breath or O₂ saturation below 92%
• Excessive nausea, vomiting, and diarrhea for over 24 hours
• Pain level over 5 on a scale of 1-10, with 10 being the highest pain level
• Extreme dizziness
• Change in mental status (not oriented to name, place or time) or more depressed than normal
• Bleeding

07 COVID-19 Treatment

Designated Contact – Angela Pulley

Locations

• Hartland Wellness Center – Rapid testing, lifestyle treatments
• Clinic/Pharmacy – for RT-PCR testing
• Culpeper Hospital – if the individual cannot be taken care of at the dorm or lifestyle center

General treatment

Note: These are recommendations. When in doubt, use caution and check with your health care provider.

• Contrast bath/showers 2 times a day (3 mins hot, 30 sec cold, at least 3 cycles, end with cold. d/c if lightheaded, weak)
• Ivermectin (if available) first 5 days

Ivermectin alternatives

–Black walnut oil: 4 drops in 4 oz, 3 times a day
–Wormwood oil: 4 drops in 4 oz, 3 times a day
–Black cumin seed extract: 40 mg/day

• Vitamin C: 500 – 1000 mg/day
• Vitamin D3: 1000 – 3000 U/day (if taking too much you will see diarrhea)
• Zinc: 30 – 40 mg/day
• Quercetin: 250 mg/day (d/c after 14 days)
• Melatonin: 6 mg/day
• Mullien Tea: 2 times a day (a teaspoon to 8 oz water, steep for 15 mins)
• NAC (optional): 1000 mg – 3000 mg daily as tolerated (d/c after 14 days)
• Wild leaf oregano oil (d/c after 14 days)

Infection: 4 drops 3 times a day, in 4 oz of water
Maintenance: 1 capsule once a day

• Example: Person A has tested positive for COVID-19

Day 1 – 14, 10 things or as many as available
(A medications kit will be provided to students)

• • Contrast bath/showers
  • Ivermectin or alternatives
  • Vitamin C: 500 – 1000 mg/day
  • Vitamin D3: 1000 – 3000 U/day (if the dose is higher than you can tolerate you will have diarrhea)
  • Zinc: 30 – 40 mg/day
  • Quercetin: 250 mg/day (d/c after 14 days)
  • Melatonin: 6 mg/day
  • Mullien Tea: 2 times a day (a teaspoon to 8 oz water, steep for 15 mins)
  • NAC (optional): 1000 mg – 3000 mg daily as tolerated (d/c after 14 days)
  • Wild leaf oregano oil: 4 drops 3 times a day, in 4 oz of water

U = units;  d/c = discontinue

For dealing with particular symptoms, check the next section, Specific Symptom Management.

Specific Symptom Management

Note: These are recommendations. When in doubt, use caution and check with your health care provider.

Fever

• Keep hydrated, 
• Pedialyte or coconut water (electrolytes)
• Cold compress for the head

Cough

• Steam inhalation with eucalyptus oil or oregano oil (1 to 3 drops in a large bowl of water)

Sore Throat 

• Gargle with salt water and turmeric and charcoal (alternate, once salt water and turmeric and another time charcoal if doing it 2 times a day)
• Heating compress over the neck 

Headache

• Hydrotherapy – Hot foot bath
• Keep head cold
• Peppermint oils massage to the temples (avoid the eyes)

Shortness of Breath, O2 sat below 92 

• Chest fomentation 
• Hot foot bath
• 325 mg Aspirin (daily) 
• Budesonide or dexamethasone (2 samples free from the lifestyle center, then prescription from Dr. Emerson)

Mental Health (Loneliness, Depression, Anxiety, etc.)

• Visits and assessments twice a day or more if necessary  
• Prayer and encouragement
• Connect with family and friends, such as video calls
• Short walks in nature if one can tolerate.