Here's how to care for loved ones suffering with coronavirus | Rachel Clarke

In normal times, there is very little that can’t be made better by General Maximus Decimus Meridius. Russell Crowe’s hard-boiled hero of the 2000 blockbuster Gladiator has the best one-liners in the whole history of amphitheatres.

These are not normal times – yet I still think that Maximus’s wisdom can work its magic. His most inspiring line of all speaks to the complexities of how we endeavour to care for each other in these daunting days of coronavirus.

“Whatever comes out of these gates,” Maximus tells his rag-tag huddle of fledgling gladiators, “we’ve got a better chance of survival if we work together. Do you understand? If we stay together, we survive.”

Rarely is teamwork imprudent and yet, when it comes to infection with Covid-19, close proximity to others might just prove fatal. Until the start of this week, official government guidance was that anyone who developed a persistent cough or fever above 37.8C needed to self-isolate at home for seven days. Then, the government ramped up its social distancing measures with the announcement that every member of a household must remain in self-isolation for 14 days if any family member develops a continuous cough or fever.

Abruptly, thousands of healthy individuals have found themselves newly quarantined for two weeks, most often with family. The new guidance has created unusual household dynamics in which the healthy and the sick co-exist, unable to leave the family home, and possibly bewildered by how best to support each other.

The NHS website offers superb, clear, concise practical information on how to manage self-isolation. In essence, the person with symptoms should stay, ideally, in a well-ventilated room with a window that can be opened, keeping a minimum distance of two metres away from other people in the home. No one in the household should go outside, even to buy food or other essentials. Exercise outside is permitted, provided it takes place at a safe distance (two metres) from others. Those feeling unwell are urged to ask family or friends for help with delivering groceries, shopping and medication – all of which should be dropped off on the doorstep.

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Ideally, any vulnerable member of the household – such as those over 70, pregnant women or people with underlying medical conditions such as diabetes – should move out when someone else becomes symptomatic. If that is not possible, then the amount of time spent with them in shared spaces such as kitchens, bathrooms and sitting rooms should be minimised. Make sure they use separate towels for handwashing and bathing, eat separately, and sleep in a separate bed. Everyone in the household should regularly wash their hands, avoid touching their face, and frequently clean surfaces.

As ever though, the real world is infinitely more challenging than theoretical advice implies. How, for example, do you maintain a two-metre safe space between you and your febrile, yet fearsomely clingy two-year-old? How do you balance your natural desire to reach out and comfort your infected spouse with the necessity of keeping six feet from them? The rules will inevitably get broken. Don’t beat yourself up. Do the best you can.

One of the most crucial worries for households is how to judge when a family member’s symptoms have become cause for alarm. For this, don’t second guess the professionals. Start with the new, online 24/7 NHS 111 coronavirus symptom checker. You can input your own or your loved one’s symptoms and be swiftly signposted to appropriate next steps. Remember the vast majority of coronavirus cases are mild and will settle on their own. If you have a medical emergency such as severe chest pain or a life-threatening inability to breathe, call 999.

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In this new, no-touch world of cohabitation at a distance, conveying comfort and care to an infected loved one may require creativity. First and foremost, ensure your loved one rests, drinks plenty of clear fluids, and takes paracetamol to help with discomfort and fever. Then, in the absence of hugs, held hands, cuddles and closeness, know that loving gestures speak volumes. The best medicine may be a small act of kindness – perhaps a handwritten note from the children, a surprise Skype call set up with their best mate, a playlist compiled from all the good times past, a letter filled with dreams for your shared future.

It is love, in the end, that makes these times feel so giddy and dreadful – our overwhelming longing to keep those we love from harm. Yet it is love, too, that can render the unbearable benign. “Transmit love,” a patient in his 90s once told me, eager to impart his lifetime’s wisdom. “That’s all that matters – make sure you transmit love.”

He was right. And one thought your loved one might find helpful is this. By staying at home, by coughing and spluttering their way through a frustrating two-week quarantine, they are quite literally helping to protect the lives of others.

Dr Rachel Clarke is a palliative care doctor


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