Suggestions on home quarantine and recovery of novel coronavirus patients

Patient education and symptomatic treatments

Patients should be educated on this disease, especially its effects on respiratory function. Adequate sleep ≥ 8 h can promote immune function, which can be achieved best during slow-wave sleep if they go to bed before 22:00.^[11] Patients with fever or pain can take antipyretics and analgesics, such as ibuprofen and paracetamol. In case of cough, compound fresh bamboo juice, Xuanfei Baidu Granules, and Jizhi Syrup can be used, or compound licorice and acetylcysteine if with excessive sputum. Huasu or Watermelon Frost lozenge can be tried when there is a severe sore or dry throat. Chlorpheniramine, Loratadine, Cetirizine, or Budesonide nasal spray can be used for stuffy and runny noses.

Physical exercises, strength workouts, and disease-coping skills

Before the breathing exercises, fans should be placed at the door and windowsill, with the air blown into the room from the door and out of the room from the window. During the exercises, the patient faces the window with a fan blowing air from their behind. We review the following breathing exercises for reference. During these exercises, the patients can have standing, sitting, or semi-recumbent position when comfortable. The air is inhaled through the nose and exhaled through the mouth.

Exercises to improve dyspnea and reduce breathing workload. (1) Pursed lip breathing.^[12] With the shoulder and neck relaxed, the patient inhales slowly, then blows the air slowly through pursed lips three times a day, 3–5 min/time, and 5–10 breaths/time. (2) Position to relieve dyspnea. When there is dyspnea, the patient should find support in the standing position, then lean forward halfway, and adjust the breathing rate with pursed lip technique. The patient, if sitting, can lean forward halfway.^[13]

Lung capacity improvement. (1) Thoracic expansion technique. Patients can place their hands in the chest area and apply slight resistance during inspiration. Patients should hold their breath for 0–3 sec (depending on the personal situation) at the end of inspiration, then slowly exhale the air. This can be performed three times/day, 3–5 min/time, and 5–10 breaths/time. (2) Necessary equipment. Patients take a deep inspiration and hold their breath for 0–3 sec (depending on the personal situation), then exhales the air slowly and fully through incentive spirometry,^[14] three times/day, 3–5 min/time, 5–10 breaths/ time. (3) Breathing exercises.^{[13, 14, 15]} a. Shoulder abduction exercise. The palms should turn inwards during the inspiration, and the shoulders should be abducted. During the expiration, the palms should turn outwards and slowly put down. b. Shoulder forwards bending exercise. The palms face downwards, and the shoulders are flexed forwards during the inspiration. Both hands are slowly put down during the expiration. These exercises can be performed twice daily and for ten breaths/time.

Breathing muscle strength improvement. The inspiratory muscle strength can be exercised through the inspiratory muscle training equipment.^[16] The patient can adjust the resistance during inspiration. This can be performed twice daily, 3–5 min/time, and 3–5 breaths/time.

The following is an example of aerobic exercise. The individual exercise plan should consult each own doctor. The exercises should begin with the easiest (heart rate is < 57% of maximum heart rate or increases by less than 30%, or exertion score is < 9/20) and be gradually adjusted based on the patient's cardiopulmonary exercise function. If there is no apparent discomfort during the easiest exercise and the blood pressure fluctuations do not exceed 20 mmHg, then the patient can start moderate exercises (heart rate is 57%–63% maximum heart rate or increases by 30%–39%, or the exertion score is 9–10/20) and vigorous exercises (heart rate is 64%–76% maximum heart rate or increases by 40%–59%, or the exertion score is 11–13/20) in one week.^[17] These exercises can be performed for 10–30 min/time. The first three and last five minutes are the warm-up and finishing stages. The patient can also perform stretching exercises (if moderate exercise is used, the accumulated exercise time is calculated). Continuous or intermittent steps, walking, treadmill, cycling, and traditional Chinese exercises such as Tai Chi, Baduanjin, and Wuqinxi can also be used.

Strength workout. Combining aerobic and resistance exercises can enhance cardiopulmonary function and muscle strength.^[18] The progressive resistance exercise method is recommended for strength training. Resistance can be achieved through self-gravity, elastic belts, dumbbells, and barbells. The four extremities and major muscles can be trained by the patient's own body weight. The core exercise can use hip, four-point support, or sit-ups. These exercises can be performed in each muscle group 2–3 times/week, 1–3 exercises/time, and 8–12 actions/exercise. The intensity range is gradually adjusted from the easiest (30%–49% incomplete rest method [IRM]) to moderate intensity (50%–69% IRM).^[17]

Flexibility exercises can focus on the major muscle groups, such as the hamstring, quadriceps, and biceps brachii, as well as the muscle groups of the neck, shoulder, and trunk while emphasizing chest expansion. Each action is maintained for 15–20 sec with 1–2 groups/time. Dynamic traction, such as cat-cow stretch, arm stroke against the wall, and yoga, can also be used.

Exercise precautions. If a patient feels weak or in pain, the exercise intensity should be reduced, and its adjustment should be slowed down. The exercises should be held if shortness of breath, suffocation, or chest tightness occurs.

Occupational therapy program. (1) Energy conservation strategy. Patients may feel fatigued. The energy conservation strategy includes optimal organization, reasonable steps to coordinate the activities, simplified activities to reduce unnecessary movements, and effort-saving activities. (2) Relaxation. Abdominal breathing, meditation, and progressive muscle relaxation can reduce oxygen consumption and fatigue.^[19] (3) Home assistance. Patients and their families can work together on psychological issues. Online psychological support and self-management groups can improve their confidence. Professional advice should be obtained once there are psychological deteriorations. (4) Lifestyle redesign. Patients can participate in personalized lifestyle programs.^[20] Routine daily exercises, especially the upper extremity exercise, should be arranged to facilitate them to transit back to their previous activities.^[19] In these exercises, the patients can engage in favorable things to have a sense of achievement and happiness.^[21]

Mental health advises

Previous findings suggested that the COVID-19 pandemic causes negative consequences for mental health, especially in young adults. Home quarantine during COVID-19 has been associated with increased psychological distress and loneliness.^[22] Thus, appropriate risk communication and social contacts via social media or video calls are suggested to mitigate the negative effects of home quarantine on mental health.^[23]