What to do when Covid-19 hits home?

Is everyone prepared? That is the question, especially now that there is a terrifying surge of the Covid-19 virus because of the new SARS-COV-2 variants. This dangerous virus is hitting many homes nowadays and affecting a family member is a most dreaded thought, no matter how we try not to think of it.

But how do we prepare against an unseen enemy? For the past year, the idea of the virus hitting many homes was not really given much thought until a few months ago.

In the webinar “What to do when Covid hits home: solutions for the current surge” organized by the santuario de san Antonio Parish, Dr. Anna Lisa Ong-lim, Professor and Division Chief, Infectious and Tropical Diseases, Department of Pediatrics, University of the Philippines, Philippine General Hospital, presented some ideas on how people can tackle having a Covid-19 patient at home.

First, the numbers

THERE are about 132 million confirmed cases globally, which means every man, woman or child in the Philippines has tested positive already. With almost 2.9 million deaths, it is like saying that everybody in Quezon City has died of Covid-19.

Last year’s statistics were still low but in the course of 12 months, and in particular, in the past two weeks, the numbers have increased exponentially to about 828,366 cases already.

“In contrast to the global data of about 2.9 million deaths, we have about 14,000 deaths here. For a country with very meager resources and very low critical care capacity, this is a very respectable number. But the 14,000 still includes people we know, people we love, people we work with, our mentors, our friends. This is not something that we can allow. We need to find better solutions,” she said.

Unfortunately, by the middle of February, the cases started to reach 2,000, 4,000, 8,000 and now it’s 11,000 or 12,000 already. “If you think that it might not be surprising for our numbers to reach a million very soon, I think you will understand that this can be a very realistic projection.”

So what do we do now?

THE situation in terms of health-care capacity is already challenging and because the majority of cases are expected to be mild, home care can be an option for family members or people who have suspected or confirmed Covid-19.

The WHO has released guidelines on home care since last year, where it recognized that home care can be considered for an adult or child with suspected or confirmed Covid-19 if in-patient care is unavailable or unsafe. Patients already discharged may also be cared for at home, if necessary. Though caring for an infected person at home instead of a medical facility may pose higher risks, the isolation of an infected person can help break the virus’ transmission chain.

she said isolation at home depends on three factors—clinical evaluation of the patient, evaluation of the home setting, and ability to monitor clinical evaluation of the patient at home. “But key questions have to be answered first, like if the patient is qualified for home care. Patient should be asymptomatic or mild/moderate without risk factors, meaning no shortness of breath, no difficulty in breathing, respiratory rate should be less than 30 breaths per minute, and oxygen saturation rate should be 94 percent or higher.”

Another thing needed to look at are risk factors, if they are above 60 years old, smokers, obese, or with non-communicable diseases like cardiovascular disease, diabetes, chronic lung disease, chronic kidney disease, if their immune systems are not functioning normally. And if they have cancer, then this category of patients will not qualify for home care.

“Whoever is left behind and fulfills the criteria for mild disease, then maybe consider treating or caring for them in the home for as long as appropriate infection prevention and control measures are implemented. Close monitoring by a trained health-care worker is also feasible,” Dr. Ong-lim emphasized.

Quarantine vs isolation

When it comes to the home setup, there is a need to understand the difference between quarantine and isolation. Isolation is done on a person who has already tested positive for Covid-19 by separating that person into an individual room, if possible, with a separate bathroom and with good airflow, and with good delivery system so the person gets his daily needs with less or without contact and should be sanitized and disinfected regularly. “The objective of isolation is to prevent the person from spreading the disease to someone else by staying at home until at least 10 days have passed. The patient should also have had no more fever and symptoms for at least three days before they are discharged from isolation.”

In contrast, quarantine observes people who have been in close contact with a positive case for 14 days over which symptoms are expected to develop. “People can be contagious even before they test positive or even before they start having symptoms. What you want to happen is for that person to stay home for 14 days since the last contact and for those people to watch their symptoms, check their temperatures, and also to stay away from people who are at high risk, so that they don’t inadvertently infect others who may be at risk.”

Dr. Ong-lim explained that it’s very important for people to continue practicing infection prevention and control, one of the critical objectives that need to be achieved in homecare, while making sure that the person who is positive is provided with the appropriate level of intervention.

Finally, there should be a reliable caregiver who can do the monitoring, and relay the information to the health-care professional with accuracy and validity of information. “If it is a civilian or a layperson who’s providing care, then the lines of communication between caregiver and trained health-care worker or public health personnel should be open. This has to be established so should there be any emergency, the channels of communication, whatever is available, are already open.”

essentially, Dr. Ong-lim said the objective of monitoring, whether daily or as frequent as possible, is to detect worsening signs and symptoms at the earliest possible time. Whenever the patient’s symptoms become worse from the initial assessment, then they should be an indicator to see urgent care. Among these signs, she said, can take the form of an increasing respiratory rate, or difficulty speaking and forming complete sentences, shortness of breath, disorientation or inability to wake up or stay awake, or looks pale or bluish gray skin, which can be signs of decreasing oxygen levels in the body.

“If each of these points are carefully assessed, then we see that there is good capability to provide care should we proceed with the decision to provide home care for our Covid-19 family members.”