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Coronavirus disease 2019 pandemic: Exploring the prospects of provision of home-Based care


1 Department of Community Medicine, Member of the Medical Education Unit and Institute Research Council, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission25-Feb-2020
Date of Decision10-Apr-2020
Date of Acceptance24-Jun-2020

Correspondence Address:
Saurabh RambihariLal Shrivastava,
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Tiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet, Kancheepuram - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_61_20

  Abstract 


The coronavirus disease-2019 outbreak in the Wuhan city of China has been declared as a public health emergency of international concern and as a pandemic, and it is a marker that the caseload of the disease is increasing at a rapid pace. It has been recommended that the suspect cases need to be isolated and monitored in healthcare establishments, keeping in mind the quality of care and security of the general population. However, in special circumstances such as lack of isolation wards or lack of infrastructure/human resources to provide healthcare or even in situations, wherein the existing hospitals refuse admission of suspects due to their own limitations, it becomes quite essential to think about home-based management. However, such a decision should be taken only after thorough clinical evaluation, after thorough assessment of the safety of the home environment, and after healthcare personnel is assigned the responsibility to act as a bridge between hospital and home care till the patient completely recovers. In conclusion, provision of home-based care for asymptomatic contacts or potential suspect with mild symptoms is a crucial domain in settings with limited healthcare infrastructure. However, considering the magnitude of the cases and lack of preparedness, it becomes very much essential to strengthen home-based care.

Keywords: Coronavirus disease-2019 pandemic, infection control, public health emergency of international concern, World Health Organization



How to cite this URL:
Shrivastava SR, Shrivastava PS. Coronavirus disease 2019 pandemic: Exploring the prospects of provision of home-Based care. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Apr 12]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=310603




  Introduction Top


The coronavirus disease-2019 (COVID-19) outbreak in the Wuhan city of China has been declared as a public health emergency of international concern and as a pandemic, and it is a marker that the caseload of the disease is increasing at a rapid pace and that too beyond the boundaries of the nation.[1] In fact, the available global estimates suggest that a total of 1,210,956 cases of the disease have been detected, of which 67,594 people have died (case fatality rate - 5.5%) due to the disease-associated complications.[2] Moreover, it is worth noting that since the inception of the outbreak, the disease has spread to 211 nations and territories and the number increases with each day.[2]


  Home-Based Care to Corona Suspects Top


The initial evidence suggests that the primary method of transmission of the disease is airborne, and thus, there is a significant need to strengthen standard infection control practices to interrupt the risk of disease transmission.[3] It has been recommended that the suspect cases need to be isolated and monitored in healthcare establishments, keeping in mind the quality of care and security of the general population.[3] However, in special circumstances such as lack of isolation wards or lack of infrastructure/human resources to provide healthcare or even in situations, wherein the existing hospitals refuse admission of suspects due to their own limitations, it becomes quite essential to think about home-based management.[4] At the same time, it has been envisaged that the high-risk population groups (viz., elderly individuals and those people with pre-existing chronic illnesses) should strictly stay at home and avoid all possible exposure to potential cases.[5]


  Recommendations for Safe Home Care Top


Even though, at present, not much is known about the novel coronavirus, the World Health Organization has proposed a set of recommendations for the provision of safe home care of potential suspects of the disease presenting with mild symptoms and for the asymptomatic contacts, provided no underlying co-existing chronic disease is present in them.[4] However, such a decision should be taken only after thorough clinical evaluation, after thorough assessment of the safety of the home environment and after a healthcare personnel is assigned the responsibility to act as a bridge between hospital and home care till the patient completely recovers. The assigned health personnel have to keep a track of the progression of symptoms, perform relevant diagnostic tests, and definitely make a daily visit to the home.[4]

It is vital to understand that the success of home-based care depends upon the ongoing support, counseling of the patient and family members (about personal hygiene, infection prevention control measures, care of the suspect, adopt measures to prevent the spread of the infection to home contacts, etc.), and continuous monitoring of the progression of the condition of the patient.[3],[4] A set of recommendations has been proposed for home care, including keeping the patient in one room only which is well-ventilated while other family members staying ideally in a different room, and limiting the number of caregivers to only one with no visitors being allowed. The assigned caregiver has to wear a mask when they are in the same room as the potential suspects and should discard their mask upon contamination and follow-it up with hand hygiene.[4]

Ensuring hand hygiene is an important aspect of healthcare and should be strictly practiced before and after cooking food, before eating or after toilet usage, using soap and water, and then dry hands with either disposable towels or earmarked cloth towels. Further, respiratory hygiene should be strictly adhered and all used tissues should be properly discarded. At the same time, contact with other body fluids or items (viz., toothbrush, plates) of the suspect patients should be avoided. The suspects should stay at home unless symptoms subside either clinically and/or two negative reverse transcriptase-polymerase chain reaction results are obtained 24 h apart.[3],[4]


  Conclusion Top


Provision of home-based care for asymptomatic contacts or potential suspect with mild symptoms is a crucial domain in settings with limited healthcare infrastructure. However, considering the magnitude of the cases and lack of preparedness, it becomes very much essential to strengthen home-based care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Statement on the Second Meeting of the International Health Regulations (2005) Emergency Committee Regarding the Outbreak of Novel Coronavirus (2019-nCoV); 2020. Available from: https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov). [Last accessed on 2020 Feb 25].  Back to cited text no. 1
    
2.
World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report – 77; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200406-sitrep-77-covid-19.pdf?sfvrsn=21d1e632_2. [Last accessed on 2020 Apr 07].  Back to cited text no. 2
    
3.
World Health Organization. 2019 Novel Coronavirus (2019-nCoV): Strategic Preparedness and Response Plan. Geneva: World Health Organization Press; 2020.  Back to cited text no. 3
    
4.
World Health Organization. Home Care for Patients with Suspected Novel Coronavirus (nCoV) Infection Presenting with Mild Symptoms and Management of Contacts – Interim Guidance. Geneva: World Health Organization Press; 2020. p. 1-3.  Back to cited text no. 4
    
5.
Kmietowicz Z. COVID-19: Highest risk patients are asked to stay at home for 12 weeks. BMJ 2020;368:m1170.  Back to cited text no. 5
    




 

 
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