With rising cases of Covid-19, and with hospitals likely to be overwhelmed, it may be important to think home-based care and support services for suspected coronavirus patients who present with mild symptoms and on public health measures related to the management of their contacts.
The World Health Organisation (WHO) has developed an interim guidance for safe home care for such patients and their contacts.
This document was adapted from the guidance on Middle East respiratory syndrome coronavirus (MERS-CoV) infection that was published in June 2018.
It has been updated with the latest information and is intended to guide public health and infection prevention and control (IPC) professionals, health care managers and health care workers (HCWs) when addressing issues related to home care for suspected Covid-19 patients who present with mild symptoms and when managing their contacts.
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Home based care, according to WHO, can be considered for patients with only mild illness, as long as they can be followed up and cared for by family members. In the WHO document, “caregivers” refers to parents, spouses, and other family members or friends without formal health care training, who are expected to give home based care.
For such care to be provided, several conditions must be met, most of which require high levels of trust and discipline.
A trained HCW must conduct an assessment to ensure residential setting is suitable for providing care.
They must assess whether the patient and the family are capable of adhering to the precautions recommended for home care isolation such as hand and respiratory hygiene, environmental cleaning, limitations on movement and disallow visitors until they are completely recovered.
In some countries where respect for public health is guaranteed, such as in Sweden and Germany, these measures have been easy for communities to follow, and have resulted in managing pandemics without overstretching public health facilities.
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Home based care is preferable to families, especially those in the lower levels of social stratification, as it is more cost effective compared to managing a disease in hospital.
It ensures people live as independently as possible at home where one is surrounded by loved ones, especially when dealing with a prolonged disease.
Where public health services are not able to cope with increasing demand for treatment and care, home based care may be the solution. These services should focus on providing social and psychological support, nutritional support and basic nursing care, which are critical success factors in the management of Covid-19 disease.
But with some basic direction, others may treat opportunistic infections associated with the virus such as headaches, cough and running nose.
To support the concept of home based care and to particularly help caregivers who provide care to the infected, involving the wider community in the provision of care and support, providing support to caregivers, addressing stigma and discrimination and caring for children is necessary.
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At the community level, it would be important to conduct education on Covid-19 so that members get basic information about prevention against and management of the disease, and on basic prevention and disposal of health wastes strategies. Involving community outreach workers, peer counsellors and other lay health workers in conducting home-based care activities, and in supporting caregivers, would also be critical in this endeavour.
Providing care for the sick is not for the faint hearted. Caregiving may place considerable strain on caregivers, and may even result in depression, exhaustion and anxiety. Such caregivers may themselves require support.
People living with life-threatening diseases usually face stigma and discrimination. Their family members, including care givers and children, may also experience stigma and discrimination, resulting in judgmental attitudes that can reinforce feelings of self-blame and depression.
Caregivers of people infected with Covid-19 may also face stigma from family, relatives, friends, neighbours and other community members, which may unfortunately add to their burden.
One way of managing Covid-19 patients is to physically isolate them. This may in itself feel like emotional isolation from social networks, friends or family from whom they can receive support, which may weigh down on the patients.
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In all this mix, children are likely to carry the heaviest burden of disease as they get neglected or overworked. In households that are headed by children, things may even be worse.
Assuming adult responsibility for looking after their families, performing household tasks, caregiving and raising income may all be the portion for the children, and is never easy.
-Prof Kiptoo is the CEO at Kenya Medical Training College