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Home-based care to help ease numbers in hospitals

Health & Science

State to release home-based care guidelines for coronavirus patients, ease burden on overwhelmed public hospitals

The government is tomorrow expected to release guidelines for home-based care for coronavirus patients.

The new plan is aimed at easing the burden on already overwhelmed public hospitals many of which are nearing their full capacities, President Uhuru Kenyatta said yesterday.

The president said home-based care would be necessary “because 80 per cent of Covid-19 patients in Kenya, like the rest of the world, are asymptomatic”.

Kenyatta said public hospitals in Siaya and Busia counties, for instance, are already overwhelmed with the former having only 10 isolation beds.

“If there is a surge in infections in these two counties, the health care system will be overwhelmed.

“The hard question to pose here, therefore, is whether Kenyans are prepared to nurse Covid-19 patients in their homes if our health care system cannot handle the numbers,” Kenyatta said.

There are 130-odd Covid-19 patients currently under home-based care in Kenya.

The Ministry of Health will release the guidelines to counties for a home-based care roll-out. This will be based on guidelines recently released by the World Health Organisation (WHO).

Acting Health Director General Patrick Amoth said they have already refined the guidelines that would be considered on a case-by-case basis.

“We have customised the guidelines for use locally and we shall disseminate them to the counties on Monday.

“This will be based on strict criteria anchored on assessment by healthcare workers to see whether that particular individual fits the bill for home-based care,” Dr Amoth said yesterday during a coronavirus status update at State House in Nairobi.  

He said not every patient would qualify for home-based care. “Selection of patients will be based on the risk posed through individual assessment.”

He added: “We will assess your home to know many rooms are there, how many people you live with and if you have anybody else in your house who is ill. We’ll also need to know if you have very young children. Do you have a caregiver who can be trained to support you during the process? All those are captured in our guidelines.”

The WHO had earlier provided an interim guidance on home-based care for Covid-19 patients presenting mild symptoms. In its document, the world health agency stated that home-based care could be considered as long as the patient can be followed up and cared for by family members. 

“Home-based care may also be considered when inpatient care is unavailable or unsafe, for example, if the capacity is limited and resources are unable to meet the demand for healthcare services.

In any of these situations, patients with mild symptoms and without underlying chronic conditions − such as lung or heart disease, renal failure, or immuno-compromising conditions that place the patient at increased risk of developing complications, will be taken care of at home,” reads the WHO document.

The WHO further recommends that health workers must assess whether the patient and the family are capable of adhering to the precautions that will be recommended as part of home-care isolation. These include hand hygiene, respiratory hygiene, environmental hygiene and limitations on movement around or from the house.

They must also be able to address safety concerns such as accidental ingestion and fire hazards associated with using alcohol-based hand rubs, the global agency said further.

“A communication link with healthcare provider or public health personnel, or both, should be established for the duration of the home care period – until the patient’s symptoms have resolved,” the WHO document said.

As for the management of contacts, the WHO guidelines say anyone who has been exposed to suspected Covid-19 case is considered a contact and should be advised to monitor their health for 14 days from the last day of possible contact.

The guidelines stipulate that home caregivers must maintain contact with a healthcare providers during the entire period.

“A way for caregivers to communicate with a healthcare provider should be established for the duration of the observation period. Also, health care personnel should review the health of contacts regularly by phone, but, ideally and if feasible, through daily in-person visits, so specific diagnostic tests can be performed as necessary. The healthcare provider should give instructions to contacts in advance about when and where to seek care if they become ill, the most appropriate mode of transportation to use, when and where to enter the designated health facility and which IPC precautions to follow,” WHO says.

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