News
Overcoming COVID-19 in the comfort of one’s home
Dr. Asela Gunawardena
The long-awaited home-isolation and management of asymptomatic (without symptoms) or mildly symptomatic COVID-19 positive patients has become a reality in the Western Province.
The strong network established to ensure the safety of these patients includes:
The Medical Officers of Health (MOH) and Public Health Inspectors (PHIs).
The ‘Patient Home Isolation and Management System’ (PHIMS) which will have the case and clinical histories of patients.
An active Call Centre (Hotline: 1390), the link between the patients and the medical team.
Specially-trained medical teams comprising Medical Officers, Specialist Family Physicians and on-call Consultants in other specialities for each district, who will be in tele-consultation with the patient.
The Regional Epidemiologists.
While drastically cutting down the huge expense and logistical nightmare of arranging transport to and facilities at distant intermediate care centres (ICCs), ‘The Integrated Home-based Isolation and Management’ System will help these patients to get the best of medical management in the comfort of their homes, the Sunday Times learns.
This is the brainchild of the Director-General (DG) of Health Services, Dr. Asela Gunawardena, supported by the DDG (Medical Services I) Dr. Lal Panapitiya and senior ministry officials.
Home-based care programmes are being followed in many countries and the World Health Organization (WHO) also recommends it, it is understood.
“Three members of the same family, father, mother and daughter, in Panadura were positive. All were asymptomatic but after studying their case histories, we found that the mother had undergone bypass surgery several years ago and was also a diabetic,” says Consultant Family Physician Dr. Malkanthi Galhena, a livewire behind this programme.
She points out that while the father and daughter were managed at home, even though the mother wanted to stay home under this programme, they explained matters to her that she was vulnerable to progression into severe disease and persuaded her to go to hospital.
Stressing that the management of each and every patient would be done on a case-by-case basis, Dr. Galhena who is the President of the Sri Lanka Association of Specialist Family Physicians, turns the spotlight on how the programme will work at ground level.
She explains that when a person tests positive, they would keep a close eye on them in the first week to try and prevent them from going into severe disease. With such close monitoring and advice, any early sign of progression into severe disease would be picked up and the person taken to hospital immediately.
Usually, 80% of infections are asymptomatic or mildly symptomatic and only 20% are otherwise (symptomatic) of which only about 5% need ICU treatment.
The danger, however, is that even an asymptomatic or mildly symptomatic person could go into severe disease, says Dr. Galhena, adding that it would depend on the person’s immunity and underlying conditions.
Those eligible for home management under strict selection criteria are:
Anyone above 2 years and under 60 years of age, without any other medical conditions.
Women who are not pregnant.
Those without any chronic co-morbidities such as morbid obesity (BMI >30), diabetes, hypertension, chronic heart/ lung/renal diseases or well-controlled other medical conditions.
Those not suffering from immune-compromised status or not on long-term immune-suppression therapy.
Those who have a separate well-ventilated room with adequate washroom facilities, etc.
Adequate self-care or caregiver support at home.
Individuals with proper communication facilities and ability to communicate (patient or caregiver).
Dr. Galhena points out that this system will help take away the burden on hospitals – staff as well as facilities and capacity, while also allowing patients to be in their homes comfortably under proper medical supervision. The authorities would also be able to save funds for other urgent COVID-19 work.
The steps being followed are:
When the MOH gets a report that the RT-PCR test of a person in the area is positive, the MOH/PHI will trace him/her, visit that person’s home and carry out an initial assessment (triage) whether the person is asymptomatic, mildly symptomatic or symptomatic. If the person is symptomatic, he/she will be taken to hospital.
In the case of those who are asymptomatic/mildly symptomatic, the MOH/PHI will assess whether he/she has enough room in the house, a separate toilet and also the awareness to isolate himself/herself.
The next step will be for the MOH/PHI to alert the relevant medical teams about the home-based isolation of that person.
Immediately, the details of the patient (clinical records) being monitored at home, would be computerized and he/she would be linked to the Call Centre.
Thereafter, the medical team will call the patient daily or even many times a day to keep a close tab on any progressive symptoms, while also advising him/her on the need to rest, proper fluid management, control of co-morbidities by taking necessary medication and other non-pharmacological methods and having a well-balanced nutritional diet.
The home-based patient too would have access to the medical team throughout the day and night, when needed.
The telephone consultations will continue and if there is the slightest indication of severe disease (shortness of breath when walking or talking, etc.), the patient would be moved to a hospital to screen for oxygen saturation or any other organ failure coordinated by the Regional Epidemiologist.
Once a patient completes 14 days without symptoms, he/she would be discharged from the programme, armed with advice on how to be alert for any symptoms of Post-COVID-19 Syndrome which can flare up and what prompt measures to take such as informing the MOH/PHI.
When asked how delays in RT-PCR testing would impact on the programme, Dr. Galhena said that if there is a person with symptoms of fever, body aches, etc., the day of their onset would be taken as the first day of the infection. If a random RT-PCR detects an infection, the day the results come, would be taken as the first day. By that time, a few days may have passed, but it wouldn’t have gone into the second week.
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