How to stay home and recover from a pandemic

* Almost 80 per cent of the asymptomatic and mild cases have been advised home isolation under medical supervision

* Home-based care is a cost-effective way of treatment as compared to hospitals, in the current scenario

When a test showed that Pallabi Samanta*, a 40-something homemaker from Kolkata who had a mild cough and fever, was Covid-19 positive, doctors recommended home care. Her businessman husband paid heed to their advice. She was treated at home — and recovered within days.

Six months after the detection of the first Covid-19 case in India, the health system across the country is bursting at the seams. On July 21, the government said the country had 4,02,529 active cases of Covid-19 and all the patients were undergoing medical supervision. A large number of these patients had little or no symptoms. According to a July 17 government statement, less than 1.94 per cent of the Covid-19 cases in the country needed treatment in intensive care units (ICUs), and 0.35 per cent required ventilators.

These figures suggest that thousands of Covid-19 patients can recover from the disease through home care. “Almost 80 per cent of the asymptomatic and mild cases have been advised home isolation under medical supervision,” the health ministry had said in the statement.

Home care for Covid-19 patients who show mild or no symptoms can substantially reduce the burden on the hospitals and care centres dedicated to treat patients with moderate to severe form of the disease. These facilities, according to the government, had 46,673 ICU beds and 21,848 ventilators across the country for critically ill patients.

Sushmita Roy Chowdhury, pulmonologist and Covid-19 consultant at the Apollo Gleneagles Hospital, Kolkata, points out that 70-80 per cent patients have mild symptoms and can be taken care of outside a hospital setting. Treatment includes symptomatic management of headache, fever, cough, loose motions and other problems whilst ensuring that patients maintained proper isolation, she notes.

“Admitting and observing asymptomatic or mildly symptomatic Covid-19 patients in a hospital facility for two weeks is a waste of resources,” stresses Diptendra Kumar Sarkar, professor of surgery and a Covid-19 strategist affiliated to the Institute of Post Graduate Medical Education and Research and SSKM hospital, Kolkata.

Individuals who fulfil the criteria of mild or asymptomatic disease and conform to social distancing requirements (separate living and washroom) and an optimum “non-stigmatised social atmosphere” should opt for home-based care, he holds.

With more and more patients opting for home care, hospitals and other care centres across big cities and towns have started offering special packages. The Samantas, for instance, opted for a package from a city hospital. Priced about ₹16,000, it included video and telephonic consultations by a doctor and dietician, nursing assistance, a toolkit comprising masks, gloves, sanitisers, a pulse oximeter (which checks the pulse and oxygen saturation levels) and so on, helpline assistance and one repeat Covid-19 test. It includes home delivery of medicines and an emergency ambulance service(free for the first use and for a limited distance) .

“Home-based care is a cost-effective way of treatment as compared to hospitals, in the current scenario,” says Gaurav Thukral, executive vice-president and chief operating officer of Noida-based home healthcare service provider HealthCare atHOME, India.

There is, however, no one-size-fits-all system, not even for those with mild symptoms. Samanta was happy with the facilities but Samir Das*, an employee in a private firm in Kolkata, was not. Das, a little above 40, says his condition deteriorated despite home care and he had to be admitted into a hospital. He states that since doctors did not visit him personally but treated him virtually, the deterioration — from mild fever to breathlessness — could not be assessed.

The US Centers for Disease Control and Prevention (CDC), a federal agency, states that the criteria for home care for a Covid-19 patient should include the patient’sability to receive home-based treatment, availability of appropriate caregivers at home, the presence of a separate bedroom where the patient can self-isolate, accessibility of food and other necessities, and ability of the patient and other household members to take the required precautionary measures.

Experts recommend that the private home-care providers in various states should fulfil all suitability criteria. According to the European Commission, Covid-19 patients capable of undergoing home care should stay in frequent contact with their healthcare providers so that their condition can be closely monitored for any signs of clinical worsening. “[As] clinical signs and symptoms may worsen … due to lower respiratory tract disease in the second week of illness, patients treated at home should be provided with instructions if they experience difficulties breathing,” says an article on the Commission’s website.

Roy Chowdhury adds that those dealing with home care should keep an eye on a patient’s oxygen saturation levels. “(They should be) transferred to a hospital as soon as saturation levels fall below 93 per cent,” she stresses.

One of the problems with home care is the panic that the disease triggers in the patient’s immediate neighbourhood. The government needs to deal with this, too, with suitable awareness campaigns, the experts emphasise. “The success of home-based treatment can be improved if the government promotes social empowerment and takes all steps to de-stigmatise the pandemic,” Sarkar notes.

(*Names changed to protect identities)

Sanjeet Bagcchi is a physician and independent writer based in Kolkata

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