Home-based care best bet for pandemic

With rising cases of Covid-19, and with hospitals likely to be overwhelmed, it may be important to think about home-based care and support services for suspected patients who present with mild symptoms and on public health measures related to managing their contacts.

The World Health Organisation (WHO) has developed an interim guidance for safe home care. Adapted from the guidance on Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection, it was published in June 2018.

The document has been updated with the latest information and is intended to guide public health and infection prevention and control professionals and healthcare managers and workers (HCW) when addressing home care issues for suspected Covid-19 patients and their contacts.

Home-based care, says the 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 document, “caregivers” refers to parents, spouses, and other family members or friends without formal healthcare training expected to give home-based care.

Several conditions must, however, be met, most of which require high levels of trust and discipline, which has at times lacked since the first case was diagnosed in the country in March.

AFFORDABLE SOLUTION

A trained HCW must assess a residential setting to ensure it is suitable for providing care, and whether the patient and the family are capable of adhering to the precautions for home-care isolation, such as hand and respiratory hygiene, environmental cleaning, limitations on movement around or from the house and disallowing visitors until the patient has completely recovered.

In some countries where respect for public health is guaranteed, like Sweden and Germany, the measures have been easy for communities to follow, resulting in good pandemic management without overstretching public health facilities.

As time goes by, the biggest percentage of care is likely to be given at home, of course linked to health services, but this may require guidance by the National Home-Based Care Policy guidelines.

Though they are for people living with HIV/Aids, it may be necessary to tailor them for Covid-19 patients.

Home-based care is preferable to, especially, families in the lower levels of social stratification as it is more cost-effective compared to hospitals.

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 cannot cope with increasing demand for treatment and care, this may be the solution.

SUPPORT CAREGIVERS

Home-based care programmes may have to be developed to assist family caregivers in providing Covid-19 care.

These services should focus on providing social and psychological support, nutritional support and basic nursing care, critical success factors in the management of Covid-19.

But with basic direction, others may treat opportunistic infections associated with the virus — such as headaches, cough and running nose.

To support the concept, and to particularly help the caregivers, involving the community in providing care and support, providing support to caregivers, addressing stigma and discrimination in families and communities, providing support to caregivers and providing care and support to children are necessary.

It would be important to conduct education on Covid-19 so that communities get basic information about prevention and management of the disease, and on basic prevention and disposal of health waste strategies.

Involving community outreach workers, peer counsellors and other lay health workers in home-based care activities, and in supporting caregivers would also be critical.

BURDENSOME TASK

Providing care for the sick is not for the faint-hearted. Caregiving may place considerable strain on caregivers and 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 caregivers and children, may also experience stigma and discrimination, resulting in judgmental attitudes that can reinforce feelings of self-blame and depression.

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.

In all this mix, children are likely to carry the heaviest burden of disease as they get neglected or overworked. And it could be worse in child-headed households as it is not an easy task.

Prof Kiptoo, an immunologist, is the chief executive officer of Kenya Medical Training College; [email protected].