Home and community care

Rightly so, the growing number of COVID-19 patients has led public and private hospitals to appeal for more government support for facilities, equipment (mainly ventilators), and personal protective equipment (PPEs) to protect health professionals and workers, for whom the term “frontliners” has now become a synonym. A glaring absence is the planning in the area of formulating guidelines, and training people, for home and community care. The sheer number of patients has strained resources even in rich countries, so we need to look at mobilizing the entire health care system.

The experience of China with a large number of patients should be instructive. A study just published in the journal The Lancet Infectious Diseases analyzed data on almost 56,000 laboratory-confirmed COVID-19 cases and found that 80 percent had mild-to-moderate disease, 13.8 percent developed severe disease, and 6.1 percent were critical, requiring intensive care. The need for hospitalization increased with age — a mere .04 percent for patients aged 10 to 19 (infections in children are very rare), moving up to 18 percent for patients aged 80 and above. Note that even with the highest age group, the majority did not need hospitalization.

The point is that most COVID-19 patients can be managed with good home and community care. In fact, I suspect we’ve already had COVID-19 cases without knowing it, given the weak testing we have, and that the patients recovered on their own at home, thinking it was just ordinary “trangkaso” (flu).

That said, it’s important to recognize that COVID-19 isn’t the ordinary flu, the most important difference being its much higher contagiousness. Even “mild” cases are contagious and, if undetected, could fuel the rapid spread of the disease. This fact makes community and home care all the more important.

By community care, I refer to the vast nationwide network of barangay health workers who have been providing primary health care, from immunizations to health education. They are under city and municipal governments, supervised by a municipal health officer who, in many cases, might even be the only physician in the entire municipality.

I am also including under community care the many small clinics that emphasize wellness, mostly providing maternal and child care and family medicine. I’m thinking for example of FriendlyCare, Ayala’s FamilyDOC, and the many midwife-managed centers.

Then there are the clinics, many in malls, managed by hospitals like The Medical City’s satellite clinics, and those operated by health maintenance organizations.

Some of the clinics, like those of The Medical City, have stayed open, but others like FriendlyCare have closed, uncertain about the future. Which is a pity, because at this point we need all hands on deck. Such centers should be considered essential health care, with government support and subsidies for their operations, employees, and patients.

Then there’s home care, with every family facing the possibility now that it will have one or several people in the household catching COVID-19.

For two reasons, communities and families are important for controlling COVID-19.

First, they are so crucial for keeping people well. The expression “Bawal magkasakit” (It is forbidden to get sick), first coined to promote a multivitamin, could not be more relevant now. Besides adding to the stress of the already overburdened hospitals, you just don’t want to end up being confined at this time because, if you don’t have COVID-19, you put yourself at risk in the hospital.

Second, the community-level facilities and staff, plus families and households, will have to be involved in caring for patients with mild to moderate COVID-19, outside of the hospitals.

There is no cure for COVID-19, so care must be given in dealing with the fever and the cough, providing adequate nutrition and hydration, AND maintaining social distancing. The poor are at a disadvantage, but there are still ways for effective isolation of COVID-19 patients in homes, providing care even as we protect elderly people, people with conditions like diabetes and hypertension, and those whose immune systems are compromised.

Community and home care training should also include knowing when to refer a possible COVID-19 case to the hospital. Many years ago in primary health care, we were training mothers to detect when a child had pneumonia and needed hospital care. That kind of training for detection will be important in homes and in communities. The barangay health workers need to be trained as well to provide emergency transport and care for patients, with or without COVID-19, especially during curfew hours.

In this war on COVID-19, we need many more frontliners, and they need not all be in hospitals.

mtan@inquirer.com.ph