What COVID-19 home care entails

We have been living in the nightmare created by COVID-19 for over a year. But the last month or so, said Jaime Almora, president of the Philippine Hospital Association, is “the worst nightmare of a hospital manager happening in reality.”

Indeed, it is a nightmare not just for hospital administrators and the “soldiers” they field in battle—doctors, nurses, medical technologists, hospital aides, and attendants—but more so for the greater public they serve: their patients, their families, and people they have had to turn away.

This is what the nightmare consists of: too many patients, too few beds, inadequate equipment and insufficient drugs, staff driven to exhaustion and despair, and families and communities reeling under the combined threat of a deadly disease and the hunger and despair following in its wake.

With the Department of Health confirming that as of Monday 86 percent of ICU beds in the National Capital Region are occupied, which is also the case with 69 percent of isolation beds and 57 percent of ward beds, health authorities are turning to dire, desperate measures.

Clearly, hurriedly built isolation and quarantine centers cannot take up the slack. Besides which, going by the firsthand accounts of folks sent to a number of such places, patients are often left to fend for themselves, with little medical supervision and support. No wonder so few volunteer themselves to be tested, for fear of being kept in quarantine hell.

The situation has led authorities to seek an alternative solution: sending home COVID-19-positive but so-called “mild” cases where they are to observe isolation, undergo the necessary treatments, and wait for the illness to run its course. Only when the illness turns serious should patients be brought to hospital—if they can find room, that is.

Before considering home care, say health authorities, mild or moderate cases should be under the age of 60, do not smoke, are not obese, and do not suffer from what are called “comorbidities” or related sicknesses or conditions like heart disease, diabetes, or cancer.

A health worker will need to assess risk factors along with the person’s symptoms, medical history, and his or her family’s ability to provide managed care.

There is also a need to assess the patient’s home or place of isolation. Is there a separate room or adequate distance from where the patient can stay away from the rest of the occupants for proper infection control? Will he or she have use of a separate bathroom, or else have the capacity to clean and sanitize the facility after each use? Will healthy food be safely prepared and collected?

Authorities stress that the patient, the caregiver (preferably only one person), and anyone else coming into contact with them (visitors should be discouraged) wear a medical mask even while inside the home, keeping the proper distance, and washing hands before and after an encounter. Good ventilation in the room is a must, keeping windows open if possible and safe to do so.

How long should a COVID-19 patient remain in isolation? Medical opinion is that he or she should stay isolated for a minimum of 10 days after the first day of developing symptoms, plus another three days after the end of symptoms “when they are without fever and without respiratory symptoms.”

Clearly, caring for a COVID-19 patient at home is, to put it mildly, a most challenging and daunting endeavor. It demands material resources for the needed medicines and treatments, as well as stores of energy, patience, empathy, and courage. The last because the caregiver puts himself/herself at real risk of contracting the disease. And following the traditional role assignments in Filipino families, the role of caregiver will most likely fall on a woman — wife, mother, daughter, granddaughter, aunt, or niece—whose burdens of looking after the family and earning a living will likely be exacerbated by this added duty. For many households, this is on top of the added chore of homeschooling children and withstanding the inevitable tensions and stresses of the times.

In the face of such trials, any “ayuda” or financial support would be a welcome relief. Perhaps PhilHealth could find some money to spare for households caring for a COVID-19 patient, thereby freeing the health insurer from costly medical treatments and freeing up more urgently needed hospital beds.

Early in the outbreak of this disease, neighbors and entire neighborhoods turned against those even just suspected of being sick with COVID-19. Heroic health frontliners also endured random attacks, with some landlords heartlessly evicting tenants who happened to work in the health field. Our hope is that such scenarios would not be and never again be repeated in these times of peril. We are living in a nightmare, true, but let’s not add to the fear and loathing it imposes on us.