COVID-19 treatment at home

Whether or not you need hospitalisation to treat a confirmed diagnosis of COVID-19 infection is not your call to take, but that of the local and state health departments, infection prevention and control experts, and healthcare personnel at hospitals. It is of utmost importance to pay attention to what healthcare professionals and state health departments are recommending during a public health emergency caused by a global pandemic. 

The first thing you need to do is report to a hospital or COVID-19 testing centre to submit your samples for testing. It’s better to call ahead if you’re doing so. You can also If you were travelling and have just arrived in the country, you will be screened at the airport itself. Be honest about your symptoms and let the healthcare experts decide what type of immediate care you need. 

Once - and if - you’re tested positive for COVID-19 infection, the healthcare professionals will give you an assessment of your health and confirm whether or not you need to be hospitalised. If you have any of the following issues, you’re more likely to be hospitalised immediately:

• Severe acute respiratory infection (ARI) associated with COVID-19
• Moderate, severe and critical illness
• Age above 60 years
• Existence of underlying comorbidities, like heart disease, diabetes, chronic respiratory disease, cancer. etc)

If you do not have any of these symptoms, have mild or no symptoms of COVID-19 despite being positive for the infection, and are deemed to have no or low risk factors, then quarantine for a designated period will be suggested for you. This type of isolation can be done at home, but only if all the facilities needed for proper quarantine and care are available.

The MoHFW has made it compulsory for all confirmed COVID-19 patients to download and activate the Arogya Setu App, keep it updated and also update the District Surveillance Officer about his or her health status during the home care stage. 

It’s important to remember that people who have symptoms similar to those of COVID-19 might not necessarily have been infected with the novel strain of coronavirus infection. The three primary markers of COVID-19 are high fever, dry cough and difficulty breathing. But the chances of being infected with COVID-19 are high only if:

• You have recently travelled to a country or region with high rates of COVID-19 infection
• You have been in contact with a confirmed patient of COVID-19 
• You live in a region with community transmission (STAGE III) of COVID-19 

If you do not have the above-mentioned risk factors but still have fever, cough, body aches, sore throat, fatigue, etc. you are likely suffering from the common cold or other respiratory illnesses - but not COVID-19. Here are a few things you must do if this is indeed the case:

• Consult a doctor and give your medical and travel history
• Get tested for COVID-19 only if the doctor deems it necessary
• Take the course of treatment for common cold or respiratory infection, as suggested by the doctor
• Self-isolate at home to minimise the risk of passing on this infection to the rest of your family until you recover
• Do not step out to crowded public places, or use public transport, until you have fully recovered

If you have COVID-19 infection with mild or no symptoms, and are considered to be at no or low risk, healthcare professionals will ask you to quarantine at home. This recommendation of quarantine and home care might seem a comfortable choice, and you might even assume that you can go about your regular life while at home, but you’d be wrong. 

Residential care of COVID-19 patients, no matter how mild their symptoms, is a very serious and sensitive issue. Healthcare professionals or the state health department, according to the CDC, will first have to assess if your residence has all the facilities needed for proper home care. The following are the considerations which will have to be taken into account:

• The patient should be stable enough to receive care at home.
• There is at least one healthy person at home who can work as an appropriate caregiver.
• There is a separate bedroom (with a separate bathroom) where the patient can recover without having to share any space with other members of the household.
• Food and other necessities are easily accessible at or near the home.
• The patient and other members of the household have adequate supply and access to protective equipment (gloves, face masks, disinfectants).
• The patient and other members of the household are capable of strictly and meticulously adhering to hygiene and safety precautions as part of home care, i.e. they are following respiratory hygiene, hand hygiene and cough etiquettes (covering the mouth with the elbow while coughing).
• There are no household members who may be at an increased risk of complications from COVID-19 infection. This means no member of the household should be above 60 years of age, pregnant, immunocompromised due to other diseases, or have cancer, heart diseases, lung diseases, chronic kidney disease, etc. 

If, and only if, your home has all of the above-mentioned facilities for quarantine will you be allowed to stay at home until you are no longer COVID-19 positive. Otherwise, the state health department will have to provide other isolated facilities for your care, like repurposed hotels.

Once your home is considered to be safe and appropriate for quarantine, you will have to go into self-isolation for at least 17 days. The following are some essential tips on how to care for COVID-19 patients at home:

• The patient must be placed in a well-ventilated single-room, i.e. the room should have enough windows. The room should also have a bathroom.
• Limit the movement of the patient in the house and minimise shared spaces.
• Limit the number of caregivers for the patient. The primary caregiver should be someone in good health, with no underlying chronic or immunocompromising conditions.
• No visitors should be allowed to meet the patient until his or her infection has completely subsided and he or she has fully recovered.
• The patient should wear a mask at all times. The primary caregiver should wear masks and gloves while in contact with the patient. The mask should properly cover both nose and mouth. (Read more: How useful are masks against COVID-19 and how to use them)
• The mask and gloves used by both patients as well as primary caregivers should be properly disposed of, and never be reused.
• Proper hand hygiene should be followed at all times, especially while handling things used by the patient, or preparing food. Hand hygiene must also be followed by the patient. Hand hygiene refers to washing hands with soap and water, or using an alcohol-based hand sanitiser.
• If the patient is washing hands with soap and water, he or she should use paper towels. If this is not possible, the towel used by the patient should be frequently washed and disinfected.
• Patients who are not able to wear a mask due to respiratory discomfort should practice respiratory hygiene rigorously. This means the mouth and nose should be covered with a disposable tissue while coughing and sneezing. Tissues should be discarded after a single use.
• Avoid direct contact with body fluids of the patient, including oral secretions, nasal secretions, urine, stool, etc. 
• Use dedicated utensils, linen and other household items for the patient. These items should be washed properly with soap and water after every use, and kept apart from the utensils and linen used by other family members.
• Clean and disinfect all surfaces, including the bathroom and toilet surfaces, that the patient comes in contact with at least once every day. A regular household disinfectant containing 0.1% sodium hypochlorite should be used for all surfaces. 
• All clothes and linen of the patient should be kept in a separate laundry bag, and should be washed separately. These can be washed with regular laundry soap.
• Gloves and protective clothing should be worn while cleaning the patient’s room or handling things used by him or her.
• Regular updates about the patient’s health should be given to the state health department or assigned healthcare providers. If the condition of the patient changes, especially for the worse, healthcare professionals should be informed immediately and their recommendations should be adhered to.

While caring for a COVID-19 patient at home is possible, it’s very important for all the household members - including the one member working as primary caregiver for the patient - need to take all the hygiene and safety protocols very seriously to minimise the spread of this contagious infection. The following are some tips that close contacts and family members of the COVID-19 patient must adhere to:

• All household members should stay in a room separate from the patient. If this is not possible, they should always maintain at least one metre of distance and sleep separately too.
• Family members should follow proper hand hygiene, i.e. wash hands regularly with soap and water, or use an alcohol-based hand sanitiser. They should also follow all other safety and hygiene precautions suggested by the healthcare professionals and state health departments, including not touching the mouth, nose or eyes with unwashed hands.
• Household members should not use the same room, bathroom, utensils, linen and other household items as the patient. Surfaces in contact with the patient should be avoided at all costs.
• Family members living in the same house as the patient should observe self-isolation and not step out of the house unless absolutely necessary. Visitors should not be allowed in and contactless deliveries of essential items should be followed.
• Proper ventilation in the house and regular cleaning and disinfecting of all surfaces is a must in the house.
• Household members should care for pets and keep them separate from the patient.
• Wash laundry, utensils, etc thoroughly and separately from the ones used by the patient.
• All disposable gloves, masks, tissues, etc should be placed in a separate bin and disposed of with care. Washing hands thoroughly with soap and water immediately before and after handling these wastes should be done. 
• If any household members show any symptoms of COVID-19 or any other illness, they should be isolated and healthcare professionals should be informed immediately.

Caring for a COVID-19 patient at home is a delicate issue, primarily because state health departments are going to be in touch with the family and caregiver of the patient. The recommendations given by the CDC as well as the state's health department must be followed to the letter in order to keep the family of the patient away from contracting the infection.

In India as well as other nations, the utmost care has to be practised by everyone involved in the care of a COVID-19 patient.