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Managing COVID in Homecare -Approach to Treatment, Monitoring, and Follow-up by the Family Physician

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Introduction: The 2 nd wave of COVID caused an unprecedented burden on health care workers and resources, calling for structured and effective management of most COVID patients in-home care by general and family physicians via digital and virtual monitoring. Methodology: A systematic treatment approach evolved from COVID diagnosis, homecare determination and isolation, oxygen saturation and temperature monitoring documentation, guidance on proning and breathing techniques, diet and lifestyle measures, evaluating comorbidities, and prescribing appropriate medicines. Timely decision making and stratification to assess disease course and need for hospitalization based on meticulous monitoring, clinical signs and appropriate tests were followed. A balanced approach avoiding unnecessary medication and tests, and allaying panic resulting from multiple information sources, was the novel challenge for physicians. Post-COVID follow up was done for three months. Results: The recovery rate in homecare with this approach was 97%, with only 11% needing corticosteroids in the second week. The need for hospitalization was in 3%. In the first month, > 90% had post-COVID symptoms, mainly lower energy, fatigue, weakness, reduced smell/taste and reduced work capacity. However, by the 3 rd month, this reduced to 33%, with only 6% showing symptoms beyond three months. Management was conservative in the majority. Conclusion: A systematic and rational approach to treating, monitoring and managing COVID patients at home can enable better care and recovery and limit unnecessary hospitalization. Diet and lifestyle measures, documentation of oxygen saturation and temperature monitoring, proning and breathing techniques, and psychological support are of great importance that aid recovery and enable sound clinical evaluation.
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International Journal of Medical
Research and Review
2021 Volume 9 Number 5 September-October
E-ISSN:2320-8686
P-ISSN:2321-127X
Research Article
COVID
Publisher
www.medresearch.in
Managing COVID in Homecare – Approach to Treatment, Monitoring,
and Follow-up by the Family Physician.
Narayanan V.1*
DOI: https://doi.org/10.17511/ijmrr.2021.i05.03
1* Varsha Narayanan, Consultant, Family Medicine and Holistic Health, Mumbai, Maharastra, India.
Introduction: The 2nd wave of COVID caused an unprecedented burden on health care workers and
resources, calling for structured and effective management of most COVID patients in-home care by
general and family physicians via digital and virtual monitoring. Methodology: A systematic
treatment approach evolved from COVID diagnosis, homecare determination and isolation, oxygen
saturation and temperature monitoring documentation, guidance on proning and breathing
techniques, diet and lifestyle measures, evaluating comorbidities, and prescribing appropriate
medicines. Timely decision making and stratification to assess disease course and need for
hospitalization based on meticulous monitoring, clinical signs and appropriate tests were followed. A
balanced approach avoiding unnecessary medication and tests, and allaying panic resulting from
multiple information sources, was the novel challenge for physicians. Post-COVID follow up was done
for three months. Results: The recovery rate in homecare with this approach was 97%, with only
11% needing corticosteroids in the second week. The need for hospitalization was in 3%. In the first
month, > 90% had post-COVID symptoms, mainly lower energy, fatigue, weakness, reduced
smell/taste and reduced work capacity. However, by the 3rd month, this reduced to 33%, with only
6% showing symptoms beyond three months. Management was conservative in the majority.
Conclusion: A systematic and rational approach to treating, monitoring and managing COVID
patients at home can enable better care and recovery and limit unnecessary hospitalization. Diet and
lifestyle measures, documentation of oxygen saturation and temperature monitoring, proning and
breathing techniques, and psychological support are of great importance that aid recovery and
enable sound clinical evaluation.
Keywords: COVID homecare, Oxygen saturation, Proning, Post-COVID, 2nd Wave
Corresponding Author How to Cite this Article To Browse
Varsha Narayanan, Consultant, Family Medicine and
Holistic Health, Mumbai, Maharastra, India.
Email:
Varsha Narayanan, Managing COVID in Homecare
Approach to Treatment, Monitoring, and Follow-up by
the Family Physician.. Int J Med Res Rev.
2021;9(5):289-297.
Available From
https://ijmrr.medresearch.in/index.php/ijmrr/article/
view/1315
Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2021-08-16 2021-08-26 2021-09-10 2021-09-20 2021-09-28
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
No Nil Yes 7%
© 2021 by Varsha Narayanan and Published by Siddharth Health Research and Social Welfare Society. This is an Open Access
article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/
unported [CC BY 4.0].
International Journal of Medical Research and Review 2021;9(5)289
Introduction
The second wave of COVID (Coronavirus Disease) in
India in April-May 2021 posed one of the most
significant challenges to the healthcare workers,
infrastructure and system. At that time, though
vaccination had begun, India, with a 1.3 billion
population, had vaccinated around 10 million health
and frontline workers with both vaccine doses, and
about 70 million people aged 45 years and above
with the first vaccine dose [1]. Therefore, most of
the population was still not immunized at the onset
of the second wave, which also brought in variants
of concern (VOCs) like Delta and Alpha strains [2].
In contrast to the first wave, the second wave saw a
predominance of younger age groups below 60
years, with often multiple family members or entire
families getting affected.
The crucial need of the time was informed and
balanced decision making by medical practitioners
to prevent unnecessary overloading of healthcare
resources and giving hospital care to those in real
need. This required timely identification of patients
with risks and alert signs for hospitalization and
oxygen therapy and managing the majority of
COVID cases which were mild, effectively in
homecare. The general practitioners (GPs) and
family physicians (FPs) are the backbones of
healthcare in India, and they are the first point of
contact for patients. Therefore, they form the firm
foundation on which effective COVID management
of the community rests. It is essential for GPs and
FPs in each region to be trained, updated and have
common platforms or chat groups created to discuss
cases and share insights and experiences. Digital,
and virtual medical care through tele/e-consultation
and monitoring, evolved significantly in the
pandemic, helping doctors and patients in safer,
more convenient and comfortable healthcare [3].
Elaborated here and suggested for GPs and FPs is a
systematic and virtual homecare management
approach to treatment, monitoring, and 3-month
post-COVID follow up for treating COVID patients
in-home care. The results are discussed for patients
managed by this approach who had symptomatic
COVID in April 2021.
Methodology
Setting: The clinical setting for COVID management
of cases represented here is homecare with virtual
digital treatment and monitoring by the physician.
For every patient that called in with symptoms for
consultation, COVID case determination and
isolation was done after detailed clinical and contact
history and performing the standard RT-PCR test for
COVID.
Duration and Type of Study: This is a
retrospective real-world reporting of COVID patients
managed in homecare by the family physician in
clinical practice. The observation period was for
three months, with initial 14 days of active
treatment and daily monitoring. Recording the day
when symptoms started (1st day of illness) as
accurately as possible was done in all patients for
effective monitoring of the disease's course and
timely decisions.
Sample size and Description: Real-world data of
63 cases in the age group 18-60 years, who sought
consultation from one family physician for COVID in
April 2021 during the 2nd wave of COVID in India,
and were managed in-home care, has been
elaborated here.
Inclusion and Exclusion Criteria: Patients aged
18-60 years who sought consultation for COVID
symptoms were evaluated with the standard RT-PCR
test. The following cases were included as COVID
and recommended immediate isolation: Those who
were RT-PCR positive; RT-PCR unknown/negative
but with symptoms strongly suggesting COVID like
loss of smell/taste with fever and cough, or known
close contact with COVID positive family/household
member in the last one week. For all such patients,
if on presentation, the oxygen saturation on pulse
oximetry was > 94% with no breathlessness, they
were recommended for non-hospitalized care at
home (if a separate isolation room with an attached
toilet and one openable window for ventilation was
available) or in repurposed primary COVID-care
centres [4]. Along with details of the presenting
symptoms, assessing the existing comorbidities like
diabetes, hypertension, cardiovascular disease
(CVD) etc., with their current status/control and
medications being taken, was done and recorded. In
such patients checking blood sugar, HbA1C,
complete blood counts, and serum creatinine (by
home blood sample collection) and blood pressure
(by home digital BP machine) were performed at
presentation. For those whose comorbidities were in
control, instruction for continuing all medications for
the same was given. In uncontrolled cases, referral
for specialist's intervention and treatment
modification where required was done.
Narayanan V. et al: Managing COVID in Homecare – Approach
International Journal of Medical Research and Review 2021;9(5)290
COVID vaccination status of the patient was also
recorded. Patients who did not qualify for home care
treatment, those who did not complete full
treatment and isolation period, and those who
modified treatment based on other medical/non-
medical opinions were excluded from the
retrospective analysis.
Procedure, Data Collection and Analysis
Monitoring: An individual day-wise chart, recording
the oxygen saturation by pulse oximetry and
temperature by an oral thermometer every 4-6
hours, was shared by each patient with the treating
physician at the end of each day for 14 days. In
addition, a column in the chart was included for
symptomatic improvement where the patient
mentioned whether feeling worse or better
compared to the previous day.
The 6-minute walk test at 6 pm (for convenient
remembrance) or at least once daily was
recommended with oxygen saturation recorded just
before and after on the chart to pick up 'happy
hypoxia' (subclinical oxygen deficiency), an alert for
compromised lung function and risk or tendency for
falling oxygen levels [5].
Conscious/awake self proning (technique and
correct placement of pillows explained pictorially)
was advised once in the morning and evening 1.5
hours post meals. Duration of proning was
recommended to be 30-40 minutes with ten deep
breaths every 10 minutes. Proning was additionally
recommended if the oxygen saturation dropped at
any point < 95% (suggesting hypoxemia
corresponding to pO2 <80 mmHg), and the post-
proning oxygen saturation was also to be captured
on the chart in such a case [6].
General Health and Hygiene Advice: All patients
were advised to drink plenty of water along with
healthy liquids like coconut water, buttermilk, lemon
juice, fresh fruit juices and turmeric milk for
adequate hydration. Information on home-cooked
food delivery initiatives and services were made
available. Diet rich in vegetables, fruits, curd,
protein-rich foods like eggs or pulses, and slices of
bread/rice along with timely meals, and avoidance
of spicy, irritant and cold/chilled food items, was
recommended. Nutritional supplements like vitamin
C, D, B-complex and zinc were not compulsorily
prescribed but were asked to be continued if taking
already.
Antiseptic gargling was advised if throat
soreness/pain was present. Steam and saline nasal
spray were recommended once or twice daily if
nasal congestion was present. Double masking
when in contact with the caregiver and overall
hygiene and frequent sanitizing was advised.
Physical activity doable without getting tired, like
medium-paced walking in the room for 10-15
minutes every few hours with light body stretches,
and 5-10 minutes of alternate breathing
(pranayama) were advised. The importance of
keeping the mind relaxed by reading and watching
pleasant content, getting adequate whole night
sleep and rest, listening to music and having video
chats with friends and family on cheerful topics was
emphasized. It was well explained that panic,
anxiety, and too many opinions/suggestions from
different sources could induce stress and sometimes
a feeling of breathlessness, palpitation and
worsening of symptoms, leading to inappropriate
decisions by both the patient and the treating
physician.
Medicines: In the first week, paracetamol was
prescribed for fever and body pain every 4-6 hours.
In exceptional cases, if the fever was high and not
responding well to paracetamol alone, mefenamic
acid was added. Medicines for symptomatic relief of
cold, cough and congestion like antihistamines and
mucolytics were given only if needed. Montelukast
was prescribed for ten days in all patients based on
preliminary and empirical evidence from some
studies on reducing inflammation, fibrosis and
oxidative stress, and protective effects against
clinical deterioration [7].
Ivermectin (as per protocol by ICMR, India) was
prescribed for five days in all patients [8].
Favipiravir was added for 7-10 days in certain
patients who had fever >101 deg F or severe
malaise/myalgia in the first 48 hours and those with
significant comorbidities [9].
Antibiotics (azithromycin/amoxicillin-clavulanate)
were not prescribed routinely, but only in those
patients who had significant cough with thick/dark
mucus or pain on swallowing, suggesting a possible
secondary bacterial throat infection [10].
Hydroxychloroquine and doxycycline were not
prescribed to any patient. None of the patients was
given corticosteroids in any form in the first week of
the disease course. The antibody cocktail was not
available in India in this period.
Narayanan V. et al: Managing COVID in Homecare – Approach
International Journal of Medical Research and Review 2021;9(5)291
Blanket prescriptions or unnecessary and over
medication was guarded against, and the same was
also discussed with patients, as adverse effects of
too many drugs can often eclipse the actual day to
day improvement in the COVID disease course and
lead to apprehensions and wrong clinical decisions.
Disease Course, Scoring and Decision Making:
With daily charts of continuous meticulous patient
monitoring, hospitalization was to be considered
immediately on any day of the course of the illness
if symptoms of breathlessness or chest
pain/pressure appeared, oxygen saturation was
constantly <94% not improving by proning or
dropping anytime below 90% (corresponding to pO2
of 60mm Hg below which there is a steep drop in
the oxygen dissociation curve) [6]. Hospitalization
was also recommended in altered mental status,
significant weakness, or inability to eat or take
medicines orally. In the absence of these signs, and
the patient doing satisfactorily in homecare in the
first week (viral phase), a planned reassessment
was done at the beginning of the second week (host
inflammation phase) with a review of clinical
symptoms, oxygen saturation trends, and laboratory
investigations of CBC, CRP, and blood sugar. Other
inflammatory markers, including D-dimer and IL-6,
were not recommended in homecare non-
hospitalized patients. Informed decision making on
further course and intervention at the end of the
first week was made as follows:
Group A: If symptoms were reducing (fever <101
deg F responding to paracetamol, cough and sore
throat improving) and oxygen saturation maintained
>94% at all times, then monitoring and observation
was continued without any additional intervention.
Group B: These patients had symptoms continuing
into the second week, with some fever readings
>101 deg F but responsive to paracetamol, or
persistent cough, and significantly raised CRP
(above five times of upper limit of normal).
However, oxygen saturation was maintained
at>94% at all times. They were monitored closely
and were also offered the option of inhaled
corticosteroids (budesonide).
Group C: In such patients, fever and cough
symptoms had not significantly improved and were
still prominent in the second week with high CRP,
and oxygen readings often borderline (92-94%) but
improving with proning. These patients were given a
short 5-7 days course of low dose oral
corticosteroids (methylprednisolone 16-32 mg/day).
Hospitalization consideration was given to elderly
>70 years, patients with diabetes, hypertension,
coronary artery disease, or any significant heart,
lung, kidney, liver or immune-suppressive
comorbidity.
Group D: If symptoms were worsening or
reappearing (fever >101 deg F not very responsive
to paracetamol, persistent cough especially with
phlegm, the appearance of chest pain/pressure or
breathlessness), and oxygen saturation showing
declining trends <92% not responding to proning,
with significantly high CRP, then immediate HR-CT
chest to assess COVID pneumonia severity, and
hospital admission was advised for oxygen therapy,
intravenous corticosteroids and other drugs.
Recovery and Post-COVID: Patients were
considered as recovered if they were fever (≥100
deg F) free and maintained oxygen saturation for
three consecutive days after ten days from the start
of symptoms [11]. After that, one additional week
of self-care isolation and monitoring was advised
before stepping out of the home with COVID
appropriate behaviour. The patients were explained
about the common post-COVID symptoms and rare
long-COVID and were advised to follow up by digital
updates every week in the first month followed by
2-3 weekly for the next two months [12].
Patients were to immediately report alert signs and
symptoms for timely pick up of thrombotic or
cardiovascular events or possible Mucormycosis,
especially in those with comorbidities like diabetes
[13,14]. These red-flag symptoms included
numbness or weakness in the face, arm, leg, or one
side of the body; mental confusion; trouble in
speaking or understanding speech; severe
unbearable headache; vision problems (blurring,
doubling or loss); losing balance or coordination;
chest pain or breathlessness which impairs daily
routine or is associated with cough; swelling,
cramping pain, or discolouration in limbs; or
persistent bone-joint pains.
All patients were asked to continue nutritious food
and adequate fluid intake, avoid smoking and limit
alcohol. It was emphasized that physical activity
should be resumed gradually and graded by
restricting working hours initially and increasing the
duration by an hour every week with frequent
breaks. Strenuous exercises like jogging, running,
cycling, or gyming were not recommended
immediately.
Narayanan V. et al: Managing COVID in Homecare – Approach
International Journal of Medical Research and Review 2021;9(5)292
It was advised to begin with less rigorous activities
like simple stretches, guided yoga, outdoor walking
at an average pace, and spot exercises for neck-
shoulder, arms, legs, and abdomen, then step up
gradually every week to reach one's average level of
physical exercise over 3-6 months. Patients were
asked to continue alternate breathing exercises,
proning and oxygen saturation checks once daily. A
home incentive respirometer was suggested in
required cases.
Patients were also encouraged to seek counselling
or support groups for post-COVID stress and
anxiety. COVID vaccination, if incomplete or not
done, was recommended three months post-
recovery following national guidelines [15]. Patients
who received oral corticosteroids were asked to
repeat CBC and blood sugar at one month. Other
post-recovery investigations were not routinely
advised for those recovered in homecare except
when comorbidities or strongly suggestive
symptoms were present.
Ethics and Consent: All data was collected,
structured and analyzed by ethical principles and
guidelines, following patient confidentiality norms
and consent.
Results
For most family physicians, the period of the second
COVID wave comprised of guiding and answering
queries of a large number of people (patients,
relatives, friends, and their referred known ones)
every month. One hundred fourteen (114) patients
sought direct consultation for confirmed
symptomatic COVID in April 2021 and were initiated
into homecare management. Among these,
retrospectively analyzed here are 63 patients (41
male) in the age group 18-60 years who completed
the entire treatment and monitoring period as
prescribed, without deviations, self-medication
initiation/modification, or multiple medical/non-
medical opinions. Fifty-one (51) patients also
completed a 3-month post-COVID follow-up.
Out of the 63 patients treated in homecare, 29/63
patients were <45 years of age, while comorbidities
were present in 14 patients (12 of them in the 45-
60 age group). None of the patients had received
the COVID vaccine. With respect to comorbidities, 7
patients had diabetes, 2 had asthma, 6 had
hypertension, and 4 had diabetes and hypertension
with a history of CVD (angina/myocardial infarction,
angioplasty/bypass graft).
Favipiravir and an antibiotic were prescribed in 21
and 9 patients, respectively. In the 2nd week, 36/63
(57% - Group A) recovered with improving
symptoms and no additional intervention, while 18
(29% - Group B) patients had significant symptoms
(fever, cough and weakness) but maintained oxygen
saturation and recovered with symptomatic
management and close monitoring. Corticosteroids
were needed in 7 patients (11% - Group C) due to
hypoxemia, significant symptoms and high
inflammatory response in the 2nd week, with
recovery after that. Only 2 patients (3% - Group D)
required hospitalization for breathlessness or falling
oxygen level. The first patient with a history of
stroke developed breathlessness on day 4. The
second patient had oxygen saturation below 92%
consistently on days 7 and 8, not responding to
proning. Both patients showed significant COVID
pneumonia on the HR-CT chest and recovered with
hospitalization for <1 week. Details of patient
factors/outcomes and group-wise recovery are
given in table 1 and figure 1, respectively.
Table 1: Patient factors and outcomes in
homecare COVID management (Total patients
= 63)
Factor/Outcome number percentage
Male 41 65%
< 45 years 29 46%
Comorbidities 14 22%
Hospitalized 2 3%
Antibiotic given 9 14%
Favipiravir given 21 33%
Corticosteroid (oral) given 7 11%
Figure 1: COVID Disease Course and
Treatment Decisions
Narayanan V. et al: Managing COVID in Homecare – Approach
International Journal of Medical Research and Review 2021;9(5)293
Group A: Symptomatic improvement, maintained
oxygen saturation and no additional intervention in
the 2nd week.
Group B: Continuing symptoms, maintained oxygen
saturation and close monitoring in the 2nd week.
Group C: Symptoms not improving, evidence of
mild hypoxemia and needing oral corticosteroids in
2nd week.
Group D: Worsening symptoms, hypoxemia and
requiring hospitalization.
Refer text under methodology for detailed group
descriptions
Out of 51 patients who followed up for post-COVID
health for three months, 47 patients had some post-
COVID symptoms in the first month, 39 continued
to have some symptoms in the 2nd month, 17 had
some symptoms in the 3rd month, and three
patients continued to have some symptoms
suggesting long COVID (figure 2). The common
post-COVID symptoms seen (table 2) were general
lethargy, fatigue, low energy and weakness;
headache, body ache or joint pains; feverish feeling
or mild fever; gastrointestinal (GI) symptoms like
indigestion, low appetite, and nausea; reduced
taste/smell; feeling breathless especially after
physical exertion like exercise, climbing stairs, etc.;
palpitations; sleeplessness (insomnia); brain fog
(feeling mentally less sharp, forgetful); hair loss;
and anxiety-depression. Most patients were
managed conservatively with diet, lifestyle
modification, breathing techniques and home
incentive respirometer, rest and graded physical
activity, and emotional reassurance. Probiotics,
protein and vitamin-mineral supplements (vitamin
B-zinc-selenium-chromium, vitamin C, vitamin D
weekly, and iron-biotin in case of hair loss), and
SOS analgesics like paracetamol were given in some
patients. Medicines for sleep were prescribed for a
limited period in low doses in 5 patients, while 4
patients were suggested counselling/therapy for
anxiety-depression. While 3 patients were
recommended a 2-D echocardiogram which was
normal, 1 patient was investigated with both HR-CT
chest and echocardiogram and referred for specialist
care due to the presence of diabetes, blood pressure
and history of coronary artery bypass graft (CABG).
Blood sugar did not show any abnormality in the
follow up of the seven patients who received oral
corticosteroids. No patient reported alarm
signs/symptoms or developed any thrombotic
complications or Mucormycosis.
Figure 2: Post-COVID symptom duration in
home-treated COVID patients
Table 2: Prevalence of different post-COVID
symptoms in home-treated COVID patients
(N=51)
Post-COVID symptom number percentage
General lethargy, fatigue, low energy and weakness 37 73%
Headache, body ache or joint pains 8 16%
Feverish feeling or mild fever 4 8%
Indigestion, low appetite, and nausea 10 20%
Subnormal taste/smell 13 25%
Breathlessness after physical exertion 7 14%
Palpitation 5 10%
Insomnia 14 27%
Brain Fog 6 12%
Hair fall 4 8%
Anxiety-Depression 7 14%
Gum swelling (gingivitis) 1 2%
Discussion
While clinical trials are done with controlled settings
and patient factors, the real-world scenario presents
varied challenges to the treating family physician.
The first among these seen during the pandemic
was the multiple sources of health information,
guidance and suggestions from the Internet, social
media, news channels and relatives-friends, which
made patients aware of different medicines and
modalities available. The absence of uniform
training modules and guidelines for GPs and CPs
across the country only added to the variability in
prescription and treatments.
Narayanan V. et al: Managing COVID in Homecare – Approach
International Journal of Medical Research and Review 2021;9(5)294
All this contributed to patient apprehensions on why
a particular medicine was not being prescribed when
it was perhaps there on other prescriptions. Getting
excess laboratory tests done and the associated
panic and anxiety led patients to self-medicate or
pressurize physicians into starting antibiotics,
favipiravir, even corticosteroids, and in some cases
directly acting oral anticoagulants (like apixaban), in
the absence of clinical need, and despite imparting
reassurance, counselling and detailed explanations
[16-18]. Therefore almost 45% (51/114) of patients
treated in homecare could not be taken for analysis
here due to such deviations.
A well-defined and systematic approach for
assessment, monitoring and treatment can only be
effective if coupled with proper care, compliance
and confidence from the patient with the support of
family and caregivers. With the mentioned clinical
approach and patient parameters here, only 2
patients required hospitalization, and corticosteroids
were given only when hypoxemia was recorded with
persistent symptoms and high CRP. Corticosteroids
in the absence of hypoxemia have not shown clinical
benefit and are not recommended [19]. However,
generally, a large number of patients during the 2nd
wave took corticosteroids in the 2nd week, or even
earlier in the viremic phase if highly symptomatic,
often with prolonged duration of dosing [17]. This
led to a more adverse result with
immunosuppression, increased blood sugar, and risk
of opportunistic infections like Mucormycosis in the
community [20]. Rampant and blanket use of
antibiotics in all cases can give rise to significant
future antimicrobial resistance and unnecessary
adverse effects [16]. In the cases given an
antibiotic here for suspected bacterial sore throat,
as a deduction in hindsight, some could have been
managed with antiseptics gargles alone. Ivermectin
was given to all based on national guidelines and
the advantage of low cost, short course duration,
accepted tolerance and adequate availability [8].
Based on the evidence for favipiravir in reducing
viral load and days of illness, it was given to the
patients who were initially highly symptomatic or
had associated comorbidities [9]. This drug has a
high cost, high pill burden and longer dosing
duration. No correlation was seen between the viral
load by RT-PCR cycle time (Ct) and the severity of
clinical symptoms.
Meticulous clinical monitoring and maintaining
oxygen saturation and daily symptom charts, along
with awake proning, are the cornerstones of
management.
Following simple lifestyle measures and maintaining
general physical and mental health go a long way in
helping recovery. The timing of laboratory tests,
initiating different medications, and clinical decisions
are crucial and require objectivity, availability of
complete monitoring charts, and absence of
pressure. Continuous communication and discussion
with the patient and family/caregivers is the key for
which digital platforms have evolved. One of the
most important factors for reducing disease severity
and hospitalization, apart from vaccination, is
controlling comorbidities with regular medication
and monitoring. Effective and early recovery in
homecare is significantly higher in such cases
without the need for hospitalization. The antibiotic
cocktail is now available for high-risk patients.
Post-COVID symptoms of tiredness and low energy
were seen in most patients, especially in the first
month. Body aches and headache, sleeping
difficulty, GI symptoms, and subnormal taste/smell
were other common post-COVID symptoms. Hair fall
was seen in some women patients. However, in
most, these were mainly in the first month and
lasting not more than three months, with possible
long COVID in 3 patients. The overall type,
prevalence and duration of post-COVID symptoms
here was seen to correspond with those reported in
the literature; however direct comparisons may be
inappropriate due to the small sample size and
subjectivity of reporting by the patient [21-23]. Age
or intensity of active COVID symptoms did not play
a role in determining the nature, severity or
duration of post-COVID symptoms. No set of routine
or standard investigations can be advocated for
post-COVID symptoms. The call must be taken on a
case-to-case basis after assessing risk factors,
whether alarm signs present and associated
comorbidities. Majority recover with conservative
and lifestyle measures. COVID vaccination can be
advocated 3-6 months after COVID recovery [15].
Conclusion
COVID cases in the 2nd wave in India were seen
commonly in the younger population of 18-60 years,
with a majority showing mild disease requiring
home care and management. However, this was
accompanied by multiple sources and access to
information coupled with panic and pressure due to
a fast rise in daily caseload and overburdening of
healthcare resources. This presented new
challenges to the family and general physicians who
were the backbone of managing COVID.
Narayanan V. et al: Managing COVID in Homecare – Approach
International Journal of Medical Research and Review 2021;9(5)295
The key was a systematic and rational approach to
treating, monitoring and managing COVID patients
at home for better care and recovery and to limit
unnecessary hospitalization. Diet and lifestyle
measures, documentation of oxygen saturation and
temperature monitoring, proning and breathing
techniques, and psychological support are of great
importance that not only aid recovery but also
enable sound clinical evaluation and decisions with
avoidance of undue over-prescription of drugs and
tests. Post-COVID symptoms were also seen to
subside in most cases by three months with
conservative health measures.
What this data adds to existing
knowledge
Holistic management of COVID by the physician
(instead of prescription medicine practice only),
meticulous monitoring and follow-up utilizing digital
means effectively, structured and timely
stratification of patients and informed decision
making can significantly improve COVID
management in homecare for both the family
physician and patient, as well as minimize clinical
deterioration, complications and need for
hospitalization. This also helps strengthen the
foundation of healthcare and reduce the severe
burden on in-patient doctors and infrastructure.
Sharing such data, insights and experiences by
family physicians can further help refine the
approach to treatment and improve patient care.
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