COVID-19 spike: Why FG’s home care policy is unsustainable

Home care for COVID-19 patients poses a lot of challenges for effective treatment and prevention of new infections amidst the rising cases of the coronavirus, Daily Trust findings have shown.

Daily Trust reports that there was poor compliance to non-pharmaceutical prevention measures such as social distancing, handwashing and use of face masks in many homes.

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Many Nigerians also live in highly populated households where they share rooms, toilets, among others with relatives and neighbours. Therefore, a COVID-19 case could infect many as most households cannot afford facilities to meet up with the guidelines to prevent the spread of the virus.

Meanwhile, the federal government is making effort to procure 20 million doses of COVID-19 vaccines in the first quarter of 2021 as part of the process of inoculating Nigerians against the virus.

A top government official, who craved anonymity, told Daily Trust yesterday, that though the Secretary to the Government of the Federation (SGF) and Chairman of the Presidential Task Force (PTF) on COVID-19, Boss Mustapha, is leading the nation’s drive against the virus, the vaccine procurement is being handled by the Ministry of Health, headed by the minister, Dr. Osagie Ehanire and the Director General, Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu.

Daily Trust recalled that Dr. Ehanire, on Thursday, during the joint national briefing of the PTF on COVID-19 had said the government was making plans to procure at least 20 million doses of COVID-19 vaccines to combat the virus.

Home care strategy

The federal government had issued guidelines for care of some COVID-19 patients within their homes in June to decongest isolation centres and ensure that health facilities were not overwhelmed as the country witnessed community transmission.

Before then, the country was managing confirmed cases in government-designated isolation/treatment centres to ensure recovery and prevent community transmission except for some VIPs with mild to moderate cases who opted for treatment at home.

Experts have expressed concern over the workability of the strategy amidst the spike in COVID-19 cases, especially with the inability of many households to meet the guidelines for such treatment as well as with the dearth of health workers.

President of the Nigerian Medical Association (NMA), Prof Innocent Ujah, said home care for COVID-19 patients in the country was unsustainable because there are not enough health workers to provide treatment for patients in their various homes.

The Nigeria Centre for Disease Control (NCDC) in its Interim Guidelines for Home Care of Confirmed COVID-19 cases, said home care became expedient following the increasing need for more bed space for admission, adding, “In order to reduce pressure on the health system, cases which are asymptomatic or have mild symptoms may remain in isolation at home with access to clinicians to monitor their health condition and to quick evacuation to a treatment centre should they need urgent attention.”

A survivor, who received treatment at home and does not want his name in print, said it was not really easy with many members of his extended family living with him in a two-bedroom apartment.

The NCDC Director General, Dr Chike Ihekweazu, said the federal government also reviewed guidelines for COVID-19 treatment in July, “So that even people taken to isolation centres do not need to continue to stay there long for treatment like before.

He said: “In June 2020, we reviewed our discharge criteria based on emerging scientific evidence. New evidence emerged that shedding of the live virus is not viable after about 10 days.

“Following this finding, WHO issued new guidance subsequently, and we did in June 2020. This discharge criteria from clinical care will also take into account the patient’s condition, disease experience and other factors. The RT-PCR test may remain positive in some patients, detecting virus segments – however, these are not viable for transmission to cause disease in others.

“These patients are then discharged to ensure continuous availability of resources.

“In deciding on the criteria for discharge of COVID-19 patients, the most important factor is the patient’s clinical status and his or her risk to others. Therefore, patients who may still pose a risk to public health will not be discharged.

“Many states are expanding their treatment centre capacity to ensure that they can meet increasing needs,” he said.

Dr Ehanire said there were four categories of COVID-19 treatment. He said: “Up to 80% of cases have little or no symptoms at all. The second category have mild symptoms. The third category have moderate symptoms while the fourth category have severe symptoms that require oxygen and even ventilators. Those with severe symptoms will go to the isolation centres like the University of Abuja Teaching Hospital (UATH), Gwagwalada while others will be in a facility where they are taken care of.”

Patients managed at home

In August, when the Lagos State Commissioner for Health, Prof Akin Abayomi, was tested positive for COVID-19, he was managed at home through the home-based care.

Also, when the Governor of Lagos State, Mr Babajide Sanwo-Olu, was tested positive a few days ago, he was managed at home and not at the isolation facilities as he was said to have mild symptoms.

In June, the Lagos State Commissioner for Health, Dr Abayomi, announced that both asymptomatic and mild cases would be treated at home through the home-based care in their various communities. This was to reduce the burden on the isolation facilities.

As at December 11, out of the total of 24,872 confirmed COVID-19 cases in Lagos, 1,612 active cases in communities are being managed under the COVID-19 Lagos home-based care and they are receiving treatment via EkoTelemed services.

Both the recovered and recovering cases were provided with EkoTelemed for consultation and a COVID-19 pack which contains gadgets to measure their temperature, oxygen level in addition to certain vitamins and painkillers.

Abayomi stated that all home-based care cases were being monitored by the COVID-19 Lagos Response team.

Experts’ views

According to the chairman, Infectious Diseases Committee, a committee of the National Body of Nigerian Medical Association, Dr Sanusi Muhd Bala, home treatment though adopted for convenience was not really the best option looking into the nature of the Nigerian community settings, the society and the capacity to handle the number of active cases.

“The best way is to have functional isolation centres. However, it is clear that our capacity to cater for all active cases in isolation centres is not adequate due to poor resources. Therefore, there is a need for an aggressive enlightenment campaign by all stakeholders to make people understand that home treatment is an option,” he said.

He stated that for the general public’s education, someone receiving care at home should use a separate room; should if possible use a separate bathroom and not share cups, towels and other personal items with family members.

“Wear a mask to interact with other members of the household. Monitor symptoms and report for emergency care if there is breathlessness or any other emergency symptoms,” he advised.

In Bauchi, the handling of COVID-19 patients has been handed over to a state Rapid Response Team (RRT), working with the Disease Surveillance Notification Officers (DSNO) in local government areas in the state.

Our report did not find any record of home treatment for COVID-19 patients in Rivers State.

A Port Harcourt-based medical doctor, Dr Matthew Ezekwem, said it was difficult for patients with COVID-19 to receive treatment from home given the state government’s aggressive commitment in the fight against the virus.

“All the cases of COVID-19 were referred to government-approved isolation centres from where the patients were treated,” he said.

Lagos weighs ‘lockdown’ options

The Lagos State government is said to be weighing all options on how to contain the spike in COVID-19 infections, Daily Trust learnt yesterday.

One of the options being considered is another lockdown or shutdown of some public places, according to a source who spoke with Daily Trust.

The government is said to be deeply concerned that people seem to have let the guard down, abandoning virtually every protocol and guideline to contain the spread of the disease.

Governor Babajide Sanwo-Olu had recently contracted the virus after undergoing the test when one of his aides tested positive for the virus.

A source told our correspondent that the government specifically warned that it might be forced to impose another lockdown going by the way people are flouting the COVID-19 protocols.

An expert, Dr. Naheem Ekemode, called on the government to immediately shut down primary and secondary schools to protect children from being infected which could deepen the spread. He said before considering another lockdown, the government should intensify the enlightenment campaign to caution people that COVID-19 remains a major public health threat.