A new guideline with landmark changes on caring for COVID-19 confirmed cases at home has been issued by Nigeria Centre for Disease Control, NCDC.
A copy of the new guideline, obtained by Compass NG, which experts said was aimed at de-congesting health facilities and reducing costs and logistics due to the rising number of cases, and was said to be interim, targets patients, patients’ household, health care workers and case managers.
The guideline recommended that where hospitalisation is not feasible, home care could be considered for patients with mild symptoms or for patients without concern for rapid deterioration.
It also allows home care in situations where “in-patient care is unavailable or unsafe, (e.g. capacity is limited, and resources are unable to meet the demand for health care services)”.
The NCDC said, “Following the outbreak of COVID-19 outbreak in Nigeria on 27th February 2020, the country has been managing confirmed cases in government designated isolation/treatment centres in order to ensure recovery of cases, as well as prevent community transmission. There is now evidence of community transmission in the country, as over 50 per cent of cases have no clear epidemiological link with a confirmed case.
“Most cases of COVID-19 in Nigeria from current data are mild (95 per cent), with several having no symptoms (asymptomatic). These cases require only isolation and supportive management to recover. As at 4th of May 2020, 417 cases have recovered with a median duration of 11 days’ hospitalisation (range of hospitalisation is 4 -37 days).
“Almost all the deaths recorded had co-morbidities, such as hypertension, diabetes, dyslipidemia, amongst others.
“As part of measures to control the outbreak, pharmacologic and non-pharmacologic measures have been implemented, which include personal hygiene, (hand washing, cough etiquette), social distancing and restriction of movement in some states.
“However, cases are still increasing with a need for more bed space for admission. In order to reduce pressure on the health system, cases which are asymptomatic or have mild symptoms may remain in isolation at home (See Guidance on Self- Isolation) with access to clinicians to monitor their health condition and have access to quick evacuation to a treatment centre should they need urgent medical intervention.
“This assessment will be based on the infrastructure of the state and health seeking behaviour of its citizens.”
Other recommendation in the guideline include that “contacts should be advised to monitor their health for 14 days from the last possible day of contact, while health care personnel should review the health of contacts by phone, and in person, if feasible, and provide instructions to contacts on what to do if they become ill.
“If home care is provided, ensure follow-up and care by a family member; If and where feasible, a communication link between the patient and health care provider and/or public health personnel should be established.
“Clinical judgment should be used and informed by an assessment of the patient’s home and environment by a trained health care worker, if and where feasible.”
The NCDC also recommended that patient and household members should be educated “about personal hygiene, infection prevention and control, IPC, measures, and how to care for the patient.”
The guideline also emphasised the need to remain isolated and limit contact with all other people, including household members, “until all symptoms have resolved and until he/she has a repeat negative test and/or a healthcare worker has cleared the patient.”
Patients are also required to “stay in a well-ventilated single room, limit movement in the house or minimise shared space, ensure shared spaces are well ventilated, follow cleaning and disinfecting guidance at home, limit the number of caregivers, and seek care urgently if there is a change in condition.”
The principle behind the guideline is that clinicians should “recommend the use of designated treatment areas, according to severity and acute care needs, to care for confirmed COVID -19 patients; home care should be recommended in patients after an appropriate risk assessment has been done and following appropriate counseling and patient information.