Home treatment of COVID-19 patients will increase infection – NMA warns

The Nigerian Medical Association on Sunday cautioned the Federal  Government against treating COVID-19 patients at home.

The NMA said the implementation of home treatment in Nigeria, where the majority of the infected people lived in crowded houses would create problems for the country.

The NMA specifically said patients, who would be treated in households with a large number of people might infect others, thus increasing COVID-19 cases in the country.

The Presidential Task Force on COVID-19, at its press briefing on April 30, had said the Federal Government was considering treating some COVID-19 patients at home.

The Nigeria Centre for Disease Control  Director-General, Dr Chikwe Ihekweazu, who disclosed this at the press briefing, said the country had only about 3,500 bed spaces for COVID-19 management.

“We are now trying to make more bed spaces available, but ultimately we might have to change our strategy and start considering homecare in certain circumstances where patients are able to provide rooms for their own management,” he said.

As of Saturday, there were 4,151 COVID-19 cases in Nigeria, with  3,278 of them still active and 745 discharged. No fewer than 128 people have died of the highly infectious virus.

According to the World Health Organisation’s guidelines disclosed by the NMA President, Dr Francis  Faduyile, all laboratory confirmed cases should be isolated and cared for in a health care facility.

The WHO explained that where isolation in a health facility was not possible for all cases, emphasis should be given to patients with severe and critical illnesses as well as mild illnesses such as “uncomplicated upper respiratory tract viral infection symptoms.

The WHO added, “If all mild cases cannot be isolated in health facilities, then those with mild illnesses and no risk factors may need to be isolated in non-traditional facilities, such as repurposed hotels, stadiums or gymnasiums where they can remain until their symptoms resolve and laboratory tests for COVID-19 virus are negative. Alternatively, patients with mild disease and no risk factors can be managed at home.

“For those presenting with mild illness, hospitalisation may not be possible because of the burden on the health care system, or required unless there is concern about rapid deterioration.”

It added in cases where care would be provided at home, a trained health care worker should conduct an assessment to verify whether the residential setting would be suitable for providing care and whether the patient and the family were capable of adhering to the precautions that would be recommended.

The WHO also recommended that the patient should be in a well-ventilated room and that face masks or gloves should not be reused.

It added, “To contain respiratory secretions, a medical mask should be provided for the patient and worn as much as possible, and changed daily. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene; that is, the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. Materials used to cover the mouth and nose should be discarded.”

The WHO also said the movement of the patient and shared spaces in the house should be minimised. “Ensure that shared spaces (e.g. kitchen, bathroom) are well ventilated (keep windows open) and use a mask when providing oral or respiratory care and when handling stool, urine, and other waste,” it advised care givers.

It said dedicated linen and eating utensils should be used for the patient, adding that the items should be cleaned with soap and water after use and may be re-used instead of being discarded.

Faduyile, in an interview with The PUNCH, said although the WHO guidelines were of global standard, he had a problem with how they would be implemented in Nigeria.

He stated, “We can’t just conform with anything from the WHO because many of those people infected are people living in rented apartments or houses that have large number of people within the household. I doubt how beneficial it is for those persons to guard against infecting others in that area. I guess we will still have problem with the implementation of such a regulation in Nigeria.”