MANILA — As soon as he arrived home in Antique, Stephen Siblag immediately changed his outside clothes and sanitized all his belongings and other items he carried.
Siblag wanted to make sure that their household would be prepared if and when COVID-19 strikes.
On top of his list of supplies were medicine for fever, cough and colds. He also has personal protective equipment, such as face masks and gloves, and cleaning and disinfection supplies.
Siblag has also prepared a room at home in case one of his household members would need to be quarantined.
“Rising ang cases ng COVID-19 and some of the nurses here (in Antique) natatakot din sila. Ang facilities dito ay kulang at puno na ang mga ospital. Kailangan talaga may home care kit tayo sa bahay dahil ito ang magsisilbing monitoring natin sa isa’t isa. We need to monitor ourselves and our family,” Siblag told ABS-CBN News on Thursday.
(Our medical facilities here in Antique are few and hospitals are already filled up. We should have our own home care kits because this will serve as our own form of monitoring.)
Dr. Anna Lisa Ong-Lim of the Philippine General Hospital earlier said that home care for COVID-19 patients could be an option as occupancy rates in the country’s health care facilities continue to rise.
But she stressed that home care might only be considered for asymptomatic cases and those with mild to moderate symptoms.
Latest data from the Department of Health showed that the country's COVID-19 cases already reached over 979,000 as of Friday, with nearly 103,000 remaining active infections.
Of those still battling the disease, 96.4% have mild symptoms, 1.3% are asymptomatic, 0.9% are severe, 0.7% are critical. and 0.58% are in moderate condition.
“The WHO guidance tells us that it is those patients who are asymptomatic or those with mild and moderate disease without risk factors,” Ong-Lim said in a forum organized by the Santuario de San Antonio Parish on April 10.
She went on, “If they are above 60 years old, they are smokers, obese or they have non-communicable diseases like cardiovascular disease, diabetes, chronic lung disease, chronic kidney disease, if they’re immunocompromised for whatever reason, their immune systems aren’t functioning normally, and if they currently have cancer—these patients will not qualify for home care.”
Ong-Lim and other public health experts have urged COVID-19 patients experiencing mild symptoms to opt for home care instead, in a bid to decongest medical facilities in the capital region and 4 nearby provinces Laguna, Rizal, Bulacan, and Cavite (the NCR Plus bubble).
Rising demand for home health care
To cope with the increasing demand for hospital care of patients with the virus, The Medical City (TMC) devised what it calls a "COVID Home Care Program."
Dr. Amiel Cornelio dela Cruz, chairman of the Department of Medicine at TMC, said the program was conceptualized last year, aiming to accommodate about 30 to 60 patients only. Due to the current surge in COVID-19 cases, however, the program has become fully operational with an increased capacity of 100 patients.
Since March 12 this year, the program has already attended to 274 coronavirus patients.
“That’s like a small hospital already. Many patients really need this service. All the hospitals are full and hospitals prioritize active cases.,” Dela Cruz said on Friday.
“Mahirap din (it is also difficult). There came a point, a week ago, that even the program itself became full… There were some patients we were not able to respond to at once," he added.
Under the program, patients will be closely monitored daily via video call and face-to-face visits of a physician and a nurse for 10 days or more.
Once the patient’s condition progresses to a severe or critical state, he or she will be brought to the hospital for admission.
“If, during the course of the program, there will be a need to follow up on the patient, then that’s already arranged. Doctors can visit for reassessment, especially for patients who we really think require hospitalization,” Dela Cruz explained.
He continued: “We were able to transfer 36 patients to the hospital because we noted there was progression of their disease. There was a need for closer monitoring in the hospital. It cannot be done at home anymore.”
The rising demand for home health care prompted home health care provider ActivCare to also cater to COVID-19 patients.
Palliative care specialist and ActivCare Home Health Solutions medical director Dr. Agnes Bausa-Claudio said they started the program last week and have so far extended home care service to 6 COVID-19 patients in Metro Manila.
She underscored the importance of early teleconsultation, and advanced planning and preparation for the conditions of an infected individual when considering home care.
“We feel there’s really a need to provide. COVID has a lot of anxieties for the patients and families that need the care of a team. That’s why we started this COVID home care. Maraming tumatawag at marami na rin kaming na-home visit,” Bausa-Claudio told ABS-CBN News.
(A lot of people called and we already visited several of them.)
“We will teleconsult first before the team goes to the house, para pagdating sa bahay, handa na ang team ano ang need ng patient, ano ang equipment na kailangan. Lesser exposure din for the team,” she added.
(We have a teleconsultation first before the team goes to the house, so that when we get there, the team is already prepared with what the patient needs and what equipment would be needed.)
Home health care challenges
Caring for a COVID-19 patient at home is a challenging and a daunting endeavor. While there is a demand for the service, there is a lack of health workers. Despite this, however, health workers remain committed.
The Medical City in Pasig City and ActivCare each have 3 to 4 teams dedicated for home care. Each team is composed of three members: the attending physician, a caregiver or nurse and an associate physician who will do the home visits.
“There’s a limitation right now because of the lack of nurses. There are not enough nurses that would want to care for a patient at home na COVID-positive,” Bausa-Claudio said.
She went on, “The time allotted for home care cannot be anticipated. Sabihin mo isang oras lang ako vi-visit sa inyo (let's just say that the time allotted for the visitation is only one hour)."
"Sometimes it will take 3 to 6 hours, especially if the case is complicated… You have to stay a little longer to evaluate your management. It takes a lot of time, kaya hindi rin lahat (not all are) comfortable to do home care because of these challenges," she added.
Dela Cruz echoed her sentiments: “It is also very challenging because it is labor-intensive, but the commitment we give to seeing these patients is the same as the ones we give to patients hospitalized.”
He also encouraged other hospitals to develop their own home care program: “I encourage other hospitals to also do the same because right now, there’s just a few of us doing it. If there’ll be more, that will help a lot of people control this pandemic.”
The doctors added that a COVID-19 home care kit consisting of personal protective equipment (PPE), cleaning and disinfection supplies, monitoring supplies to report the patient’s vital signs, such as a thermometer, pulse oximeter and BP cuff, and medicines, is also necessary.
On the home setup, Bausa-Claudio explained that the patient must have a separate bedroom and bathroom with good airflow. The patient’s food and needs should be handed over without contact with other family members.
But if one cannot avoid being with the patient in the same room, wearing of face masks is required for both the patient and the caregiver.
Household members also have a vital role in home care service, she said.
“Continuous ang communication. 24/7 ang monitoring… We always do family meetings—before the visit, ano ang expectations at role ng team at family, during the visit, that’s another discussion, what are the things to be done,” the doctor said.
“I think it (COVID-19 home care) will go on for as long as COVID is there. Marami talagang patients na ayaw magpadala sa hospitals. They are comfortable at home and they want to stay with family.”
(A lot of patients do not want to be admitted to hospitals.)