Ghar pe raho, swasth raho

Apollo Hospitals’ homecare team helped turn a hotel room into an ICU-like arrangement in Kolkata. Pic Courtesy/Apollo Homecare Kolkata

In early April, Indranil Chakraborty, an engineer by profession, developed a mild fever and began suspecting Covid-19. So, he decided to get an RT-PCR test done. He isolated himself immediately from the rest of his family, and once his results came in, contacted Dr Manjeet Singh Arora, consultant and general medicine and community health expert at Fortis Hospital, Mulund. After learning of his symptoms, Dr Arora put him on a course of medication. Chakraborty also decided to avail of Fortis's homecare services, a Rs 7,000-package for both him and his son, who also tested positive later. The package involved close monitoring from the hospital's medical support staff, who closely tracked his temperature and oxygen levels on the phone three times a day for a span of 17 days. They also kept an eye out for any abnormalities, and included dieticians and physicians who instructed him to follow a certain diet and workout plan.

"If you go to a hospital, you are entering a space where the viral load is very high. So, if you can manage the whole thing in your home, that is the best thing," says Chakraborty. He admits that there was an initial fear of a sudden crisis unfolding at home, but having a doctor to consult over telephone and video calls put his mind at ease. Early detection and awareness along with the stringent care plan of a competent doctor and regular follow-ups by the homecare team, he says, helped him manage the infection at home. Chakraborty believes that if doctors were similarly available on call in sync with a homecare treatment setup, a lot of the present problems faced by people would be solved.

Dr Arora describes these packages as economical and practical at a time when hospitals are running short of doctors specialising in Covid-19 and infectious diseases. At the start of the pandemic last year, Dr Arora, despite a 31-year-long career, was put on dedicated emergency call room duty. He applauds the foresight of Fortis's zonal director, Dr Narayani Shivkumar, who believed that their "own people" and not call centre representatives needed to respond to the crisis. "I was answering 65-70 calls per day, taking all the queries," says the doctor, who got closely involved with the hospital's homecare facilities.

Dr Manjeet Singh Arora, Dr Sulaiman Ladhani and Dr Shruti Tapiawala

He speaks of Fortis's active and passive services, the first for patients quarantining at home and the second for those returning home after hospital stays. "There is a need to raise people's awareness of methods of precaution and treatment. Treating patients remotely involves instilling best practices in them, about ways to do steam inhalation, when to take fever medication, breathing exercises to increase vital capacity, the six-minute walk test and an avoidance of unnecessary CT scans," he says. This pandemic has taught us that what the community needs is stability, humanity, solidarity, sanity and awareness. "The ultimate end of this disease will come through education."

Also Read: Covid-19: Can Mumbai blueprint work for other metros?

Dr Sulaiman Ladhani, a chest physician attached to Masina, Prince Aly Khan and Wockhardt hospitals, further categorises COVID-19 homecare cases into mild and moderate. The first are often asymptomatic and clinically stable where tele-consultations are sufficient, while for the latter, where patients are comorbid, symptomatic, old or with chronic illnesses where recovery periods are unknown, homecare setups seem viable.

These, organised by some private organisations, come with oxygen cylinders or concentrators, non-invasive ventilators like BI-PAP, air beds, nebulisers, suction machines, IV stands for fluids and antibiotics, with round-the-clock doctors and nurses who keep constant tabs. "They have their own ethical and legal challenges which have to be kept in mind. But when there is no option left and things are beyond reach, this can help us tide over the crisis," Dr Ladhani remarks. Fear around the disease and what might follow deter many from approaching hospitals, and instead opt for home care where, he says, there is the added advantage of having family members around.

However, with ICU-like arrangements at home, rooms need to be sanitised periodically, as chances of secondary infection are very high. The steep expense coupled with limited space available in Indian homes and the informality of the residence environment, which may lead to lenient isolation plans, are some of the disadvantages.

For Dr Shruti Tapiawala, nephrologist and transplant physician with Reliance Foundation and Global hospitals, who has been arranging home dialysis for COVID-positive patients so that they do not have to step out of their homes, the unavailability of beds and the resultant strain are the biggest problems this time around. "This second wave is a killer. Last year was just a trailer. The morale is breaking because we are losing a lot of patients this time. [What we are seeing now is that] the virus eventually goes away but the lungs start deteriorating and that is the end of it," she says.

Dr Tapiawala admits that tracking patients remotely and checking to see if their inflammatory markers are going up is stressful as the patient is not in an environment equipped to handle an emergency. "It's hard to monitor a patient who is desaturating; once your oxygen levels start dropping, it is not safe to stay at home," she says.

She recalls how patients were sometimes unnecessarily made to stay in hospitals for 14 days last year, when the crisis of beds wasn't so severe. "If I have to refuse a patient and he or she dies, it makes me feel so much worse than the stress of a patient who is mildly symptomatic at home. I'd rather deal with that stress than see a life lost because of no hospital beds," she says.

Rs 7k
Fortis's homecare charges for two COVID-positive patients for 17 days