Only a week to go before the end of April when the government will decide whether to change or maintain the current MECQ (Modified Enhanced Community Quarantine) status in NCR Plus. But with the Department of Health’s report on having 66% of the country’s ICU beds solely for COVID-19 patients already utilized, it is clear that the healthcare system still needs more time to recover. In fact, PGH (Philippine General Hospital) spokesperson Dr. Jonas del Rosario stated, “Extension of MECQ will probably help in further decreasing the transmission, and then fewer people will get hospitalized.”

As of writing, the World Health Organization (WHO) has recorded over 143 million confirmed cases of COVID-19, and over 3 million deaths worldwide. Because this scenario may be difficult to imagine, Dr. Anna Lisa Ong-Lim, division chief of the Department of Pediatrics’ Infectious and Tropical Disease in PGH offers this explanation: “That means every man, woman and child who lives in the Philippines has tested positive. When you talk about the deaths, that’s kind of saying that everybody in Quezon City has died of COVID.” She added that she wouldn’t be surprised if the DOH’s current tally of over 971,000 cases hit 1 million very soon. As of April 22, the country’s total active cases are almost 108,000 with over 16,000 deaths.

With NCR hospitals in almost-full capacity, alarming stories of patients having to go outside of Metro Manila to seek medical care abound. But with DOH stating that more than 97% of current COVID-19 cases are mild and asymptomatic, home care may be feasible. To learn more about this, The Sanctuario de San Antonio Parish Team held the webinar entitled What to Do When COVID Hits Home with Dr. Ong-Lim as guest speaker.

When COVID Homecare is Feasible

In March last year, WHO began releasing homecare guidelines for mild cases when “in-patient care is unavailable or unsafe”, which is currently the case in NCR. To determine which cases are eligible for home care, Dr. Ong-Lim proposes asking three questions:

1. DOES THE PATIENT QUALIFY FOR HOME CARE?

According to WHO, the following cases qualify for home care:

• Asymptomatic or those with mild or moderate disease
• No risk factors for poor outcome. Risk factors include being more than 60 years old, smoking, obesity, cardiovascular disease, diabetes, chronic lung or kidney disease, immunosuppression and cancer.

Dr. Ong-Lim expounds on this by saying that the patient should not have difficulty in breathing to qualify for home care. This can be concluded when the patient is able to do the following:

• Comfortably breathe and does not have any shortness of breath
• Comfortably speak in full sentences. Patient doesn’t catch his/her breath when speaking.
• Has a respiratory rate of less than 30 breaths per minute at rest
• Oxygen saturation without any oxygen supplementation is at least 94%. This can be measured by using a pulse oximeter device.

2. IS THE HOME SETTING SUITABLE FOR HOME CARE?

Though both isolation and quarantine seek to limit the patient’s movement to avoid passing on the virus, Dr. Ong-Lim enumerated their differences. 

Physical requirements for home care include:

• A separate room and bathroom for patient. Patient’s door need to be closed to contain airflow.
• A delivery system for patient’s daily needs that allow minimal exposure for caregiver. 
• Only one caregiver for patient. Caregiver should be in good health without underlying chronic conditions.
• If contact and exposure with patient is necessary, caregiver should wear a face shield and face mask, and maintain a distance of 1 meter from the infected person. 

Additional tips for infection prevention in the home include:

• Provide patient with medical masks. After use, masks should be disposed of in a separate trash bin. 
• Patient should have his/her own utensils and linen. Before washing used linen, place them in a laundry bag. Don’t shake the bag so as not to aerosolize the virus. Use regular soap and water for washing. Wear gloves and a face mask when washing.
• Frequently clean and disinfect surfaces at home. Wear gloves and a face mask when cleaning. A disinfecting solution consists of 45 ml bleach for every liter of water. Prepare the solution daily because this evaporates, affecting its efficacy.
• If patient used a shared space such as the bathroom or kitchen, sanitize the area right away.
• Household members should constantly practice hand hygiene.
• Visitors should not be allowed in the home.

3. CAN THE PATIENT BE PROPERLY MONITORED AT HOME?

Aside from having no risk factors and being below 60 years old, the caregiver should also also be reliable. This ensures the accuracy of information that will be relayed to the healthcare professional. 

According to Dr. Ong-Lim, the caregiver should be equipped to do the following:

• Monitor vital signs of patient by recording the date, time, heart rate, respiratory rate, oxygen saturation, temperature and blood pressure. Do this 1 to 3 times, or every 8 hours daily.
• Make sure patient takes his/her maintenance medicines.
• Maintain a supply of medication for fever, cough, and colds.
• Be vigilant of worsening symptoms that require urgent professional care.

The Centers for Disease Control and Prevention (CDC) states that these signs merit emergency medical attention:

• Trouble breathing
• Persistent pain or pressure in chest
• Patient being confused and disoriented, which may be a sign of decreasing oxygen levels in the body
• Inability to wake or stay awake
• Pale, bluish gray skin, lips or nail beds

Dr. Ong-Lim added that patients with mild to moderate disease without risk factors could take about 10 days to recover. The important thing is that the patient should be improving, and not progressing toward severe or critical illness. When the latter happens, the patient needs to be transferred to a hospital.

A Side Note on Ivermectin

So far, three hospitals in the country have secured permission to use ivermectin against COVID-19. Oral ivermectin, which was previously used in the Philippines only for parasite infestations among animals, is now allowed by the Food and Drug Authority (FDA), under a special permission, to be given to COVID patients. Currently, ivermectin clinical trials in the country are underway.

However, health experts including the FDA and WHO have been vocal against the use of the drug, citing that there isn’t enough evidence to prove that its effectivity against COVID-19. About this, Dr. Ong-Lim said, “Even if there are scientific publications saying that there is evidence for it, unfortunately, the studies are affected by the fact that they involved different kinds of populations. Ivermectin in those trials may have been used with other interventions, so it’s very difficult to isolate and say that the effect is solely due to ivermectin.” 

Aside from its lack of efficacy, health experts are also concerned about ivermectin’s possible toxicity. “Is it right to put our faith into something that needs more sound evidence?” Dr. Ong-Lim asked in Filipino. “We need more evidence before we can trust it. Otherwise, we have misplaced faith. We need to understand what we’re really afraid of. We’re afraid of getting sick. How can we prevent that? By just utilizing your mask and shield properly, your distancing, your circulation, and your time of interaction— if you put that all together, the numbers supporting prevention with the proper use of your PPEs is much, much higher than any intervention, whether that’s ivermectin or even some of the vaccines.”

Watch the full webinar here.