Australia has recorded more than 6000 cases of COVID-19, with most mild and being treated at home.
Still, this means that family members and housemates who have taken on a carer role are in the frontline of defence against the spread of the disease.
The World Health Organisation (WHO) has published detailed advice on how to care for a patient at home, and how to manage contacts.
We advise it is well worth downloading because online advice from state governments tend to cover the basics in a few bullet points that lack practical detail.
Is home the best place to be?
Firstly though, WHO advises that “if and where feasible, a trained (health care worker) should conduct an assessment to verify whether the residential setting is suitable for providing care”.
The health care worker should also “assess whether the patient and the family are capable of adhering to the precautions that will be recommended as part of home care isolation (e.g., hand hygiene, respiratory hygiene, environmental cleaning, limitations on movement around or from the house) and can address safety concerns (e.g., accidental ingestion of and fire hazards associated with using alcohol-based hand rubs).”
It’s unclear to what extent this monitoring of home-bound patients and the quality of their care is occurring in Australia.
Dr Chris Moy is a GP in Adelaide and chair of the AMA ethics and medicolegal committee. He said some states were doing better than others, and that a standard national playbook would have served the community better than what appears to be an ad hoc response from state to state.
“The variation across states in how positive COVID patients who require self isolation are assessed and supported is another example of on the ground practical strategies that would have been better addressed on a consistent level nationally by a National Centre for Disease Control,” Dr Moy said.
“Although it must be acknowledged that we have done well so far, there has still been a significant degree of inconsistency, confusion and duplication of basic strategies between states which would have been better addressed if everyone had a single playbook to work from instead of having to make it up as we have gone along.”
South Australia doing it well
Dr Moy suggested that SA Health appears to adhere closest to the WHO guidelines. The health department has enlisted a group of specialist GPs to assess patients’ circumstances and suitability for home care via telephone consultations.
Team leader Dr Jenny Goold told The New Daily: “Initially the assessment is really about are they well enough to be home at that time. Then we do a series of medical checks. What symptoms did they start with? What have they got now?
“We also explore their home situation. We have a template that we work off: Where do they live? Are they living in an at-risk place such as a nursing home or boarding house? Who else lives with them?
“Are their any particular vulnerable individuals living with them, such as someone undergoing chemotherapy or particularly elderly people. Do they have their own bedroom? A separate bathroom. Sometimes we find it’s not suitable for them to stay at home because of their home environment.”
A medical surveillance unit then work to get those patients relocated, sometimes to a hotel or other alternative accommodation.
For those remaining at home, Dr Goold’s team then establishes what social and psychological support the patient requires.
An email from the Department of Health and Human Services Victoria, responding to questions, said, “GPs and other healthcare workers assess if patients have access to suitable home care if they are diagnosed with coronavirus.
“People who test positive for coronavirus and remain at home are contacted daily by DHHS, and are not allowed to end self-isolation before a number of criteria have been met to ensure they are no longer infectious.”
What carers require: Many pairs of rubber gloves
According to the WHO document, maintenance of hygiene protocols tends to be the most demanding aspect caring for someone at home.
So if you’re taking on the carer role, and it’s advised that one person in the home take on this role, this is some of what you’re in for:
- Caregivers should wear a medical mask that covers their mouth and nose when in the same room as the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty from secretions, it must be replaced immediately with a new clean, dry mask.
- An exception may be made for breastfeeding mothers. Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother can continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby. She will also need to follow the other hygiene measures described in this document.
- Remove the mask using the appropriate technique – that is, do not touch the front, but instead untie it. Discard the mask immediately after use and perform hand hygiene.
- Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves and a mask when providing oral or respiratory care and when handling stool, urine, and other waste. Perform hand hygiene before and after removing gloves and the mask.
- Do not reuse masks or gloves.
- Use dedicated linen and eating utensils for the patient; these items should be cleaned with soap and water after use and may be re-used instead of being discarded.
- Daily clean and disinfect surfaces that are frequently touched in the room where the patient is being cared for, such as bedside tables, bed frames, and other bedroom furniture. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.1 per cent sodium hypochlorite should be applied.
- Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.1 per cent sodium hypochlorite should be applied.
- Clean the patient’s clothes, bed linen, and bath and hand towels using regular laundry soap and water or machine wash at 60–90 °C with common household detergent, and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid contaminated materials coming into contact with skin and clothes.
- Gloves and protective clothing (e.g. plastic aprons) should be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Depending on the context, either utility or single-use gloves can be used. After use, utility gloves should be cleaned with soap and water and decontaminated with 0.1 per cent sodium hypochlorite solution. Single-use gloves (e.g. nitrile or latex) should be discarded after each use.
- Perform hand hygiene before putting on and after removing gloves.
- Gloves, masks, and other waste generated during home care should be placed into a waste bin with a lid in the patient’s room before disposing of it as infectious waste.