Home-treatment of mild and moderate Covid-19 cases in Nepal

With a steady increase in daily Covid-19 cases, its patients occupy almost all beds and Intensive Care Units of hospitals across the country. Against this backdrop, management of asymptomatic, mild, and moderate cases of Covid-19 at home or non-healthcare settings is important for both patients and authorities in order to relieve pressure on the healthcare system.  

Moreover, the WHO says 80 percent Covid-19 are asymptomatic, mild or moderate cases, 15 percent have severe infections, and the remaining 5 percent are critically infected patients. The apex global health organization says asymptomatic cases including patients with mild and moderate symptoms can be treated at home by following preventive measures.

Mild cases of Covid-19 are the ones diagnosed positive in PCR test but without any evidence of viral pneumonia or hypoxia while the Moderate cases have mild pneumonia. Fever (<102.38°F), dry cough, smell blindness, and sore throat are the most common symptoms in mild to moderate cases. Severe and critical cases have trouble breathing, persistent pain in the chest, bluish lips, serious to severe pneumonia, or acute respiratory distress syndrome (ARDS). Both severe and critical cases require emergency treatment or hospitalization.

Irrespective of the level of severity of the coronavirus infection, pregnant women or those above 60 or individuals with underlying medical conditions like diabetes, asthma, hypertension, kidney problems, cancer, and obesity must seek hospital treatment. Home-based care is recommended for adults or children when the hospital setting is unsafe, health facilities limited in numbers or unable to meet demand. 

Covid-19 Cases Isolation Management Guidelines issued by the Government of Nepal also say asymptomatic and mild cases can be managed through home isolation by following set preventive measures to avoid cross-transmission. The below-mentioned measures are as helpful for home-quarantined patients as well:

Physical exercise: Activities like walking within the room, for 15-20 minutes at least three times a day, help maintain proper blood circulation and prevents blood clots in lower limbs from prolonged bed rest. Deep breathing through the nose, spirometer or balloon blowing exercise 8-10 times a day helps restore lung function and improve oxygenation in mild cases. (But lung exercises are not recommended soon after food consumption.)

Gargling: Coughing, the second most common symptom after fever, causes sore throat. Gargling, an ancient therapeutic measure, four times a day, at an interval of four hours, helps reduce viral load in the oropharynx and remove throat irritation. Betadine diluted with lukewarm water in the ratio of 1:3 can be used to gargle on throat made sore by corona infection. You should not eat at least 15-20 minutes after the gargle with betadine.

Balanced diet: The person in isolation needs to eat low-carb but protein-rich foods with spices like ginger, turmeric, and garlic that generally boost physical immunity. Combination of food rich in Vitamin C, Vitamin D, and zinc that produce a synergistic role in boosting immunity is recommended. Alcohol drinking during isolation can result in anxiety disorders or depression, with greater risk of suicide. In addition, alcohol harms the immune system. Smoking by individuals with mild or moderate symptoms further weakens their respiratory system and elevates the risk of severe pneumonia. Avoiding both alcohol and smoking is important during the infection.

Medical Evaluation through Measurement of Vitals and Observation: The health condition of mild or moderate coronavirus patients must be monitored at least thrice a day and their health status updated. The patients too must immediately contact concerned authorities if their health condition worsens or they experience any difficulty. Patients can take their vitals like body temperature with thermometer and blood oxygen saturation with pulse oximeter.  If body temperature steadily increases above 102.38°F and oxygen saturation (SPO2) gradually drops below 90-92 percent, help must be immediately sought. Besides these, if there are threatening medical conditions like troubled breathing, persistent chest pain/pressure, dehydration, mental confusion, and bluish lips, immediate medical attention must be sought at government-assigned Covid-19 dedicated hospitals.   

Regular communication: The government’s isolation guidelines say at least one health worker should be assigned to monitor 50 patients under self-isolation. As per the guidelines, the designated health worker must monitor health condition of the patients, especially vital measurements at least two times a day through a phone call or message. The health worker can prescribe antipyretics drugs like paracetamol and ibuprofen for management of fever and pain during isolation. Patients also must immediately contact their health worker if they experience further symptoms or if their caretaker observes deteriorating health conditions.

Patients should disassociate themselves from rumors and misinformation about coronavirus and maintain regular communication with their friends, family, and relatives via phone or video chatting to keep themselves in good spirits—all vital to beat the infection.  

Precaution by caretakers: Children and pregnant women without underlying medical conditions but with mild and moderate symptoms can be treated at home. However, they require a caretaker at home during their isolation period. Caretakers must maintain personal hygiene and sanitation and put on a medical mask, plastic apron, and gloves while providing care or disinfecting the frequently touched surfaces, clothes, and bed items.

The WHO estimates that people with mild to moderate symptoms generally recover within two weeks. But there are some instances of the symptoms extending by a week. Hence it is advisable not to overlook the cases as mild or moderate and seek immediate medical attention if symptoms prevail for over three weeks.

Asymptomatic patients in home isolation can discontinue their self-isolation 10 days after the date of their first positive RT-PCR test on mild or moderate cases; for those with symptoms, self- isolation can end after at least 10 days from the onset of symptoms and three more days without any symptoms. More importantly, if the patients with mild or moderate symptoms have a fever, it must recede without the use of any antipyretic drugs 24 hours before discontinuing self-isolation.

The author is a graduate in Epidemiology and Biostatistics from SRM University, India