April

10, 2021

WHEN COVID HITS HOME: SOLUTIONS FOR CURRENT SURGE

1. HEALTH CARE CAPACITY

Extremely challenged, and majority cases are mild so home care should be considered
A. Does the patient qualify for home care?
i. Asymptomatic, mild, or moderate disease without risk factors for severe disease
>60 years old
1. No shortness of breath, breathing is comfortable
2. Able to speak comfortably, long sentences
3. Respiratory rate <30 breaths per minute at rest
4. Oxygen saturation on room air at least 94%
ii. Conditions for implementing IPC
iii. Close monitoring

2. QUARANTINE VS. ISOLATION

Isolation implemented for those already tested positive for COVID-19
- Separate into individual room, with a separate bathroom
- Prevent positive patient from spreading disease to someone else
- Stay home at least 10 days since symptoms first appeared
- At least 24 hours with no fever without fever-induced meds
- Symptoms have improved
Quarantine is to observe those who have had close contact with a positive case
- Stay home for 14 days since last contact
- Watch your symptoms and check your symptoms twice a day
- Stay away from high-risk people

3. HOME CARE QUALIFICATIONS

- Separate room and bathroom
- Good air flow
- Keep door closed
- Implement good delivery system for daily needs without a lot of contact between
other individuals
 • PPE to be worn (if you have to enter the room) OR can just leave items at the
door for them to take it themselves

4. ADVICE FOR CAREGIVERS

1. Limit patient’s movement
2. Minimize shared space
3. Ensure shared spaces are well ventilated and well-sanitized
4. Household members should avoid entering the room where the patient is located
5. Limit the number of caregivers – ideally assign one person who is in good health has
no underlying health risks
6. Visitors not allowed
7. Maintain good hygiene
8. Use medical masks – for patient and caregiver
9. PPE or materials should be disposed or cleaned appropriately after use – DO NOT
reuse medical masks or gloves
10. Clean and disinfect surfaces
11. Use dedicated linen and eating utensils
12. Place contaminated linen in a laundry bag – do not shake soiled laundry and avoid
contaminated materials
13. Utility gloves should be cleaned with soap and water, with 0.1 sodium hypochlorite
solution
14. Waste generated at home should be packed in strong bags before disposal
15. Avoid other types of exposure to contaminated items from patient’s immediate
environment

5. HOME CARE KIT – IN PREPARATION

1. PPEs
2. Cleaning and disinfection supplies
a. Bleach solution: dilute 45ml per liter of water
b. Must be prepared daily
3. Monitoring supplies: vital signs record, thermometer, BP cuff, pulse oximeter
a. To observe trends and communicate these trends to healthcare
professionals
b. Monitor every 8 hours, or 1-3 times a day
4. Medications: Fever, cough, colds, patient’s maintenance medications

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6. ABILITY TO MONITOR CLINICAL EVOLUTION OF A PATIENT WITH COVID-
19 AT HOME
• Ensure patient can be adequately monitored by someone who is not at risk
• By healthcare worker if possible
• If not, establish open communication lines with healthcare professionals so the
channels are already open if anything should happen
• Check if patient’s symptoms become worse (light headedness, difficulty breathing,
chest pain, dehydration, etc.)

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7. CONCLUSION
• Current surge has challenged the healthcare capacity in NCR
• Majority of cases expected to be mild, home care can be an option for low-risk
individuals
• Evaluate the ff: patient risk factors, capacity of home environment

Q&A:
1. If a whole household is positive, can they quarantine together?
- Yes, but not for mixed group. Ensure you understand difference between need for
isolation or quarantine.
- If one is in isolation, 10 day waiting period
- If one is quarantined, 14 day waiting period
2. Is home care better than being in a corridor of a hospital?
- Depends on what the patient is experiencing / medical situation
- Mild or asymptomatic – home care is better
- Moderate to high risk – hospital is better
3. Vaccination for those wanting to get pregnant
- Vaccines are made up of dead particles of virus – no way for the organism to come
back from the dead and affect a baby should you become pregnant
- Will it affect one’s fertility?
o 4 technologies – 3 already have record of use and no impact on fertility,
MRNA so far no impact observed
- Will it affect the baby?
o No
4. Ivermectin
- Scientific standpoint: not enough evidence for ivermectin as preventive measure or
treatment for COVID
- Studies done difficult to determined sole effect of Ivermectin as they were used with
other methods
- More solid evidence needed for its use
5. How reliable is RT-PCR? There are some cases of false positives
- Affected by patient group you use it in and time point in which test is applied
- Best for those who already have symptoms of COVID-19
- For those without symptoms, pick-up rate is going to be lower, but will be better for
those who had close contact with a positive person
- There are also false negative rates

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6. Kasambahays tested within a week – swab negative, antibody positive, swab negative
- BEST OPTION: Quarantine for 14 DAYS
- 14-Day quarantine would be the best way to find out if they develop symptoms or
not
7. Should a family be tested using antigen testing every 14 days?
- it would only make sense if none of them leave the house
- Antigen sensitivity not high for asymptomatic individuals, it will have higher
sensitivity for those who have symptoms already
8. Vaccine
Should I still take the 2nd dose if I test positive?
- Must complete the 2-dose series
- IF asymptomatic, wait 14 days before you take the 2nd dose to avoid infecting others
around you
- Vaccine would be an extra layer of protection
Who cannot get vaccinated?
- If you develop a severe allergy to the first dose – e.g. anaphylaxis (1 out of 100,000)
- If you have cancer for example, best to consult your doctor
How long after being positive can someone get a vaccine?
- Once fully recovered
If someone is taking Ivermectin, can they take the vaccine?
- Medications don’t usually have any impact on vaccines
- Flag vaccinator if you are taking Aspirin or blood thinners
Can you mix 2 different brands for both doses, or take double doses / two brands?
- not recommended as there is currently no data
For those fully vaccinated, are they still required to wear a mask?
- YES
If you’re taking medication, should you stop taking it prior to taking the vaccine?
- No.
9. SINOVAC
- Vaccines are being recommended for use by Government vaccine expert panels (6
teams looking at different aspects of vaccine safety and efficacy)
- Global FDAs have accepted reports from manufacturers indicating vaccines are ok
for emergency and due to shortage of vaccines to try and contain the surge

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10. ASTRAZENECA
- Because administration/ suspension been suspended, take it as a positive thing
- We should trust the system to check and ensure the safety of the product
11. COVID positive patient
- You may be positive for up to 90 days after testing positive
- Studies show that no one was indicated to be contagious after 10 days
12. If I’m exposed to a COVID positive patient, what can I do to prevent
- You should be tested Day 5 after exposure
- Some studies indicate topical disinfectants might help (eg. Betadine mouthwash)
but no indication of how long they are effective for
13. If someone was positive and has isolated for 14 days, can they end isolation?
- Positive patients with symptoms are no longer considered contagious after 10 days,
BUT add 3 days without symptoms
- For asymptomatic, just 10 days after positive test
- General rule: 14 days
14. Would you recommend steaming for prevention?
- No – it may actually harm you