Home- & Community Based Care for COVID-19

When someone has COVID-19 sickness from infection with novel coronavirus, the most common symptoms are:

  1. fever
  2. cough, 
  3. tiredness, and 
  4. shortness of breath. 

Sometimes people may also have aches and pains, nasal congestion, runny nose, a sore throat or a headache. Rarely, patients may also present with diarrhoea, nausea, and vomiting. 

If someone is sick with these symptoms, it’s possible that the person has COVID-19. Anyone with COVID-19 sickness can spread coronavirus to other people, through the droplets that leave from their mouth and nose, especially when they cough or sneeze. They may have these droplets on their hands.

If you suspect that you or a member of your household/community may have COVID-19, please take the following immediate actions:

  1. Self-isolate (keep a distance of minimum 1m from everyone else in your household)
  2. Phone your health professional (see information below if you do not have a direct number to call)
  3. Act in accordance with the advice your health professional gives you.

This document has been prepared to aid anyone who is caring for someone at home or in their community, but in no way takes the place of a medical health-care professional’s advice or care. Please ensure that you have a communication plan with a health-care professional that allows the health professional to review the health of the sick person regularly by phone. This plan should be established for the duration of the home care period – that is, until the patient’s symptoms have completely resolved.

Your health-care professional should give instructions in advance about when and where to seek care if the sick person’s state becomes worse – and how to get there. Have these instructions visible to all members of your household/community. Some notes are provided at the end of this document to help you, but do not override your health care professional’s advice.

If you do not have a health-care professional to contact: A number of doctors have set up a helpline to provide care for people living in townships and communities in South Africa who have scarce access to healthcare. This is a free medical consultation service and referral process to testing centres local to where patients live, throughout South Africa. You can contact them on 031 001 1299.

You can also phone the following numbers:

Public Hotline on 0800 029 999

Whatsapp Support Line: 0600-123456

These guidelines have been developed in accordance with the World Health Organization’s recommendations on safe home care. Home care may be advised by your health-care professional or may be considered when inpatient care is unavailable or unsafe (e.g. capacity is limited, and resources are unable to meet the demand for health care services). Persons over 60 years of age, pregnant women, those who are immunocompromised and those with chronic cardiovascular disease, chronic respiratory disease, diabetes and cancer are considered to be high-risk patients and should be cared for in the health facilities if possible. 

Tips for the Person who is sick:

  1. Most people with COVID-19 sickness will have a mild illness and recover completely after some days. There is no treatment that will help them recover faster. A few people, mainly people who are elderly, will become very ill.  If someone is so sick that they have severe difficulty drinking or breathing, some health facilities may be able to help them with IV (intravenous) fluids or oxygen.
  2. It is important for the person with COVID-19 sickness to stay well hydrated (drinking at least 1.5 litres of water each day).
  3. It is good for people who are unwell to spend time outside (away from other people).
  4. The person with COVID-19 sickness can take paracetamol to reduce fever and pains.
  5. If the sick person is close to another person, it is good for the sick person to wear a mask as much as possible. The mask should be changed daily.  Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene; that is, the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. 
  6. Materials used to cover the mouth and nose should be discarded or cleaned appropriately after use (e.g. wash handkerchiefs using regular soap or detergent and water).
  7. People with COVID-19 sickness should not touch phones that are used by other people.

Tips for Caregivers (those who are caring for a person who is sick with COVID-19)

  1. Limit the number of caregivers. Ideally, there should be only one dedicated person to take care of the person who is sick. Visitors should not be allowed until the patient has completely recovered and has no signs or symptoms of COVID-19.
  2. The caregiver should be someone who is not at high risk – a person who is in good health, under the age of 60, with no underlying chronic or immunocompromising conditions. Specifically, people with pre-existing problems with their heart or lungs should not be caring for others during this time.
  3. A person with COVID-19 can easily spread coronavirus to someone else.  Anyone who is not caring directly for a person who is sick with COVID-19 should stay at least 2 meters from them. It is much better if they are further away, or spend their time in a separate room or hut. If this is not possible, all other household members should maintain a distance of at least 1 metre from the ill person (eg. sleep in a separate bed)
  4. Place the patient in a well-ventilated single room (i.e. with open windows and an open door).
  5. Limit the movement of the patient in the house and minimize shared space. Ensure that shared spaces (e.g. kitchen, bathroom) are well ventilated (keep windows open).
  6. The caregiver should wash his or her hands with soap and water well after any type of contact with the patient or their immediate environment.  The caregiver should be careful not to touch his or her face. 
  7. Hand washing/sanitising should also be performed before and after preparing food, before eating, after using the toilet, and whenever hands look dirty. If hands are not visibly dirty, an alcohol-based hand rub can be used. For visibly dirty hands, use soap and water. 
  1. When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.
  2. Caregivers should wear a mask or something 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.
  3. 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 wash your hands.
  4. Avoid direct contact with body fluids, particularly oral or respiratory secretions (fluids from mouths and noses), and stool (poo). Use disposable gloves and a mask when providing oral or respiratory care and when handling stool, urine, and other waste. Wash or sanitise hands before and after removing gloves and the mask.
  5. Do not reuse masks or gloves.
  6. 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.

Maintaining a Healthy Environment:

  1. Daily clean and disinfect surfaces that are frequently touched in the room where the patient is being cared for, such as bedside tables, bedframes, and other bedroom furniture. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant such as bleach (Jik) should be applied.
  2. 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 such as bleach (Jik) should be applied.
  3. Clean the patient’s clothes, bed linen, and bath and hand towels using regular laundry soap and water and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled (dirty) laundry and avoid contaminated materials coming into contact with skin and clothes.
  4. 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 bleach (Jik). Single-use gloves (e.g. nitrile or latex) should be discarded after each use. Wash or sanitise hands before putting on and after removing gloves.
  5. 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. The onus of disposal of infectious waste resides with the local sanitary authority.
  6. Avoid other types of exposure to contaminated items from the patient’s immediate environment (e.g. do not share toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths, or bed linen).
  7. People who are sick should not touch phones that are used by other people.

If the sick person needs to be taken to hospital

  1. Notify the receiving medical facility that a symptomatic person will be arriving.
  2. While traveling to seek care, the sick person should wear a medical mask.
  3. The sick person should avoid taking public transportation to the facility; an ambulance can be called, or the person who is sick can be transported in a private vehicle with all windows open, if possible.
  4. The sick person should be advised to perform respiratory hygiene (cover cough & sneeze) and hand hygiene (sanitise, wash hands) and to stand or sit as far away from others as possible (at least 1 metre) when in transit and when in the health care facility.
  5. Any surfaces that become soiled with respiratory secretions or other body fluids during transport should be cleaned with soap or detergent and then disinfected with a regular household product containing a 0.5% diluted bleach solution.

After the person begins to recover:

For mild laboratory-confirmed patients who are cared for at home, to be released from home isolation, cases must test negative using PCR testing twice from samples collected at least 24 hours apart. Where testing is not possible, WHO recommends that confirmed patients remain isolated for an additional two weeks after symptoms resolve.

Caregivers who have been exposed to individuals with suspected COVID-19 are considered contacts and must monitor their health for 14 days from the last day of possible contact.

A contact is a person who is involved in any of the following from 2 days before and up to 14 days after the onset of symptoms in the patient:

  1. Having face-to-face contact with a COVID-19 patient within 1 meter and for >15 minutes;
  2. Providing direct care for patients with COVID-19 disease without using proper personal protective equipment;
  3. Staying in the same close environment as a COVID-19 patient (including sharing a workplace, classroom or household or being at the same gathering) for any amount of time;
  4. Travelling in close proximity with (that is, within 1m separation from) a COVID-19 patient in any kind of conveyance; 
  5. and other situations, as indicated by local risk assessments.

COVID-19 & Malaria:

If the sick person has fever and lives in an area with malaria, it is good to get a malaria test. All children under the age of 8 with fever must get a malaria test.  

If the sick person has a positive malaria test result, he/she should take malaria treatment. It is possible for someone to have both malaria and COVID-19 sickness at the same time. If the person with a positive malaria test result has a cough, sneezes, or breathing difficulties, the person should take precautions for COVID-19 sickness in addition to taking malaria medicines. (Cumberland, 2020)

COVID-19 & Breastfeeding:

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. (WHO, 2020)

References & Sources:

  1. “Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts – Interim guidance 17 March 2020 – World Health Organisation” https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts  – WHO reference number: WHO/nCov/IPC/HomeCare/2020.3
  2. Home-based Care in Resource-Limited Settings, Dr Peg Cumberland, Niassa, Mozambique
  3. https://www.westerncape.gov.za/department-of-health/coronavirus
  4. https://sacoronavirus.co.za/

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