Medicosnext
“COVID-19 can be treated at home with adequate doctor consultation and care”
Dr. Arup Bikram Shah (MBBS), who is connected with Yeti Hospital, Bafal, Kathmandu, and Nepal National Hospital, Kalanki, Kathmandu, is in-charge of the COVID-19 department of Kantipur Hospital, Teenkune, Kathmandu. He owns and operates A-One Doctor Home Service, which offers in-home care services to patients through its pool of highly qualified and dedicated team of medical professionals. According to him, he is probably the first doctor in Nepal to treat a COVID-19 patient at home.
Can you explain why home care is important and how it works?
When it comes to home care services in the medical field, the majority of them were founded on the idea of providing patients with nursing care and doctor follow-ups. They were mostly catering to geriatric, post-operative care, people with disability, and other clinical disorders. However, in recent years, home care services have expanded to include services such as PCR collection at home, nursing care, laboratory sample collection, online pharmacy, physiotherapy, and many more. There are advertisements for many home care services in the valley these days, and even reputable hospitals have started home care services.
But, I believe many home care service providers are still far from providing ideal care to their clients. The focus of home care service should be on patients’ care and respect for the patients’ party. Also, proper counseling is crucial in the treatment of patients. When a patient visits the hospital, doctors usually allot 5-15 minutes for patient counseling. But, most service providers overlook this part.
When we visited patients at their home, they would open up and share their difficulties with us as if we were family members, which helped us comprehend their issues. What I used to do was provide them proper counseling, treatment, and follow-ups. Most of the time, I felt like I was dealing with members of my own family.
There are several home care services in the valley, but only a few provide proper care, including follow-up visits and phone calls to patients. It is a good thing that the number of home care services is increasing in Nepal, as patients can receive treatment without having to leave their homes. But, the government should monitor these services, because we have learned that patients are not receiving proper treatment, and service providers are charging them exorbitant fees, which is completely wrong.
Are people interested in in-home care services?
Yes, people are becoming more interested in in-home care services these days. Patients and their family members are more at ease in a home care setting. What I’ve noticed, since the beginning of the pandemic and during the second wave of COVID-19, is that most people preferred to be treated at home rather than in a hospital.
Most people believed that getting admitted to a hospital would be difficult for them and their families, and also more expensive, thus they preferred receiving treatment at home. As we all know, the second wave of COVID-19, with a new strain has resulted in the deaths of a large number of people, including healthcare workers. Many believe that going to a hospital and being admitted will be tough for both patients and relatives, and that going to the hospital will increase their family’s chances of receiving COVID-19.
Even though they are infected with COVID-19, many patients, especially the elderly, are afraid of and refuse to go to the hospital. A few of my patients strongly believed that they would die if they went to the hospital, and pleaded to be treated at home as much as possible.
Due to the high rise in cases during the second wave, hospitals were unable to supply adequate oxygen, ICU beds, and HCU. Most of the patients took oxygen to their homes at the time, and I believe that people were drawn to home care services as the first choice for COVID-19 treatment. Even though the number of cases is decreasing lately, people still choose to receive home care, rather than go to the hospital.
What are the differences in COVID-19 treatment between the first and second wave?
To the best of my knowledge, I am the first doctor to treat a COVID-19 patient at home. I used to go to patients’ homes one by one in the first wave. People were more fearful and hesitant to perform a PCR test at that time, and they would hide their symptoms. Everyone was terrified, including healthcare workers, such as doctors, who were afraid to touch patients. When someone came to their house with a PPE suit, people would be afraid, even if it was their neighbor.
During the first wave, there was no proper medication and direction to treat patients, as it was new to everyone, including myself. We used to treat the symptom, rather than the infection, as per the international guidelines. In comparison to the second wave, there were fewer complications at that time.
I used to attend alone at that time, and then we started preparing a team for the second wave, which included a total of 25 members. Doctors, nurses, laboratory, and pharmacy are part of a dedicated team for COVID-19 treatment.
I don’t want to recall the second wave of COVID-19, but my crew and I used to get home around 2:00 p.m. to 3:00 p.m. every day. Oxygen, beds, ICU, and other supplies were all in short supply. In the second wave of COVID-19, we discovered that most of the patients had pneumonia and a few cases of jaundice, in addition to being COVID-19 positive. Patients’ treatment was more difficult in the second wave than in the first.
Can you tell us about your COVID-19 success story from the second wave?
Speaking about success stories, according to our statistics from the first and second waves, we saw nearly 1500 patients at home. I don’t recall the figures from online consultations. The data from the online consultation was extremely difficult to acquire.
It was difficult for me to keep track of calls that came in at 3:00 a.m. The most memorable experience was treating a family from Bengal, India, who was visiting Kathmandu. They had a total of six members in the family, two were 75 years old and older, two were 45 years old, and two were 14 and 18 years old, respectably. All the family members tested positive, with all older persons with COVID-19 and severe pneumonia. When they refused to go to the hospital, as we suggested, we followed the COVID-19 regimen to treat them.
All of the members were on oxygen, which was quite difficult to obtain at the time. We handled two cylinders on the first day at 11:00 p.m. On the second day, we used one cylinder for two people, using my stethoscope. The next day, after a full day of searching, we were able to locate two more cylinders, as well as an oxygen concentrator.
We treated them for a week in this manner, and all but one of the members, a 75-year-old lady, recovered. Getting a hospital bed at the time was quite difficult, but after two days, we were able to secure one. A lady died two days after being transferred to a new hospital. We had three casualties among 1500 patients, all of whom died after being transferred to the hospital.
Is the COVID-19 third wave on the way?
Yes, that’s unavoidable, as we’ve seen since the lockdown was lifted. It appears that everyone is in a race, and individuals are behaving recklessly again. We must recognize that the world is going through a dangerous period as a result of the fast spread of the Delta and Delta Plus variants of COVID-19.
I’m not sure when the third wave will begin, but it will most likely begin around the end of August and peak by the end of September. It could be delayed if we strictly follow the COVID-19 guidelines, which include wearing a mask, keeping a safe distance, washing our hands, and participating in the government’s rapid immunization program.
