The Nigerian Medical Association and the National Association of Nigerian Nurses and Midwives on Sunday cautioned the Federal Government against treating COVID-19 patients at home.
The NMA and the NANNM, in separate interviews with The PUNCH, said the implementation of home treatment in Nigeria, where the majority of the infected people lived in crowded houses would create problems for the country.
The NMA specifically said patients, who would be treated in households with a large number of people might infect others, thus increasing COVID-19 cases in the country.
The Presidential Task Force on COVID-19, at its press briefing on April 30, had said the Federal Government was considering treating some COVID-19 patients at home.
The Nigeria Centre for Disease Control Director-General, Dr Chikwe Ihekweazu, who disclosed this at the press briefing, said the country had only about 3,500 bed spaces for COVID-19 management.
“We are now trying to make more bed spaces available, but ultimately we might have to change our strategy and start considering homecare in certain circumstances where patients are able to provide rooms for their own management,” he said.
As of Saturday, there were 4,151 COVID-19 cases in Nigeria, with 3,278 of them still active and 745 discharged. No fewer than 128 people have died of the highly infectious virus.
WHO recommends use of ventilated houses
According to the World Health Organisation’s guidelines sent to one of our correspondents by the NMA President, Dr Francis Faduyile, all laboratory confirmed cases should be isolated and cared for in a health care facility.
The WHO explained that where isolation in a health facility was not possible for all cases, emphasis should be given to patients with severe and critical illnesses as well as mild illnesses such as “uncomplicated upper respiratory tract viral infection symptoms.
The WHO added, “If all mild cases cannot be isolated in health facilities, then those with mild illnesses and no risk factors may need to be isolated in non-traditional facilities, such as repurposed hotels, stadiums or gymnasiums where they can remain until their symptoms resolve and laboratory tests for COVID-19 virus are negative. Alternatively, patients with mild disease and no risk factors can be managed at home.
For those presenting with mild illness, hospitalisation may not be possible because of the burden on the health care system, or required unless there is concern about rapid deterioration.
It added in cases where care would be provided at home, a trained health care worker should conduct an assessment to verify whether the residential setting would be suitable for providing care and whether the patient and the family were capable of adhering to the precautions that would be recommended.
The WHO also recommended that the patient should be in a well-ventilated room and that face masks or gloves should not be reused.
It added, “To contain respiratory secretions, a medical mask should be provided for the patient and worn as much as possible, and 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. Materials used to cover the mouth and nose should be discarded.
The WHO also said the movement of the patient and shared spaces in the house should be minimised. “Ensure that shared spaces (e.g. kitchen, bathroom) are well ventilated (keep windows open) and use a mask when providing oral or respiratory care and when handling stool, urine, and other waste,” it advised care givers.
Dedicated linen and eating utensils recommended for home patients
It said dedicated linen and eating utensils should be used for the patient, adding that the items should be cleaned with soap and water after use and may be re-used instead of being discarded.
Our overcrowded homes will breed more infections — NMA president
Faduyile, in an interview with The PUNCH, said although the WHO guidelines were of global standard, he had a problem with how they would be implemented in Nigeria.
He stated, “We can’t just conform with anything from the WHO because many of those people infected are people living in rented apartments or houses that have large number of people within the household. I doubt how beneficial it is for those persons to guard against infecting others in that area. I guess we will still have problem with the implementation of such a regulation in Nigeria.”
Plan to treat COVID-19 patients at home worries nurses
On its part, the NANNM expressed displeasure over plans by the Federal Government to treat coronavirus patients at home.
The President of the NANNM, Abdulrafiu Adeniji, in an interview with The PUNCH, said, “There is an adage that necessity is the mother of invention. Personally, I just see that it won’t have been the best but government doesn’t have any other way out. What the government is now saying is that the bed spaces in the hospitals are occupied.
No critical case will be treated at home, says LASG
But the Lagos State Government has said no critical case of coronavirus will be treated at home.
The state Commissioner for Information, Mr Gbenga Omotosho, in a chat with one of our correspondents on Sunday, noted that only 44 per cent of the state’s isolation centre capacity had been used.
He said, “As of Friday, there were 1,683 cases: 713 were on admission, 448 discharged and 33 deaths. The average duration of admission is 11 days.
“On severity of admissions, we have 59 per cent mild cases, 38 per cent moderate cases, two per cent severe cases and one per cent critical case.
“On the capacity of isolation centres, there has only been 44 per cent utilisation: Lagos Mainland (56 per cent); Lagos University Teaching Hospital (95 per cent) Onikan (68 per cent.
Landmark in Eti-Osa LGA (34 per cent); Lekki (44 per cent); Agidingbi, Ikeja (39 per cent) and Gbagada (0 per cent). So, there are 330 bed spaces still available out of the 600 bed spaces.”
Omotosho explained that the state Governor, Babajide Sanwo-Olu, would consult with the Federal Government if the state needed to resort to community care.
He insisted that the state had not got to that level.
That has its own protocols. An expert would ask certain questions to know the severity of the case. No critical case will be treated at home. Most of the cases we have are mild. If you have a mild case, after say 12 to 13 days of treatment, it should clear off. The health commissioner even said none of our patients needed a ventilator and that is because people report early. Those who died did not report early,” he added.
Meanwhile, another traditional title holder in Kano, the Dan Iyan of Kano, Alhaji Yusuf Bayero, is dead.
Until his death, Bayero was the District Head of Dawakin Kudu in Dawakin Kudu Local Government Area of the state.
The Secretary of Sallaman Kano at the Emir’s Palace, Alhaji Muhammadu Muhammad confirmed the death of the deceased to The PUNCH in Kano on Sunday.
He said the monarch, who died in the early hours of Sunday, was the first District Head of Ajingi Local Government Area.
The Bauchi State Governor, Senator Bala Mohammed, has said massive deaths in Azare town, the headquarters of the Katagum Local Government Area of the state within the last two weeks, were not caused by COVID-19.
He, however, said that from records available, within the last one month, no fewer than 150 people had died from hypertension and other diseases.