Bogotá, July 26, 2020. The first six months of managing the covid-19 epidemic have served to identify some medical practices that can be more effective, to succeed in having a greater number of recovered patients and a decrease in the number of people deceased.
"One of these alternatives is the early identification of people with the highest risk of developing a severe covid-19 condition, where they can self-monitor their symptoms at home. This allows them to be treated as early as possible when there is an indication that they are getting worse," said Leonardo Arregocés, director of Medicines and Health Technologies.
This strategy has been successfully used in Colombia by the SURA Health Promotion Organization (EPS) and will now be adopted by the rest of the EPSs and the Entities of Mandatory Compensation (EOC) for the benefit of the Colombian population.
What it is
According to the scientific literature, patients with covid-19 who have oximetry levels below 94% have a higher risk of having a serious illness or of dying. In many, the blood oxygen level decreases subtly without feeling severe symptoms.
"Low oximetry levels at the moment of receiving medical attention are associated with poorer health outcomes. This suggests that a timely detection of a drop in blood oxygen levels and putting measures in place to bring the blood oxygen back to adequate levels could lead to a better outcome," Arregocés explained.
Hence the importance of a timely assessment and providing oxygen to patients with suspected or confirmed covid-19 who meet the clinical criteria for treatment once the patient has been seen and evaluated by a medical professional.
This strategy seeks to provide home health care for these patients with the highest risk, and if necessary, prescribe home oxygen, in addition to all biosafety measures that prevent the spread of the disease. Home isolation must be maintained for 14 days, guaranteeing home care via telemedicine and when indicated, in person, in order to reduce the need to go to medical services and thus maintain an epidemiological barrier.
According to what is planned, people with a diagnosis or suspicion of covid-19 with risk factors are candidates to be managed at home, through constant monitoring or self-monitoring which means taking their temperature and pulse oximetry, among others, so that an early intervention can be perfumed with oxygen therapy. "Thus, a smaller number of patients would require hospital care, optimizing the installed capacity of hospital beds," said the director of Medicines.
In this way, the patients who meet the eligibility criteria to be part of the home care strategy will receive sufficient guidance, which includes the delivery of a monitoring/self-monitoring kit (thermometer and pulse oximeter), advice and follow-up using telemedicine, by respiratory physicians and therapists and, if necessary, oxygen treatment. If the patient's condition worsens, the patient will be transferred for hospital management. Otherwise, home management will continue until resolution of the disease.
Challenges
There are significant challenges in being able to treat patients, with suspected or confirmed covid-19 infection, at home. Patients who cannot be guaranteed monitoring with pulse oximetry or temperature taking at home, who decompensate from other concomitant diseases or who do not accept management at home will not be able to be treated using this domiciliary scheme.
In the same sense, Arregocés indicated that in cases in which the patient with suspected or confirmed covid-19 lives in overcrowded conditions, resides in an area not covered by any home health service provider, or that does not have electricity or aqueduct services or the patient is a minor, under 18 years of age, or over 50 years without a caregiver may be transferred to foster homes or hotels during the treatment period.
Sura EPS figures
According to Sura EPS, as of July 1, a total of 4,466 patients enrolled with this entity with suspected or confirmed covid-19 infection received home care under the strategy outlined here. Of these patients, 109 (2.44%) required oxygen at home and 61 (1.37%) required to be transferred for in-hospital care. Only 11 patients (0.25%) required management in the Intensive Care Unit and only 3 patients (0.07%) died. These encouraging results suggest that early identification of decreased blood oxygen levels and a timely supply of oxygen are part of achieving better outcomes.
