Sat, September 25, 2021

in-focus

How Home and Community isolation will reduce infections and deaths in Thailand


Over the past week, the terms Home Isolation and Community Isolation have become familiar to many, after they were adopted as key strategies to cope with the surge in new Covid-19 cases. Hospitals, field hospitals and hospitels are now being overwhelmed by the rapid rise in infections, while the need to prevent infected people from developing severe symptoms or dying remains paramount. So does the need to bring down the number of new infections in communities.

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On the surface, the Home Isolation and Community Isolation process appear to be easy tasks that require an approach similar to the better-known telehealth service that was adopted in previous waves of Covid-19. But in reality, we need to ponder several factors before implementing Home and Community Isolation. Among these factors are the condition of the home, the number of people living in it, how much the other members of the community agree with these forms of isolation in their community, the ability of the community or healthcare provider concerned to take care of patients who also need to be supplied with three meals a day, stigma attached to Covid-19 infection, discrimination against infected people, the risk of their rights being violated and the stress associated with the infection. So, this is not simply arranging the telehealth service for people who have to go into isolation at home or in the community.

In this regard, the team providing Home Isolation and Community Isolation services should consist of members from various disciplines – including the infected people themselves, their families, community leaders, nurses and doctors. Policymakers, meanwhile, have to respect and trust all parties in the team and also listen to their opinions. Policymakers also need to improve public understanding of the goal and importance of Home Isolation and Community Isolation as well as roles of the individuals in these Covid-19 isolation formats. The government also needs to plan and invest in bolstering public confidence in these isolation programmes and enhancing people’s ability to become a part of the programmes, in order to prevent miscommunication that may result from different political preferences and concerns among certain experts.

Effective cooperation among interdisciplinary parties in creating a good standard of Home Isolation and Community Isolation is also crucial for assuring the infected people and their families that they will receive good and standard holistic care in the home or community, although they may not be able to be admitted to hospital just yet. The standard of Home Isolation and Community Isolation must accord with the National Health Security Office’s reimbursement regulations and guidelines on Covid-19 treatment and care by the Department of Medical Services. And it is equally important to assure healthcare providers in the community, medical clinics and hospitals that what they are doing is subject to daily adjustment in line with the changing Covid-19 situation and that they will be totally supported.

They need to be assured also that sufficient funds are earmarked to finance these isolation services while mechanisms to prevent corruption and misuse of these funds and medical supplies are implemented all along. More importantly, these healthcare providers need to be assured that they won’t end up facing investigation or criticism and be judged as if they were working in a normal situation. Neither should any investigation order that they return money paid to them for providing the isolation service once the public health crisis has ended.

Prompt provision of home or community healthcare to Covid-19 patients with no or mild symptoms (Green group) as soon as they are confirmed infected is important. So is constant follow-up care by the people in the same house or community and nurses and doctors providing telehealth services. These elements are crucial for assuring patients that they will promptly receive favipiravir when signs of lung infection emerge. Patients with moderate (Yellow group) and severe (Red group) symptoms must also be assured they will receive favipiravir to keep lung infection at bay, and other treatment to control other symptoms if they still have to wait for a hospital bed. These measures are all aimed at “mitigating the severity of Covid-19 infection and reducing the number of fatalities”.

As for the need to “curb the number of new infections in the community as fast as possible”, a key factor is how well an infected person is isolated from the rest of the family or housemates during Home Isolation or Community Isolation. Both infected people and other people living in the same house or community require not only knowledge about effective Covid-19 isolation but also other forms of support, including three meals a day. They may also need basic necessities in cases where the infected individuals are the main source of financial support for their families. They will also need help with disinfecting their houses and household utensils. Some may need help with improving understanding among their neighbours and dealing with the parties that violate their rights such as the media, their employers or their schools.

These are all required to ensure the Covid-19 isolation at home or in the community is conducted properly and not impacted by social and economic factors. Aside from preventing infected people from spreading the virus to others in the family or community, continuous active case finding is also important for curbing the number of new infections and needs. Contacts of a confirmed Covid-19 case need to be sorted into groups according to their risk level and go into isolation as well. Prioritising who should get vaccinated first in communities suffering serious outbreaks is also important for containing the spread of the virus.

Since Home Isolation and Community Isolation now undeniably concern everyone, it is important not only to understand the processes but also to spread knowledge to others to improve public understanding about Covid-19 isolation. Some may produce content to publish on various media platforms to educate groups of people about the procedure of Home Isolation and Community Isolation. Others can help prepare meals to supply to people in isolation or deliver thermometers, pulse oximeters and medication to the infected patients. Those unable to get involved in such voluntary activities may choose instead to donate money to purchase such medical devices. Meanwhile, people who can speak languages used by migrant workers in Thailand can also help by volunteering as interpreters for healthcare workers handling migrant workers.

I strongly believe everyone can help make the country’s Home Isolation and Community Isolation a good quality service via flexibility and maximum participation by communities.

In conclusion, Home Isolation and Community Isolation consist of four key elements: public and community preparation, prompt provision of care and treatment for Covid-19 patients, fast and effective tracing of contacts of infected people, and improving access to vaccination. These elements will gradually improve the hospital bed shortage situation and we will soon see a drop in the number of Covid-19 deaths and new infections.

 


How Home and Community isolation will reduce infections and deaths in Thailand

I strongly believe everyone can help make the country’s Home Isolation and Community Isolation a good quality service via flexibility and maximum participation by communities.

In conclusion, Home Isolation and Community Isolation consist of four key elements: public and community preparation, prompt provision of care and treatment for Covid-19 patients, fast and effective tracing of contacts of infected people, and improving access to vaccination. These elements will gradually improve the hospital bed shortage situation and we will soon see a drop in the number of Covid-19 deaths and new infections.

How Home and Community isolation will reduce infections and deaths in Thailand

Published : August 06, 2021

By : Nittaya Phanuphak, MD, PhD, Executive Director, Institute of HIV Research and Innovation (IHRI)