Home hospital care through telehealth during COVID-19 pandemic in Nepal

Ashok Devkota,Anish Shah,Sagar Pandey,Rahul Thakur,Sumit Sah,Durgesh Chaudhary,Amrit Pathak,Yam Acharya,Shradha Acharya,Yadav Pandey,Aakash Mahato,Prakash Paudel,Hari Neupane,Anjan Kumar Basnet

doi:10.46405/ejms.v4i1.375

Abstract

COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 has been occurring in waves due to emergence of different strains. During second wave of COVID pandemic in Nepal, largely caused by Delta variant, due to rapid rise in cases, existing hospitals and health facilities were overwhelmed. As a result, telemedicine was expanded to help reduce strain on the healthcare system and meet unusually high demands. A team of physicians with the support from the local government provided hospital level care for patients at home in rural district of Dang in Nepal. This research analyzes implementation of this model of care and outcomes based on review of patient records and treatment guidelines. Within a month, from May 5 to June 13, 2021, a total of 102 patients received care at home. While most patients had mild to moderate disease, 12.8% of patients had severe disease. Telemedicine usage was highest among the 40-59 years age group, with overall recovery rate of 85.3%. The patient satisfaction survey revealed that majority, 86.5% were happy with the medical care they received. This home hospital care model has shown excellent clinical outcomes and high patient satisfaction even in resource limited setting.

Highlights

Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first recognized in Wuhan, China, in December 2019
Triage and Clinical Service Delivery The care team obtained the list of newly diagnosed COVID-19 patients from the local coordinators in Dang, called them www.europasianjournals.org to assess their general clinical condition and triaged based on illness severity and the presence of risk factors associated with severe disease
Screening was done based on clinical symptoms, oxygen saturation and risk factors using the tools adapted from WHO COVID-19 clinical management: living guidance.[4]

Summary

Introduction

Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first recognized in Wuhan, China, in December 2019. While some regions in Europe and America were devastated during the first wave, a South Asian nation of Nepal was not as affected. During the first wave which peaked around third week of October 2020 in Nepal, there were cumulative 144,872 cases with 1084 deaths.[1]. Nepal was neither expecting nor prepared for subsequent rise in COVID-19 cases until second wave hit very hard during May 2021. As of May 11, 2021, there were 413,111 confirmed cases with 4,466 deaths in Nepal with maximum recorded 9,317 case detection in a single day.[1]. A landlocked country which shares open border with India, saw covid-19 cases skyrocket by 1360% in one month after mid-April in parallel to rapidly rising number of cases in India.[1]. With only 713 tests per million people nationally and a test positivity rate as high as 40% at the end of May, the actual number of positive cases is clearly underestimated due to the limited healthcare testing capabilities.[2]

Results

Discussion

Conclusion