The announcement by State Minister of Primary Health Services, Pandemics and COVID Prevention Dr. Sudarshani Fernandopulle that asymptomatic COVID 19 patients would be treated at their homes indicates the gravity of the problem the health officials and the government are faced with in respect of the pandemic. Sometimes this decision might be a turning point in handling the matter, for better or worse.
Once the health authorities were informed of a patient with or without symptoms during the first wave of the COVID 19 in the country, they whisked him/her away to a hospital or a COVID 19 treatment centre while the first contact persons of the patient including the family members were taken to a government-run quarantine centre. With the authorities being exhausted in handling the quarantine centres, only the patients were taken away for treatment leaving the family member and other first contact persons in their homes with instructions for undergoing quarantine. Now, with the saturation of hospitals and other treatment centres with COVID 19 patients, government is compelled to leave the patients too in their homes.
As we editorially pointed out on Saturday, the authorities engaged in combatting COVID 19 are not speaking in voice on this issue as well. Although the State minister announced that the new system would commence on Monday (yesterday), other officials involved in containing the pandemic were pessimistic on the date. Army Commander, General Shavendra Silva who is also the head of the National Operation Centre for the Prevention of Covid-19 Outbreak (NOCPCO), told media yesterday that President Gotabaya Rajapaksa had instructed the Director General of Health Services to formulate criteria on how to implement the home-treatment scheme, and the criteria would be worked out this weekend. Deputy Director General of Health Services Dr. Hemantha Herath also said that the guidelines for home treatment have not been finalised.
It would be the responsibility of the public health professionals rather than the medical professionals to handle the patients left at their homes, if the idea is implemented. They are also now overburdened with various kinds of COVID 19 prevention activities such as monitoring persons undergoing quarantine in their homes and implementing the vaccination drive apart from other usual disease preventive measures.
Yet, they complain that they are not provided with adequate facilities to handle the home-bound COVID patients. The Public Health Inspector’s Union (PHIA) says the Association was ready to cooperate in the effort to treat patients at their homes, if necessary facilities are provided immediately. PHIU President Upul Rohana said that there is a risk of patients dying at home if the process is not expedited. His public statement indicates that the authorities have not discussed the matter with the main stakeholder of the proposal - the public health officials.
It was several leading organisations of medical professionals that first mooted the idea for this scheme. Writing to the President on May 8, the Sri Lanka Medical Association (SLMA), Government Medical Officers Association (GMOA), the Association of Medical Specialists (AMS) and the SLMA Intercollegiate Committee (SMIC) recommended the commencement of home management of asymptomatic cases.
In fact, there are merits as well as demerits in implementing a home treatment scheme for COVID 19 patients. Already patients are left at their homes for days after being diagnosed with the infection for want of transport facilities and beds in hospitals. At the same time experts claim that 80% of the people infected with the coronavirus are asymptomatic. Hence, if a proper and safe mechanism is put in place it would largely ease the burden on the public coffers as well as the stress on the part of the health workers.
However, if lethargy and negligence creeps into the mechanism as the medical professionals are no longer within sight of the patients, it would result in a catastrophic situation. For instance, can the authorities assure that the calls for help from patients or their relatives in cases of complications would immediately be heeded? Already clinics for various non-communicable diseases are not functioning for the past one year; only medicines are sent to the patients’ homes with patients not being checked for complications. Now there are complaints that some hospitals have stopped sending medicines as well. It foretells another health issue is in the offing.
Therefore, the proposed scheme demands strict and close observation on the part of the highest authorities of the Health Ministry.