Humera Nagori, 21, was hoping this year would pan out differently. Having undergone a heart transplant surgery in February 2019, the third-year BCom student was forced to take a break from academics, as she had been advised complete bed rest for a year. She was to resume college this year, but when the pandemic broke out in the city, her home-confinement was extended indefinitely, given her vulnerable condition. To add to this, she tested positive for COVID-19 on June 11.
"I had been wearing a mask since the surgery to avoid getting any infection. But the precautions weren't enough. Early in June, I started feeling nauseous and had breathing difficulties," said Nagori, who tested positive for the virus, soon after. "I had experienced the challenges of being admitted to hospital once and I didn't want to do it again. Since I had mild symptoms, my doctors advised me to get treated at home," she added. Nagori is among the many COVID-19 patients in the city, who opted for home care services being offered by private hospitals, to help deal with the large volume of cases, and the shortage of beds in both, government as well as private institutions. The services are currently available to patients who are asymptomatic or have mild symptoms.
The economical option
While hospitalisation costs can run into several lakhs, home care packages range between R3,700 and R11,000 for two weeks, depending on the kind of services a patient signs up for. Some packages are basic and involve a certain number of online consultations with the doctor and nurse, while the more expensive packages include a comprehensive medical kit and sessions with a dietician and psychologist.
Though most private hospitals offer remote consultation through phone calls and video conferencing, hospitals like HN Reliance Hospital also have nurses who conduct home visits. Nagori signed up for their special package, which includes five visits by the nurse and consultations with the doctor, counsellor and dietician. A resident of Dongri, she lives in a 1 BHK with her parents and had isolated herself in the drawing room, during treatment. Since they have one bathroom in the house, her parents used the bathroom at her aunt's residence in the same building. "When the nurse would visit in a PPE kit, my parents would stay in the bedroom. I'm used to wearing a mask all day and I only take it off, when I go to bed," she said.
For most patients, home care is not only an economical option, it also allows them to be around family.
Saurav Prakash, 32, who lives with his wife, mother and maternal grandparents and was being treated at home by doctors at Nanavati Hospital, said that he was less anxious, because he was around family. "Home isolation is more convenient, and due to the regular consultations and monitoring of my vitals, I knew I was in safe hands," he said. Prakash lives in a 3 BHK in Andheri and was isolated in a bedroom. He followed all precautions to ensure that the infection didn't spread to his family, especially his 82-year-old grandfather, who has diabetes.
Bubai Dev, 52, was the second person in the family to test positive for COVID-19 on July 16. While her symptoms—throat irritation, headache and loss of taste—were mild, her 57-year-old husband was suffering from high fever and respiratory issues and was hospitalised at Fortis Hospital. "I was really worried for my husband, as I couldn't accompany him. I had COVID-19 too, but I had mild symptoms. I opted for the home package, and it was reassuring to know that a doctor was just a call away," she said.
"When her husband was hospitalised, Dev's 20-year-old son shouldered all the responsibilities at home, while she isolated herself."
New lessons for med staff
Treating patients at their home was an unusual experience for many medical personnel, as well. Prajakta Chavan, 22, a nurse with HN Reliance Hospital, conducts around eight home visits daily. Every visit lasts for around 15 minutes. "I change into the PPE kit before entering and take the patient's vitals. Depending on the symptoms, I also help them with steam inhalation and deep-breathing exercises for lung expansion. Sometimes, some people find it difficult to stay by themselves and begin to feel depressed. We counsel them and make them understand that they have to remain in isolation for the safety of their family members," she said.
After conducting the home visits, nurses are required to go to the hospital to complete the documentation of the patients' vitals. This is followed by a video consultation by a doctor.
Chavan lives in Bhandup with two other flatmates, who are aware of the risks of her job. "When I reach home, I sanitise my bag and then take a bath before I do anything else. My friends are supportive and they remind me to take care of myself."
Private hospitals have seen a growing demand for the home care packages over the past few weeks. HN Reliance Hospital was the first to start it in the city, in early June, and is reportedly the only one to offer home visits by a nurse. At Fortis Hospital, the home care packages were launched on June 12 and until Thursday, they had 61 patients. Hinduja Hospital, which began the service on July 1, already has about 200 patients. Nanavati Hospital started the service on July 27, and has had 12 patients till date.
In the absence of physical examination, consulting with patients electronically presents some challenges for the hospitals, too.
Dr Manjit Singh Arora, a consultant of general medicine with Fortis Hospital said that treating patients over a video call or telephone has been a learning experience. "I had one patient who said that her oxygen saturation is low. So, I asked her to remove any nail polish she might be wearing. After removing it, when she used the oxymeter again, her oxygen saturation was above 95 per cent. Another patient complained of breathing difficulties. When I listened closely to her breathing, she was wheezing and I realised that she was asthmatic, something she hadn't mentioned in her medical history," he said. Given his experience with around 60 patients, Dr Singh feels that these home care packages help relieve patients of anxiety and panic they feel after they test positive for COVID-19.
Gautam Khanna, CEO of Hinduja Hospital, said that remote consultation, ensures healthcare is available to all, while also reducing pressure on the hospitals. "We started five kinds of home care packages. We don't accept everyone who applies for it and have a screening process, depending on the patient's condition," Khanna said. He said that while nearly 200 patients have been treated so far, 70 were not registered since they didn't fit the criteria. Elaborating on the challenges, Khanna said, "Sometimes, patients expect consultants to be available 24/7. In some cases, patients don't check their vitals regularly and don't share the information that needs to be shared with the doctor. Some patients even want to keep consulting with the doctor, beyond the duration of the package. However, we guide the relatives of the patients to deal with the issues," he said. He added that the home care package isn't restricted to Mumbai and they have registered patients from other cities in Bihar and Karnataka, as well.
Total no. of patients who accessed Hinduja Hospital's home care package
Source - mid-day.com