Turning homes into hospitals eases pressure on overwhelmed doctors, nurses

When she tested positive for Covid-19, Durban pilot Fathima Khan Gabie had a mini hospital ward set up in her home, with care from a nurse, doctors and a psychologist.

Khan, who is CEO of her own flight school, was relieved not to have to go to hospital when she suffered breathing problems, temperature spikes and dizziness.

Overcrowded wards and overwhelmed health-care professionals have prompted some private doctors to create Covid-19 “wards” in patients’ homes. Many patients refuse to go to hospital for fear of not seeing their families again. Others have been turned away because of hospitals’ lack of capacity.

In Gauteng and KwaZulu-Natal, people have been treated at home by doctors. This is done through virtual house calls, medication packs and whatever equipment is necessary, such as oxygen meters, thermometers, blood-sugar and -pressure monitors.

Khan, who was infected after coming into contact with a relative, resorted to home care after her symptoms went from “nothing” to “aggressive” overnight.

“I was suffocating, my temperature was fluctuating and I was dizzy. My doctor was in my home along with a nurse, administering drips and other care,” she said.

“I basically had a small hospital in my home. When you are in this position these medical professionals are your lifeline.”

Durban doctor Naseeba Kathrada started a Covid home-management team to alleviate stress on hospitals and on infected patients.

“We provide support to doctors to better manage their patients at home by assisting with the oxygen concentrators, thermometers, machines to monitor blood-sugar and -pressure levels, the supply of supplements, a laboratory to conduct tests, psychologists, physiotherapists and a chiropractor,” she said.

Doctors direct physiotherapists to do mainly virtual home care by helping with breathing techniques. In severe cases, patients are referred to hospital. Kathrada said that with hospitals filling up, many patients could be treated at home.

Claire van Staden, a nurse who works with Covid-19 patients in Durban, sees a “big demand” for home care.

“People are nervous about hospital, which is understandable,” she said.

“I work with a doctor who assesses the patient and makes a medical decision whether they can be treated at home or in a hospital environment. We only see patients who are safe enough to be at home.”

She employs extreme protection against infection.

“I don’t go into a patient’s household until I am fully kitted up, including mask, shield, goggles, full gown, gumboots and double gloving. If I’m not safe, I won’t be able to care for others,” said Van Staden.

In Johannesburg a network of doctors and civil society groups helps to provide home care for Covid-19 patients, some of whom receive treatment free if they cannot afford it.

Specialist physician Dr Shoyab Wadee, who is part of the Islamic Medical Association, has been advising doctors on the best way to help patients receiving home care.

“The virus is surging in Gauteng. Both private and public hospitals are fairly full,” she said.

Wadee found that many Covid-19 patients were reluctant to go to hospital because their families could not visit them.

“Obviously they are also worried about the care they will get, both in the private and public sector because doctors are under significant strain.”

Wadee said doctors worked closely with families to help patients recover by providing medical support such as conducting blood tests to assess risks and supplying medicines like steroids as well as oxygen.

“The majority of patients are doing well with just oxygen, but there are some patients who need to go to hospital.

“Sometimes this type of care buys them time to get a hospital bed.

“There are checks and balances. You don’t want to give oxygen to a patient who doesn’t need it, and you don’t want to give a false sense of security to a patient who actually needs to go to hospital. It’s not perfect. I think we are all still learning.

“This helps to save the hospitals for those who are most in need of that care.”

Dr Riaz Ismail, head of the Islamic Medical Association in the Western Cape, said the association had oxygen concentrator machines for home care available to relieve the stress on hospitals.

“Currently we have hospital beds available. There seems to be a slight downturn in the number of patients admitted.

“We have yet to use any of these machines. But we can’t be complacent; we have to be prepared.

“A second peak is what many international experts have spoken about,” said Ismail.