The Patient Home Isolation and Home Management System (PHIMS) is a special programme that was launched recently under the guidance of former Health Minister Pavithra Wanniarachchi to look after COVID-19 positive patients at their homes in order to reduce congestion at state hospitals.
The programme which is being implemented through a call centre and a medical care team will be extended across the entire country with a well-trained team of 1,000 doctors. The programme was launched in the Rathnapura District last Saturday (14). The programme has been implemented successfully in the Kalutara District since June. All required health staff have already been trained for this programme and 426 medical interns who are awaiting placement for internships have also been added to this team and arrangements have also been made to train more such medical interns in order to strengthen this programme.
All COVID-19 positive patients aged between 2 and 65 with no symptoms (asymptomatic) or mild symptoms will be treated under this programme following their request to enter into the programme. Once they get registered themselves with the programme, they will be looked after 24/7 under the over-the-phone consultation of a well-trained team of doctors. The service will be provided for a period of 14 days and then the patient can also obtain the service for a further seven days. A special set of guidelines has already been issued in connection with home care for COVID-19 patients.
The programme explores expertise in different fields related to this crisis including many physicians, family medicine professors, Science professors, physiotherapists, paediatricians, gynaecologists and other specialists.
If, in case, a patient develops breathing difficulty or any other complication, he or she will be immediately hospitalised with the assistance of the team of doctors, PHIs and the MOH. Patients need to register their phone numbers with the service through the PHI and MOH in order to obtain the free service of the call centre hotline, 1390.
Patients are first registered in the computer network system and then are connected to the call centre 1390 service. Then the call centre gets the
Pulse Oximeter
details of the patient confirmed and connects that person to the team of doctors. The doctors are ready at any time to provide consultation while also recording the information provided by the patient. Arrangements have been made through Provincial Directors of Health Services to hospitalise patients, if necessary, without any delay. If required, the COVID-19 positive patients who are being quarantined at home will be directed to relevant hospitals and intermediate care centres.
National Hospital of Sri Lanka (NHSL) Physician Dr. Upul Dissanayake said that COVID-19 positive patients are required to be admitted to a hospital only if their oxygen percentage drops below 96 percent, and breathing difficulties or other major complications such as high blood sugar level are identified.
According to Dr. Dissanayake, even if one family member becomes positive, the rest of the family is also considered positive for COVID-19 no matter whether they have any symptoms or not. No other medications should be taken for fever except Paracetamol. Bed rest is a must. Bed rest reduces the oxygen requirement. Women who test positive should also bed rest without attending to household chores as on normal days.
Dr. Dissanayake pointed out that COVID-19 positive patients who are at home should rest in bed and drink 2,500 millilitres of liquid per day. They can drink anything other than alcohol such as water, soup, fruit juice, porridge etc. They should sleep more on their tummy in order to increase oxygen intake. They should measure oxygen percentage using a pulse oximeter. The patient should measure his/her oxygen level and then sit and stand up six to eight times continuously on a chair and then measure the oxygen level again using the pulse oximeter.
“If the percentage drops by two, he/she should get admitted to a hospital. For example, if a patient’s oxygen level is 98 before starting the sitting down and standing up process and if it becomes 96 after completing the eight rounds of sitting down and standing up process, he/she should be admitted to a hospital,” he said.
Dr. Dissanayake stressed that no COVID-19 positive patient should try to use any other method to check the oxygen level or ability to breathe, especially the methods mentioned in social media or on the internet. They should not climb staircases to check themselves as advised in social media and on the internet.
According to NHSL Physician Dr. Upul Dissanayake, the Delta variant of COVID-19 can exist inside small air-conditioned cubicles/ rooms for 16 hours while in an open big room without air conditioning, it is about five minutes. Therefore, it is important to keep doors and windows open in all cubicles/rooms for proper ventilation.
He said that partitioning of cubicles/rooms using polythene reduces the air flow and the virus can exist inside those cubicles/rooms for longer periods as there is no proper air flow due to polythene covers. These days, a large number of offices, shops etc. use polythene to cover cubicles and rooms which lowers air flow instead of facilitating it.
Dr. Dissanayake pointed out that the best place with good ventilation is the beach where a mask is not necessary on normal days. But, these days, it is necessary to wear a mask on the beach as well to protect against COVID-19.
The first and the important point is that the patient should stay in a separate room, says Dr. April Baller of the WHO. If this is not possible, then he or she should have a designated part at home and his or her movements around the house should be limited. Also, there should be kept one metre, at least one metre distance between them and anyone else. Secondly, it is critical to have good ventilation in that patient’s room and any shared spaces. So, this means to have fresh, clean air coming through as much as possible.
The sleeping position that increases the oxygen level of an infected person.
And this can be done just by opening the windows. Unfortunately, it obviously needs to be safe to do so. Thirdly, there should only be one person who is the caregiver for that patient and that caregiver should have no underlying condition. Fourthly, whenever patients receive care, they should wear a medical mask, as should the caregiver. And as soon as the caregiver leaves the room, they need to make sure to wash their hands. Also, the patients should have their own designated or personalised dishes and cups, towels and bed linens.
And these should be washed with soap and water at least once a day. Also importantly, any frequently touched surfaces by the patient have to be cleaned and disinfected every day and any waste generated from that patient should be packed safely. And finally, there should be no visitors allowed during the time that the patient is ill.
When caring for patients at home, it is important to monitor the condition regularly. Ideally, this should be at least once a day for any signs and symptoms, complications or red flags. And the important point here to note is that the flags can vary slightly depending on the age. So for adults, there are ones complaining of lightheadedness. They could be having shortness of breath, heavy breathing, chest pains, or look dehydrated.
For children, it can often be them suddenly appearing confused, being off their food, having blue lips or face. And infants, an inability for them to breastfeed. So in any of these cases, urgent care needs to be seen. While at home, some patients may be asked to measure the oxygen saturation with a pulse oximetry. This is a medical device that monitors the blood oxygen level.
It is a useful device. However, it is important that the user has clear instructions on how to use it and also to know what is an abnormal reading or a normal measure. And when it is abnormal, importantly, they need to urgently call their healthcare provider.
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