Home Care as a Safe Alternative during COVID-19 Crisis

*Heloisa Amaral Gaspar and Claudio Oliveira Flauzino*

## **Abstract**

High mortality rate for the coronavirus disease (COVID-19) has been reported worldwide in nursing home residents, and the global concern about the safety of patients and professionals in these institutions is relevant. A large part of post-acute and chronic patient care in Brazil is performed at home through Home Care (HC) services. The objectives of this chapter are to describe the main measures that can be implemented in patient homes in order to keep professionals, patients, and family members safe and to analyze the safety of choosing the home as the place of care during a pandemic, especially in contrast to the results observed in long-term care facilities. COVID-19 infection data among home care patients, obtained after a year of severe epidemic in Brazil, demonstrate that home care is safe and is associated with a low incidence and low lethality related to the new coronavirus.

**Keywords:** Home care, safety, pandemic, COVID-19, professional protection equipment

#### **1. Introduction**

In Brazil, the first confirmed case of COVID-19 occurred on February 26th. Since then, the number of cases has grown exponentially and, despite recognized underreporting, the country ranked second in the world among countries with the highest number of cases and deaths due to COVID-19 [1, 2].

COVID-19 is a potentially severe acute respiratory infection caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical presentation is generally that of a respiratory infection with symptom severity ranging from a mild common cold-like illness to a severe viral pneumonia leading to acute respiratory distress syndrome that is potentially fatal. Characteristic symptoms include fever, cough, dyspnea, and loss of taste/smell, although some patients may be asymptomatic. Complications of severe disease include, but are not limited to, multi-organ failure, septic shock, and venous thromboembolism. Symptoms may be persistent and continue for more than 12 weeks in some patients. After the acute phase and especially following hospital discharge patients may present with muscular weakness, oxygen dependency requiring extra-hospital rehabilitation and, still, may need continuous care for complications such as infectious, thrombosis or wounds [3].

#### **1.1 How did the pandemic affect Brazil?**

The pandemic struck Brazil in an overwhelming way. The lack of effective preventive measures added up to a poor coordination by the various spheres of

#### *Fighting the COVID-19 Pandemic*

government, resulting in a favorable environment for viral transmission and the emergence of new variants. The explosion in the number of infections, reaching more than 15 million Brazilians infected, a number that is underestimated due to the low availability of diagnostic tests especially at the beginning of the pandemic, led to the largest health and hospital collapse in the country's history. The ICUs were filled in several states both in the public and private system and patients died while waiting in line for a hospital bed.

In 2021 the country faced, and still faces, a shortage of human resources in hospitals, a shortage of medications, and a severe crisis in the supply of medicinal oxygen.

#### **1.2 How did the pandemic affect patients with comorbidities and those who are more dependent?**

Advanced age and the presence of comorbidities are associated with increased mortality due to the new coronavirus. The high prevalence of this combination, associated with physical environments that provide inadequate barriers to infection control, place patients in long-term care facilities at greater risks. Studies show that once the first case in these institutions exists, the possibility to have the infection spread to other patients is quite high [4–6]. There are several reports worldwide about high mortality related to COVID-19 among residents of long-term care institutions (LTCI) with up to 2/3 of patients affected within a period of 3 weeks and mortality reaching levels as high as 72% [7]. Dr. Grabowski's [6] point of view highlights the elevated mortality rates due to COVID-19 among LTCI residents, representing 25% of the deaths from COVID-19 in the US. Percentages are even higher in some US states and European countries such as France and Ireland. The concern with the safety of patients and professionals at these facilities is extremely relevant and compels us to make a deeper reflection.

The HC sector has grown exponentially in the last few decades. Currently it is estimated that approximately one million patients/year from the public and private sectors use HC in Brazil, where much of post-acute care, rehabilitation, and longterm chronic patient care is provided at home. Data from 2019 revealed that the number of patients treated at home was equivalent to 5% of the number of hospital beds in our country [8].

**Figure 1.** *Most frequent therapies performed by home Care in Brazil.*

*Home Care as a Safe Alternative during COVID-19 Crisis DOI: http://dx.doi.org/10.5772/intechopen.98529*

This modality of treatment includes drug administration, enteral nutrition, wound care, rehabilitation, oxygen therapy, respiratory support, and more complex therapies such as parenteral nutrition and invasive or non-invasive mechanical ventilation (**Figure 1**).

Home care is available in both public and private health sectors and has been distinguished by humanized care, the patient's reintegration into society, and low incidence of infections.
