Ilesanmi OS, et al., Journal of Ideas in Health 2020;3(4):252-253 © The Author(s). 2020 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. e ISSN: 2645-9248 Journal homepage: www.jidhealth.com Open Access The new norm in the management of COVID-19 positives: Home- based care Olayinka Stephen Ilesanmi1,2*, Abolanle Adesile Oguntoye2, Aanuoluwapo Adeyimika Afolabi1 Abstract Background: The Coronavirus disease (COVID-19) has disrupted health systems globally and locally. The increasing number of COVID-19 positives has overwhelmed healthcare facilities and health workers. Home-based care (HBC) is a new norm in the management of COVID-19 positives. We aimed to give insight into the HBC of COVID-19 positives in Nigeria. Methods: We conducted a descriptive review of the existing literature and summarized the authors' opinions regarding HBC in Nigeria. Results: HBC has increasingly gained recognition for the management of COVID-19 positives. The HBC of COVID-19 positives provides the opportunity for patient management under an atmosphere of emotional, physical, and spiritual fulfillment as required for quick recovery. Guidelines have been developed for HBC of COVID-19 positives; however, negligence to these measures has been noted. Conclusion: To ensure compliance and harness HBC's benefits, community leaders, religious organizations, civil- based organizations, and opinion leaders should be actively involved in HBC activities. Also, enforcement authorities such as the Civil Defence Corps could help to improve adherence to HBC restrictions. Keywords: COVID-19; Home-based care, COVID-19 positives, Management of COVID-19 positives, Nigeria. Background The Coronavirus disease outbreak 2019 (COVID-19) has signaled a disruption in health systems across the globe [1,2]. The increasing number of COVID-19-infected persons have placed great pressure on the health system with resulting exhaustion of available health facilities, non-admittance of new COVID-19 positives, and increased workload for health workers (HW) [1,3]. Therefore, it becomes necessary to explore other options that assure adequate patient management and reduce the burden placed on the health system. This, therefore, justifies the evolution of home-based care (HBC) of positives during the COVID-19 pandemic. The HBC has been defined as any form of care provided to ill individuals in their homes while drawing on the sound and evidence-based recommendations and support from HW [4,5]. Contrary to the management at isolation centers, HBC of COVID-19 positives provides the opportunity for patient management under an atmosphere of emotional, physical, and spiritual fulfillment as required for quick recovery [3]. As of 1st November 2020, COVID-19 cases have risen to 46,156,540 globally, with Nigeria accounting for 62,853 [6]. The pre- existing weakness of Nigeria’s health system provides substantial evidence to prove that the country's existing health facilities are insufficient to serve these ones [1]. Therefore, in line with the World Health Organization recommendations, the Nigeria Center for Disease Control (NCDC) has issued an advisory for the management of severe COVID-19 positives in treatment centers [5,7]. On the other hand, mildly symptomatic or asymptomatic COVID-19 positives are to be placed on HBC. The HBC of COVID-19 positives is not a venture which could be haphazardly coordinated or poorly implemented [7]. For this cause, HBC guidelines are required to be developed by each of the 36 states in Nigeria as well as the Federal Capital Territory. The development of these local guidelines considers the peculiarities of each State and the adaptability of HBC in each setting, a feat that may not be possible on a general platform. The decision on home isolation and care of COVID-19 positives critically depends on the results obtained from the assessment of the following factors, namely; the clinical condition of each COVID-19 positive, the availability of HBC personnel to monitor the clinical progression of the COVID-19 positive in his/her home, and an assessment of the feasibility of ___________________________________________________ ileolasteve@yahoo.co.uk 1,2Department of Community Medicine, University College Hospital, Ibadan, Oyo State, Nigeria Full list of author information is available at the end of the article http://www.jidhealth.com/ Ilesanmi OS, et al., Journal of Ideas in Health (2020);3(4):252-253 253 home care in the proposed home setting where the COVID-19 positive is to be managed. After that, subsequent visits are made by HWs, including community HWs, to these sites to ascertain the compliance of COVID-19 positives and relatives to homecare restrictions [7,8]. These include the isolation of patients into single ventilated rooms where possible or a portion of a room with a minimum of two meters from other persons. Infection prevention and control (IPC) materials such as face masks and hand gloves are used and discarded after each use. Wastes generated by the COVID-19 patients should be handled as contaminated materials, which should be properly disposed of. In addition, visitors are not expected to enter such rooms, and patients are not expected to be seen in public places as a strategy to forestall onward transmission of COVID-19 [7]. Despite restrictive measures that have been put in place to reduce the risk for onward familial transmission of COVID-19, anecdotal evidence has reported non-adherence to these directives among COVID-19 patients on HBC. Such disregard of recommended guidelines compromises the HBC's effectiveness in breaking the epidemic chain of COVID-19 [7]. Conclusion The HBC strategy offers a promising approach to the effective management of COVID-19 positives from the home settings. To maximize the potential benefits presented by the HBC strategy for COVID-19 positives, the services of enforcement authorities such as the Civil Defence Corps could help improve adherence to HBC restrictions. Also, community leaders, religious organizations, civil based organizations, and opinion leaders could both serve as authorities for maintaining COVID- 19 guidelines and as focal persons in case of non-adherence. Besides, the roles of community HWs should clearly include strategies to ensure accurate reporting of HBC activities to present a true reflection of the COVID-19 infection in communities. Furthermore, the development of HBC guidelines should be hastened in states that are lacking to assess the HBC strategy's effectiveness on a national level. Abbreviation COVID-19: Coronavirus Disease; HW: Health Workers; HBC: Home-Based Care; NCDC: Nigeria Centre for Disease Control; IPC: Infection Prevention and Control Declaration Acknowledgment None Funding The authors received no financial support for the research, authorship, and/or publication of this article. Availability of data and materials Data will be available by ileolasteve@yahoo.co.uk Authors’ contributions Olayinka S. Ilesanmi (OSI), Abolanle A. Oguntoye (AAO), and Aanuoluwapo A. Afolabi (AAA) are the principal investigators of this manuscript. All authors have equally participated in the study concept, design, writing, reviewing, editing, and approving the manuscript in its final form. All authors have read and approved the final manuscript. Ethics approval and consent to participate We conducted the research following the Declaration of Helsinki. However, Commentary Articles need no ethics committee approval. Consent for publication Not applicable Competing interest The author declares that he has no competing interests. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Author details 1Department of Community Medicine, Lecturer 1, University of Ibadan, Ibadan, Oyo State, Nigeria; Department of Community Medicine, Honorary Consultant, University College Hospital, Ibadan, Oyo State, Nigeria. 2Department of Community Medicine, Resident Doctor, University College Hospital, Ibadan, Oyo State, Nigeria. 3Department of Community Medicine, Post-graduate student, University of Ibadan, Ibadan, Oyo State, Nigeria. Article Info Received: 10 October 2020 Accepted: 03 November 2020 Published: 24 November 2020 References 1. Ilesanmi OS, Afolabi AA. Time to move from vertical to horizontal approach in or COVID-19 response in Nigeria. SciMed. 2020; 2(Special Issue "COVID-19"):28-29. 2. Ilesanmi OS, Afolabi AA. Ilesanmi O, Afolabi A. Perception and practices during the COVID-19 pandemic in an urban community in Nigeria: a cross-sectional study. Peer Journal. 2020; 8: e10038. https://doi.org/10.7717/peerj.10038. 3. Ilesanmi OS, Afolabi AA. Six months of COVID-19 response in Nigeria: Lessons, challenges, and way forward. Journal of Ideas in Health. 2020;3(Special 1):198-200. https://doi.org/10.47108/jidhealth.Vol3.IssSpecial1.63 4. World Health Organization. Home care for patients with COVID- 19 presenting with mild symptoms and management of their contacts. Available from: https://www.who.int/publications- detail/home-care-for-patients-with-suspected-novel-coronavirus- (ncov)-infection-presenting-with-mild-symptoms-and- management-of-contacts. [Accessed on 5 October 2020]. 5. Ilesanmi OS, Afolabi AA. A scope review on home-based care practices for COVID-19: What Nigeria can learn from other countries. Ibom Med J. 2021;14(1). 6. European Center for Disease Prevention and Control. COVID-19 situation update worldwide, as of 1 November 2020. Available from: https://www.ecdc.europa.eu/en/geographical-distribution- 2019-ncov-cases. [Accessed on 1 November 2020]. 7. 7.Nigeria Center for Disease Control, 2020. 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