Private Hospitals Target Mildly Ill Covid-19 Patients With At-Home Care Plans

Satvik Tandan, 34, first had a cold and it progressed into fever and breathlessness. The symptoms were mild and occurred separately over a week. He didn’t think much of it and was on the mend when his doctor advised him to get tested for Covid-19. On April 27, his report came out—it was positive.

Tandan, who wants to be identified by a pseudonym to maintain privacy, lives with his wife, seven-month-old child and a 63-year-old parent. He checked with several hospitals if he could move in.

“It sounded like they wanted my kidney in exchange for recovery,” he said, referring to exorbitant rates at private hospitals that has triggered calls for pricing caps.

Luckily for Tandan, India had allowed home quarantine of infected patients while extending the world’s most punishing lockdown. On the advice of his doctor, he safely recovered at his home.

Like Tandan, eight out of 10 Covid-19 patients show none to mild symptoms, according to the Indian Council of Medical Research. They need counsel and care but not necessarily in a hospital. Sensing an opportunity in such cases when non-Covid healthcare has all but ceased, some of India’s largest private hospitals are offering at-home care packages to the infected. These cover everything from medical kits and blood pressure machines to psychological consultation.

The total number of confirmed infections in India has crossed 3.45 lakh, fourth highest in the world. Mumbai and New Delhi together account for over a lakh cases, pushing health infrastructure in the two metropolises to its limit and sending patients on a hunt to find a bed.

For the mildly ill who don’t need hospitalisation, private hospitals in Mumbai and Delhi offer at-home care charging anything between Rs 350 to Rs 1,500 a day. This includes medical kits comprising a thermometer and body oxygen monitoring device, home delivery of medicines, consultation with doctors online or over the phone, and nurse-supervised monitoring of vitals up to twice a day. Higher-priced plans include sessions with psychologists and dietitians, a BP machine, and, in some cases, PPE kits and hand sanitisation stands.

Among the healthcare providers that have launched such packages are Fortis Hospitals in Mumbai and Delhi, Reliance Foundation Hospital in Mumbai, and Medanta and Max Home in Delhi-National Capital Region.

Mumbai’s PD Hinduja National Hospital and Medical Research Centre is working on similar packages, Rajiv Himmat, deputy director of marketing told BlooombergQuint. The Lilavati Hospital & Research Centre will also launch a package soon, a spokesperson said.

The home care initiative is fairly new and will need some time to be deployed and analysed, Rinku Mavani, business partner for sales at Fortis Hospitals in Mumbai, said over email. “However, home care for mild and asymptomatic Covid-19 patients will certainly help bring down hospitalisations.”

According to the Health Ministry’s June 13 guidelines, mild cases of Covid-19 can be managed at home if the residence meets the requisite conditions of enough space, availability of a constant caregiver and link with a hospital. Such cases are defined as patients with symptoms like fever, cough, sore throat, nasal congestion, malaise, headache and without the onset of breathlessness or complication of respiratory infection.

The guidelines advise patients to get shifted to a supervised quarantine centre or a hospital if symptoms progress.

This will in part help ease burden from hospitals and also save patients from exorbitant bills, according to Shahid Jameel, virologist and chief executive officer of India Alliance, a public charity that funds research in health and biomedical sciences. “I know someone who was positive and had fever for one day and had to spend Rs 45,000 daily for 15 days. All he was doing was reciting poetry.”

But the important question, Jameel said, is how many in India will be able to afford at-home care despite being cheaper than treatment at hospitals.

Mildly ill Covid-19 patients, according to the Health Ministry, need regular tracking of temperature, vitals and oxygen levels, more so for people with co-morbidities. Besides medicines to ease symptoms. it advises adequate nutrition and appropriate rehydration. For those 60 years of age or more or with hypertension, diabetes, chronic lung, kidney, liver or cerebrovascular diseases or obesity, there is recommended medication but to taken under strict medical supervision.

Dr. Anant Bhan, researcher, global health, bioethics and health policy said it is unclear if these packages are enough to track the progress of patients. “The way these are packaged seem to be to in a way to enhance revenue,” he said. “Whether the combination is the most apt and evidence-based medical oversight mechanism for mildly ill Covid-19 patients is unclear.”

Dr. Oommen John, public health expert at George Institute for Global Health, however, sees one big advantage such at-home packages offer: privacy. But this, he said, is still an interim step.

“While technological telemedicine can play a significant role in addressing surging demand in pandemic settings, we must be mindful that digital health tools are means to an end and not an end in itself,” he said. “If the end is quality healthcare delivery, then we need to invest in infrastructure for primary healthcare.”