This review presents considerations for care and infection prevention and control (IPC) for Covid-19 in home and community-based care settings.
Community-based care generally refers to any care that happens outside of hospital settings – such as in private homes, primary care facilities or residential care facilities. In an outbreak, this might also include care provided in small-scale temporary structures or repurposed buildings like hotels.
Depending on the health system resources available, it is likely that community-based care will be provided or supported by people in the state or private sectors, and by a range of lay, professional, informal and paid and unpaid health workers with at least some health training. They may be nurses, doctors, paramedics, community health workers, or others.
In this review, home care specifically refers to care provided in the private home of a person with a probable or confirmed case of Covid-19, most immediately by a caregiver who would not necessarily have formal health care training, but can be supported by people who do. They may be a spouse, parent, other household member, friend or peer of the patient. In some instances, people might be alone in their home.
Caregivers and those doing self-care can have varying levels of formal support. Home care can additionally be important in an outbreak for those with pre-existing medical or disability-related needs, or underlying health conditions that place them at greater risk of contracting SARS-COV-2 and experiencing more severe disease.
This review considers only home care, and to a lesser extent, community-based care in temporary or repurposed facilities for those with a probable or confirmed case of Covid-19. In contexts where testing for Covid-19 is limited, it will inevitably be difficult to distinguish definitively between Covid-19 and other conditions that have similar symptoms and which may be prevalent.
We explain why home care is important and give an overview of existing guidance and models for home and community-based care for Covid-19, with an emphasis on low-and-middle-income countries (LMICs). The guidance reviewed includes government documents, websites and briefs as well publicly available information from NGOs and community-based organisations.
We then assess the gaps in this guidance and suggest ways they might be addressed, including by highlighting innovative examples and drawing on knowledge of past outbreaks of disease. Recommendations are aimed at governments, NGOs and community-based organisations who are mobilising to provide guidance and support for home care.