INTRODUCTION:

Several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS -COV) and Severe Acute Respiratory Syndrome (SARS). The most recently discovered coronavirus causes coronavirus disease COVID-19.¹

WHO announced the common symptoms of Covid-19 is fever, dry cough, and tiredness and less common symptoms are aches and pains, nasal congestion, headache, conjunctivitis, sore throat, diarrhoea, loss of taste or smell or a rash on skin or discoloration of fingers or toes.

It was reported that around 80% of the people recover from disease without any medical help but Around 1/ 5^th of the people who gets COVID-19 becomes seriously ill and develops difficulty breathing.¹

As it is the deadly disease, the elderly people are more vulnerable to this illness. Many research findings are showing that adults 60 and older, especially those with pre-existing medical conditions, especially cardio vascular diseases, respiratory disease, metabolic diseases such as diabetes or cancer are more likely to have severe even deadly coronavirus infection than other age groups.² In subjects with diabetes mellitus, infection may be more frequent and severe.³ However it can affect at any age group, whoever experience the above mentioned symptoms is recommended to call for health care facility to avoid community spread. Even though it was reported the way of spread of covid-19 by WHO, (The disease spreads primarily from person to person through small droplets from the nose or mouth, which are expelled when a person with COVID-19 coughs, sneezes, or speaks), it is still conducting research to find out the way the COvid-19 spreads. Some reports have indicated that It is possible to catch COVID-19 from someone who has just a mild cough and people with no symptoms and does not feel ill can transmit the virus.¹ According to WHO interim guidance no antiviral treatment for coronavirus infection has been proven to be effective and so far no vaccine have been invented. So self-precaution is the only way to prevent this disease.⁴

When it comes to care takers and care recipients of both home and health care facility, it is now big challenge to provide services without fear of getting covid-19. Either caregivers or takers, everyone is at equal risk for developing covid-19 and following proper precautions believed to be helpful in preventing this deadly disease.

PRECAUTIONS FOR THE CAREGIVERS:

First and most important, as a caretaker one avoid being infected or spreading COVID-19 by taking some simple precautions such as-

I. Wash hand:

Time for wash hand:

At the time of COVID-19 pandemic, caregivers should clean hands before and after providing care, preparing food, using the bathroom, or after blowing nose, coughing, or sneezing after or he/she have been in a public place and touched an item or surface that may be frequently touched by other people, such as door handles, tables, gas pumps, shopping carts, or electronic cashier registers/screens, etc. one should wash hand before touching eyes, nose, or mouth because that’s how germs enter our bodies.

Solution for wash hand:

Regularly and thoroughly washing hands with soap and water for at least 40 seconds is the best way to get rid of germs in most situations. If soap and water are not readily available, use a hand sanitizer (at least 70% alcohol based) if soap and water not available cover all surfaces of your hands and rub them together until they feel dry. We should keep in mind that hand sanitizers may not be as effective when hands are visibly dirty or greasy and also it do not get rid of all types of germs. So washing with soap and water is recommended at most of the time.⁵

Steps to wash hand:

One has to follow the recent WHO guidelines/CDC guidelines for hand washing. Follow these five steps every time given by CDC.

1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.

2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.

3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.

4. Rinse your hands well under clean, running water.

5. Dry your hands using a clean towel or air dry them.⁶

II. Wear Mask and manage mask:

Use a mask whenever developed fever, cough or difficulty in breathing, when visiting a health care facility and when are caring for an ill person or when contact tracing. Medical masks should not be used by healthy persons who are not having any symptoms because it create a false sense of security that can lead to neglecting other essential measures such as washing of hands

Step to wear mask correctly:

· Unfold pleats, facing down, place over nose, mouth and chin.

· Fit nose piece over nose-bridge. Tie strings upper string tied - top of head above ears lower string at the back of the neck.

· Leave no gaps on either side of the mask, adjust to fit.

· Do not pull the mask down or hang from the neck

· Avoid touching the mask while in use.

· Replace masks with a new clean, dry mask as soon as they become damp/humid, 6 -8 hours.

· A medical mask, if properly worn, will be effective for 8 hours. If it gets wet in between, it needs to be changed immediately.

Steps to remove and dispose the mask correctly:

· Do not re-use single-use masks

· Do not touch other surfaces of the mask while removing.

· To remove mask first untie the string below and then the string above and handle the mask using the upper strings. Other surfaces may be potentially contaminated

· remove the mask by using appropriate technique (i.e. Do not touch the front but remove the lace from behind)

· After removal or whenever you inadvertently touch a used mask, clean hands by using a 70% alcohol-based hand rub or soap and water for 40 seconds.

· discard single-use masks after each use and dispose of them immediately upon removal.

Used mask should be considered as potentially infected. Masks used by patients / care givers/ close contacts during home care should be disinfected using ordinary bleach solution (5%) or sodium hypochlorite solution (1%) and then disposed of either by burning or deep burial.⁷

III.Clean touched surfaces:

An infected droplet gets on someone hand when we touch the surface virus transferred, as this infection spread from infected person when he coughs or sneezes. Clean frequently touched surfaces in home often, including mobility and medical equipment used by care recipients, such as walkers, canes and handrails and even tablets.^5,8

IV. Respiratory measures:

It is advised to avoid going to crowded places. If caregivers cough or sneeze, he should use a handkerchief or a tissue to cover the face while coughing or sneezing. One has to throw the used tissue immediately into a closed dustbin. If caregiver doesn’t carrying a tissue or a kerchief he should sneeze into his bent upper arm. He has to keep his hands away from his face. He has to wash hands immediately after he has covered his sneeze or cough. If caregiver has the habit of spitting he should use wash basin for spiting but do not spit in open places. Never use saree pallu or chunni to cover the face while coughing or sneezing. Everyone can have a cough and it need not to be covid-19, so caregiver should be advised to take some medicine from PHC to relieve the symptoms, as it can scare everyone.⁵

V. Social distance:

Caregiver should stay at home unless absolutely necessary. It is mandatory to keep a distance of at least one meter between oneself with another person. Caregiver should not go to any events where more ore crowd can be expected. Caregiver should not go to crowded places like markets, shopping, melas, parties and he/she should not use public transport.⁹

VI. Measures immediately on reaching home

Carefully remove and dispose off your face mask by soaking in bleach solution and then throwing it in a covered dustbin, follow the instructions given regarding how to manage mask. Wash hands with soap and water or alcohol based hand-sanitizer before touching anything else. Wipe down items carried like purse and mobile with home based disinfectant (4 tsps. of household bleach in 4 cups of water). If got any symptoms like fever, cough or difficulty in breathing report to the nearest government facility or district surveillance officer immediately.⁵

VII. If caretakers itself high risk group:

If the caretaker itself is high risk group, then he/ she must be extremely careful. And strictly have to follow all the precautions.²

VIII. If caretaker suspected for covid-19 contact:

A contact is a person who is involved in any of the following: 1. providing direct care without proper personal protective equipment (PPE) for covid-19 patients 2. Staying in the same close environment of a covid-19 patient (including workplace, classroom, household, gatherings) and 3. Traveling together in close proximity (less than 1 m) with a symptomatic person who later tested positive for covid-19.

Person high risk for covid-19:

The person who are high risk of covid -19 are- person who touched body fluids of the patient (respiratory tract secretions, blood, vomit, saliva, urine, faeces), who had direct physical contact with the body of the patient, shook hands, hugged or took care of, who touched or cleaned the linen, clothes, or dishes of the patient, who lived in the same household as the patient, and anyone in close proximity (less than one meter) of the confirmed case without precaution and passenger traveling in close proximity (less than one meter) for more than 6 hours with a symptomatic person who later tested positive for covid-19.¹⁰

IX. If caretaker suspected for covid-19 infection:

A person with acute respiratory illness (fever and at least one sign/symptom of respiratory disease (e.g. Cough, shortness of breath) and a history of travel to or residence in a country/area or territory reporting local transmission of COVID-19 disease during the 14 days prior to symptom onset or a person with any acute respiratory illness and having being in contact with a confirmed COVID-19 case in the last 14 days prior to onset of symptoms or a person with severe acute respiratory infection {fever and at least one sign/symptom of respiratory disease (e.g, Cough, shortness of breath)} and requiring hospitalisation and with no other etiology that fully explains the clinical presentation or a case for whom testing for COVID-19 is inconclusive.⁵

X. Measures for infected caregivers.

Symptomatic caregivers: If the person is symptomatic he/she should be use mask, and have to self-isolate himself/herself and immediately have to inform local health official by telephone.

Asymptomatic caregivers: If the person is asymptomatic he/she should be home quarantined for at least 28 days after the last exposure with the case. Initiate self-health monitoring for development of fever or cough and maintain a list of contacts on daily basis should be done. Active monitoring (e. g. Daily visits or telephone calls) for 28 days after the last exposure shall be done by ANM/ASHA/identified person. Direct and high-risk contacts of a confirmed case should be tested once between day 5 and day 14 of coming inn his/her contact.

During Home quarantine: Stay in a well-ventilated specific room and away from other people in your home. Restrict movement if available, use a separate bathroom. Avoid visitors in the house because if infected one can spread infection to others. Do not go to work, school, or public areas like markets, cinemas etc. Avoid using public transport. If suffering from cough or fever or breathing difficulty and suspecting contact, wear a mask, and notify nearest health facility / ASHA/ANM immediately. Wear a mask correctly when you are around other people and whenever you enter a healthcare provider’s clinic.⁵

XI. Measures for family members.

Household members should stay in another room or be separated from the patient as much as possible. Household members should use a separate bedroom and bathroom, if available. Avoid sharing household items e.g. dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with other people at home. Wash hand as often thoroughly with soap and water (40secs) or with 70% alcohol-based hand sanitizer. When in contact with the person who is quarantined, the family members should wear a three layered mask at all the times. disposable masks are never to be reused. Used mask should be considered as potentially infected. Dispose mask by soaking in home bleach solution and then throwing in a dustbin. Do not let small children play with the masks.

Environment safety measures and laundry management: Assigned family member to take care of infected person helping them follow doctor’s instructions for medication (s) and care. Should follow strict hand washing and clean and disinfection of all the touched surfaces such as table tops, doorknobs, bathroom fixtures, toilets, phones, every day. also, wipe any surfaces that may have blood, stool, or body fluids on them using bleaching powder solution (4 tsp of household bleach in 4 cups of water).

All clothes and household materials used by confirmed caregivers should be disinfected. Wash laundry thoroughly and avoid shaking soiled linen. Immediately remove and wash clothes or bedding that have blood, stool, or body fluids on them. Keep away from body. Wash and disinfect linen in warm water and soap, dry in sun. Washing machine: use disinfectant, soap, and warm water, dry in sun. Linen can be soaked in hot water and soap in a large drum, using a stick to stir, avoiding splashing (soak linen in 1% chlorine for approximately 30 minutes. finally, rinse with clean water and let linen dry fully in the sunlight. Place all used disposable gloves, facemasks, and other contaminated items in a lined container before disposing of them with other household waste. Note: infected person may be ambulatory or bed-ridden.

The care recipient and other family members have to call health care facility if any follow up help is needed for the infected caretakers as well as any infected family members. Family members should talk to the caregivers who are quarantined to avoid feeling of isolation.⁵

PRECAUTIONS FOR THE CARE-RECIPIENT:

Older adult living with chronic illness, have important relationships with their caregivers. It is difficult to limit their relationship but we can limit in-person visits older adult in the family to avoid catching COVID-19. We need to keep older adults safe, but social isolation can have a negative impact on older people’s immunity and mental health.” In terms of social contacts, older adult should be encouraged to think beyond their usual circle of friends and family.

Older adults should put off non-essential travel, particularly cruises or trips with itineraries that would expose them to crowds. Caregivers can arrange online services and outreach for spiritual solace and support. Show them how to video chat with others using smartphones, laptops or tablets. Use apps on these devices to provide captions for adults with hearing challenges. Encourage friends and family outside of your household to telephone, write notes or send cards to lift your loved one’s spirits.

If an older adult is feeling well, consider helping them postpone elective procedures, annual check-ups and other non-essential doctor visits. Ask their doctors’ offices if they offer telemedicine, which enables doctors and patients to communicate over video, email or other means rather than face-to-face.

If caregivers become sick he should, involve older family member in discussions of how they have to manage interruptions of routines. Talking things through ahead of time as a family can reduce stress and help everyone feel more involved and prepared. Caregiver can designate someone nearby whom he could rely on to care for elderly family member if he himself becomes ill.

Gather one to three months of medications, and at least two weeks’ worth of food, over-the-counter remedies, pet supplies, and other essentials will reduce the unwanted situations. It is better to find out which delivery services are available in area to serve.

If elder adult might have been exposed to someone diagnosed with COVID-19 or if anyone in the household develops symptoms such as cough, fever or shortness of breath, immediately have to family doctor, nurse or helpline or urgent care facility.²

CONCLUSION:

Covid -19 is emerging pandemic disease. The main drawback of this current disease is, it has no treatment to treat or no vaccine to prevent. Older adults with comorbid disease have more risk of getting this disease and older adult living with chronic illness; have important relationships with their caregivers. If caregiver gets disease, then easily he can transmit disease to his care recipient too. The only way to keep everyone safe is to follow the precautions. Many online courses are required for caregivers to train themselves to handle the current covid -19 situation to keep them safe as well as to provide uninterrupted services to their care recipient.

CONFLICT OF INTEREST:

The author declare no conflict of interest.

REFERENCES:

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2. Arbaje .A. Coronavirus and COVID-19: Caregiving for the Elderly. John Hopkins Health. [Internet]. 2020 [cited 2020 June 9]; Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-caregiving-for-the-elderly.

3. Penlioglou T, Papachristou S, Papanas N. COVID-19 and Diabetes Mellitus: May Old Anti-diabetic Agents Become the New Philosopher's Stone? Diabetes Ther. 2020; 1‐3. doi:10.1007/s13300-020-00830.

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8. COVID-19: Guidelines on disinfection of common public places including offices. MOHFW. [cited 2020 June 10]; Available from https://www.mohfw.gov.in/pdf/Guidelinesondisinfectionofcommonpublicplacesincludingoffices.pdf.

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Received on 07.01.2024 Modified on 22.01.2024

A and V Pub Int. J. of Nursing and Medical Res. 2024; 3(1):45-49.

DOI: 10.52711/ijnmr.2024.09