Venezuelan COVID patients increasingly seeking in-home care
CARACAS, Venezuela (AP) — Chef Carlos Páez has a long and tough road ahead after a serious case of COVID-19 that required a constant supply of oxygen. He is showing improvement, but his health is still fragile.
Páez, however, didn’t receive treatment at one of Venezuela’s hospitals despite appallingly low oxygen saturation levels. He was treated at his home in the capital, Caracas, because it is not easy to find a bed at a public hospital these days — the outcome of a recent increase in coronavirus cases and chronic understaffing — and he was priced out of a private facility despite having health insurance.
He is one of a growing number of coronavirus patients who are choosing to be cared for by health care professionals at home during their illness, even if their cases warranted hospital stays.
“I don’t know what I would have done,” Páez, a grill master, said, referring to the home health service. The 55-year-old is still hooked to an oxygen concentrator and has difficulty speaking.
The South American country has recently seen a spike in COVID-19 cases, which the government has partially attributed to a virus variant that scientists believe originated in neighboring Brazil. The increase has pushed already struggling hospitals to see more patients than at any other time during the pandemic.
Venezuela Vice President Delcy Rodríguez on Friday said the country was facing a “second wave” of infections, though she did not give hospitalization figures. On Sunday, Medicos Unidos de Venezuela, an organization established to protest the longstanding shortage of medical supplies in the country’s hospitals, warned that “the capacity of intensive therapies, both in public and private centers, is insufficient for the number of patients who are being admitted in serious condition and require the support of a ventilator, which can only be provided in these units.”
The government has reported more than 151,100 coronavirus infections and 1,493 deaths related to COVID-19 since the pandemic began. But the Academy of Physical, Mathematical and Natural Sciences of Venezuela has warned about the possibility of a “significant underreporting” of infected people due to poor diagnostic capacity, among other factors.
People who seek care at private hospitals face bills that, in cases like Páez’s, can exceed $50,000 for two weeks of in-patient care. That is unaffordable for most in an economically battered nation where workers earn an average of $2 per month.
Fees for doctors who provide in-home care can bring the cost of COVID-19 treatment to about half of that of a private clinic. The terms of payment are also negotiable.
In this country plagued by four-digit inflation and prices that are increasingly set in dollars instead of the local currency, most health insurers are unable to cover even the cost of routine lab tests or an appointment with an internal medicine specialist. Páez’s family is raising money online to cover his mounting medical bills.
Dr. Leonardo Acosta and two other physicians began offering in-home services in May. Initially, Acosta said, their patients were people who “did not want to go to the clinic,” not even to be tested, out of fear that authorities — complying with President Nicolás Maduro’s order that all patients be hospitalized — “would go looking for them at their homes.”
As time went on, Acosta said, he and his colleagues began to “see a little more complicated patients.” Then came those like Páez, whose condition included oxygen saturation levels that dipped below 50% and warranted a stay in the hospital. But hospitalization was not an option.
“We had to support him here,” Acosta said at the home of the Páez family. The chef’s room still has several bulky pieces of medical equipment, including his oxygen concentrator. During the worst of Páez’s illness, Acosta said his patient was hooked up to a non-invasive ventilator.
The in-home medical team consists of about 15 people, including three doctors who handle complicated cases, other physicians, medical students and nurses specialized in intensive care. They offer coronavirus testing and other lab work as well as imaging and respiratory therapy services. The team members take turns monitoring patients 24/7.
Venezuela’s former minister of health and member of the non-governmental organization Red Defendamos la Epidemiología Nacional, José Felix Oletta, told The Associated Press that the vast majority of COVID-19 patients recover without the need for hospitalization. On average, he said, 17% of those infected “have significant symptoms, and of those, only 2% require intensive care, so you should hospitalize only 2% of the total.”
It is convenient “to make rational use of limited resources in a country that does not have the capacity to respond,” Oletta said. “If you compulsively force everyone who is not symptomatic or is slightly symptomatic to occupy a bed, the day you need that bed you won’t have one.”
Maduro last week ordered lockdowns in Caracas and other cities to stop the spread of a variant of the coronavirus known as P1. He acknowledged Sunday that the increase in infections is also related to the easing of curfews and other measures implemented earlier in the pandemic.
Maduro said the country’s case rate last week increased from 21 per 100,000 people to 27 per 100,000 people.
“In the last week, we have maintained an average of 739 new cases and 456 recovered per day, after months of staying even,’” he said, adding that at the same time, “the occupation of hospital beds” is growing, but he did not give other details.
Even before the virus variant began spreading in Venezuela, independent physicians were inundated with a mix of coronavirus and general patients. Some went from a few patients to more than 30 and had to reject up to 300 requests for their services on a daily basis.
Medical equipment suppliers also cannot keep up with demand. Acosta said oxygen concentrators are difficult to obtain and his team is working “at maximum capacity.”
“The demand for people seeking care is very high,” Acosta said.