Could home management of COVID-19 cases alleviate strain on the fragile healthcare system in Damascus, Syria: a prospective cohort study

Abstract

Abstract The global impact of COVID-19 was devastating, particularly in low-income countries. Conflict zones like Syria, already plagued by political and socioeconomic instability, faced additional hardships, resulting in a fast collapse of the healthcare system. The overwhelmed system necessitated the implementation of home-based management as a practical solution to alleviate strain on hospitals. This study documents the efforts of a volunteer team during the initial COVID-19 wave in Damascus, Syria (August-September 2020) in implementing management through home visits and evaluates its outcomes in terms of recovery, hospitalization, and mortality. Out of the managed 770 moderate and severe cases, approximately 80% reported full or partial recovery from COVID-19, with only 6.6% experiencing persistently low peripheral blood oxygen levels at follow-up. Nonetheless, 28.6% of patients necessitated hospitalization, 14.5% were admitted to intensive care units, and 15.3% died. Age, masculinity, and cardiac comorbidities were associated with a higher need for oxygen support and led to higher hospitalization and mortality rates. This approach effectively steered most patients toward recovery and facilitated the timely identification and management of critical cases until their transition to hospital care when capacities allowed, proving to be a pivotal asset to the healthcare system in the face of such challenging circumstances.