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

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 770 home visits and evaluates its outcomes in terms of recovery, hospitalization, and mortality three weeks after. Out of the moderate and severe cases managed, 81.4% (n = 276) reported full or partial recovery, with only 6.6% (n = 19) persistently experiencing low peripheral blood oxygen levels at follow-up. Nonetheless, 97 patients (28.6%) necessitated hospitalization, 49 (14.5%) were admitted to intensive care units, and 52 (15.3%) died. Age, male gender, and cardiac comorbidities were associated with a higher need for oxygen support and led to higher hospitalization and mortality rates. These home visits 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 significant asset to the healthcare system in the face of such challenging circumstances.