WHO declared COVID-19 disease to be a public health emergency of international concern, characterized as a pandemic4 which is more than an epidemic. Till date, no drugs or biologics have been approved by the FDA for the prevention or treatment of COVID-19. Numerous other antiviral agents, immunotherapy, and vaccines continue to be investigated and developed as potential therapies. Searching for effective therapies for COVID-19 infection is a complex process5.

In Bangladesh, anecdotally it is said that common patients of COVID-19 did not follow with the WHO guideline. They have been utilizing different modalities of treatments ranging from allopathic treatments to treatment given by unauthorized persons quite often termed as local healers and practitioners. In the recent past, there have been numbers of stories of COVID-19 survivors or warriors in the newspaper and other media. However, it is not clear how the confirmed cases are being treated at home, how they manage to get a consultation from doctors, what medicines they are getting from the Government or if they are procuring medicines on their own, which treatment protocols they follow, what kind of alternative medicines or ancillary services or “POTTHYO” they are getting, what indigenous knowledge they are getting or being practiced, what precautionary measures are being taken by the caregivers at home, etc3.

There is a scarcity of the health service providers (represented by the data that, only 0.3 doctor and 0.17 nurses are there for 1000 people in Bangladesh7).In the country, most of COVID-19 patients prefer home treatments. That is why there has been a need to understand the treatment arrangement, medicines and alternative medicine used commonly in managing COVID-19 patient at home set up. To understand the home-based COVID-19 care and treatment management a qualitative study was conducted between 04 June 2020 to 30 August 2020 interviewing COVID-19 +ve patients who stayed at home and got well and also by interviewing a few providers who helped these patients.

In this study, in-depth interviews (IDIs) were conducted based on the administration of a semi-structured questionnaire (Annex – 1) and an informed consent (Annex – 2) used among the confirmed COVID-19 positive (+ve) patients over telephone. After quite a bit of effort 101 interviews could be completed of which 66.6% respondents were from urban and 33.4% were from rural areas. The interviews were conducted by trained 4 junior female doctors. The objectives of the assessment/study were to investigate:a) What kinds of the treatment regimen, medicines used commonly in treating confirmed COVID-19 patient at home set up; b) Duration of the different drug used by the positive persons; c) Alternative medicine and practices; and “POTTHYO” used in helpingthe recovery of patients; d) Institutional or community or societal mechanism for supporting (or de-stigmatizing) COVID-19 patients in securing the treatment at home; and e) Precautionary measures taken at home so that rest of the family members does not get infected.

The mean age of the respondents was 31.3±10.9 years and most of the respondents were educated as about 63% of the respondents have completed their graduation level of education. The respondents were predominantly Muslims (94%), with 5% being Hindu or the followers of “Sonaton” or indigenous religion and 2% were Catholic Christians. The income levels of the respondents were of moderate quintile. It was found that among the males a large proportion of the COVID-19 +ve patients were doing some kind of a job (private service, Government service, and Police) whereas the females mostly were homemakers and Nurses (Fig –1).

Fever was the most frequent symptoms of our responders, almost 71% of interviewees had a fever during there illness. The second most common symptom was generalized weakness followed by cough and sore throat. Seventeen out of 101 interviewees reported that they had a loss of smell (Table -3) and 23 out of 101 confided that they had suffered from Aguesia (loss of taste).

It was found that on an average the respondents spent Tk. 12, 000 for the cost of medicines etc. during their illness due to COVID-19 (Table -4). The reason for such a huge amount of money had been the high cost of the medicines and at times the specific medicines were not available in the pharmacies.

All of the patients interviewed took Paracetamol followed by different Vitamins such as Vit. C, B and A. In the study antibiotics particularly Azythromycin has been taken by almost 70% of the patients followed by

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Doxycycline in 10% and Chloroquine and Hydroxychloroquine in about 9% of the patients. Very few of the patients mentioned of taking other antibiotics such as Amoxicillin, Levofloxacin and Amoxicillin plus Clavuronic acid etc. In very few cases the positive patients have used hydrocortisone and Ivermectine.

All the participants took precautionary measures and supplementary food besides taking medicine and regular foods. Some participants reported multiple precautionary measures/ practice during the infection period. Hot water gurgling (84%), and steam inhalation (79%), drinking hot water (76%) out to be the most used items by the +ve patients, followed by breathing exercise (35%), free hand exercise (10%) and prone breathing (20%).

There had been lots of challenges in this study of which full address and telephone numbers collection was the biggest one. The positive persons had a lot of questions and at the end, only 101 respondents gave complete interviews.

COVID-19 infection and its scourge are not going away from the country. Common people will continue to suffer and as such everyone should come up with ideas how to alleviate the sufferings of the common people. The recommendations thus coming out of the study is that the Government should have a thorough review of how and what +ve patients are doing while staying at home. The findings of this study will help the Government in taking the next step of doing the national level review and develop future guidelines.

Although Bangladeshi’s are used to a bad habit of obtaining any kind of medicines without prescription also evidenced in this study and as such people should be made aware that many of the medicines taken are un-necessary and have not been proven to be effective in curing COVID-19 and have side effects and, in that case, they should know what steps should be taken.

Taking of vitamins, different kinds of fruits and spices are certainly of no harm but may be some nutritionist could develop a list of the most important and essential ones and those could get on to the national guidelines.

Many of the precautionary measures used by the positive persons are very helpful such as the respiratory exercises but currently not being promoted by the Government. These should get incorporated in detail in the National Guideline for the Care and Management of COVID-19 Infections.