Clinical Outcomes of a Pathophysiology-informed Home-care Approach during the COVID-19 Delta Wave: A Prospective Observational Study in Primary Care

Introduction: During the COVID-19 delta wave, healthcare systems in India were overwhelmed, necessitating large-scale home-based management. Standard domiciliary kits primarily focused on symptomatic relief, with limited attention to key pathophysiological mechanisms such as early inflammation and COVID-associated coagulopathy. This study evaluated clinical outcomes associated with a pathophysiology-informed home-care regimen. Methodology: A prospective observational study was conducted in a primary care setting in Andhra Pradesh, India, during April–May 2021. Sixty consecutive adults with mild severe acute respiratory syndrome coronavirus 2 infection received a home-care regimen comprising aspirin (150 mg daily for 28 days), along with prednisolone (10 mg twice daily) and azithromycin (250 mg twice daily) for 7 days. Outcomes were compared with 60 contemporaneous family-member controls managed at government facilities using standard care (doxycycline, ivermectin, and paracetamol). Patients were followed up virtually for 14 days. Primary outcomes included symptom resolution and hospitalization. Results: In the study group, 59/60 (98.3%) patients achieved symptom resolution within 7 days, with 1 (1.7%) requiring hospitalization. In the control group, 8/60 (13.3%) required hospitalization due to worsening hypoxemia (odds ratio: 0.11, 95% confidence interval: 0.01–0.91; P = 0.02). Persistent symptoms at day 14 were less frequent in the study group (13.3% vs. 63.3%; P < 0.001). Conclusions: This observational study documented differences in clinical outcomes during the delta wave. However, selection bias, use of family member controls, and nonrandomized design limit causal inference. These findings reflect crisis-era clinical decision-making and do not support deviation from current evidence-based guidelines.