Home Based Ventilator Support during Covid-19 Pandemic: A Double-Edged Sword

Data from SARS outbreak due to corona virus 1 has shown that high viral load during transmission was associated with poor clinical outcome (1). Zou et al has reported comparable viral load in throat and nasopharyngeal swab of symptomatic and asymptomatic covid-19 patients suggesting noninvasive ventilation (NIV) induced aerosolization of secretion from asymptomatic patients will pose similar risk of viral transmission to household contact of the Covid-19 patients.(2). WHO has listed noninvasive ventilation including CPAP therapy as highly aerosol generative intervention putting healthcare workers and caregiver of patient at risk of contracting the disease. Recent guidelines regarding home based ventilatory support has tried to balance the risk associated with stopping the support against risk of transmission to family members and caretakers (4, 5) we need to discuss this issue broadly in context of covid19 outbreak.