New Delhi: The Ministry of Health & Family Welfare has issued revised guidelines for home isolation of mild/asymptomatic COVID-19 patients.
Since a majority of cases are either asymptomatic or have very mild symptoms and usually recover with minimal interventions, they can be managed at home under proper medical guidance and monitoring.
The guidelines say such cases should have the requisite facility at their residence for self-isolation and for quarantining the family contacts. A caregiver (ideally who has completed his vaccination schedule) should be available 24 x7. A communication link between the caregiver and a doctor is a prerequisite for the duration of home isolation.
Patients eligible for home isolation are those who are clinically assigned as mild/ asymptomatic cases by the doctor. Patients suffering from immune-compromised status (HIV, Transplant recipients, Cancer therapy etc.) are not recommended home isolation and shall only be allowed so only after proper evaluation by the treating medical officer.
While in home isolation, the patient must isolate himself from other household members, stay in the identified room and away from other people, especially the elderly and those with co-morbid conditions. He/she should stay in a well-ventilated room with cross ventilation and windows should be kept open to allow fresh air to come in. The patient should at all times use a triple-layer medical mask. They should discard the mask after eight hours of use or earlier if the mask becomes wet or is soiled. Both caregiver and patient may preferably consider using an N-95 mask. Mask should be discarded after cutting them to pieces and putting them in a paper bag for a minimum of 72 hours.
The patient must take rest and drink a lot of fluids to maintain adequate hydration, follow respiratory etiquettes at all times, undertake frequent hand washing with soap and water for at least 40 seconds or clean with an alcohol-based sanitiser.
The patient shall not share personal items including utensils with other people in the household. It is needed to ensure cleaning of frequently touched surfaces in the room (tabletops, doorknobs, handles, etc.) with soap/detergent and water. It can be undertaken duly following required precautions such as the use of masks and gloves.
Patients may perform warm water gargles or take steam inhalation thrice a day. If fever is not controlled with a maximum dose of Paracetamol 650 mg four times a day, the doctor is to be consulted.
Self-monitoring of blood oxygen saturation with a pulse oximeter for the patient is advised. The patient shall self-monitor his/her health with daily temperature monitoring and report promptly if any deterioration of symptom is noticed. The status shall be shared with the treating Medical Officer as well as surveillance teams/Control room.
Precautions for family members
It has been advised to avoid direct contact with body fluids (respiratory, oral secretions including saliva) of the patient by family members or caregivers. Use of disposable gloves while handling the patient is also advised. Food must be provided to the patient in his room.
Utensils and dishes used by the patient should be cleaned with soap/detergent and water while wearing gloves. The utensils may be re-used after proper cleaning. Triple-layer medical masks and disposable gloves should be used while cleaning or handling surfaces, clothing or linen used by the patient.
The guidelines say effective and safe disposal of general wastes such as disposable items, used food packets, fruit peel offs, used water bottles, left-over food, etc. should be ensured. They should be collected in bags securely tied for handing over to waste collectors. Further, the used masks, gloves and tissues or swabs contaminated with blood/body fluids of patients, including used syringes, medicines, etc., should be treated as biomedical waste and disposed of by collecting the same in a yellow bag and handed over to waste collector separately so as to prevent further spread of infection. Else they can be disposed of by putting them in appropriate deep burial pits which are deep enough to prevent access to rodents or dogs etc.
Information floating through social media mentioning non-authentic and non-evidence-based treatment protocols can harm patients. Misinformation leads to panic and in turn undertaking tests and treatment, which are not required has to be avoided, the advisory says.
It further says, “Do not rush for self-medication, blood investigation or radiological imaging like chest X-ray or chest CT scan without consultation of your treating Medical Officer. Steroids are not indicated in mild disease and shall not be self-administered. Overuse and inappropriate use of steroids may lead to additional complications. Generic sharing of prescriptions shall be avoided. In case of falling oxygen saturation or shortness of breath, the person may require hospital admission and shall seek immediate consultation of their treating Medical Officer/surveillance team /Control room.”
Serious signs or symptoms include unresolved high-grade fever (more than 100° F for more than 3 days), difficulty in breathing, dip in oxygen saturation (SpO2 ≤ 93% on room air at least 3 readings within 1 hour) or respiratory rate >24/ min, persistent pain/pressure in the chest, mental confusion or inability to arouse severe fatigue and myalgia.
Role of administration
The district administration concerned, under the overall supervision of the State Health Authority, shall be responsible for monitoring the patient under home isolation. Surveillance Teams (ANM, Sanitary inspector, MPHW etc) shall be responsible for the initial assessment of the patient and whether the requisite facilities are there for home isolation. The health worker should contact the patient daily preferably in-person or over telephone/ mobile and obtain the details of temperature, pulse, oxygen saturation, patient overall wellness and worsening of signs/ symptoms. The Surveillance Team may provide Home Isolation Kits to the patient/ caregiver as per the policy of the State Government. The Kit may contain masks, hand sanitisers, paracetamol along with a detailed leaflet to educate patients and family members in the local language. If there is reported worsening of signs/ symptoms and/or fall in oxygen saturation, the team shall re-assess the patient and inform the Control Room for shifting the patient to the hospital.
District and sub-district control rooms will be made operational and their telephone numbers should be well publicised so that people under home isolation may contact the control rooms for seamless transfer of patients through ambulance from home to the dedicated hospital. These Control Rooms shall also make outbound calls to the patients under home isolation to monitor their status. The district administration has been asked to monitor all cases under home isolation on a daily basis.
Patients under home isolation will stand discharged and end isolation after at least 7 days from testing positive and no fever for 3 successive days and they shall continue wearing masks. There is no need for re-testing after the home isolation period is over. Asymptomatic contacts of infected individuals need not undergo COVID test and monitor health in home quarantine.