Home isolation is now an option for pre-symptomatic, mild cases

Govt. move comes as hospitals shift asymptomatic patients to quarantine facilities

06/05/2020, SPECIAL CORRESPONDENT ,CHENNAI

Fire station personnel disinfecting a street in Chennai.

In accordance with the guidelines of the Indian Council of Medical Research, patients who have been clinically categorised as having a very mild or pre-symptomatic coronavirus disease (COVID-19) would have the option of home isolation, provided they have the necessary facilities at their residence. They would have to submit an undertaking that they will adhere to self-isolation norms.

Based on a proposal of the Directorate of Public Health and Preventive Medicine, the government has issued an order, setting out guidelines for home isolation of very mild/pre-symptomatic COVID-19 cases. This comes at a time when hospitals across the city are shifting asymptomatic and stable patients to quarantine facilities to free up beds for those in need of treatment.

Eligibility criteria

People who are suspected to have symptoms of COVID-19 and are awaiting test results, as well as confirmed cases, are currently being isolated and managed in hospitals with the intention of breaking the chain of transmission. During the containment phase, patients should be clinically categorised as cases that are very mild/mild, moderate or severe, and treated accordingly in health facilities, the G.O. said.

The patients should be clinically categorised as very mild cases/pre-symptomatic cases by the treating medical officer. They should have requisite facilities at their residence for self-isolation and quarantining family members, and a well-ventilated single-room, preferably with an attached/separate toilet.

A caregiver should be available 24x7, and a communication link between the caregiver and the hospital is a prerequisite for the entire duration of home isolation. The caregiver and all close contacts should take hydroxychloroquine prophylaxis as per protocol and as prescribed by the treating medical officer. The patient and the caregiver should be given a course of zinc and vitamin C/multivitamin tablets for 10 days, apart from the herbal concoctions nilavembu kudineer and kabasura kudineer.

They should download the Aarogya Setu mobile app, which should remain active at all times through bluetooth and Wi-Fi. The patient should agree to monitor his/her health and inform the District Surveillance Officer/Deputy Director of Health Services about his/her condition for follow-up action, and give an undertaking on adherence to self-isolation and home quarantine guidelines.

Patients should self-monitor their health with daily temperature checks, and report promptly in case of any deterioration of symptoms. They should use a triple-layer medical mask at all times, and discard it after eight hours of use, or earlier if it becomes wet or visibly soiled. Masks should be discarded only after being disinfected.

Patients should stay in the identified rooms and away from others residing in their homes, especially the elderly and those with co-morbid conditions like hypertension, cardiovascular diseases and renal disease. They should follow respiratory etiquette and wash their hands often with soap and water. Their clothes and other linen should be washed and dried separately. Surfaces should be cleaned with disinfectants.

They should restrict their movement within their house, and should not attend any social/religious gatherings. The caregivers too should wear a triple-layer medical mask while in the same room as the patients, and use disposable gloves. They should follow hand hygiene and self-monitor their health.

Both the patient and the caregiver should seek immediate medical attention if they develop the following signs and symptoms — persistent cough/continuous fever of above 102°F/difficulty in breathing, persistent pain/pressure in the chest, mental confusion, inability to arouse the patient, somnolence and poor feeding in children, seizures, decreased urine output, persistent or worsening of initial symptoms beyond 72 hours, and developing bluish discolouration of lips/face.

The home isolation will come to an end once the symptoms are clinically resolved and a medical officer certifies that the patient is free of infection after laboratory testing.