home isolation. ‘Home isolation only on doctors orders’

The Health Ministry on Thursday came out a fresh set of guidelines for home isolation of those with mild symptoms of Coronavirus or asymptomatic.

The new norms coincide with the rising numbers of Covid infections and health infrastructure being stretched to the limits in many places.

As the conditions of patients are rapidly worsening during the course of infection, the government wanted each patient going for home isolation to be clinically assigned by a treating doctor as mild case or asymptomatic. While asymptomatic cases are laboratory confirmed cases not experiencing any symptoms and having oxygen saturation at room air of more than 94 per cent. Clinically assigned mild cases are patients with upper respiratory tract symptoms, irrespective of having fever or not but without shortness of breath and having oxygen saturation at room air of more than 94 per cent.

“Elderly patients aged more than 60 years and those with co-morbid conditions such as hypertension, diabetes, heart disease, chronic lung/liver/ kidney disease and cerebro-vascular disease shall only be allowed home isolation after proper evaluation by the treating medical officer,” the Health Ministry said while further adding that patients suffering from immune- compromised status like HIV, transplant recipients, or those undergoing cancer therapy are not recommended for home isolation and shall only be allowed home isolation after proper evaluation by a medical specialist.

It also advised caregivers and all close contacts of mild or asymptomatic cases to take “Hydroxychloroquine prophylaxis” as per protocol and as prescribed by the treating medical officer.

The Health Ministry has insisted that patients should at all times use triple layer medical mask and discard mask after eight hours of use or earlier if they become wet or visibly soiled. In the event of care giver entering the room, both care giver and patient should be wearing an N95 mask. Mask should be discarded only after disinfecting it with 1 per cent sodium hypochlorite solution.

“Self monitoring’

The ministry has advised such patients to do self-monitoring of blood oxygen saturation with a pulse oximeter, temperature etc and other symptoms every four hours.

For those who are home isolated, if fever is not controlled with a maximum dose of Paracetamol 650mg tablet four times a day, they must consult the treating doctor to step the treatment.

The decision to administer Remdesivir or any other investigational therapy must be taken by a medical professional and administered only in a hospital setting,” the ministry added.

‘ Only in hospital setting’

The government has cautioned against procuring or administering Remdesivir at home. “Systemic oral steroids not indicated in mild disease. If symptoms persist beyond 7 days (persistent fever, worsening cough etc.) consult the treating doctor for treatment with low dose oral steroids. In case of falling oxygen saturation or shortness of breath, the person should require hospital admission and seek immediate consultation of their treating physician/surveillance team,” the guidelines said.

Immediate medical attention must be sought if serious signs or symptoms develop which could include difficulty in breathing, dip in oxygen saturation (SpO2 < 94 per cent on room air), persistent pain/pressure in the chest, mental confusion or inability to arouse.

“Patient under home isolation will stand discharged and end isolation after at least 10 days have passed from onset of symptoms (or from date of sampling for asymptomatic cases) and no fever for three days. There is no need for testing after the home isolation period is over,” the ministry further added.

Furthermore, states and districts should monitor all cases under home isolation and details about patients under home isolation should also be updated on Covid-19 portal and facility app (with DSO as user). Senior State and District officials should monitor the records updation. All family members and close contacts shall be monitored and tested as per protocol by the field staff, as per the guidelines.

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