Explained: Asymptomatic contacts not to be tested, isolation at home cut to 7 days

The asymptomatic contacts would not be tested but would be required to monitor their health in home quarantine.

The new guidelines replace those issued on April 29, 2021, under which a patient under home isolation was supposed to be “discharged and end isolation” after “at least 10 days” have passed from the onset of symptoms (or from date of sampling for asymptomatic cases) and has had “no fever for 3 days”. Besides, all family members and close contacts were required to be “monitored and tested”.

Earlier, South Africa, which was among the first countries to report Omicron cases, did away the requirement of quarantine for contacts of people confirmed with the infection, and said contacts would be tested only if they showed symptoms.

The Centers for Disease Control and Prevention in the US has also specified now that testing is not required for a Covid patient to emerge from five days of isolation, while halving the isolation time for cases without symptoms or with mild symptoms, and shortening the quarantine period of their close contacts from 10 days to five.

Issuing the revised guidelines Wednesday, the Health Ministry said: “Over the past two years, it has been seen globally as well as in India that a majority of the cases of Covid-19 are either asymptomatic or have very mild symptoms. Such cases usually recover with minimal intervention and accordingly may be managed at home under proper medical guidance and monitoring.”

The revised guidelines identify asymptomatic cases as “laboratory-confirmed cases who are not experiencing any symptoms and have oxygen saturation at room air of more than 93%”. “Clinically assigned mild cases” are defined as “patients with upper respiratory tract symptoms with or without fever, without shortness of breath and with oxygen saturation at room air of more than 93%”.

In the earlier guidelines, the oxygen saturation threshold for both category of cases was above 94%.

On clinical management of “mild/ asymptomatic cases”, the guidelines say: “The patient should be clinically assigned as mild/ asymptomatic case by the treating Medical Officer. Further a designated control room contact number at the district /sub district level shall be provided to the family to get suitable guidance for undertaking testing, clinical management related guidance, assignment of a hospital bed, if warranted.”

Patients have to maintain a self-health monitoring chart, with details like date and time, temperature, heart rate (from pulse oximeter), SpO2 (from pulse oximeter); and whether their breathing or condition is “better/ same/ worse”.

The district administration is required to monitor the cases under home isolation on a daily basis. The patients must have a “caregiver”, ideally someone who has completed his Covid vaccination.

The guidelines ask people not to rush in for “self-medication, blood investigation or radiological imaging like chest X ray or chest CT scan” without consulting their Medical Officer. They also warn against “overuse” or “inappropriate” use of steroids, saying these were not needed in mild cases and could lead to additional complications.

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The guidelines say “immediate medical attention” must be provided in case of symptoms such as unresolved high-grade fever (more than 100° F for more than three days); difficulty in breathing; dip in oxygen saturation below 93% in room air in at least three readings within an hour or a respiratory rate of above 24/ min; persistent pain/pressure in the chest; mental confusion or inability to respond; and severe fatigue and myalgia (muscle pain).

As per Health Ministry data, India reported 58,097 new cases of Covid-19 in the past 24 hours, taking the active caseload to 2,14,004.