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Thursday, July 09, 2020

Explained: Govt’s guidelines for home isolation of mild and pre-symptomatic Covid-19 patients

Coronavirus (COVID-19): The government has revised its guidelines to allow mild or pre-symptomatic patients to opt for self-isolation at their homes. Who is eligible? What are the dos and dont's for the patient?

By: Explained Desk | New Delhi | Updated: April 28, 2020 7:31:27 pm
Explained: Govt's guidelines for home isolation of mild and pre-symptomatic Covid-19 patients At a quarantine centre in Uttar Pradesh during the nationwide lockdown imposed in the wake of the Covid-19 pandemic. (Express Photo: Vishal Srivastav)

The Ministry of Health and Family Welfare has revised its guidelines for home isolation of very mild or pre-symptomatic Covid-19 patients.

Earlier, in April, The Indian Express had reported that the government was considering a change in its policy, limiting hospitalisation to patients who really needed it in order to rationalise the use of hospital beds. The decision to keep patients facing milder symptoms at home was also considered to help lower the risk of infection for frontline workers.

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All suspected and confirmed Covid-19 cases are currently being isolated and managed in a hospitalised setting. As per the existing guidelines, cases should first be clinically assigned as mild, moderate or severe and accordingly be admitted either to a Covid-19 care centres, dedicated health care centres or hospitals.

The revised guidelines allow mild or pre-symptomatic patients to opt for self-isolation at their homes. Pre-symptomatic patients can transmit the infection before the onset of symptoms.

Covid-19: Who is eligible for home isolation?

The following people are eligible for home isolation:

i. The person should be clinically assigned as a very mild case/ pre-symptomatic case by the treating medical officer

ii. Such cases should have the requisite facility at their residence for self-isolation and also for quarantining the family contacts

iii. A caregiver should be available to provide care on a 24×7 bases. A communication link between the caregiver and hospital is a prerequisite for the entire duration of home isolation

iv. The caregiver and all close contacts of such cases should take Hydroxychloroquine prophylaxis as per protocol and as prescribed by the treating medical officer

v. Patients are also required to download the Arogya Setu App on their mobile phones

vi. The patient shall agree to monitor his health and regularly inform his health status to the District Surveillance Officer for further follow up by the surveillance teams

vii. The patient will fill in an undertaking on self-isolation and shall follow home quarantine guidelines.

When should mild or pre-symptomatic patients seek medical attention?

Mild or pre-symptomatic Covid-19 patients should seek medical attention if they have difficulty in breathing, feel a persistent pressure or pain in the chest, experience mental confusion or inability to arouse, in case they develop bluish colouration of the lips or the face, or if advised by their treating medical officer.

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When can home isolation be discontinued?

Covid-19 patients can end home isolation when their symptoms are clinically resolved and their surveillance medical officer certifies them free of infection after laboratory testing.

Do’s and don’ts for Covid-19 patients in home isolation

Patients should at all times use a triple layer medical mask. Discard mask after 8 hours of use or earlier if it becomes wet or visibly soiled.

Mask should be discarded only after disinfecting it with 1 per cent Sodium Hypo-chlorite.

Patients must stay in the identified room and away from others at home, especially elderly people and those with co-morbid conditions like hypertension, cardiovascular disease, renal disease etc.

The patient must take rest and drink a lot of fluids to maintain adequate hydration.

The patient must follow respiratory etiquette; wash hands often with soap and water for at least 40 seconds or clean with alcohol-based sanitizer.

The patient should not share personal items with others.

Surfaces in the room occupied by the patient that are touched often (tabletops, doorknobs, handles, etc) should be cleaned with a 1 per cent hypochlorite solution.

The patient must strictly follow the physician’s instructions and medication advice. The patient will self-monitor his/her health with daily temperature monitoring and report promptly if he develops any deterioration of symptoms.

Home isolation instructions for caregivers

Masks: The caregiver should wear a triple layer medical mask appropriately when in the same room with the ill person. The front portion of the mask should not be touched or handled during use. If the mask gets wet or dirty with secretions, it must be changed immediately. Discard the mask after use and perform hand hygiene after the disposal of the mask. He/she should avoid touching his/her own face, nose or mouth.

Hand hygiene: This must be ensured following contact with an ill person or his immediate environment. Hand hygiene should also be practiced before and after preparing food, before eating, after using the toilet, and whenever hands look dirty. Use soap and water for handwashing at least for 40 seconds. Alcohol-based hand rub can be used if hands are not visibly soiled.

After using soap and water, the use of disposable paper towels to dry hands is desirable. If not available, use dedicated clean cloth towels and replace them when they become wet.

Exposure to the patient: Avoid direct contact with the body fluids of the patient, particularly oral or respiratory secretions. Use disposable gloves while handling the patient. Perform hand hygiene before and after removing gloves.

Avoid exposure to potentially contaminated items in his immediate environment (e.g. avoid sharing cigarettes, eating utensils, dishes, drinks, used towels, or bed linen).

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 wearing gloves. The utensils and dishes may be re-used. Clean hands after taking off gloves or handling used items.

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Use a triple layer medical mask and disposable gloves while cleaning or handling surfaces, clothing, or linen used by the patient. Perform hand hygiene before and after removing gloves.

The caregiver will make sure that the patient follows the prescribed treatment.

The caregiver and all close contact will self-monitor their health with daily temperature monitoring and report promptly if they develop any symptom suggestive of Covid-19 (fever/cough/difficulty in breathing).

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