Monday, June 14, 2021

Covid-9 Update: Home isolation of mild, asymptomatic Covid cases, Govt revises guidelines

Massive surge in coronavirus cases in the country resulting in shortage of beds, oxygen supply in hospitals, and isolation centers, the Union health ministry on Thursday revised the home isolation rules of mild and asymptomatic Covid-19 patients.

“As per the guidelines, the patients who are clinically assigned to be mild /asymptomatic are recommended for home isolation,” an official statement said.

Here is a complete guide for home isolation as released by health ministry:

Patients eligible for home isolation:

i. The patient should be clinically assigned as mild/ asymptomatic case by the treating Medical Officer.

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

iii. A caregiver should be available to provide care on 24 x7 basis. A communication link between the caregiver and hospital is a prerequisite for the entire duration of home isolation.

iv. Elderly patients aged more than 60 years and those with co-morbid conditions such as Hypertension, Diabetes, Heart disease, Chronic lung/liver/ kidney disease, Cerebro-vascular disease etc shall only be allowed home isolation after proper evaluation by the treating medical officer.

v. Patients suffering from immune-compromised status (HIV, Transplant recipients, Cancer therapy etc.) are not recommended for home isolation and shall only be allowed home isolation after proper evaluation by the treating medical officer.

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

Instructions for the patient:

i. Patient must isolate himself from other household members, stay in the identified room and away from other people in home, especially elderlies and those with co-morbid conditions like hypertension, cardiovascular disease, renal disease etc.

ii. The patient should be kept in a well-ventilated room with cross ventilation and windows should be kept open to allow fresh air to come in.

iii. Patient should at all times use triple layer medical mask. Discard mask after 8 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 may consider using N 95 mask.

iv. Mask should be discarded only after disinfecting it with 1% Sodium Hypochlorite.

v. Patient must take rest and drink lot of fluids to maintain adequate hydration.

vi. Follow respiratory etiquettes at all times.

vii. Frequent hand washing with soap and water for at least 40 seconds or clean with alcohol-based sanitizer.

viii. Don’t share personal items with other people in the household.

ix. Ensure cleaning of surfaces in the room that are touched often (tabletops, doorknobs, handles, etc.) with 1% hypochlorite solution.

x. Self-monitoring of blood oxygen saturation with a pulse oximeter is strongly advised.

xi. The patient will self-monitor his/her health with daily temperature monitoring and report promptly if any deterioration of symptom as given below is noticed.

When to seek medical attention:

Patient / Care giver will keep monitoring their health. Immediate medical attention must be sought if serious signs or symptoms develop. These could include:

i. Difficulty in breathing,

ii. Dip in oxygen saturation (SpO2 < 94% on room air)

iii. Persistent pain/pressure in the chest,

iv. Mental confusion or inability to arouse

Treatment for patients with mild /asymptomatic disease in home isolation:

i. Patients must be in communication with a treating physician and promptly report in case of any deterioration.

ii. Continue the medications for other co-morbid illness after consulting the treating physician.

iii. Patients to follow symptomatic management for fever, running nose and cough, as warranted.

iv. Patients may perform warm water gargles or take steam inhalation twice a day.

v. If fever is not controlled with a maximum dose of Tab. Paracetamol 650mg four times a day, consult

the treating doctor who may consider advising other drugs like non-steroidal anti-inflammatory drug (NSAID) (ex: Tab. Naproxen 250 mg twice a day).

vi. Consider Tab Ivermectin (200 mcg/kg once a day, to be taken empty stomach) for 3 to 5 days.

vii. Inhalational Budesonide (given via inhalers with spacer at a dose of 800 mcg twice daily for 5 to 7days) to be given if symptoms (fever and/or cough) are persistent beyond 5 days of disease onset.

viii. The decision to administer Remdesivir or any other investigational therapy must be taken by a medical professional and administered only in a hospital setting. Do not attempt to procure or administer Remdesivir at home.

ix. 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.

x. 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.

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