As India inches closer to reporting 3 million cases, several people who tested positive for COVID-19 are advised home isolation as opposed to getting admitted in any COVID-19 care facilities. The Ministry of Health and Family Welfare has issued specific guidelines for both home quarantine as well as home isolation.
Home isolation is after a person tests positive and is asked to continue treatment from home. Quarantine on the other hand, is for people who have either recently travelled, or are contacts of positive people and are likely to have been exposed to the virus but are not confirmed to be positive. They are asked to follow strict social distancing norms. In quarantine, minimal movement around the house is permitted, but in isolation the person is expected to stay within a confined space even within the house.
In Mumbai, at the beginning of the pandemic, when the cases increased in the slum areas, several positive patients were sent to COVID-19 care centres. After contact tracing, the people at risk were sent to special quarantine facilities. As the number increased in the buildings, the instances of COVID-19 home isolation, increased.
On August 19, Mumbai issued additional home isolation guidelines stating that people over the age of 50 will not be allowed home isolation. "This decision was taken to reduce Mumbai's mortality rate as people with or without co-morbidities in the age group above 50 have been more vulnerable to succumbing to the disease," said Dr. Mangala Gomare, Executive Health Officer, Brihanmumbai Municipal Corporation (BMC).
"Individuals who are asymptomatic, or exhibiting mild and moderate symptoms and have the feasibility and space to be isolated at home, are asked to isolate themselves from their families at home," said Dr. Daksha Shah, Deputy Executive Health Officer, BMC.
The BMC follows the Centre's guidelines while assessing whether a particular individual should follow home isolation or should be sent to an available facility. "As soon as we are notified of a case, the medical officers of the health posts from the specific wards visit with a team and take a detailed medical history. Even if a person does not have co-morbidities, we suggest institutional isolation if others in the family have any health issues," explained Dr.Shah.
Home isolation was also debated in Delhi in the month of June. While the Kejriwal government wanted home isolation for positive COVID-19 patients, the Governor, Lt. Anil Baijal had issued an order that every positive patient irrespective of whether they were asymptomatic, or exhibited mild/moderate symptoms had to visit a COVID-19 care facility. The Kejriwal government was not in support of this rule as they thought it would put an additional strain on the health facilities.
After deliberations, this order was scrapped and the Governor issued an order to permit home isolation. In a statement the LG's office wrote, "for those who test positive through RT-PCR Test, the patient shall be allowed home isolation if, as per the assessment of Home Isolation team sent by the District Surveillance Officer (DSO), the patient is mild/pre-symptomatic/asymptomatic and has a residence of two rooms or a separate room and a separate toilet for the patient. He/she will be provided a contact number for any consultation required by him along with details of CATS Ambulance call number for transfer to hospital in case symptoms develop."
Ministry Rules For Home Isolation
The Ministry of Health and Family Welfare has issued specific guidelines for home isolation which includes the following points:
-The person should be clinically assigned as a very mild/pre-symptomatic/asymptomatic case by the treating medical officer.
-Should have the requisite facility at their residence for self-isolation and also for quarantining the family contacts.
- Should not be immuno-compromised (HIV, Transplant recipients, Cancer therapy etc)
- Should be less than 60 years
- Should not have any co-morbid conditions such as Hypertension, Diabetes, Heart disease, Chronic lung/liver/ kidney disease, Cerebro-vascular disease etc. They shall only be allowed home isolation after proper evaluation by the treating medical officer.
- Should have a care giver who could connect with the hospital for the entire duration of home isolation.
The patients are asked to fill an undertaking on self-isolation and follow home quarantine rules. The positive individuals have to wear a triple- layered mask which should be changed every 8 hours and stay isolated in a designated area far away from the other members of the house. Following basic hand hygiene, along with cleaning surfaces that they touch is another home isolation guideline.
The patients are also expected to download the Aarogya Setu app. Along with this, the individuals are asked to self- monitor their health by monitoring their temperature daily. The medical officers are expected to follow up with the patients and track symptoms.
"If at any time during the home isolation, the medical officer feels that the health of the person is deteriorating or that there are chances of them transmitting the virus, the medical officer will ask the person to move into any of the institutions," concluded Dr. Shah.
After a period of 10 days, if the symptoms subside, the patients are expected to further quarantine for 7 days. An RT-PCR test is not mandatory to check if the patient has tested negative.