Centre issues revised guidelines for home isolation of mild, asymptomatic COVID-19 cases

Amid a surge in coronavirus cases in India that resulted in a shortage of beds, the oxygen supply in hospitals, and isolation centers, the Union health ministry on Thursday revised the home isolation guidelines of mild and asymptomatic Covid-19 patients. As per the guidelines, mild and asymptomatic patients have been recommended for home isolation, an official statement said. Also Read | Coronavirus India: PM Narendra Modi a ‘super-spreader’ of COVID-19, says IMA Vice President Complete guidelines for home isolation as released by the health ministry: Patients eligible for home isolation

• The patient should be clinically assigned as mild/ asymptomatic case by the treating Medical Officer.
• Such cases should have the requisite facility at their residence for self-isolation and for quarantining the family contacts.
• A caregiver should be available to provide care on a 24 x7 basis. A communication link between the caregiver and hospital is a prerequisite for the entire duration of home isolation.
• 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.
• 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.
• The caregiver and all close contacts of such cases should take Hydroxychloroquine prophylaxis as per the protocol and as prescribed by the treating medical officer.

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• The patient must isolate himself from other household members, stay in the identified room, and away from other people in a home, especially elderlies and those with co-morbid conditions like hypertension, cardiovascular disease, renal disease, etc.
• 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.
• The patient should at all times use a triple-layer medical mask. Discard masks after 8 hours of use or earlier if they become wet or visibly soiled. In the event of a caregiver entering the room, both the caregiver and the patient may consider using N 95 mask.
• Mask should be discarded only after disinfecting it with 1% Sodium Hypochlorite.
• A patient must take rest and drink lot of fluids to maintain adequate hydration.
• Follow respiratory etiquette at all times.
• Frequent handwashing with soap and water for at least 40 seconds or clean with an alcohol-based sanitizer.
• Don’t share personal items with other people in the household.
• Ensure cleaning of surfaces in the room that are touched often (tabletops, doorknobs, handles, etc.) with 1% hypochlorite solution.
• Self-monitoring of blood oxygen saturation with a pulse oximeter is strongly advised.
• The patient will self-monitor his/her health with daily temperature monitoring and report promptly if any deterioration of symptoms as given below is noticed.

Treatment for patients with mild /asymptomatic disease in home isolation

• Patients must be in communication with a treating physician and promptly report in case of any deterioration.
• Continue the medications for other co-morbid illness after consulting the treating physician.
• Patients to follow symptomatic management for fever, running nose and cough, as warranted.
• Patients may perform warm water gargles or take steam inhalation twice a day.
• 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 a non-steroidal anti-inflammatory drug (NSAID) (ex: Tab. Naproxen 250 mg twice a day).
• Consider Tab Ivermectin (200 mcg/kg once a day, to be taken empty stomach) for 3 to 5 days.
• Inhalational Budesonide (given via inhalers with spacer at a dose of 800 mcg twice daily for 5 to 7 days) to be given if symptoms (fever and/or cough) are persistent beyond 5 days of disease onset.
• 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.
• 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 from their treating physician/surveillance team.

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• Patient/caregiver will keep monitoring their health. Immediate medical attention must be sought if serious signs or symptoms develop. These could include. Difficulty in breathing.
• Dip in oxygen saturation (SpO2 < 94% on room air)
• Persistent pain/pressure in the chest,
• Mental confusion or inability to arouse.

When to discontinue home isolation Patients under home isolation will stand 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 no fever for 3 days. There is no need for testing after the home isolation period is over. These were the revised guidelines for home isolation. Click here to follow PTC News on Twitter -PTC News