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New Guidelines For Home Isolation Of Mild, Asymptomatic COVID-19 Patients: What You Need To Know

On Wednesday, the Union Health Ministry published revised guidelines for the isolation of mild and asymptomatic COVID-19 patients at home. The government released the revised guidelines on the same day the country reported more than 58,000 cases of COVID-19.

In its latest guidelines, the ministry has clarified the criteria, precautions that patients and their families should observe, and signs that should be monitored and promptly reported to health facilities.

Guidelines For Home Isolation Of Mild, Asymptomatic COVID-19 Patients

Below are the new guidelines for home isolation that apply to patients who have been diagnosed as mild or asymptomatic cases of COVID-19 based on clinical assessment:

What Are The Instructions For COVID Patients?

  • Patients must isolate themselves from other household members.
  • The patient must remain in the designated room and be separated from other people in the residence.
  • Patients, particularly the elderly and patients with co-morbid conditions such as hypertension, cardiovascular disease, renal disease, etc.
  • Patients should be kept in a well-ventilated room with cross ventilation, and windows should be kept open to allow fresh air to enter the room.

What Are Asymptomatic Cases/Mild Cases Of Coronavirus?

  • Patients who are asymptomatic are those who have had their laboratory diagnosis confirmed but are not experiencing any symptoms.
  • Patients have an oxygen saturation at room air of greater than 93 per cent.
  • Mild cases are defined as patients with upper respiratory tract symptoms without fever or shortness of breath and with oxygen saturation at room air above 93 per cent.
  • Who Are Eligible For Home Isolation?

    • A treating physician should consider the patient a mild/asymptomatic case.
    • Individuals with such clinical conditions should have the requisite facilities at their residence for self-isolation and for quarantining family members.
    • A caregiver (ideally someone who has completed his Covid-19 vaccination schedule) should be available 24x7 to provide care.
    • Communication between a caregiver and a medical officer is essential throughout the duration of home isolation.
    • Those older than 60 years of age and those with co-morbid conditions, such as hypertension, diabetes, heart disease, chronic lung/liver/kidney disease, cerebrovascular disease, etc, should only be allowed home isolation after appropriate evaluation by the treating physician.
    • Immunocompromised individuals (HIV patients, recipients of transplants, cancer patients, etc.) should not be placed into home isolation, and should only be allowed to remain at home after proper evaluation by their treating physician.
    • Although a patient is permitted to remain at home in isolation, all members of the family, including other contacts, must follow the home quarantine guidelines.

When To Seek Medical Care?

  • The patient or caregiver will continue to monitor their health. If symptoms or signs of serious illness develop, medical attention should be sought immediately. These could include unresolved high-grade fever (above 100°f for more than three days), breathing difficulties, dip in oxygen saturation (SpO2 = 93% on room air at least three times within one hour) or respiratory rate >24/min, chest pain/pressure that persists, mental confusion or inability to arouse and myalgia and severe fatigue.
  • When To Discontinue Home Isolation?

    • Patients in home isolation will be discharged and let go of their isolation after at least 7 days have passed from the time of their last positive test and after 3 consecutive days without fever. Patients will continue to wear masks until they are discharged and no longer require isolation.
    • After the period of the home isolation has ended, there is no need for retesting.
    • Asymptomatic contacts of infected individuals are not required to undergo a Covid test and monitor health in-home quarantine.
    • What Should You NOT Do?
    • Do not self-medicate, have blood tests conducted, or undergo radiological imaging such as chest X-rays or chest CT scans without first consulting your treating physician.
    • In mild disease, steroids should not be prescribed and should not be self-administered.
    • Overuse or inappropriate use of steroids may lead to additional complications.
    • Each patient's treatment needs to be monitored individually according to their specific medical conditions, which is why generic prescriptions shall not be shared.
    • In the event of a decrease in oxygen saturation or shortness of breath, an individual may require hospitalization. He/she should consult with their treating physician/surveillance team/control room immediately.

Instructions For Care Givers

Mask Guidelines

  • A triple layer medical mask should be worn by the caregiver.
  • When in the same room as someone who is ill, it may be appropriate to wear an N95 mask.
  • The front portion of the mask should not be handled.
  • The mask must be changed immediately if it becomes wet or dirty with secretions.
  • After cutting the mask into pieces and placing it in a paper bag for a minimum of 72 hours, the mask should be discarded.
  • After disposing of the mask, it is important to perform hand hygiene.
  • The individual should avoid touching their own face, nose, or mouth.
  • Hand Hygiene Guidelines

    • Following contact with a sick person or his immediate environment, it is imperative to maintain proper hand hygiene.
    • You should wash your hands for at least 40 seconds with soap and water.
    • If the hands are not visibly soiled, it is possible to use an alcohol-based hand rub.
    • The use of disposable paper towels is recommended after washing your hands with soap and water.
    • Whenever possible, use clean cloth towels and replace them when they become wet.
    • Wash your hands before and after removing gloves.

Exposure To Patients' Environment

  • Avoid contact with body fluids (respiratory, oral secretions, including saliva) of the patient. Wear disposable gloves when handling the patient.
  • Avoid exposing him to potentially contaminated items in his immediate environment (for example, do not share utensils, dishes, drinks, towels or bed linen).
  • Food should be provided to the patient in his room. All utensils and dishes used by the patient should be cleaned with soap/detergent and water while wearing gloves. After proper cleaning, the utensils may be re-used.
  • Always wash hands after removing gloves or handling used items.
  • When cleaning or handling surfaces, clothing or linen belonging to the patient, wear a triple layer medical mask and disposable gloves.
  • Wash hands before and after removing the gloves.
  • Disposal Of Biomedical Waste

    • General wastes such as disposable items such as food packets, fruit peels, used water bottles, left-over food, disposable food plates, etc. should be disposed of in an effective and safe manner.
    • They should be collected in bags tied securely and given to waste collectors.
    • The used masks, gloves and tissues or swabs contaminated with blood/body fluids of Covid-19 patients, as well as used syringes, medicines and other items should be disposed of as biomedical waste by placing the same in a yellow bag and handing them over to the waste collector separately, so as to prevent the spread of infection within the household and the community.
    • Else they can be disposed of by putting them in appropriate deep burial pits which are deep enough to prevent access to rodents or dogs etc.

Treatment In Home Isolation

  • In the event of any deterioration, the patient must remain in contact with the treating physician.
  • Following consultation with the treating physician, the patient must continue taking medications for other co-morbid conditions or illnesses.
  • In cases of fever, running nose and cough, patients should follow symptomatic treatment.
  • Warm water gargles or steam inhalations can be performed by patients three times per day.
  • If fever cannot be controlled with a maximum dose of Tab Paracetamol 650 mg four times a day, consult your physician.
When should a COVID patient seek medical help?

In the following cases, medical attention should be sought immediately:

  1. Unresolved high-grade fever (over 100 F for more than 3 days)
  2. Breathing difficulties
  3. Drop in oxygen saturation (Sp02 * 93% on room air for at least 3 readings within 1 hour) or respiratory rate over 24/min
  4. Pain or pressure in the chest that persists
  5. Confusion or disorientation
  6. Extreme fatigue and myalgia
Who should not be quarantined at home?

For patients older than 60 years of age, those with comorbidities, and those with compromised immune systems, home isolation is not recommended. In accordance with the new rules, it may only be permitted after evaluation by the treating physician.

Who is considered asymptomatic?

A person who has tested positive but is not experiencing any symptoms and has an oxygen saturation of more than 93 per cent at room temperature.

What are mild cases?

A clinically-defined mild case is characterized by upper respiratory symptoms with or without fever, without shortness of breath, and an oxygen saturation level of more than 1% at room temperature.

Should I get tested after home isolation is over?

Retesting is not necessary following the period of home isolation.

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