Covid Home Isolation Guidelines: Department of Health issues revised home isolation guidelines for mild and asymptomatic Covid-19 patients; Key points | India News

NEW DLEHI: The Union Ministry of Health on Wednesday released revised guidelines for the home isolation of mild and asymptomatic Covid-19 patients.
In its updated directive, the ministry clarified the criteria, the precautions that should be followed by these patients and their families, the signs that require monitoring and prompt reporting to health facilities.
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These are the guidelines that apply to patients of Covid-19 who have been clinically evaluated and classified as mild / asymptomatic cases of Covid-19-
What are asymptomatic / mild cases of coronavirus
  • Asymptomatic cases are laboratory-confirmed cases that do not show any symptoms.
  • The patients have an oxygen saturation in the ambient air of more than 93%.
  • Clinically assigned mild cases are patients with upper respiratory tract symptoms with or without fever, without shortness of breath, and with ambient oxygen saturation greater than 93%.

Who are eligible for home isolation

  • The patient should be clinically classified as mild / asymptomatic by the attending physician.
  • Such cases should have the necessary facilities at their residence for self-isolation and for quarantining family contacts.
  • A caregiver (ideally someone who has completed their Covid-19 vaccination schedule) should be available to provide 24/7 care.
  • A communication link between the caregiver and a medical consultant is a prerequisite for the entire duration of home isolation.
  • Patients over the age of 60 and those with comorbidities such as hypertension, diabetes, heart disease, chronic lung / liver / kidney disease, cerebrovascular disease, etc. will only be allowed to be isolated at home after an appropriate assessment by the attending physician.
  • Immunocompromised patients (HIV, transplant recipients, cancer treatment, etc.) are not recommended for home isolation and will only be allowed home isolation after appropriate assessment by the attending physician.
  • While a patient is allowed to be home isolated, all other family members, including other contacts, should follow home quarantine guidelines.

What are the instructions for patients

  • The patient must isolate himself from other members of the household.
  • Patients should stay in the identified room and away from other people in the house.
  • Patients, especially the elderly and those with co-morbidities such as hypertension, cardiovascular disease, kidney 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 enter.

Use of masks

  • Patients should always use a triple-layered medical mask.
  • They should discard the mask after 8 hours of use or sooner if the mask is wet or visibly soiled.
  • If the caregiver enters the room, the caregiver and patient may preferably consider using an N-95 mask.
  • Masks should be discarded after cutting them into pieces and putting them in a paper bag for at least 72 hours.

Personal care and hygiene

  • The patient should rest and drink plenty of fluids to maintain adequate hydration.
  • Observe respiratory labels at all times.
  • Wash your hands frequently with soap and water for at least 40 seconds or clean them with an alcohol-based hand sanitizer.
  • Patients should not share personal items, including utensils, with other people in the house.
  • Need to ensure cleaning of frequently touched surfaces in the room (tableware, doorknobs, handles, etc.) with soap / detergent and water.
  • Cleaning can be carried out either by the patient or by the caregiver, observing the required precautions such as the use of masks and gloves.
  • Self-monitoring of blood oxygen saturation with a pulse oximeter for the patient is advised.
  • The patient should self-monitor his condition with daily temperature monitoring (as shown below) and promptly report any deterioration of symptoms.
  • The status must be shared with the attending physician as well as with the monitoring / control room teams.

Caregiver instructions

  • The caregiver should wear a triple-layer medical mask.
  • The N95 mask can be considered when you are in the same room as the sick person.
  • The front part of the mask should not be touched or manipulated during use.
  • If the mask is wet or soiled with secretions, it should be changed immediately.
  • Masks should be discarded after cutting them into pieces and putting them in a paper bag for at least 72 hours.
  • Perform hand hygiene after disposing of the mask.
  • He / she should avoid touching his / her face, nose or mouth.

Hand hygiene

  • Hand hygiene should be ensured following contact with a sick person or their immediate environment.
  • Use soap and water to wash your hands for at least 40 seconds.
  • An alcohol-based hand sanitizer can be used if the hands are not visibly soiled.
  • After using soap and water, it is desirable to use disposable paper towels to dry your hands.
  • If they are not available, use dedicated clean cloth towels and replace them when wet.
  • Wash hands before and after removing gloves.

Patient exposure / patient environment

  • Avoid direct contact with bodily fluids (respiratory, oral fluids, including saliva) of the patient. Use disposable gloves when handling the patient.
  • Avoid exposure to potentially contaminated objects in the immediate environment (eg avoiding sharing used kitchen utensils, dishes, drinks, towels or bed linen).
  • Food should be provided to the patient in their room. Utensils and dishes used by the patient should be cleaned with soap / detergent and water while wearing gloves. Utensils can be reused after proper cleaning.
  • Wash hands after removing gloves or handling used items.
  • Use a triple-layered medical mask and disposable gloves when cleaning or handling surfaces, clothing, or linens used by the patient.
  • Wash hands before and after removing gloves.

Disposal of biomedical waste

  • Efficient and safe disposal of general waste such as disposables, used food packages, fruit peels, used water bottles, food scraps, disposable plates, etc. must be assured.
  • They should be collected in securely tied bags for delivery to waste collectors.
  • In addition, used masks, gloves and tissues or swabs contaminated with blood / body fluids from patients with Covid-19, including syringes, drugs, etc. used, must be treated as biomedical waste and disposed of accordingly by collecting it in a yellow bag. and given to the waste collector separately to prevent further spread of infection within the household and community.
  • Otherwise, they can be disposed of by placing them in appropriate burial pits and deep enough to prevent access to rodents or dogs, etc.

Home isolation treatment

  • Patients should be in communication with an attending physician and promptly report any deterioration.
  • The patient should continue medication for other comorbidities / illnesses after consulting the attending physician.
  • Patients should undergo symptomatic management of fever, runny nose, and cough, if necessary.
  • Patients can gargle with lukewarm water or take a steam inhalation three times a day.
  • If the fever is not controlled with a maximum dose of Tab.
  • Paracetamol 650 mg four times a day, consult the attending physician.

Covid and disinformation

  • Information circulating on social media that mentions inauthentic, non-evidence-based treatment protocols can be harmful to patients.
  • Misinformation leads to the creation of panic and in turn undertaking tests and treatments which are not necessary should be avoided.

What you should not do

  • Do not rush for self-medication, blood work, or X-ray imaging such as a chest x-ray or chest CT scan without consulting your doctor.
  • Steroids are not indicated for mild cases and should not be self-administered.
  • The abuse and inappropriate use of steroids can lead to additional complications.
  • The treatment of each patient should be monitored individually according to the specific condition of the patient concerned and, therefore, generic sharing of prescriptions should be avoided.
  • In the event of a decrease in oxygen saturation or shortness of breath, the person may require hospitalization and should immediately consult their attending physician / monitoring team / control room.

When to consult a doctor
The patient / caregiver will continue to monitor their condition. Immediate medical attention should be sought if severe signs or symptoms develop. These could include-

  • High unresolved fever (over 100 ° F for more than 3 days)
  • Difficulty breathing,
  • Decrease in oxygen saturation (SpO2 = 93% on ambient air at least 3 readings in 1 hour) or respiratory rate> 24 / min
  • Persistent pain / pressure in the chest
  • Mental confusion or inability to wake up
  • Severe fatigue and myalgia

When to end home segregation

  • Patients placed in home isolation will be released and end the isolation after at least 7 days after testing positive and without fever for 3 consecutive days and they will continue to wear masks.
  • There is no need to retest once the home isolation period is over.
  • Asymptomatic contacts of infected individuals do not need to undergo a Covid test and home health monitoring in quarantine.

Maria J. Book