Government announces home isolation guidelines

Udupi, July 02: The guideline for home isolation of COVID-19 cases has been issued by Ministry of Health and Family Welfare- Government of India. In view of evolving situation of COVID-19 in the state, the following guidelines are issued:

• Only those who are asymptomatic or mild symptomatic shall be allowed to be in isolation at home
• They shall be oriented to the protocol of home isolation
• Health team from district health authority/ BBMP shall visit the house and assess its suitability for home isolation and also do triage of the patient.
• Tele-consultation link shall be established for initial triage and daily follow-up of the patient during the entire period of home isolation
• The patient shall report to the physician/ health authorities about their health status every day
• The patient shall have pulse oximeter, digital thermometer and personal protective equipment (facemasks, gloves) to be used during home isolation.
• The release of the patient home isolation shall be as per the existing discharge protocol of the state for COVID-19 (vide below sl no.10)
• The home isolation shall be with the knowledge of the family members, neighbours, treating physician and local health authorities.

1. Initial assessment and triage of patient by health team at patient’s house

• After receipt of positive report, the patient shall isolate himself/herself at home in a separate room. Health team shall visit and assess the suitability of the house for isolation of the patient at home and also do triage of the patient
• Ask regarding following symptoms: Fever, cold, cough, throat pain, difficulty in breathing, etc.
• The health staff shall assess the following parameters (Triage)
• Thermal scanning for fever
• Pulse oximetry for SpO2 and pulse rate
• Glucometer for random blood sugar
• BP apparatus for blood pressure recording
• Enquire for co-morbidities like hypertension, diabetes, severe obesity, thyroid disease, cancer, kidney diseases including patients on dialysis, heart diseases, stroke, Tuberculosis, People living with HIV, immune-compromised, on steroids and immune-suppressants,  etc.
• Arrange a tele-consultation call for initial assessment (Swasth App)
• For further daily follow-up of the patient, tele-consultation through government or private hospital shall be arranged as desired by the patient.

• The person shall be clinically assigned as asymptomatic/mild case by the treating medical officer/ physician
• Such cases should have the requisite facility at their residence for self-isolation and also for quarantining the family contacts
• A caregiver should be available to provide care on a 24 x7 basis. A regular communication link between the caregiver and hospital is a pre-requisite for the entire duration of home isolation
• Oxygen saturation should be ≥ 95%
• Age shall be less than 50 years
• If the patient has the following co-morbidities- Hypertension, diabetes, obesity, thyroid disease; they shall be well managed and under good clinical control as assessed by medical officer/physician
• Shall not have any comorbid conditions like kidney diseases including patients on dialysis, heart diseases, stroke, Tuberculosis, cancer, People living with HIV, immune- compromised, on steroids and immune-suppressants, etc.
• The patient shall agree to monitor his/her health and regularly inform their health status to the physician and District Surveillance Officer (DSO) for further follow up by the surveillance teams.
• The patient shall provide a signed undertaking on self-isolation (Annexure I) and follow guidelines of home isolation
• Home isolation shall not be applicable for pregnant women. However, lactating mothers shall be allowed for home isolation after assessment and instructions.

Separate well ventilated room for the person in isolation, preferably with attached toilet.

The patient shall stay in the identified room and away from other persons in the home (especially the elderly and those with comorbid conditions like hypertension, cardiovascular disease, renal disease, etc.).

(If the patient does not fit to the above criteria for home isolation or the house is not suitable for home isolation, then isolation at a facility (CCC/DCHC/DCH) is recommended)

Further medical advice shall be immediately sought if the following symptoms and signs develop;

• Difficulty in breathing
• Persistent pain/pressure in the chest
• Mental confusion or inability to arouse
• Developing bluish discolorations of lips/face
• Oxygen saturation ≤ 94% using fingertip pulse oximeter
• Any other symptom the person considers serious
• as advised by treating physician

Ensure strict enforcement of isolation of patient at home

• Home isolation notice shall be pasted on the front door of the house
• Hand stamping shall be done for the patient in home isolation for a duration of 17 days
• E-tag band shall be put on to the left wrist. This shall alert any violation by the patient to the protocol of home isolation
• Information to two neighbours regarding isolation of patient at home
• Three member team in the ward/ village/ booth level/ resident welfare or apartment owners’ association shall oversee compliance of the patient to isolation at home
• If the patient is found violating the protocol of home isolation, then the ‘flying Squad, shall issue a warning and if there is any further violation, an FIR shall be filed and he/she shall be shifted to CCC.
• IVRS outbound calls through Apthamitra helpline (14410) shall be made to the patient on a daily basis

The caregiver and all close contacts of such cases shall take Hydroxychloroquine prophylaxis as per protocol and as prescribed by the treating medical officer/physician

Telephonically or using tele-consultation mode, check the patient for development of new symptoms or fever or deterioration in oxygen saturation (<94%) at least once daily

Gloves, masks, and other waste generated during home isolation shall be placed into a waste bin with a lid in the patient’s room before disposing of it as infectious waste. The disposal of infectious waste shall be the responsibility of the local municipal authority

Inform the neighbours to be kind to the person in isolation and the family and not to stigmatise

• The patient shall wear N-95/medical facemask at all times. The mask shall be discarded after 8 hours of use or earlier if they become wet or visibly soiled.
• Mask shall be discarded only after disinfecting it with 1% Sodium Hypo-chlorite solution
• The patient must stay in the identified room only and maintain a physical distance of 2 meters/ 6 feet from other people in the home, especially elderly and those with comorbid conditions like hypertension, cardiovascular disease, renal disease etc.
• The patient shall take rest and drink a lot of fluids to maintain adequate hydration. Drink at least 2 litres of water per day. Use boiled and cooled water for drinking.
• Shall follow cough etiquettes at all times
• Hands shall be washed often with soap and water for at least 40 seconds or clean with an alcohol-based sanitizer.
• Do not share personal items like utensils, towels, etc. with other family members. Keep them separate.
• Clean surfaces in the room that are touched often (table-tops, doorknobs, handles, etc.) with 7% Lysol or 1% sodium hypochlorite solution
• Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, followed by 1% sodium hypochlorite solution.
• The patient shall strictly follow the physician’s instructions and medication advice.
• The patient shall self-monitor his/her health with a fingertip pulse oximeter and digital thermometer daily
• The patient shall report promptly if he/she develops any worsening of symptoms, as mentioned above (Sl no. 4)
• Smoking, chewing tobacco and alcohol intake shall be strictly avoided
• The patient shall receive counselling services when necessary
• Download Arogya Setu App on mobile (available at https://www.mygov.in/aarogya- setuapp/) and it should remain active at all times (through Bluetooth and Wi-Fi)

• The caregiver shall wear N-95/medical facemask appropriately when in the same room with the ill person. The front portion of the mask should not be touched or handled during use.
• If the mask gets wet or dirty with secretions, it shall be changed immediately. Discard the mask after use and perform hand hygiene after disposal of the mask into separate closed bin.
• He/she shall avoid touching eyes, nose or mouth.
• Hand hygiene shall be ensured following contact with the patient.
• Hand hygiene shall be practised before and after preparing food, before eating, after using the toilet, and whenever hands look dirty. Use soap and water for handwashing at least for 40 seconds. Alcohol-based hand rub can be used if hands are not visibly soiled.
• After using soap and water, use of disposable paper towels to dry hands is desirable.
• Exposure to a patient: Avoid direct contact with body fluids of the patient, particularly oral or respiratory secretions. Use disposable gloves while handling the patient. Perform hand hygiene before and after removing gloves.
• Avoid exposure to potentially contaminated items (e.g. avoid sharing food, utensils, dishes, drinks, used towels or bed linen).
• Food must be provided to the patient in his/her room.
• Utensils and dishes used by the patient shall be cleaned with soap/detergent and water wearing gloves. The utensils and dishes may be re-used—clean hands after taking off gloves or handling used items.
• Patient’s clothes, bed linen, and bath and hand towels shall be washed using regular laundry soap and water or machine wash at 60–90 °C (140–194 °F) with common household detergent, and sun dry thoroughly
• Gloves and protective clothing (e.g. plastic aprons) shall be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Single-use gloves shall be used and discarded after each use. Perform hand hygiene before putting on and after removing gloves.
• The caregiver shall make sure that the patient follows the prescribed treatment.
• The caregiver shall ensure counselling services to the patient whenever necessary.
• The caregiver and all close contacts will self-monitor their health with daily temperature monitoring and report promptly if they develop any symptom suggestive of COVID-19 (fever, cough, cold, sore throat, difficulty in breathing, etc.)

• Do not panic. Do not stigmatise.
• Keep the patient cheerful and boost their morale
• Ensure that the person is in strict home isolation
• Maintain a physical distance of at least 2 metres/ 6 feet
• Visitors should not be allowed until the patient has completely recovered and has no signs or symptoms of COVID-19
• Remember, the fight is against the disease and not the person
• For any assistance, please call Apthamitra helpline – 14410

• Do not panic. Do not stigmatise.
• Support them by providing essential items like medicines, rations, vegetables, etc. until they get cured as may be required
• Keep a vigil on them to ensure strict home isolation.
• Maintain a physical distance of 2 metres/6 feet.
• Remember, the fight is against the disease and not the person
• For any assistance, please call Apthamitra helpline – 14410

• No symptoms
• No fever (recorded temperature ≤ 37.50C or ≤99.50 F )
• Maintains saturation above 95%
• Respiratory rate less than 24 per minute