The Ministry of Health and Family Welfare (MoHFW), Government of India has recently issued revised guidelines for home isolation of asymptomatic and mild cases of COVID-19.

Background Information:

Asymptomatic cases: Laboratory confirmed COVID-19 cases having oxygen saturation of more than 94% at room air and not experiencing any symptoms.

Clinically assigned mild cases: Laboratory confirmed COVID-19 cases having oxygen saturation of more than 94% at room air with upper respiratory tract symptoms (with/without fever) without shortness of breath.

Recommendations:

Patient eligibility for home isolation

• Patient should be clinically assigned as mild/asymptomatic case by the treating Medical Officer
• Facility for self-isolation and quarantining of family contacts should be available at their residence.
• A care giver should be available 24×7 to provide care.
• There should be a communication link between caregiver and hospital for entire duration of home isolation.
• Caregiver and all close contacts of such cases should take Hydroxychloroquine prophylaxis as per protocol/prescribed by treating Medical Officer.

Home Isolation is to be allowed only after proper evaluation by treating Medical Officer for:

• Elderly patients (age more than 60 years)
• Those with Hypertension, Diabetes, Heart disease, Chronic lung/liver/kidney disease, Cerebrovascular disease, etc.
• Those with immunocompromised status (HIV, Transplant recipients, Cancer therapy, etc.)

Instructions for the Patient

• Patients must isolate themselves from other household members, stay in the identified room and away from other people at home, especially the elderly and those with comorbid conditions (hypertension, diabetes, renal disease, etc.)
• Patients should be in a well-ventilated room with cross ventilation and windows should be kept open to allow fresh air to come in.
• Patients should wear triple layer medical mask at all times. Masks should be discarded after 8 hours of use (earlier if wet or visibly soiled). If caregiver enters the room both patient and caregiver may consider using N95 mask.
• Mask should be discarded only after disinfecting it with 1% Sodium Hypochlorite.
• Patients must drink lot of fluids to maintain adequate hydration and take rest.
• Respiratory etiquette must be followed at all times.
• Personal items should not be shared with other people.
• Hands must be washed with soap and water for at least 40 seconds or should be cleaned with alcohol-based sanitizer.
• Self-monitoring of blood oxygen saturation with a pulse oximeter is strongly advised. Normal SpO2 should be 95% or above. If SpO2 is below 95%, the patient should be immediately referred to the Medical Officer. Do not test on fingers with nail polish to avoid wrong pulse oximeter readings.
• Patients should self-monitor their health with daily temperature monitoring. Any temperature of 100.4 F (38 degree Celsius) or greater is considered as fever.

When to seek Medical Attention (Patients/ Care-Givers)

• Difficulty in breathing
• Unresolved high grade fever (more than 100 F for more than 3 days)
• Dip in oxygen saturation (SpO2 less than 94% on room air at least three readings in one hour) or respiratory rate more than 24 breaths per minute
• Persistent pain/pressure in the chest
• Mental confusion or inability to arouse
• Severe fatigue and myalgia

Instructions for Care-Givers:

• Caregiver(s) should wear a triple layer medical mask. N95 mask may be considered when in the same room with ill person.
• Front portion of the mask should not be touched or handled during use.
• Mask must be changed immediately if it gets wet or dirty with secretions.
• Discard the mask after use and perform hand hygiene after disposal of the mask.
• Avoid touching own face, nose or mouth.

Exposure to Patient/Patient’s Environment:

• Avoid direct contact with body fluids of the patient, particularly oral or respiratory secretions.
• Use disposable gloves while handling the patient.
• Avoid exposure to potentially contaminated items in the patient’s immediate environment (avoid sharing cigarettes, eating utensils, dishes, drinks, used towels, or bed linen).
• Food must be provided to patients in their (respective) rooms. Utensils and dishes used by the patient should be cleaned (wearing gloves) with soap/detergent and water. The utensils and dishes may be re-used.
• Use triple layer medical mask and disposable gloves while cleaning or handling surfaces, clothing, or linen used by the patient. Clean hands after removing gloves or handling used items.

When to Discontinue Home Isolation

End home isolation after

• at least 10 days have passed from 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 period of home isolation is over.

Useful Link:

Link to the Revised Guidelines:

https://www.mohfw.gov.in/pdf/RevisedHomeIsolationGuidelines05012022.pdf