Health ministry releases revised guidelines for home isolation of mild COVID-19 cases

The health ministry on Thursday issued the "Revised guidelines for home isolation of mild/asymptomatic COVID-19 cases", in which it advised against attempting to procure or administer Remdesivir injections at home, underlining that it should be administered only in a hospital setting.

The guidelines stated that systemic oral steroids are not indicated in mild cases and if the symptoms (persistent fever, worsening cough, etc.) persist beyond seven days, the treating doctor should be consulted for treatment with low-dose oral steroids.

Elderly patients aged more than 60 years and those with co-morbid conditions such as hypertension, diabetes, heart disease, chronic lung or liver or kidney disease, cerebrovascular disease, etc. shall only be allowed home isolation after a proper evaluation by the treating medical officer, it added.

In case of falling oxygen saturation levels or shortness of breath, the person should require hospital admission and seek immediate consultation with the treating physician or surveillance team.

Elderly patients aged more than 60 years and those with co-morbid conditions such as hypertension, diabetes, heart disease, chronic lung or liver or kidney disease, cerebrovascular disease etc. shall only be allowed home isolation after a proper evaluation by the treating medical officer.

According to the revised guidelines, the 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 650 mg four times a day, consult the treating doctor, who may consider advising other drugs like non-steroidal anti-inflammatory drug (NSAID) (ex: tab. Naproxen 250 mg twice a day).

"Tab. Ivermectin (200 mcg/kg once a day, to be taken on empty stomach) for 3 to 5 days should be considered," the guidelines stated.

Inhalational Budesonide (given via inhalers with spacer at a dose of 800 mcg twice daily for five to seven days) to be given if the symptoms (fever and/or cough) persist beyond five days, they added.

The decision to administer Remdesivir or any other investigational therapy must be taken by a medical professional and it should be administered only in a hospital setting, the ministry said.

"Do not attempt to procure or administer Remdesivir at home. Systemic oral steroids are not indicated in mild disease. If symptoms persist beyond seven days (persistent fever, worsening cough etc.), consult the treating doctor for treatment with low-dose oral steroids," the guidelines said.

The revised guidelines stated that the asymptomatic cases are laboratory-confirmed cases that are not experiencing any symptoms and having oxygen saturation at room air of more than 94 per cent, while the mild cases are patients with upper respiratory tract symptoms (and/or fever) without shortness of breath and having oxygen saturation at room air of more than 94 per cent.

Those patients eligible for home isolation should be clinically assigned as mild or asymptomatic case by the treating medical officer and they should have the requisite facility at their residence for self-isolation and quarantining the family contacts.

The caregiver and all close contacts of such cases should take Hydroxychloroquine prophylaxis in accordance with the protocol and as prescribed.

The patients must isolate themselves from the other family members, stay in the identified room and away from others, especially elderly people and those with co-morbid conditions like hypertension, cardiovascular disease, renal disease etc.

The patients should be kept in well-ventilated rooms with cross-ventilation, the windows should be kept open to allow fresh air to come in and should at all times use a triple-layer medical mask, the guidelines read.

"The mask should be discarded after eight hours of use or earlier if they become wet or visibly soiled. In the event of the caregiver entering the room, both the caregiver and the patient may consider using the N95 mask.

"The masks should be discarded only after disinfecting it with one per cent sodium hypochlorite," the guidelines stated.

A caregiver should be available to provide care on a 24x7 basis. A communication link between the caregiver and the hospital is a prerequisite for the entire duration of home isolation.

Patients suffering from an immune compromised status (HIV positive, transplant recipients, cancer therapy etc.) are not recommended for home isolation and shall only be allowed home isolation after a proper evaluation, the guidelines read.

It advised the patients to take rest and drink lot of fluids to maintain adequate hydration, follow respiratory etiquettes at all times, not share personal items with others.

"Ensure cleaning of surfaces in the room that are touched often (tabletops, doorknobs, handles etc.) with a one-per cent hypochlorite solution. Self-monitoring of blood oxygen saturation with a pulse oximeter is strongly advised," the guidelines stated.

According to the guidelines, the patients must be in communication with a treating physician and promptly report to the latter in case of any deterioration. They should continue the medications for other comorbidities after consulting the treating physician.

Patients under home isolation will stand discharged after at least 10 days have passed from the onset of the symptoms (or from the date of sampling for asymptomatic cases) and no fever for three days. There is no need for testing after the home isolation period is over, the document stated.