The AIIMS has given guidelines on Covid management in home isolation at a recent training session for 14 experts from tertiary care centres across the country. In his presentation, Assistant Professor of Pulmonary, Critical Care and Sleep Medicine, Saurabh Mittal, highlighted how home isolation helps free hospital space and contain spread of disease. It was noted that only patients having mild disease, in which there are only upper respiratory tract symptoms and no shortness of breath, are recommended for home isolation, but the decision about whether it is mild will be taken by a doctor.
The availability of requisite facility with attached separate bathroom at the residence is necessary for self-isolation. However, immunocompromised patients like HIV+ people are not recommended for home isolation and can be allowed it only after proper evaluation by a doctor, while elderly patients with comorbidities shall only so allowed after proper evaluation by the treating doctor, and should have a caregiver on 24X 7 basis, it was stressed.
The caregiver should have link with a hospital for entire duration of home isolation, and the treating physician should be kept updated regarding worsening symptoms. Patients should continue medications for comorbid conditions, and should be hydrated and well rested. Antipyretics should be consumed as per doctor's prescription.
Mittal said that monitoring of symptoms is the most important segment in home isolation. Patients should make use of pulse oximeter and should promptly report any deterioration of symptoms.
It was also noted that patients must stay in an identified room with attached bathroom which should have cross ventilation. They should stay away from other family members, especially the elderly, and should not share personal items with other members.
Patients should use triple-layer medical mask all the time which should be discarded after 8 hours of use. It should be disinfected with sodium hypochlorite before discarding.
Caregivers should also wear triple-layer mask within the house, and ensure hand hygiene before and after wearing mask and also after contact with patient and his/her immediate surroundings.
Regularly touched surfaces like table-tops, and door knobs should be cleaned with 1 per cent hypochlorite solution or phenyl. Alcohol-based sanitisers are not recommended for disinfecting surfaces.
Potentially contaminated items in immediate environment of the patient should be avoided. Food must be provided to the patient in his/her room, and the utensils and dishes used cleaned with soap and detergent.
Patients should follow the instructions regarding physical distancing, mask use, handwashing, self-monitoring, and constant contact with healthcare provider.
For symptomatic management, a patient may perform warm saline gargles twice a day, and steam inhalation for a few minutes may also be done. Patient can also consume vitamin C and zinc tablets.
The decision to administer Remdesivir should be taken only by a medical professional, and patient should not attempt to procure or administer it at home. Oral steroids should not be taken in mild disease, and only a doctor can take decision about a low dose of oral steroids if symptoms persist beyond seven days.
Patients should seek help of a hospital if they develop difficulty in breathing or oxygen saturation goes below 94 per cent, and also, if they feel persistent pain in the chest or mental confusion or inability to rise.
For patients who are borderline hypoxic, proning is recommended to increase oxygen saturation by two to three points to avoid panic order stress.
Patients under home isolation can end it after 10 days of symptoms' onset or if there is no fever for three days. There is no need for testing after the home isolation period is over.
