Revised Guidelines For Home Isolation of Mild / Asymptomatic Covid-19 Cases

Background

Over the past two years, it has been seen globally as well as in India that majority of cases of COVID-19 are either asymptomatic or have very mild symptoms. Such cases usually recover with minimal interventions and accordingly may be managed at home under proper medical guidance and monitoring.

Ministry of Health & Family Welfare has thus issued and updated guidelines for home isolation from time to time to clarify selection criteria, precautions that need to be followed by such patients and their families, signs that require monitoring and prompt reporting to health facilities. 

The present guidelines are applicable to COVID-19 patients who have been clinically assessed and assigned as mild /asymptomatic cases of COVID-19.

Asymptomatic cases/mild cases of COVID-19

The asymptomatic cases are laboratory confirmed cases who are not experiencing any symptoms and have oxygen saturation at room 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 having oxygen saturation at room air of more than 93%

Patients eligible for home isolation

The patient should be clinically assigned as mild/asymptomatic case by the treating Medical Officer. Further a designated control room contact number at the district /sub district level shall be provided to the family to get suitable guidance for undertaking testing, clinical management related guidance, assignment of a hospital bed, if warranted. 

Such cases should have the requisite facility at their residence for self-isolation and for quarantining the family contacts.

A caregiver (ideally someone who has completed his COVID-19 vaccination schedule) should be available to provide care on 24 x7 basis. A communication link between the caregiver and a Medical Officer is a prerequisite for the entire duration of home isolation.
Patients suffering from immune compromised status (HIV, Transplant recipients, Cancer therapy etc.) are not recommended for home isolation and shall only be allowed home isolation after proper evaluation by the treating Medical Officer.
Elderly patients aged more than 60 years and those with co-morbid conditions such as Hypertension, Diabetes, Heart disease, Chronic lung/liver/ kidney disease, Cerebro-vascular disease etc shall only be allowed home isolation after proper evaluation by the treating medical officer.
While a patient is allowed home isolation, all other members in the family including other contacts shall follow the home quarantine guidelines available at:
https://www.mohfw.gov.in/pdf/Guidelinesforhomequarantine.pdf.

Instructions for the patient

Patient must isolate himself from other household members, stay in the identi�ed room and away from
other people at home, especially elderly and those with co-morbid conditions like hypertension, cardiovascular disease, renal disease etc.
The patient should stay in a well-ventilated room with cross ventilation and windows should be kept
open to allow fresh air to come in.

Patient should at all times use triple layer medical mask. They should discard mask after 8 hours of use
or earlier if the mask becomes wet or is visibly soiled. In the event of Caregiver entering the room,
both Caregiver and patient may preferably consider using N-95 mask.
Mask should be discarded after cutting them to pieces and putting in a paper bag for a minimum of
72 hours.
Patient must take rest and drink lot of fluids to maintain adequate hydration.
Follow respiratory etiquettes at all times.
Undertake frequent hand washing with soap and water for at least 40 seconds or clean with alcohol-based sanitizer.
The patients shall not share personal items including utensils with other people in the household.
Need to ensure cleaning of frequently touched surfaces in the room (tabletops, doorknobs, handles, etc.) with soap/detergent & water. The cleaning can be undertaken either by the patient or the caregiver duly following required precautions such as use of masks and gloves.
Self-monitoring of blood oxygen saturation with a pulse oximeter for the patient is advised.
The patient shall self-monitor his/her health with daily temperature monitoring and report promptly if any deterioration of symptom is noticed. The status shall be shared with the treating Medical Officer as
well as surveillance teams/Control room.

Instructions for care-givers

The caregiver should wear a triple layer medical mask. N95 mask may be considered when in the same room with the ill person.
Front portion of the mask should not be touched or handled during use.
If the mask gets wet or dirty with secretions, it must be changed immediately. 
Mask should be discarded after cutting them to pieces and putting in a paper bag for a minimum of 72 hours.
Perform hand hygiene after disposal of the mask.
He/she should avoid touching own face, nose or mouth.

Hand hygiene

Hand hygiene must be ensured following contact with ill person or his immediate environment.
Use soap and water for hand washing 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. If not available, use dedicated clean cloth towels and replace them when they become wet.
Perform hand hygiene before and after removing gloves.

Exposure to patient/ patient’s environment

o Avoid direct contact with body fluids (respiratory, oral secretions  including saliva) of the patient. Use disposable gloves while handling the patient.
o Avoid exposure to potentially contaminated items in his immediate environment (e.g. avoid sharing eating utensils, dishes, drinks, used towels or bed linen).
o Food must be provided to the patient in his room. Utensils and dishes used by the patient should be cleaned with soap/detergent and water while wearing gloves. The utensils may be re-used after  proper cleaning.
o Clean hands after taking off gloves or handling used items. Use triple layer medical mask and disposable gloves while cleaning or handling surfaces, clothing or linen used by the patient.
o Perform hand hygiene before and after removing gloves.

Biomedical Waste disposal

o Effective and safe disposal of general wastes such as disposable items, used food packets, fruit peel offs, used water bottles, left-over food, disposable food plates etc. should be ensured.
o These should be collected in bags securely tied for handing over to waste collectors.
o The used masks, gloves and tissues or swabs contaminated with blood / body fluids of COVID-19 patients, including used syringes, medicines, etc., should be treated as biomedical waste and disposed of accordingly by collecting the same in a yellow bag and handed over to waste collector separately so as to prevent further spread of infection within household and the community.
Alternatively, these can be disposed off by putting them in an appropriate deep burial pits which are deep enough to prevent access to rodents or dogs etc.

Treatment for patients with mild/ asymptomatic disease in home isolation

Role of State/ District Health Authority

Responsibilities of the District/ Sub-District Control Room

Role of District Administration

Source : MoHFW