5 reasons why scrapping home isolation of asymptomatic Covid-19 patients in Delhi may not be a good idea
Experts feel that home isolation of asymptomatic and mildly symptomatic patients is a crucial strategy in the fight against the highly infectious coronavirus disease.Updated: Jun 20, 2020 14:35 IST
The Delhi Disaster Management Authority (DDMA) has ordered a mandatory five-day institutional quarantine for all Covid-19 cases, including asymptomatic patients and those with mild signs of the infection. The move could strain the Capital’s health infrastructure, which is already stretched; result in a shortage of health care workers; militate against people getting tested; hamper the detection rate; and throw Delhi’s long-term plan out of gear at a time when infections continue to rise. We look at five principal reasons why it may not be a good idea:
1) Overrun health care infrastructure
Adding thousands of people in institutional quarantine – 10,490 people were in home quarantine as of Friday night – will require a sudden and steep ramping up of the Capital’s health care infrastructure, increasing the risk of the system being overwhelmed by those being admitted. According to the government’s June 19 bulletin, 5,078 of its 10,961 Covid-19 beds were vacant, and 5,036 beds were available (out of 6,318) in Covid care and health centres. A senior Delhi government official, who spoke on condition of anonymity, said that this availability of resources was mainly because of the success of the home quarantine scheme.
Experts feel that home isolation of asymptomatic and mildly symptomatic patients is a crucial strategy in the fight against the highly infectious disease. “Why unnecessarily burden the health infrastructure that anyway gets overwhelmed when there is surge in cases? Medical beds should be kept for serious patients needing specialised care, otherwise where will you keep your serious patients whose lives we have to save? Home can be the best isolation facility so long as all protocols are followed,” said T Jacob John, the former head of virology at CMC, Vellore.
2) Spark a severe staff shortage
If all cases are to be admitted to institutional facilities in the Capital, the authorities will have to find additional doctors, nurses and health workers. HT reported on Wednesday that the plan to add 23,800 beds this month for Covid-19 patients will require roughly 2,000 doctors and 3,000 nursing staff – resources that it has not been able to secure so far. To add to the shortfall, several health care workers testing positive are going into quarantine on coming in direct contact with Covid-19 patients. The government will also find it difficult to draw doctors, nurses and staff from its smaller non-Covid-19 hospitals.
The challenge to secure more people has been intensified by the fact that some health workers fear getting infected. “Most of our nurses put down their papers when we were asked to earmark beds for Covid-19. Several other demanded higher salaries, it is not possible to do so in this economy,” said a doctor at a private hospital, asking not to be named. In a statement, the Delhi government said: “Entire manpower of the Delhi government is already stretched. Now, large quarantine centres would need to be made to house thousands of asymptomatic people.”
3) People may stop getting tested
The move is also likely to discourage asymptomatic and mildly symptomatic people from undergoing tests. Some feel that moving to institutional quarantine amid a shortage of beds and support staff will mean that the facilities are not up to the mark; they fear this will prompt people to avoid getting tested. Atishi, a legislator from the Kalkaji constituency and a spokesperson of the Aam Aadmi Party (AAP) who tested positive for Covid-19 two days ago and is currently under home isolation, said it has emotional and psychological benefits. “There is a lot of comfort attached to home isolation compared to institutional quarantine because you have your own room and most importantly, your own washrooms... In home isolation, you have your family to look after you.” She added that if institutional quarantine is made mandatory, then fewer people will opt for testing of Covid-19. “Police, along with medical staff, will come to pick even asymptomatic people up and take them to quarantine centres. People will be scared with all this and many will fear themselves from getting tested,” she said.
4) Cases may go undetected
If fewer people are willing to get tested, the undetected spread from such patients is likely to grow in the Capital. With the detection rate dipping, more people are likely to reach hospitals after their infection has advanced, which could possibly also impact the recovery rate. Experts also point to the risks of infections from crowded quarantine facilities.
Home quarantine for patients has been approved by the Union government as an effective way to preserve health care infrastructure for future challenges, under certain guidelines. DDMA, however, said in its order on Friday that it fears “home isolation without physical contact to monitor the patients may be a reason for the increase in the spread of Covid-19 infections in Delhi”.
5) Long-term strategy takes a hit
To meet the need for around 150,000 beds by the end of July, the Delhi government has planned to use stadiums as makeshift hospitals. It has also identified neighbourhood facilities to meet the need for the beds, according to its prediction of the infection’s peak in the Capital. This strategy, however, was devised on the model which included mild cases being quarantined at home. With the latest guidelines, this plan stands compromised. A member of a committee created to look into the augmentation of Delhi’s health infrastructure previously told HT that the panel’s calculations, based on the Capital’s population and the current model, may have to be reworked and a new strategy may have to be devised. Experts insist that if the guidelines are changed on a regular basis, the projections and modelling of the scenarios will repeatedly need to be revised, creating a challenge for the long-term strategy. They also say that most countries in the world recommend home isolation for mild cases and the latest move by DDMA should be rethought.