Covid-19: Why home isolation is a critical pillar
As mildly symptomatic Covid-19 patients under home isolation, the Bharatiya Janata Party (BJP)-led central government’s initial decision to end home isolation on Friday was puzzling, and its roll back of the order on Saturday is welcome. A mandatory five-day institutional quarantine for all new Covid-19 patients, as originally ordered, would have been unprecedented. Nowhere in the world do governments force every coronavirus patient into public isolation facilities. Even the Indian Council of Medical Research guidelines recommend home isolation for most cases, given that 80% of the patients are either asymptomatic or mildly symptomatic.
It is important to understand the system in place now. Our experience of home isolation has been beneficial for our health and well-being. Our samples were collected on Tuesday and we tested positive for coronavirus on Wednesday. Fortunately, we had no severe symptoms and did not need hospitalisation. That same day we received a phone call from a government telemedicine service that offered medical advice. An ASHA worker visited our homes, confirmed we were mildly symptomatic patients and pasted a sticker next to our main doors, giving neighbours fair warning.
From the second day onwards, our health and symptoms were being monitored daily through the Delhi government’s tele-monitoring service that also provided guidance on the isolation process. An emergency phone number was also given to us to be called if our symptoms were to escalate. An ambulance would take us to a hospital if we were to report any escalation in symptoms.
In one go, on Friday, the Centre shut down the most smoothly functioning piece of the coronavirus puzzle that is home isolation. One of the lessons of governance the Aam Aadmi Party (AAP) has learnt is — do not fix something that is not broken. The roll back of the order is good because it would have otherwise created new problems for the city and its government, dealing a deadly blow to containment efforts in Delhi.
The thought of being dragged into a railway coach parked at the Anand Vihar station upon testing positive would have driven away people from voluntarily coming forward to test themselves. And if asymptomatic and mildly symptomatic patients refuse testing and carry on with their lives, they would have ended up infecting others.
Compulsory quarantine would have also needed additional resources, diverting medical staff, ambulances, and personal protective equipment kits away from hospitals that are treating critical patients.
An already stretched medical system would have been forced to look after thousands of patients who may have never needed medical attention. The cost of providing hygienic quarantine facilities, food, water and sanitation to thousands of patients would have proved debilitating to the cash-strapped state government. Delhi is expected to have hundreds of thousands of cases over the next few weeks. The state should focus its efforts and resources on treating the sick, not providing shelter and food to asymptomatic and mildly symptomatic patients.
The data on Delhi’s home isolation programme shows why it is highly recommended around the world. Only 6% of all positive patients under home isolation have been required to be shifted to a hospital or quarantine facility during their home isolation period. Of more than 27,000 patients who have been under home isolation thus far, only 1,618 reported a deterioration in their symptoms and had to be shifted to hospitals. This is 6% of all home isolation patients. We are happy with the roll back of the order because better sense has prevailed. Otherwise, Delhiites would have paid a huge cost.