Confusion persists on home isolation rules for Covid-19 patients with mild symptoms

To be eligible for home isolation, a patient’s house needs to have a separate room with an attached bathroom, and space for isolation for a dedicated caregiver and other family members.
New Delhi, India - June 19, 2020: A health worker in PPE seen at a COVID-19 tesing centre in SKV Government Girls Senior Secondary School, in Chandni Chowk, New Delhi.(Amal KS/HT PHOTO)
New Delhi, India - June 19, 2020: A health worker in PPE seen at a COVID-19 tesing centre in SKV Government Girls Senior Secondary School, in Chandni Chowk, New Delhi.(Amal KS/HT PHOTO)
Updated on Jun 22, 2020 06:31 AM IST
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Hindustan Times, New Delhi | ByRisha Chitlangia & Abhishek Dey

A day after the Delhi Disaster Management Authority (DDMA), headed by Lieutenant Governor Anil Baijal, scrapped its order mandating five days of institutional quarantine even for those with mild Covid-19 symptoms, but said that every person who tests positive be taken to Covid Care Centres (CCC) for an assessment of their clinical conditions, some district administration officials in the city are calling the move impractical on the grounds that it would increase the risk of the infection.

Meanwhile, with no new standard operating procedure (SOP) issued yet, there was confusion on how to deal with new cases on Sunday, and some other district officials said they continued with the previous protocol — sending health officials to the patient’s residence for a clinical diagnosis

The order on Saturday night, issued by principal health secretary Vikram Dev Dutt, said “all individuals who are positive will be referred to the COVID Care Centres for assessment of clinical conditions, the severity of illness and presence of comorbidities”.

To be eligible for home isolation, a patient’s house needs to have a separate room with an attached bathroom, and space for isolation for a dedicated caregiver and other family members.

As of Sunday evening, 12,106 Covid-19 patients in the city are under home isolation.

But, senior officials in the government said that another problem had emerged because of a Friday order that coincided with the one in which five days’ institutional quarantine was made mandatory for all patients — the scrapping of the contract of the company that was handling the contact and management of all home quarantine patients.

A senior government official said that on Saturday, when the LG withdrew the mandatory five-day institutional quarantine rule, he allowed Portea Medical to operate for the time being, until an alternative was given by the Delhi health department.

The rule, however, has a catch, the official said. “The company has been allowed to operate, but it has not been allowed to take any new Covid patient since Friday’s order. So, they are tracking only the old 10,490 patients that were in home isolation until Friday. As a result, there is no one now to follow up on the new asymptomatic and mild patients in home isolation,” the officer added.

An analysis of government data revealed that since Friday, 9,767 new Covid-19 cases have been added in the Capital. Of these, about 1,600 were admitted in hospitals, Covid Health Centres and Covid Care Centres.

“The company used to make calls twice a day to every patient under home isolation. The patient’s temperature, signs of any symptoms and other factors were recorded. In case anyone reported of any symptoms, the information was sent to the district surveillance officers (DSOs) for shifting him/her to a Covid facility,” another government official said.

At Monday’s DDMA meeting, the health department is likely to inform the LG that it is going to rope in medical students to make the phone calls. It is also being planned that the surveillance teams will be made responsible for tracking these patients, a government official said. “However, with districts already facing a major staff crunch, the chief minister’s office has raised concern as to who will follow up with every patient for 14 days,” the official said.

In any case, the decision to send all patients to care centres for assessment has district officials worried at a time when the Capital is recording an average of 2,652 new Covid-19 new cases a day for the past week. “How will they travel to a care centre? We don’t have enough infrastructure to take all new cases, there are logistical issues. And we can’t allow them to go to a centre on their own, as it will increase the risk of transmission,” said a district magistrate.

“While the ambulance fleet has been augmented and 500-odd more ambulances will be added to the existing fleet soon, it won’t be possible to take all patients to CCC for clinical assessment,” a Delhi government official said.

A second district magistrate said: “The order doesn’t say all new cases have to be taken to CCC. Our teams are going to the homes of people who have tested positive and doing the assessment there.”

But a senior Delhi government official said, “The order is clear and has to be implemented. There will be no separate SOPs, which will be issued.”

Saturday’s order said: “All individuals who are positive will be referred to the COVID care centres for assessment of clinical conditions, severity of illness and presence of co-morbidities.”

According to a Delhi government official familiar with the matter, the DMs in all 11 revenue districts will be in charge of the management of patients under home isolation in localities under their jurisdiction. The health department will submit a plan for the same to the DDMA by Monday afternoon, the official said.

Meanwhile, several Covid-19 patients who were under home isolation were shifted to institutional quarantine following Delhi L-G’s order on Friday, which was then revoked on Saturday.

A doctor with a district surveillance team said: “After Friday’s order, we had shifted a few people from home isolation. Now they will be shifted home only after a proper physical assessment of their house is done as per the new order.”

Dr Jugal Kishore, head of community medicine at Safdarjung Hospital said, “Bringing them to centres for clinical assessment will only increase the risk of transmission.”

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