Home isolation is a good idea | HT Editorial
But it can only work if patients are honest; monitoring is strongUpdated: Apr 28, 2020 18:43 IST
In new guidelines released on Monday, the health ministry prescribed an important new method for the management of suspected and confirmed cases of Covid-19. Those with very mild symptoms, or who are asymptomatic — and have requisite facilities at home — can now be in home isolation, instead of being admitted in a hospital. This is contingent on a set of conditions. There should be a 24*7 caregiver; there should be constant communication between the caregiver and a hospital; the patient should have downloaded the Aarogya Setu app and keep it active; the patient should regularly provide updates to the district surveillance officer; the caregiver and other close contacts should take hydroxychloroquine; if severe symptoms develop, the patient must seek immediate medical attention; and the period of home isolation will end only after the patient is tested negative and a medical officer provides a certificate.
This is a welcome move. Based on what is now known about the coronavirus disease, it is clear that a larger number of infected individuals are either asymptomatic or have mild symptoms. They will also recover with adequate care. Health systems across the world — and more so in developing countries such as India — are already stressed. The period of the lockdown has, to be sure, been used to ramp up testing, increase hospital beds, create dedicated quarantine facilities, and ensure the availability of more ventilators. But if there is a surge of cases — which is likely once restrictions are eased — India will not have the requisite infrastructure to cope with it. This is where home isolation will help. With adequate precautions, patients can stay home — and recover — without straining the health system.
But there are real implementation challenges. Given India’s high density of population, and the fact that large sections of citizens live in cramped homes, sharing a room with a dozen other people, many do not have the space to exercise this option. For those who can avail this option, the obstacle will be in monitoring. The entire idea is contingent on two major variables — of patients and their caregivers voluntarily providing accurate information on an everyday basis; and of already over-stretched district medical authorities keeping track of such cases and intervening when required. If either of these conditions is not met, the plan will not work. It is also important to note that there is often a rapid decline, where patients with no symptoms end up developing severe symptoms, at which point, the chances of survival diminish. This means that there must not be any delay in hospital admissions. But if these issues are addressed, the experiment of home isolation can provide a much-needed breather to India’s health system.