The Union government issued new guidelines on Wednesday to reduce the home isolation period for people with Covid-19 from 10 days to seven as long as they have not had fever in the last three days.
The move follows similar steps by the UK and the US, where isolation periods have been cut, following the near-global pandemic takeover by the Omicron variant of the Sars-CoV-2, which studies have established to be leading to milder disease.
India reported 89,972 new cases on Wednesday, continuing a sharp spike. Compared to Tuesday’s numbers, Wednesday saw new infections rise by more than 58%, as per HT’s Covid dashboard. In Delhi, this number jumped 94.6% in a single day to lead to 10,665 new cases.
Top government officials said the current R number of the epidemic, a measure of the intensity of the outbreak, has now reached 2.69, surpassing the 1.69 recorded during the Delta variant peak, although the outbreak is leading to fewer hospitalisations.
“It seems hospitalisation rate is very low. We are following this data very closely… In Delhi, the hospitalisation rate is about 3.7%, and in Mumbai, we heard an officer saying it was around 5%. In previous waves, last year and in 2020, the typical hospitalisation rate was 20%,” said Niti Aayog member VK Paul during the health briefing.
{{/usCountry}}“It seems hospitalisation rate is very low. We are following this data very closely… In Delhi, the hospitalisation rate is about 3.7%, and in Mumbai, we heard an officer saying it was around 5%. In previous waves, last year and in 2020, the typical hospitalisation rate was 20%,” said Niti Aayog member VK Paul during the health briefing.
{{/usCountry}}But, he cautioned, “it was important to remember that if there is a very large number of cases, even these small proportions will become a lot in numbers”.
Experts said the sharp surge and the milder outcomes complicate efforts to balance containment measures and avoid a disproportionate disruption to everyday life if those who don’t need to are forced to isolate.
The new guidelines thus carry some more relaxations, like not needing close contacts of a confirmed case to be tested as long as they do not have any symptoms.
“The new home isolation guidelines relate to all Covid-19 cases. Omicron as well a Delta is part of these cases... hence, these home isolation guidelines apply to all Covid-19 cases,” a Union health ministry note said.
“The way cases are rising, and which is expected with the new variant, institutional isolation does not make sense any longer. Experts were consulted and after detailed deliberation it was decided that those who are mildly symptomatic, or asymptomatic, should be allowed home isolation under certain conditions,” said a senior public health expert with the government aware of the matter, on condition of anonymity.
A second official, who asked not to be named, said because of the exponential surge, “measures such as contact tracing and creating containment zones will not serve any concrete purpose”.
“The onus lies on an individual now to take preventive measures such as Covid-appropriate behaviour; wearing a mask; avoiding mass gatherings to avoid getting infected. For those who show symptoms, it is better to get tested at home and isolate if the symptoms are mild. It makes sense to not rush to a hospital unnecessarily,” this person added.
During the briefing, Union health ministry joint secretary Lav Agarwal said the guidelines now specify how best people should isolate, and when they need to seek attention. People who end isolation at seven days should continue wearing masks when they go out, he stressed.
The new guidelines, uploaded by the health ministry on its website, also specified the patients who should not be recommended for home isolation: those compromised immunity, like HIV-infected people, transplant recipients and cancer patients. People above the age of 60 years with comorbid conditions such as hypertension, diabetes, heart disease and chronic lung/liver/ kidney diseases will only be allowed home isolation after proper evaluation by the treating medical officer.
Among the other changes mentioned in the revised guidelines, the Centre also asked for requisite facilities at home for other family contacts to be able to quarantine and for a caregiver to be fully vaccinated against Covid-19.
The rest of the guidelines are largely the same as released last year.
Asymptomatic cases have been defined as laboratory confirmed cases without any symptoms and with 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 with oxygen saturation at room air of more than 93%.
Experts said case numbers are going to keep rising for a while, making it important to monitor the hospitalization rate.
“Cases are going to increase substantially because of the new variant in circulation; but the main issue is to see how mild it remains. It is the rate of hospitalisation that will eventually decide how concerning the spread is as merely rising numbers should not be of a serious concern,” said Dileep Mavalankar, director, Indian Institute of Public Health, Gandhinagar.
“If positive cases are getting better on their own without hospitalization, there is no worry. Level of mildness of the virus and higher immunity because of vaccines and natural infection will balance out things. In next two-three weeks we should know clearly how mild the disease is proving to be in our population,” Mavalankar added
The health expert added that gross mortality too should be monitored for any concerning spike. “ What works in our favour is the fact that our population is young compared to US or UK,” he said, while also calling for authorities to consider a full market authorisation for the vaccines in use to allow people who want to.