Guidelines for home isolation of mild/asymptomatic COVID-19 cases

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Asymptomatic cases/ mild cases of covid-19

Patients who are clinically assigned to be mild/asymptomatic are recommended for Home Isolation

The Asymptomatic cases are laboratory confirmed cases not experiencing any symptoms and having oxygen saturation at room air of more than 94%. Clinically assigned mild cases are patients with upper respiratory tract symptoms (&/or fever) without shortness of breath and having oxygen saturation at room air of more than 94%.

  1. PATIENTS ELIGIBLE FOR HOME ISOLATON
  • The patient should be clinically assigned as mild/Asymptomatic case by the treating Medical Officer
  • Such cases should have the requisite facility at their residence for self-isolation and for quarantining the family contacts.
  • A caregiver should be available to provide care on 24X7 basis. A communication link between the caregiver and hospital is a prerequisite for the entire duration of home isolation.
  • Elderly patients aged more than 60 years and those with co-morbid conditions such as Hypertension, Diabetes, Heart disease, chronic lung/liver/kidney disease, Cerebro-vascular disease etc shall be allowed home isolation after proper evaluation by the treating medical officer.
  • Patients suffering from immune compromised status (HIV, Transplant recipients, Cancer therapy etc.) are not recommended for home isolation and shall only be allowed home isolation after proper evaluation by the treating medical officer.
  • The care giver and all close contacts of such cases should take Hydroxychloroquine prophylaxis as per protocol and as prescribed by the treating medical officer.
  1. INSTRUCTIONS FOR THE PATIENT
  • Patient must isolate himself from other household members, especially elderly and those with co-morbid conditions like hypertension, cardiovascular disease, renal disease etc.
  • Patient should be kept in a separate well-ventilated room with cross ventilation and windows should be kept open to allow fresh air to come in.
  • Patient should at all times use triple layered medical, ask. Discard mask after 8hours of use or earlier if they become wet or visibly soiled. Both care giver and patient may consider using N95 mask.
  • Patient must take rest and drink lots of fluids. Frequently wash hands with soap & water
  • Don’t share personal items with other people. Follow respiratory etiquettes all the time.
  • Ensure cleaning of surfaces in the room that are frequently touched (tabletops, doorknobs, handles etc.)
  1. SELF MONITORING OF BLOOD OXYGEN SATURATION WITH AN OXIMETER IS STRONGLY ADVISED.
  • If pulse oximeter is not available, a single breath holding test may be done.(Patient has to take a full but not too deep breath and hold it as long as possible). Based on duration of breath holding patients are categorized into:

25 seconds – Normal cardiopulmonary reserve.

15 to 25 seconds – limited cardiopulmonary reserve (Review with the medical Officer)

15 seconds – very poor cardiopulmonary reserve (Shift to hospital)

  1. THE PATIENT WILL SELF-MONITOR HIS/HER HEALTH WITH DAILY TEMPERATURE MONITORING AND REPORT PROMPTLY IF ANY DETERIORATION OF SYMPTOM AS GIVEN. Fever: Any temperature of 100.4F(38 degree celcius) or greater is considered as fever.
  2. INSTRUCTIONS FOR CARE-GIVERS
  • The caregiver should wear a triple layer medical mask.
  • Hand hygiene must be ensured following contact with ill person.
  • Avoid direct contact with body fluids of the patient, particularly oral or respiratory secretions.
  • Patient/Care giver will keep monitoring their health. Immediate medical attention must be sought if serious signs or symptoms develop.
  1. TREATMENT FOR PATIENTS WITH MILD/ASYMPTOMATIC DISEASE
  • Patients must be in communication with a treating physician and promptly report in case of any deterioration.
  • Continue the medications for other co-morbid illness after consulting the treating physician.
  • Patients to follow symptomatic management for fever, running nose and cough, as warranted.
  • Patients may perform warm water gargles or take steam inhalation twice a day.
  • In case of falling oxygen saturation or shortness of breath, the person should require hospital admission and seek immediate consultation of their treating physicians/surveillance team.
  1. WHEN TO SEEK MEDICAL ATTENTION

Patient/care giver will keep monitoring their health. Immediate Medical attention must be sought if serious signs or symptoms develop. These could include:

  • Difficulty in breathing
  • Dip in oxygen saturation (SpO2 less than 94% on room air )
  • Persistent pain, pressure in the chest,
  • Mental confusion or inability to arouse
  • High grade fever/ severe cough, particularly if lasting for more than 5 days.
  1. WHEN TO DISCONTINUE HOME ISOLATION

Patient under home isolation will stand discharged and end isolation after atleast 10 days have passed from onset of symptoms (or from date of sampling for asymptomatic cases) and no fever for 3days.

  1. MILD DISEASES:

Upper respiratory tract symptom (&/or fever) WITHOUT shortness of breath or hypoxia.

  • MUST DOs
  • Physical Distancing, indoor mask use, strict hand hygiene.
  • Symptomatic management (hydration, anti-pyretics, anti-tussive, multi-vitamins)
  • Stay in contact with treating physicians.
  • Monitor temperature and oxygen saturation (by applying a SpO2 probe to fingers).
  • MAY Dos

Therapist based on low certainty of evidence:

  • Tab Ivermectin (200mcg/kg once a day for three days). Avoid in pregnant and lactating women.

OR

  • Tab HCQ (400mg BD for one day f/b 400mg OD for four days) unless contraindicated.
  • Inhalational Budesonide (given via metered dose in halers/ dry powder inhaler) at a dose 800 mcg BD for five days) to be given if symptoms (fever and / or cough) are persistent beyond five days of disease onset.

Note:    ALL MEDICINES SHOULD BE TAKEN ONLY UNDER MEDICAL PRESCRIPTION & ADVICE.

*High-risk for severe disease or mortality

  • Age>60 years
  • Cardiovascular disease, Hypertension, CAD
  • DM (Diabetes Mellitus) and other immune compromised states.
  • Chronic lung/kidney/lung disease.
  • Cerebrovascular diseases
  • Obesity

Department of Health & Family Welfare, Government of Nagaland.

Contact your nearest health units for more information. State Helpline No: 1800-345-0019

The guidelines on Home–quarantine for other members are available at: https://www.mohfw.gov.in/pdf/Guidelinesforhomequarantine.pdf, shall be also followed