New Delhi: Government of India is working in coordination and cooperation with the State / UT Governments to tackle and manage Covid-19 in the country. A number of strategic and appropriate steps have been taken to prevent, prevent and manage Covid-19. The Ministry of Health and Family Welfare has issued revised guidelines in place of the guidelines issued on this subject today (2 July 2020).
According to the guidelines, home isolation is recommended to patients with mild / no symptoms (asymptomatic) identified in the clinical examination.
Mild / uncomplicated cases of Covid-19 In cases of untreated Covid, the laboratory confirms the corona virus in the patient’s body, but the patient does not have corona symptoms and the oxygen level of the patient in room air is also higher than 94 percent. In cases of symptomatic Kovid, the patient has upper respiratory neurological symptoms (and / or fever), but has no difficulty in breathing and the oxygen level of the patient in room air is more than 94 percent. it happens.
Patients eligible for home isolation The patient should be certified as a low symptom / non-symptomatic patient on the basis of clinical examination by the treating medical officer. In all such cases, adequate arrangements should be made at the patient’s home for self-isolation and quarantining the family members. The person caring for the patient should be available on a 24×7 basis. For the duration of home isolation, contact between the person caring for the patient and the hospital on a regular basis via telephone is a mandatory condition. Elderly patients over 60 years of age and patients with hypertension, diabetes, cardiovascular disease, weak lung / liver / kidney disease, cerebro-vascular disease, etc., will be allowed home isolation only after treatment and adequate examination by the medical officer. Patients with low immunity (HIV, transplants, cancer sufferers, etc.) are not sent to home isolation, and such patients will be allowed home isolation only after adequate examination by the treating medical officer. The person taking care of the patient and those close to the patient should undergo hydroxychloroquine prophylaxis as per the COVID protocol and consultation with the medical officer treating it. Additionally, the guidelines on home-quarantine available at this link for other family members https://www.mohfw.gov.in/pdf/Guidelinesforhomequarantine.pdf should also be followed.
Patient instructions Patients separate themselves from other family members, stay in a designated room and keep proper distance from other members of the household, especially the elderly and those suffering from diseases such as high blood pressure, heart disease, kidney disease. The patient should stay in a room with good ventilated cross ventilation and the windows of the room should always be open so that clean air comes into the room. The patient should always use a three-layer medical mask. The mask should be destroyed after every 8 hours, or before 8 hours if it is wet or dirty. When entering the room of the person caring for the patient, both the patient and the caretaker must use the N95 mask. The mask should be disinfected only after disinfecting it with the help of 1% sodium hypochlorite. To maintain sufficient amount of water in the body, the patient should rest and consume plenty of fluids. Follow breathing rules at all times. Wash hands after a while with soap and water for at least 40 seconds, or clean hands with alcohol-containing sanitizer. Do not share your personal belongings with any household member. Clean commonly used items / spaces (tables, door handles, handles, etc.) in the room with 1% hypochlorite solution. Make sure to regularly monitor blood oxygen levels with the help of a pulse oximeter. The patient will self-monitor his health on a daily basis with a body temperature check and will report immediately if the condition appears to be worsening in any of the following symptoms.
Masks The caregiver must wear a triple-layer mask. The N95 mask should be worn in case of being in the same room with the sick person. The front part of the mask should not be touched while using the mask. If the mask has become wet or dirty, it should be replaced immediately. Destroy the mask after use, and clean the hands thoroughly after destroying the mask. Avoid touching your face, nose and mouth on your own.
Hand hygiene The hands should be thoroughly cleaned after coming in contact with or passing through the patient. It is mandatory to clean hands thoroughly before and after cooking, before eating, after using the toilet and whenever the hands appear dirty. Use soap and water to wash hands thoroughly for at least 40 seconds. After washing hands with soap and water, you can use disposable paper to dry hands. In the event that disposable paper is not available, use a cloth towel and replace it immediately when it is wet. Before wearing gloves and after taking off, clean hands thoroughly.
In the event of exposure of the patient / surroundings of the patient Avoid direct contact with the patient’s body fluids, especially oral or respiratory secretions. Use disposable gloves while caring for the patient. Avoid exposure to potentially contaminated objects in the environment around the patient (eg, sharing cigarettes, food utensils, foods, beverages, used towels or bed sheets ). The patient should be provided with food in his room. The utensils that the patient has used should be cleaned thoroughly with soap / detergent by wearing gloves in hands. The patient’s food utensils can be reused. Clean the hands thoroughly after taking off the gloves or keeping the used items. Use triple-layer medical masks and disposable gloves while cleaning clothing or sheets used by the patient and surrounding surfaces. Before wearing gloves and after taking off, clean hands thoroughly.
Biomedical Waste Disposal Effective waste disposal will be ensured indoors to prevent the spread of infection from proceeding further. Waste (masks, disposable products, food packets, etc.) must be disposed of according to CPCB guidelines (available at this link: http://cpcbenvis.nic.in/pdf/1595918059_mediaphoto2009.pdf).
Home isolation treatment for mild / non-symptomatic Kovid patients The patient should be in regular contact with the treating doctor and should be informed immediately in the event of a deteriorating health. After consulting with the treating doctor, take the medicine of other diseases (in addition to Kovid, which is already in the body, whose medicines are already taken.). The patient will have to follow the same management and protocol as the symptomatic patient (Symptomatic) in case of fever, runny nose and cough. The patient may take heat and steam twice a day to get warm. If the fever does not come under control even after taking paracetamol 650mg tablet four times a day, contact the treating doctor immediately. The doctor may advise you to take some other medications, such as non-steroidal anti-inflammatory drugs. (For example: tablet naproxin 250mg, twice a day). Tablet ivermectin (200 mcg / per kg, once a day, empty stomach) – for three to five days. Inhalation budesonide (800 mcg through an inhaler with a spacer, twice a day – five to seven days) will be given if symptoms (fever and / or cough) persist even five days after the onset of the disease. The decision to apply Remadecivir or any other such therapy will be taken by a professional doctor, and any such injection will be applied only in the hospital premises. Do not try to buy Remadecivir injection or have it delivered at home. Oral steroids will not be given in case of mild symptoms. If your symptoms persist for more than seven days (fever, worsening cough), consult your doctor for treatment with low amounts of oral steroids. In the event of a drop in oxygen level or difficulty in breathing, the patient should be admitted to the hospital and the treating doctor / monitoring team should be consulted immediately. When to get medical help The patient / caregiver will monitor the patient’s health. In case of severe symptoms, immediate medical attention (medical help) will be required. These symptoms include –
Shortness of breath A drop in oxygen levels (below 94 percent of apo 2 in room air). Continuation of chest pain / pressure. Inability to get up physically or a state of mental confusion. When to end home isolation Patients following home isolation after at least 10 days have passed after onset of Covid symptoms (patients with no symptoms after the confirmed date of Covid) and in the event of no fever during the last three days. Can be eliminated. There is no need to re-examine after the end of the home isolation period.
Role of State / District Authorities State / district authorities should monitor all cases under home isolation. The field staff / monitoring team should monitor the current health status of the patients with home isolation either by going to the patient’s home or through a dedicated call center set up to follow up the patients’ health on a daily basis. The clinical status (body temperature, pulse rate and oxygen level) of each case of home isolation should be recorded by the field staff / call center. The field staff will guide the patient and give necessary instructions (to the patient and the person caring for them) about measuring all these parameters. This system of regular monitoring at daily level will be strictly followed in case of home isolation. Details of patients with home isolation should also be updated on the Kovid-19 portal and the convenience app (with the help of DSO as a user). Senior officials of the state / district should monitor the records being updated. In case of violation of the Home Isolation Rules or in need of treatment, an adequate mechanism for transferring the patient will be established and implemented. An adequate number of dedicated ambulances will be arranged to meet this objective. Wide publicity will be done to make people aware about it. The field staff will monitor and examine all family members and close people in contact with the patient under the Covid Protocol.