New norms: Space for more in home isolation

As concern remained high over non-availability of hospital beds, the Union Health Ministry on Thursday revised its guidelines for home isolation to include Covid-19 patients with upper respiratory tract symptoms such as sore throat and persistent cough, and oxygen saturation of more than 94 per cent at room air.

The Ministry recommended four drugs that can be prescribed by doctors to patients in home isolation if mild symptoms persist. It also allowed home isolation for immuno-compromised patients, based on evaluation by doctors.

Earlier, immuno-compromised patients – those with HIV, those undergoing cancer therapy, transplant recipients, etc. – could not remain in home isolation after testing positive for the coronavirus. In the new guidelines, the Ministry, while reiterating that those suffering from “immune-compromised status…are not recommended for home isolation”, has also said that such patients “shall only be allowed home isolation after proper evaluation by the treating medical officer”.

The guidelines detail for the first time, the treatment protocol for patients in home isolation with mild symptoms. They recommend symptomatic management for fever, running nose and cough, and warm-water gargles or steam inhalation twice a day.

If fever is not controlled with the maximum dose of paracetamol (650 mg four times a day), the patient should consult a doctor “who may consider advising other drugs like a non-steroidal anti-inflammatory drug (NSAID)” such as Naproxen (250 mg twice a day), the guidelines say.

For home isolation, the guidelines say doctors should consider Ivermectin (200 mcg/kg once a day, to be taken on an empty stomach for 3-5 days). Inhalational Budesonide (given via inhalers with spacer at a dose of 800 mcg twice daily for 5-7 days) is recommended if symptoms such as fever and/or cough persist beyond five days after the onset of the disease. If symptoms persist for longer than seven days, patients should consult doctors for treatment with low-dose oral steroids, the guidelines say.

On the use of the in-demand antiviral remdesivir, the guidelines say: “The decision to administer remdesivir or any other investigational therapy must be taken by a medical professional and administered only in a hospital setting. Do not attempt to procure or administer remdesivir at home… In case of falling oxygen saturation or shortness of breath, the person should require hospital admission and seek immediate consultation of their treating physician/surveillance team.

Immediate medical attention must be sought if the patient develops four specific symptoms: difficulty in breathing; dip in oxygen saturation (SpO2 less than 94 per cent on room air); persistent pain/pressure in the chest; mental confusion or inability to arouse from deep sleep.

“The caregiver should wear a triple layer medical mask. N95 masks may be considered when in the same room with the ill person. Front portion of the mask should not be touched or handled during use. If the mask gets wet or dirty with secretions, it must be changed immediately,” the guidelines say.

AIIMS Director Dr Randeep Guleria had emphasized on Monday that people with mild symptoms should not panic, as that could overwhelm the health infrastructure. “In this critical phase of the pandemic, we have to ensure that our hospital facilities are optimally utilised. There is an unnecessary panic that is causing more harm than good. There is panic among patients who are tested positive, and have normal oxygen saturation; they also start searching for hospital beds because of which we are experiencing a huge rush outside the hospitals. The genuine patients will suffer because of this panic because they will not receive proper treatment,” Dr Guleria had said.

He had specifically addressed the need for rational use of oxygen at home. “Some people also think that if they store oxygen and start oxygen therapy from the first day then they would not need oxygen later. These are wrong notions. Oxygen is an important aspect of Covid-19 treatment, but its misuse also is an equally important aspect. Even (in) those who 94-95 oxygen saturation level, the oxygen is reaching the key organs. There is no requirement to make it 98-99 through oxygen therapy. This is misuse because that same oxygen can be used for those whose levels are below 90. When it is falling (below 94), contact your doctor,” Dr Guleria had said.