The health ministry on
Thursday issued the "Revised guidelines for home isolation of
mild/asymptomatic COVID-19 cases", in which it advised against attempting
to procure or administer Remdesivir injections at home, underlining that it
should be administered only in a hospital setting.
The guidelines
stated that systemic oral steroids are not indicated in mild cases and if the
symptoms (persistent fever, worsening cough etc.) persist beyond seven days,
the treating doctor should be consulted for treatment with low-dose oral steroids.
Elderly patients aged more than 60 years and those with co-morbid conditions
such as hypertension, diabetes, heart disease, chronic lung or liver or kidney
disease, cerebrovascular disease etc. shall only be allowed home isolation
after a proper evaluation by the treating medical officer, it added.
In case of falling
oxygen saturation levels or shortness of breath, the person should require
hospital admission and seek immediate consultation with the treating physician
or surveillance team.
Elderly patients
aged more than 60 years and those with co-morbid conditions such as
hypertension, diabetes, heart disease, chronic lung or liver or kidney disease,
cerebrovascular disease etc. shall only be allowed home isolation after a
proper evaluation by the treating medical officer.
According to the
revised guidelines, the patients may perform warm-water gargles or take steam
inhalation twice a day.
"If fever is
not controlled with a maximum dose of tab. Paracetamol 650 mg four times a day,
consult the treating doctor, who may consider advising other drugs like
non-steroidal anti-inflammatory drug (NSAID) (ex: tab. Naproxen 250 mg twice a
day).
"Tab.
Ivermectin (200 mcg/kg once a day, to be taken on empty stomach) for 3 to 5
days should be considered," the guidelines stated.
Inhalational
Budesonide (given via inhalers with spacer at a dose of 800 mcg twice daily for
five to seven days) to be given if the symptoms (fever and/or cough) persist
beyond five days, they added.
The decision to
administer Remdesivir or any other investigational therapy must be taken by a
medical professional and it should be administered only in a hospital setting,
the ministry said.
"Do not
attempt to procure or administer Remdesivir at home. Systemic oral steroids are
not indicated in mild disease. If symptoms persist beyond seven days
(persistent fever, worsening cough etc.), consult the treating doctor for
treatment with low-dose oral steroids," the guidelines said.
The revised
guidelines stated that the asymptomatic cases are laboratory-confirmed cases
that are not experiencing any symptoms and having oxygen saturation at room air
of more than 94 per cent, while the mild cases are patients with upper
respiratory tract symptoms (and/or fever) without shortness of breath and
having oxygen saturation at room air of more than 94 per cent.
Those patients
eligible for home isolation should be clinically assigned as mild or
asymptomatic case by the treating medical officer and they should have the requisite
facility at their residence for self-isolation and quarantining the family
contacts.
The caregiver and
all close contacts of such cases should take Hydroxychloroquine prophylaxis in
accordance with the protocol and as prescribed.
The patients must
isolate themselves from the other family members, stay in the identified room
and away from others, especially elderly people and those with co-morbid
conditions like hypertension, cardiovascular disease, renal disease etc.
The patients
should be kept in well-ventilated rooms with cross-ventilation, the windows
should be kept open to allow fresh air to come in and should at all times use a
triple-layer medical mask, the guidelines read.
"The mask
should be discarded after eight hours of use or earlier if they become wet or
visibly soiled. In the event of the caregiver entering the room, both the
caregiver and the patient may consider using the N95 mask.
"The masks
should be discarded only after disinfecting it with one per cent sodium
hypochlorite," the guidelines stated.
A caregiver should
be available to provide care on a 24x7 basis. A communication link between the
caregiver and the hospital is a prerequisite for the entire duration of home
isolation.
Patients suffering
from an immune compromised status (HIV positive, transplant recipients, cancer
therapy etc.) are not recommended for home isolation and shall only be allowed
home isolation after a proper evaluation, the guidelines read.
It advised the
patients to take rest and drink lot of fluids to maintain adequate hydration,
follow respiratory etiquettes at all times, not share personal items with
others.
"Ensure
cleaning of surfaces in the room that are touched often (tabletops, doorknobs,
handles etc.) with a one-per cent hypochlorite solution. Self-monitoring of
blood oxygen saturation with a pulse oximeter is strongly advised," the
guidelines stated.
According to the
guidelines, the patients must be in communication with a treating physician and
promptly report to the latter in case of any deterioration. They should
continue the medications for other comorbidities after consulting the treating
physician.
Patients under
home isolation will stand discharged after at least 10 days have passed from
the onset of the symptoms (or from the date of sampling for asymptomatic cases)
and no fever for three days. There is no need for testing after the home
isolation period is over, the document stated.
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