New Delhi: A number of private hospitals in the national capital region (NCR) have begun care packages for coronavirus disease (Covid-19) patients who are in home isolation, offering remote monitoring by nurses and doctors and medical care kits that will help detect if their condition deteriorates.
The Delhi government has said that Covid-19 positive persons are eligible for home treatment as long as they can isolate themselves and not infect other members of the household, a decision meant to reduce the burden on hospitals as cases rise.
Among the providers of such services are Max Healthcare, Medanta and Fortis. Max’s Max@Home services includes a medical kit (with a thermometer and an oxygen saturation metre), daily monitoring of the vitals by a trained nurse twice a day, a tele-review with a doctor every third day as well as home delivery of medicines.
Medanta’s Covid-19 home care services are split into basic packages for monitoring or more thorough ‘complete covid care’ offering that includes a Covid-19 test; N-95 and other masks, gloves, sanitisers, a pulse oximeter, a digital thermometer, a blood pressure machine, a PPE kit, as well as vitals monitoring tools with built-in critical alert system.
Max has at least 100 patients while Medanta has around 90 patients using their home care services.
Experts welcomed such offerings. “If the patient is suspected clinically but doesn’t have any breathing difficulty or pneumonia or any other life-threatening symptoms, the patient should stay home. In fact the patient will get more infections if he or she is in a hospital. These patients should register with a medical facility. A nurse or doctor should be in touch over the phone every day,” said Dr Jacob John, professor emeritus and former head of virology at Christian Medical College, Vellore.
“Majority of people with Covid-19 will require a pulse oximeter (oxygen saturation metre) and a CT scan of the chest or a good quality chest X ray to see if there is pneumonia. The patient can check pulse oxygen levels at home. Doctor or nurse on call will have to watch for symptoms every day. If fever settles then there is no need for admission, if not a bed can be readied for the patient in hospital. This is needed to un-clutter the system right now,” he added.
According to Medanta’s standard protocol for home isolation, warning signs that a patient must report are persistent fever of over 101°F for 72 hours, breathlessness or fast breathing, blood in sputum, confusion, loss of consciousness and altered behaviour or severe abdominal pain with diarrhoea. A pulse rate of more than 110 per min or oxygen saturation of less than 94% is also a cause for concern. “We decide if the patient needs hospitalisation based on these standard parameters,” said Dr Sushila Kataria, senior director, internal medicine at Medanta in Gurugram.
A second expert said that it is now crucial to treat mild infections at home. “Complacency is likely to be more when at home but in Delhi cases are touching 1,000 to 1,500, so where do you have so many beds? Home isolation of those without risk factors and those who are comfortable, eating well, do not have breathlessness should stay home and isolate themselves in a room and use a separate bathroom,” said Dr GC Khilnani, PSRI institute of critical and pulmonary and critical and former and head of pulmonary medicine at AIIMS.
In a paper in Lancet led by Saw Swee Hock School of Public Health, Singapore University in April said institution-based isolation was better suited to reduce household and community transmission citing example of isolation shelters in Wuhan that provided triage, basic medical care, frequent monitoring, rapid referrals.
Delhi at present has a tie-up with private medical services provider Portea to monitor home isolation cases. If their condition deteriorates, Portea schedules an appointment with a doctor or a Delhi hospital immediately.
In the past month, there have been 7,300 Coovid-19 patients who have been monitored by Portea remotely and around 2,000 of them have been discharged, and 200 needed hospitalisation.
“Delhi government doctors choose which patients are asymptomatic or have mild illness and who have the space to be isolated at home. Medication, PPE, diet chart, brochures etc are given by Delhi government. We are in touch with the patients on a daily basis. There is an option for the patient to also call in if his or she is feeling very unwell. So far compliance has been good and patients have responded to calls,” said Meena Ganesh, MD and CEO, Portea Medical.
Who is eligible for home isolation?
• Patient should be clinically assigned as a very mild case or pre-symptomatic case by the treating medical officer
• Such cases should have the requisite facility at their residence for self-isolation and also for quarantining the family contacts
• A care giver should be available to provide care on 24 x7 basis
• A communication link between the caregiver and hospital is a prerequisite for the entire duration of home isolation.
• 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
• Download Arogya Setu App on mobile (available at: https://www.mygov.in/aarogya-setuapp/) and it should remain active at all times (through Bluetooth and Wi-Fi)
• The patient shall agree to monitor his health and regularly inform his health status to the District Surveillance Officer for further follow up by the surveillance teams
• The patient will fill in an undertaking on self-isolation (Annexure I) and shall follow home quarantine guidelines
When do you seek emergency care/hospital care?
• Difficulty in breathing
• Persistent pain/pressure in the chest
• Mental confusion
• Developing bluish discolorations of lips/face
• As advised by treating medical officer
When can you discontinue home isolation?
• after 17 days of onset of symptoms (or date of sampling, for pre-symptomatic cases) and no fever for 10 days.
• There is no need for testing after the home isolation period is over
Source: Ministry of Health and Family Welfare