Triple-layer mask to steam inhalation: Centre issues revised guidelines for home isolation, asymptomatic patients

SRINAGAR:  As the second COVID wave batters India, the central government has come up with revised guidelines for home isolation of mild and asymptomatic patients.

Under the revised guidelines issued by the Union Ministry of Health and Family Welfare, the patient can be clinically assigned as a mild and asymptomatic case only 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 on 24 x7 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 only be allowed home isolation after proper evaluation by the treating medical officer,” said the ministry.

However, patients suffering from immune-compromised status (HIV, Transplant recipients, Cancer therapy, etc.) are not recommended for home isolation.

“The caregiver and all close contacts of such cases should take Hydroxychloroquine prophylaxis as per protocol and as prescribed by the treating medical officer,” the ministry said.

The government said the patient must isolate himself from other household members, stay in the identified room and away from other people in-home, especially elderlies and those with co-morbid conditions like hypertension, cardiovascular disease, renal disease, etc.

“The patient should be kept in a well-ventilated room with cross ventilation and windows should be kept open to allow fresh air to come in. The patient should at all times use a triple-layer medical mask. Discard masks after 8 hours of use or earlier if they become wet or visibly soiled. In the event of caregiver entering the room, both caregiver and patient may consider using N 95 mask,” said the ministry.

The government said masks should be discarded only after disinfecting it with 1% Sodium Hypochlorite.

“Patient must take rest and drink a lot of fluids to maintain adequate hydration. Follow respiratory etiquette at all times.  Frequent handwashing with soap and water for at least 40 seconds or clean with an alcohol-based sanitizer,” the government said.

The ministry asked the patients not to share personal items with other people in the household.

“Ensure cleaning of surfaces in the room that are touched often (tabletops, doorknobs, handles, etc.) with 1% hypochlorite solution. Self-monitoring of blood oxygen saturation with a pulse oximeter is strongly advised.  The patient will self-monitor his/her health with daily temperature monitoring and report promptly if any deterioration of symptom,” the ministry said.

 The government said patients must be in communication with a treating physician and promptly report in case of any deterioration.

“Continue the medications for other co-morbid illnesses 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,” it said.

The government said if fever is not controlled with a maximum dose of Paracetamol 650mg 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). Consider Tab Ivermectin (200 mcg/kg once a day, to be taken empty stomach) for 3 to 5 days.  

“Inhalational Budesonide (given via inhalers with spacer at a dose of 800 mcg twice daily for 5 to 7 days) to be given if symptoms (fever and/or cough) are persistent beyond 5 days,” said the government.

The ministry said 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. Systemic oral steroids not indicated in mild disease. If symptoms persist beyond 7 days (persistent fever, worsening cough, etc.) consult the treating doctor for treatment with low dose oral steroids,” it said.

The ministry also issued detailed instructions for caregivers to prevent them from contracting an infection while tending to positive cases.

“The caregiver should wear a triple layer medical mask. N95 mask may be considered when in the same room with the ill person. The 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. Discard the mask after use and perform hand hygiene after disposal of the mask. He/she should avoid touching own face, nose or mouth,” the government said.