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Delhi fixes home isolation SOP but concerns remain

June 23, 2020 06:22 AM


Delhi fixes home isolation SOP but concerns remain
RULES : Medical officer to decide if patient with mild symptoms can stay at home
Anonna Dutt and Sweta Goswami


New Delhi : The Delhi health department on Monday issued a new set of guidelines for how patients will be assessed, requiring anyone who tests positive through a lab-based swab test to be taken to a Covid care centre where a medical officer will determine whether they are eligible for home isolation, and anyone who tests positive through a rapid antigen test be assessed on the spot at testing centres or in their localities.

The guidelines ended confusion over the status of mild and asymptomatic patients after the Delhi Disaster Management Authority (DDMA), headed by Lieutenant Governor Anil Baijal, first made it mandatory on Friday that all Covid patients stay in institutional quarantine for at least five days, and then retracted the order the following day amid opposition from the Delhi government.

Monday’s new guidelines – signed by the Directorate General of Health Services (DGHS) -- appeared to reconcile some differences between DDMA and the state government on the issue of home isolation.

“The new SOPs have been issued to ensure that everyone who qualifies for home isolation gets the best medical attention and anyone who doesn’t have facilities to do the same, gets moved to Covid care centres. Even if the patients are asymptomatic, we want to ensure they get regular medical attention and all the assistance they need,” said a statement issued by the government late on Monday.

Just hours before that, however, the Delhi government (which has consistently pushed home isolation as a sustainable treatment option, particularly since a surge in cases could overwhelm the city’s hospitals), and DDMA appeared to be at odds over how to resolve two key questions surrounding home isolation.

The first was whether all positive patients need to make at least one mandatory visit to a Covid care centre — it was part of the DDMA’s Saturday order but the Delhi government felt that it would potentially lead to a spread in infections.

And the second was about a private firm that was so far handling the routine care management of Covid patients under home isolation, but whose contract was cancelled.

The Delhi government roped in Portea Medical for the follow-up process with home isolation cases before the arrangement was called off by the DDMA. As part of a stop-gap arrangement, the private agency continued its followup calls till the SOP was announced on Monday.

According Monday’s guidelines, follow-ups will now be carried out via telephone calls by a team “outsourced/from linked health centre/medical students from various medical colleges” for a period of nine days after a person tests positive. It was not immediately clear if the order paves the way for Portea to be engaged again.

This difference in opinion manifested itself early on Monday, when deputy CM and interim health minister Manish Sisodia described DDMA’s Saturday order of mandatory assessment at a Covid care centre as impractical. “The L-G’s rule of taking all patients to CCCs is not practically possible. The district magistrates (DMs) have reported to us that they do not have enough ambulances to take patients to the CCCs. Their concern is valid also because in the entire city, we currently have only 250 government ambulances,” he said.

Sisodia also said that the health department and DDMA was scheduled for a meeting around midday -- which the LG’s office denied. “There was no meeting notice issued. It is wrong on the part to the government to talk about an agenda on their own with the media first and later put it on the L-G,” said a spokesperson of the L-G office.

Sisodia, the deputy chief minister, is temporarily looking after the health department after his colleague Satyendar Jain had to be hospitalised with the virus.

Since Saturday, local health officials followed different rules. “Some have devised their own plan where they are continuing with the old system which was valid until Friday where a team led by the district surveillance officer (DSO) visits the house of the Covid positive patients and do all the required assessment. So, there is a lot of confusion, not just with the local teams, but more importantly, patients are also clueless,” Sisodia said earlier on Monday.

While the new guidelines will likely bring uniformity on what the correct protocol is, officials at the district level say the logistical challenge will persist.

“This order was given without any consultation with us. We are likely to face practical problems on ground,” said an official from one of Delhi’s 11 districts, asking not to be named.

“Moving over 100 patients in each district to CCC (Covid care centre) and back will likely be a challenge. But, we will try to follow the guidelines given to us to the best of our abilities,” a second official added.

The DGHS guidelines suggest every Covid positive patient will need to be assessed at a facility at least once. For those that test positive using the rapid antigen test kit – for which they are likely to have been at the testing centre or in their localities – the assessment of whether their health permits them will be made on the spot. A medical officer will determine in which category the patient’s Covid infection is – mild, moderate or severe – and check for any comorbidities.

A patient with no symptoms but with an underlying health condition such as heart disease, diabetes or lung ailment will be made to stay at a Covid care centre. A separate team from the district surveillance office will determine if a person’s residence is adequate for home isolation.

For people who test positive through a lab-based RT-PCR, district officials will first establish contact by phone. The patient will then be taken to a CCC for assessment, while a separate team will do a house visit.

Experts said there are valid concerns on both sides of the debate on the mandatory assessments. “Home isolation is essential for managing Covid-19. The kind of care a patient gets at home he/ she will never get at a hospital. However, this is not fit for all and that is where the problem came in. 30% of Delhi lives in slums, where several people stay in the same rooms, home isolation is not feasible in such cases,” said Dr Jugal Kishore, head of the department of community medicine at Safdarjung hospital.

“But, you cannot have ten patients coming into the Covid centres just to get assessed. You would be exposing ten vehicles, ten ambulance drivers, and ten attendants to the infection. So for every ten cases, you are exposing 30 people. What is the point? Instead, sending one team with a doctor to a patient’s house is logistically more sound,” he added

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