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Bengaluru : The guideline for home isolation of COVID-19 cases has been issued by Ministry of Health and Family Welfare- Government of India. In view of evolving situation of COVID-19 in the state, the following guidelines are issued:

The persons who have tested COVID positive shall be permitted to be in “home isolation” with the following conditions:

1. Only those who are asymptomatic or mild symptomatic shall be allowed to be in isolation at home

 2. They shall be oriented to the protocol of home isolation

 3. Health team from district health authority/ BBMP shall visit the house and assess its suitability for home isolation and also do triage of the patient.

 4. Tele-consultation link shall be established for initial triage and daily follow-up of the patient during the entire period of home isolation

5. The patient shall report to the physician/ health authorities about their health status every day

6. The patient shall have pulse oximeter, digital thermometer and personal protective equipment (facemasks, gloves) to be used during home isolation.

7. The release of the patient home isolation shall be as per the existing discharge protocol of the state for COVID-19 (vide below sl no.10)

8. The home isolation shall be with the knowledge of the family members, neighbours, treating physician and local health authorities.

The detailed guidelines for home isolation are as follows:

1. Initial assessment and triage of patient by health team at patient’s house

● After receipt of positive report, the patient shall isolate himself/herself at home in a separate room. Health team shall visit and assess the suitability of the house for isolation of the patient at home and also do triage of the patient

● Ask regarding following symptoms: Fever, cold, cough, throat pain, difficulty in breathing, etc.

● The health staff shall assess the following parameters (Triage) o Thermal scanning for fever o Pulse oximetry for SpO2 and pulse rate o Glucometer for random blood sugar o BP apparatus for blood pressure recording

● Enquire for co-morbidities like hypertension, diabetes, severe obesity, thyroid disease, cancer, kidney diseases including patients on dialysis, heart diseases, stroke, Tuberculosis, People living with HIV, immune-compromised, on steroids and immune-suppressants, etc.

● Arrange a tele-consultation call for initial assessment (Swasth App)

● For further daily follow-up of the patient, tele-consultation through government or private hospital shall be arranged as desired by the patient. 2. Eligibility for Home Isolation

● The person shall be clinically assigned as asymptomatic/mild case by the treating medical officer/ physician

● Such cases should have the requisite facility at their residence for self-isolation and also for quarantining the family contacts

● A caregiver should be available to provide care on a 24 x7 basis. A regular communication link between the caregiver and hospital is a pre-requisite for the entire duration of home isolation

● Oxygen saturation should be ≥ 95%

● Age shall be less than 50 years

● If the patient has the following co-morbidities- Hypertension, diabetes, obesity, thyroid disease; they shall be well managed and under good clinical control as assessed by medical officer/physician

● Shall not have any comorbid conditions like kidney diseases including patients on dialysis, heart diseases, stroke, Tuberculosis, cancer, People living with HIV, immunecompromised, on steroids and immune-suppressants, etc.

● The patient shall agree to monitor his/her health and regularly inform their health status to the physician and District Surveillance Officer (DSO) for further follow up by the surveillance teams.

● The patient shall provide a signed undertaking on self-isolation (Annexure I) and follow guidelines of home isolation

● Home isolation shall not be applicable for pregnant women. However, lactating mothers shall be allowed for home isolation after assessment and instructions 3. Requisite facility at home for isolation

● Separate well ventilated room for the person in isolation, preferably with attached toilet.

● The patient shall stay in the identified room and away from other persons in the home (especially the elderly and those with comorbid conditions like hypertension, cardiovascular disease, renal disease, etc.). If the patient does not fit to the above criteria for home isolation or the house is not suitable for home isolation, then isolation at a facility (CCC/DCHC/DCH) is recommended

● The following criteria shall be used for shifting the patient to CCC, DCHC or DCH as applicable: Criteria COVID care Centre* (CCC) Dedicated COVID Health Centre(DCHC) (Beds with Oxygen facility) Dedicated COVID Hospital (DCH) (ICU Beds Available) Clinical condition Asymptomatic or Mild Moderate Severe Measure Oxygen Saturation with fingertip Pulse oximeter SpO2more than 94% SpO2between 90 to 94% SpO2less than 90% Symptoms Asymptomatic or mild symptoms Symptomatic Or Asymptomatic (persons with comorbidity, age below 10 years, age more than 50 years, pregnant women) Symptomatic Age Between 10 to 50 years All Ages All ages Co-morbid Conditions Without Co-morbid conditions With co-morbid condition Without Co-morbid conditions (age below 10 years, age more than 50 years, pregnant women) With co-morbid condition Pregnant women No Yes Yes Note: * when the house is found not suitable for isolating the patient at home, besides this may also be considered if the asymptomatic patient opts for CCC 4. When to seek further medical advice Further medical advice shall be immediately sought if the following symptoms and signs develop;

● Difficulty in breathing

● Persistent pain/pressure in the chest

● Mental confusion or inability to arouse

● Developing bluish discolorations of lips/face

● Oxygen saturation ≤ 94% using fingertip pulse oximeter

● Any other symptom the person considers serious

● as advised by treating physician 5. Instructions to health staff monitoring the patient in home isolation ● Ensure strict enforcement of isolation of patient at home o Home isolation notice shall be pasted on the front door of the house o Hand stamping shall be done for the patient in home isolation for a duration of 17 days o E-tag band shall be put on to the left wrist. This shall alert any violation by the patient to the protocol of home isolation o Information to two neighbours regarding isolation of patient at home o Three member team in the ward/ village/ booth level/ resident welfare or apartment owners’ association shall oversee compliance of the patient to isolation at home o If the patient is found violating the protocol of home isolation, then the ‘flying Squad, shall issue a warning and if there is any further violation, an FIR shall be filed and he/she shall be shifted to CCC. o IVRS outbound calls through Apthamitra helpline (14410) shall be made to the patient on a daily basis

● The caregiver and all close contacts of such cases shall take Hydroxychloroquine prophylaxis as per protocol and as prescribed by the treating medical officer/physician

● Telephonically or using tele-consultation mode, check the patient for development of new symptoms or fever or deterioration in oxygen saturation (<94%) at least once daily ● Gloves, masks, and other waste generated during home isolation shall be placed into a waste bin with a lid in the patient’s room before disposing of it as infectious waste. The disposal of infectious waste shall be the responsibility of the local municipal authority ● Inform the neighbours to be kind to the person in isolation and the family and not to stigmatise 6. Instructions to the patient in home isolation ● The patient shall wear N-95/medical facemask at all times. The mask shall be discarded after 8 hours of use or earlier if they become wet or visibly soiled. ● Mask shall be discarded only after disinfecting it with 1% Sodium Hypo-chlorite solution ● The patient must stay in the identified room only and maintain a physical distance of 2 meters/ 6 feet from other people in the home, especially elderly and those with comorbid conditions like hypertension, cardiovascular disease, renal disease etc. ● The patient shall take rest and drink a lot of fluids to maintain adequate hydration. Drink at least 2 litres of water per day. Use boiled and cooled water for drinking. ● Shall follow cough etiquettes at all times ● Hands shall be washed often with soap and water for at least 40 seconds or clean with an alcohol-based sanitizer. ● Do not share personal items like utensils, towels, etc. with other family members. Keep them separate. ● Clean surfaces in the room that are touched often (table-tops, doorknobs, handles, etc.) with 7% Lysol or 1% sodium hypochlorite solution ● Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, followed by 1% sodium hypochlorite solution. ● The patient shall strictly follow the physician’s instructions and medication advice. Page 5 of ● The patient shall self-monitor his/her health with a fingertip pulse oximeter and digital thermometer daily ● The patient shall report promptly if he/she develops any worsening of symptoms, as mentioned above (Sl no. 4) ● Smoking, chewing tobacco and alcohol intake shall be strictly avoided ● The patient shall receive counselling services when necessary ● Download Arogya Setu App on mobile (available at https://www.mygov.in/aarogyasetuapp/) and it should remain active at all times (through Bluetooth and Wi-Fi) 7. Instructions to caregivers ● The caregiver shall wear N-95/medical facemask appropriately 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 shall be changed immediately. Discard the mask after use and perform hand hygiene after disposal of the mask into separate closed bin. ● He/she shall avoid touching eyes, nose or mouth. ● Hand hygiene shall be ensured following contact with the patient. ● Hand hygiene shall be practised before and after preparing food, before eating, after using the toilet, and whenever hands look dirty. Use soap and water for handwashing at least for 40 seconds. Alcohol-based hand rub can be used if hands are not visibly soiled. ● After using soap and water, use of disposable paper towels to dry hands is desirable. ● Exposure to a patient: Avoid direct contact with body fluids of the patient, particularly oral or respiratory secretions. Use disposable gloves while handling the patient. Perform hand hygiene before and after removing gloves. ● Avoid exposure to potentially contaminated items (e.g. avoid sharing food, utensils, dishes, drinks, used towels or bed linen). ● Food must be provided to the patient in his/her room. ● Utensils and dishes used by the patient shall be cleaned with soap/detergent and water wearing gloves. The utensils and dishes may be re-used—clean hands after taking off gloves or handling used items. ● Patient’s clothes, bed linen, and bath and hand towels shall be washed using regular laundry soap and water or machine wash at 60–90 °C (140–194 °F) with common household detergent, and sun dry thoroughly ● Gloves and protective clothing (e.g. plastic aprons) shall be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Single-use gloves shall be used and discarded after each use. Perform hand hygiene before putting on and after removing gloves. ● The caregiver shall make sure that the patient follows the prescribed treatment. ● The caregiver shall ensure counselling services to the patient whenever necessary. ● The caregiver and all close contacts will self-monitor their health with daily temperature Page 6 of monitoring and report promptly if they develop any symptom suggestive of COVID-19 (fever, cough, cold, sore throat, difficulty in breathing, etc.) 8. Instructions to the family members of person in home isolation ● Do not panic. Do not stigmatise. ● Keep the patient cheerful and boost their morale ● Ensure that the person is in strict home isolation ● Maintain a physical distance of at least 2 metres/ 6 feet ● Visitors should not be allowed until the patient has completely recovered and has no signs or symptoms of COVID-19 ● Remember, the fight is against the disease and not the person ● For any assistance, please call Apthamitra helpline – 14410 9. Instructions to neighbours of patients who are home isolated ● Do not panic. Do not stigmatise. ● Support them by providing essential items like medicines, rations, vegetables, etc. until they get cured as may be required ● Keep a vigil on them to ensure strict home isolation. ● Maintain a physical distance of 2 metres/6 feet. ● Remember, the fight is against the disease and not the person ● For any assistance, please call Apthamitra helpline – 14410 10. When to release the patient from isolation at home ● They shall be released if the following criteria are met: o No symptoms o No fever (recorded temperature ≤ 37.50C or ≤99.50 F ) o Maintains saturation above 95% o Respiratory rate less than 24 per minute ● Patient under home isolation shall end home isolation 17 days after onset of symptoms (or date of sampling, for asymptomatic cases) and no fever for 10 days. ● There is no need for the RT-PCR/CBNAAT/True-NAT test after the home isolation period is over. ● The person shall be allowed to resume duty only after satisfactory completion of home isolation Page 7 of ● Disinfection of the house: After completion of home isolation, disinfect all>at least once daily

● Gloves, masks, and other waste generated during home isolation shall be placed into a waste bin with a lid in the patient’s room before disposing of it as infectious waste. The disposal of infectious waste shall be the responsibility of the local municipal authority

● Inform the neighbours to be kind to the person in isolation and the family and not to stigmatise 6. Instructions to the patient in home isolation

● The patient shall wear N-95/medical facemask at all times. The mask shall be discarded after 8 hours of use or earlier if they become wet or visibly soiled.

● Mask shall be discarded only after disinfecting it with 1% Sodium Hypo-chlorite solution

 ● The patient must stay in the identified room only and maintain a physical distance of 2 meters/ 6 feet from other people in the home, especially elderly and those with comorbid conditions like hypertension, cardiovascular disease, renal disease etc.

● The patient shall take rest and drink a lot of fluids to maintain adequate hydration. Drink at least 2 litres of water per day. Use boiled and cooled water for drinking.

● Shall follow cough etiquettes at all times

● Hands shall be washed often with soap and water for at least 40 seconds or clean with an alcohol-based sanitizer.

● Do not share personal items like utensils, towels, etc. with other family members. Keep them separate.

● Clean surfaces in the room that are touched often (table-tops, doorknobs, handles, etc.) with 7% Lysol or 1% sodium hypochlorite solution

● Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, followed by 1% sodium hypochlorite solution.

● The patient shall strictly follow the physician’s instructions and medication advice.  

● The patient shall self-monitor his/her health with a fingertip pulse oximeter and digital thermometer daily

● The patient shall report promptly if he/she develops any worsening of symptoms, as mentioned above (Sl no. 4)

● Smoking, chewing tobacco and alcohol intake shall be strictly avoided

● The patient shall receive counselling services when necessary

● Download Arogya Setu App on mobile (available at https://www.mygov.in/aarogyasetuapp/) and it should remain active at all times (through Bluetooth and Wi-Fi) 7. Instructions to caregivers

● The caregiver shall wear N-95/medical facemask appropriately 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 shall be changed immediately. Discard the mask after use and perform hand hygiene after disposal of the mask into separate closed bin.

● He/she shall avoid touching eyes, nose or mouth.

● Hand hygiene shall be ensured following contact with the patient.

● Hand hygiene shall be practised before and after preparing food, before eating, after using the toilet, and whenever hands look dirty. Use soap and water for handwashing at least for 40 seconds. Alcohol-based hand rub can be used if hands are not visibly soiled.

● After using soap and water, use of disposable paper towels to dry hands is desirable.

● Exposure to a patient: Avoid direct contact with body fluids of the patient, particularly oral or respiratory secretions. Use disposable gloves while handling the patient. Perform hand hygiene before and after removing gloves.

● Avoid exposure to potentially contaminated items (e.g. avoid sharing food, utensils, dishes, drinks, used towels or bed linen).

● Food must be provided to the patient in his/her room.

● Utensils and dishes used by the patient shall be cleaned with soap/detergent and water wearing gloves. The utensils and dishes may be re-used—clean hands after taking off gloves or handling used items.

● Patient’s clothes, bed linen, and bath and hand towels shall be washed using regular laundry soap and water or machine wash at 60–90 °C (140–194 °F) with common household detergent, and sun dry thoroughly

● Gloves and protective clothing (e.g. plastic aprons) shall be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Single-use gloves shall be used and discarded after each use. Perform hand hygiene before putting on and after removing gloves.

● The caregiver shall make sure that the patient follows the prescribed treatment.

● The caregiver shall ensure counselling services to the patient whenever necessary.

● The caregiver and all close contacts will self-monitor their health with daily temperature  monitoring and report promptly if they develop any symptom suggestive of COVID-19 (fever, cough, cold, sore throat, difficulty in breathing, etc.) 8. Instructions to the family members of person in home isolation

● Do not panic. Do not stigmatise.

● Keep the patient cheerful and boost their morale

● Ensure that the person is in strict home isolation

● Maintain a physical distance of at least 2 metres/ 6 feet

● Visitors should not be allowed until the patient has completely recovered and has no signs or symptoms of COVID-19

● Remember, the fight is against the disease and not the person

● For any assistance, please call Apthamitra helpline – 14410 9. Instructions to neighbours of patients who are home isolated

● Do not panic. Do not stigmatise. ● Support them by providing essential items like medicines, rations, vegetables, etc. until they get cured as may be required

● Keep a vigil on them to ensure strict home isolation. ● Maintain a physical distance of 2 metres/6 feet. ● Remember, the fight is against the disease and not the person

● For any assistance, please call Apthamitra helpline – 14410 10. When to release the patient from isolation at home

● They shall be released if the following criteria are met: o No symptoms o No fever (recorded temperature ≤ 37.50C or ≤99.50 F ) o Maintains saturation above 95% o Respiratory rate less than 24 per minute

● Patient under home isolation shall end home isolation 17 days after onset of symptoms (or date of sampling, for asymptomatic cases) and no fever for 10 days.

● There is no need for the RT-PCR/CBNAAT/True-NAT test after the home isolation period is over.

● The person shall be allowed to resume duty only after satisfactory completion of home isolation

● Disinfection of the house: After completion of home isolation, disinfect all the commonly touched surfaces inside the house with 1% sodium hypochlorite solution. Spraying on the floors, walls above 6 feet, ceiling and open places shall not provide any benefit. The floors shall be wet mopped with common household detergent.