Healthcare workers did not visit most home quarantines
- Authorities in the country have failed to evaluate the suitability of homes, say govt officials
- India’s decision to focus on home quarantines was due to lack of resources and infrastructure
Health authorities across the country have failed to evaluate the suitability of homes to prevent the coronavirus from spreading, though home quarantine remains the recommended first step for treating covid-19 patients.
The majority of homes where patients are quarantined have never been visited by a healthcare worker, according to officials in the Union health ministry.
India’s decision to focus on home quarantine was triggered by the paucity of healthcare providers, lack of infrastructure and resources, including hospital beds, and an unabated increase in covid-19 cases.
According to the World Health Organization (WHO), home care may be considered for confirmed or suspected covid-19 case when inpatient care is unavailable or unsafe, such as when capacity is insufficient to meet the demand for healthcare services.
However, caring for an infected person at home, rather than in a medical or other specialized facility, increases the risk of transmitting the virus to others at home, the WHO said in its interim guidance issued this month on home care for patients.
The WHO unequivocally calls for evaluation of the home setting. A trained health worker must assess whether the home is suitable for isolation and the provision of care, including whether the patient, caregiver, and other household members have all they need to adhere to the recommendations for home care isolation, the WHO said, citing the need for social distancing, separate toilets, and hand and respiratory hygiene.
“Government policy specifically mentioned that the decision of home quarantine or isolation would be made by health professionals after proper assessment of the home condition. However, this was not followed in all the cases,” said Dr Jugal Kishore, professor and head, department of community medicine, Safdarjung Hospital.
The government has been successful in using home quarantine, Prime Minister Narendra Modi said during a recent meeting with state government officials for taking stock of the covid-19 situation.
“In a majority of the cases, the patients get well and a lot of government resources are saved. However, continued monitoring and safety measures should have been instituted apart from allowing home isolation policy for further control of the transmission and severity of covid- 19,” said Kishore.
Attempts by states such as Uttar Pradesh to push for mandatory institutional quarantine have been deeply unpopular among the public. Many persons across the country tried to escape their quarantine institutions during the initial days of the covid-19 pandemic.
“India, not being prepared for a calamity such as coronavirus, has not been efficient in providing quarantine facilities. The institutions provided for the services suffer from a huge lack of clean beds, bathrooms, hand sanitizers, and drinking water. Such conditions further trigger people to escape such facilities,”’said Suresh Sharma, head, Population Research Center, Institute of Economic Growth, Delhi University.
“Home quarantine was considered a good option, but it is not suitable for every part of the country such as in urban slums, especially in Delhi and Mumbai, where the living spaces are very small,”’said Sharma.
Covid-19 cases continue to rise in India with nearly 69,640 cases in the last 24 hours taking the tally to 3.08 million on Sunday. A total of 57,263 covid-19 patients have died so far.
The recovery rate reached 75% with the recovery of 57,989 covid patients in the last 24 hours. The total number of recoveries reached 2.3 million.
More than 850,000 tests were conducted on Sunday, taking the total tests to 35 million.
The decision as to whether to isolate and care for an infected person at home, WHO said, depends on three factors: clinical evaluation of the covid-19 patient, evaluation of the home setting, and the ability to monitor the clinical evolution of the patients.
“India lacks the resources and infrastructure to be able to assess the homes of individuals who have been home quarantined. Thus, the government has asked the hospitals to consult the patients through tele-consultations and has enabled helplines for people,” said Dr Nitin Jain, director and head, critical care, Paras Hospitals, Gurgaon.
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First Published:24 Aug 2020, 06:36 AM IST
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