Lockdown or quarantine
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Assam government has decided to allow COVID19 patients to remain in home isolation, subject to compliance with several conditions.

The state health department on Saturday issued an order stating that the decision has been taken with “great reluctance” for those COVID19 patients who insist on to allow them to remain in home isolation.

The order, issued by principal secretary to the state health department, Samir K. Sinha, said those COVID19 patients would be allowed to remain in home isolation, “without burdening the public healthcare system and subject to compliance with several conditions”.

The principal secretary said the bed capacity in the hospitals across the state has been ramped up considerably and the COVID Care Centres have been set up in order to accommodate asymptomatic and mildly symptomatic patients.

It has been stated that the COVID19 situation has necessitated deployment of a large number of doctors, nurses, paramedical staffs as well as deployment of huge number of ambulances to transfer around 700 patients to the COVID hospitals and COVID Care Centers on a daily basis

The principal secretary said “some individuals, who have tested positive, have been insisting on permission to undergo isolation at home”.

But the health department said its policy is that “all COVID patients will be kept under close medical observation in COVID hospitals or COVID Care Centres so that timely treatment can be provided as required and home isolation of COVID-19 patients is not preferred by the department”.

It said “home isolation of COVID-19 patients carries risk of transmitting the infection to other resident of the home and neighbourhood”.

The health department asserted that it has deployed all available medical personnel to take care of the patients in the government faculties and hence “it is not possible to spare medical staff to monitor the condition of individual COVID-19 patients at their residences”.

The department said as its ambulances are fully engaged in transfer of patients, hence it may be difficult to quickly make available ambulance if the condition of a patient rapidly deteriorates at home.

It is noted that “forced hospitalisation or forced home isolation of a person is against the principles of liberty and freedom of choice”, the principal secretary said in the order.

“Now, therefore, after careful consideration of the circumstances, health & family welfare department has, with great reluctance, decided that COVID-19 patients who insist on remaining in home isolation will be allowed to do so but without burdening the public healthcare system and subject to compliance with following conditions,” the order said.

According to the order, the COVID patient may be allowed to stay in home isolation if the “patient is asymptomatic, and that he/she is, prima facie, in good clinical condition without serious co-morbid conditions.”

The second condition is: “There is no person living in the house along with the patient, who is above 60 years of age/ a pregnant lady/ amongst the high risk category in respect of COVID-19.”

According to the third condition, “all persons living in the house along with the patient shall voluntarily get themselves tested for COVID19 on the 4th day after beginning of home isolation period.”

“In case, any of these persons develop symptoms, they shall get tested immediately,” the order said.

The house must have separate well ventilated room with a separate toilet for the person to remain in isolation.

The entire residence shall be converted to containment zone for 14 days, it said.

“In case of the residence of the patient being located in an apartment or densely packed neighbourhood, and the neighbours object to the home isolation on reasonable and good grounds, then the patient will have to be shifted to a hospital,” said the order.

A caregiver should be available to provide care on a 24 x7 basis and the patient/guardian shall arrange for a private medical practitioner to regularly monitor the patient’s condition in person or through tele/ video-link.

During the period of home isolation, the patient shall strictly adhere to the medical advice given by medical practitioner in respect of clinical aspects as well as hygiene and social distancing to be observed in the residence, the order said.

The other condition is that the “patient shall keep a fingertip pulse oximeter and thermometer at hand, and keep a proper record of the oxygen saturation level, pulse rate and temperature readings at regular intervals.”

In case, the oxygen saturation level falls below 95% or there are any dangerous symptoms and signs, the patient shall be shifted to a hospital by the guardian/care-giver, the order said.

“As the government ambulances are fully engaged in ferrying patients to government facilities at all hours, the patient/guardian will shall make arrangements for a private vehicle to be available at all hours, in case the need arises to shift the patient to a private hospital which is treating COVID patients or to Government COVID hospital,” it said.

According to the health department’s condition, the patient/guardian shall make arrangement for treatment in a private sector hospital, if need arises.

However, the patient will be allowed to be treated in government facility, if he/she so desires.

A patient, who has completed 14 days of home isolation without any complications, shall be deemed to be discharged in consultation with State Discharge Board.

The COVID19 patient will have to furnish an undertaking to the district administration.

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