MANAGEMENT OF COVID-19

PATIENTS IN HOME ISOLATION

Prof. (Dr). Bibhuti Saha Prof. (Dr). Jyotirmoy Pal Prof. (Dr). Soumitra Ghosh

 

Clinical Presentation

• Malaise
• Fever
• Dry cough
• Rhinorrhoea • Headache

• Anosmia • Dysgeusia • Ageusia
• Irritability • Diarrhoea • Weakness • Confusion



Whom To Test

• Patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath), or any history suggestive of COVID 19 and a history of travel to or residence in a location reporting community transmission of COVID-19 disease during the 14 days prior to symptom onset.

• A patient with any acute respiratory illness or any history suggestive of COVID-19 and having been in contact with a confirmed or probable COVID-19 case in the last 14 days prior to symptom onset.

• A patient with severe acute respiratory illness and in the absence of an alternative diagnosis that fully explains the clinical presentation.

• HCWs with any symptom suggestive of COVID 19.



When To Test

• After 5 -10 days of Contact with positive patient
• First day of onset of symptom suggestive of COVID 19.



Modalities Of Testing

Nasopharyngeal swab used as sample

• RAPID ANTIGEN TEST
Rapid detection of SARS-CoV-2 (causing COVID-19) specific

antigens

• RT-PCR
RT PCR for SARS CoV-2 has a high specificity and moderate

sensitivity.

In case of a negative result with RT PCR, the test may be repeated after 48 hours if the patient is a COVID suspect and symptomatic.

• TRUNAAT

If negative consider negative
If Positive to be confirmed by RT-PCR

• CBNAAT
If negative consider negative

If Positive to be considered positive

    

Interpretation Of Rapid Antigen Test

 

Spectrum of Presentation



1. Asymptomatic and Mild

• No or Mild Symptoms – uncomplicated upper respiratory tract infection without evidence of breathlessness /hypoxia, Anosmia

2. Moderate Disease: Pneumonia with no signs of severe disease

• Adolescent or adult with presence of dyspnea and /or
hypoxia

• Respiratory Rate ≥ 24 /minute

• Blood Oxygen Saturation ≤ 94 % in room air

Spectrum of Presentation

Contd.

3. Severe Disease
• Clinical signs of Pneumonia PLUS one of the following:



– Dyspnea – Respiratory Frequency ≥ 30/minute – Blood Oxygen Saturation ≤ 90 %

• Case with Moderate Disease PLUS
ARDS / Acute Respiratory Failure and/or, Sepsis with Multi-Organ Dysfunction Syndrome Septic Shock

and/or,

Spectrum of Presentation

  

Home isolation / safe home



Risk Factors For Severe Disease



1. Age > 50 years
2. Diabetes mellitus
3. Hypertension
4. Chronic Lung disease
5. Chronic Kidney disease
6. Chronic Liver disease
7. Cardiovascular disease
8. Cerebrovascular disease
9. Severe Obesity (BMI ≥40) 10. Cancer
11. HIV
12. Immunosuppressive Drugs

Where to treat ?



Cases

Treatment at

Suspected Mild Case

Home isolation

Suspected Moderate / Severe Case (SARI)

SARI ward

Test Confirmed Mild Case

Home isolation/ Safe Home

Test Confirmed Moderate / Severe Case AND
Test Confirmed Mild Case with High Risk*

Designated COVID ward/ CCU/ HDU

Eligibility For Home Isolation

1. Symptoms – Mild / Very Mild / Asymptomatic (as clinically assigned by the treating physician)

2. Facility – One separate room to stay in isolation with own toilet. Room for others with separate toilet

3. Doctor – Each patient must be under one qualified Doctor, who is available for Teleconsultation, Medical Care and Guidance 24×7

4. Care Giver – To provide care 24×7. Communication with Health Set up for the entire duration of home isolation.



Eligibility For Home Isolation

Contd.

5. Care giver and all close contacts of such cases should take Ivermectin prophylaxis as per protocol and as prescribed by the treating medical officer.

6. Consent – To monitor own health, obey the Doctor and to inform Health Team

7. Undertaking – His own choice and will follow Home isolation Guidelines



Criteria For Safe Home Admission

• Home isolation not suitable for him
• No caretaker at home
• Higher age group (>50 yrs ) plus one Risk Factor • Two risk factors irrespective of age.



Parameters To Be Observed

• Temperature
• SpO2 (By Pulse Oximeter)
• Blood Pressure
• Sensorium (conscious, drowsy or stupor) • Pulse
• Urine Output (approx.)



Investigations For Home Isolated Cases

• Complete Hemogram

• X-Ray Chest PA view (if Possible)

• LFT

• Serum Creatinine

• Blood Glucose Level

• ECG: (if possible)

• CRP



Advice To The Patient During Home

Isolation

1. Mandatory use of Mask

2. Absolute rest

3. Monitoring of SpO2 and Temperature, at least four times daily

 

Advice To The Family Members

1. Use of Mask by caregiver when going near the patient

2. To stay at home mandatorily for a stipulated period as advised by doctor

3. Test for COVID-19 as soon as any member becomes symptomatic

4. Test for COVID-19 of Asymptomatic family

members who has High Risks and who are Close Contacts of the patient on Day-5 – Day-10



Treatment

• Tab Ivermectin12 mg once daily for 5 days PLUS Cap/ Tab Doxycycline 100 mg twice a day for 7 days

Or

Tab HCQs for mild cases with high risk factors.
Dose : 400 one tab twice daily on D1 then 400 daily for 4 days.

• Tab Paracetamol for fever
• Tab Vitamin C 500 mg twice daily
• TabZinc50mgperday
• Vitamin D3 60000 IU weekly
• Supportive treatment for cough, diarrhea etc.



Warning signs:

Clinical Suspicion:



• • • • •

• • •

Difficulty in breathing

Persistent pain or pressure in the chest

Mental confusion or inability to arouse

Developing bluish discolorations of lips/ face

SpO2 < 94% at Room Air (For Obstructive Airway Diseases: SpO2 < 90% at Room Air)

Stupor, Drowsiness or Confusion
SBP <90 mmHg AND/ OR DBP <60mmHg HR >100/min

Warning signs:

Laboratory Markers/ parameters: [if available]

• Chest X-Ray showing Bilateral infiltrate (predominantly lower zones & periphery)/ Ground glass opacity

• ST-T changes in ECG or high cardiac markers suggestive of Myocarditis (Trop-T positive)

• Exacerbation of Co-morbid laboratory parameters

• Neutrophil : Lymphocyte Ratio ≥3.13

• Development of Acute Kidney Injury

• Raised Bilirubin or Liver Enzymes
Go by clinical parameters if laboratory service not available



When To Discontinue Home Isolation

• After 17 days from Onset of Symptoms (10+7) where afebrile for 10 days

• After 17 days from Testing Date, if the patient is asymptomatic

• No need of Repeat Testing (to prove Negative) after the home isolation period is over



Ivermectin

Doses:

For Treatment in mild cases: Tab Ivermectin12 mg once daily for 5 days

Take Ivermectin with a fatty meal

For prophylaxis:
Tab Ivermectin 12 Mg once daily on Day 1, Day 7 and followed

by 12 mg once every 30 days.

Side effects: It is usually well tolerated. Decreased leukocyte count (3%), eosinophilia (3%),.

Caution: Hepatic impairment, allergic disorders, HIV infection. Avoid in Pregnancy and children below 2 years.

    

Hydroxychloroquine

For Treatment :

Tab. Hydroxychloroquine – 400 mg BD on Day 1, followed by 400 mg OD for 4Days

Contraindications:

Children below 15 years, QTc in ECG >500 msec, Retinopathy, Drug Interactions, Myasthenia Gravis, Porphyria, Epilepsy, G6PD deficiency, pregnancy, lactation.

  

HCQ Prophylaxis

 Asymptomatic household contacts of laboratory

confirmed cases

400 mg twice a day on D1, followed by 400 mg once weekly for next 3 weeks; to be taken with meals.

  

Follow Up



• The first follow-up visit should be within 14 days after home isolation/discharge or as required.

• Look for common Post-Covid complications: • Pulmonarycomplication

• CardiacComplication
• RenalComplication
• Impairedbloodglucose • Psychological issues

Follow Up Advice For Patients:



• • •

• •

Nutritious diet, adequate sleep and rest.

Avoid smoking and consumption of alcohol.

Continue use of mask, hand & respiratory hygiene, physical distancing.

Regular medications as advised after discharge and also for managing comorbidities

New onset of confusion, focal weakness etc if present, contact nearby hospital/ physician.

UNDERTAKING ON SELF-ISOLATION

I …………………………………………………………………………………………………………………
S/W of …………………………………………………………………………………………………………., Resident of…………………………………………………………………………………………………being

diagnosed as a confirmed/suspect case of COVID-19, do hereby voluntarily undertake to maintain strict self- isolation at all times for the prescribed period. During this period, I shall monitor my health and those around me and interact with the assigned surveillance team/ with the call centre (1800313444222) in case I suffer from any deteriorating symptoms or any of my close family contacts develops any symptoms consistent with COVID-19. I have been explained in detail about the precautions that I need to follow while I am under self-isolation. I am liable to be acted on under the prescribed law for any non-adherence to self- isolation protocol.

Signature:

Contact Number

Date:

If A Separate Bathroom Is Not Available



•

•

If a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person.

If this is not possible, the caregiver should wait as long as practical after use by an ill person to clean and disinfect the high-touch surfaces.

Cleaning Of Toilets

• Toilet seat/pot, commode: To be cleaned with 1% Sodium Hypochlorite solution

• Toilet floor, tap & other areas: To be cleaned with soap water

Toilet to be cleaned after every use by the patient

Preparing 1% Sodium Hypochlorite

Solution

• Add 15 grams of Bleaching Powder in 1 liter water

• To be kept in a covered container

• To be used within 24 hours of preparation

  

   

Take Home Message



• Amid the COVID pandemic don’t forget common causes of fever eg. Malaria, Dengue, Enteric fever etc.

• Patients who have been advised home isolation as per set criteria and allotted to you are to be followed up as per guideline

• You are the best care taker and guide for your patients

• Please provide service as you have been doing for years

• DON’T FORGET to take appropriate precautions to protect yourself

Thank you