Should Pre-symptomatic or Asymptomatic COVID-19 Cases be Quarantined at Home or Dedicated COVID-19 Quarantine Facilities?

The COVID-19 pandemic is spreading fast in India. With improved testing facilities, many of the positive cases are being found in the pre-symptomatic or asymptomatic stage. This is causing a dilemma on how to care for such cases, especially on whether they should be quarantined at home, or dedicated COVID-19 facilities.

Image by Alexey Hulsov from Pixabay

The ministry of health, the government of India recommends both the options for eligible cases. Let us see who is eligible for home quarantine per the govt. guidelines:

i. The person should be clinically assigned as a very mild case/ pre-symptomatic case by the treating medical officer.

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

iii. A caregiver should be available to provide care on a 24 x 7 basis. A communication link between the caregiver and hospital is a prerequisite for the entire duration of home isolation.

iv. The caregiver and all close contacts of such cases should take Hydroxychloroquine prophylaxis as per protocol and as prescribed by the treating medical officer.

v. Download Arogya Setu App on mobile (available at https://www.mygov.in/aarogya-setuapp/) and it should remain active at all times (through Bluetooth and Wi-Fi)

vi. The patient shall agree to monitor his health and regularly inform his health status to the District Surveillance Officer for further follow up by the surveillance teams.

vii. The patient will fill in an undertaking on self-isolation and shall follow home quarantine guidelines.

In summary, the government recommends that the case should be confirmed as very mild in nature by a medical officer, he/she should have enough facilities at home including a caregiver, a communication link with the hospital, access to hydroxychloroquine for caregiver and contacts so that it does not spread to them, and the health of the person should be monitored daily.

Though these requirements may sound simple, they are not so!

One of the biggest challenges is that having a caregiver on a 24 x 7 basis is not possible for most people in nuclear families, especially those having children. Hiring an individual caregiver is not feasible in most instances because of the fear of the spread of infection. Secondly, most people do not have homes that are designed for isolated living. Third, monitoring of oxygen saturation requires a pulse oximeter that is expensive.

On the other hand, institutional quarantine offers many benefits including sharing of caregivers, facilities across the cases leading to improved monitoring and the possibility of strong referral linkages to dedicated hospitals. It may, however, lead to dissatisfaction of being away from family and friends and would be associated with some financial costs.

Even then home isolation seemed to be a good option when the caseload was low. But, as the caseload increases in big cities, systematic management of quarantine facilities is the need of the hour.

The pre-symptomatic and symptomatic cases should not shy away from institutional quarantine, instead, they should see institutional quarantine as a progressive social measure not only for the safety of their family and neighborhood but for their own safety too.

The debate on home vs. institutional quarantine must end soon, hopefully in the favor of institutional quarantine, provided excellent institutional quarantine facilities are available at reasonable costs, which the state must ensure before pushing people towards institutional quarantine.

About the author: Dr. Naval Asija is a licensed MBBS Physician from India. MBBS is the equivalent of the MD degree offered by international medical schools. He is based in Delhi, India, and works as a medical writer, editor, and consultant. He supports medical researches as an author's editor, medical communication companies involved in medico-marketing activities, and medical technology companies in improving their products. He can be contacted via his LinkedIn Profile: https://www.linkedin.com/in/navalasija/