At least five days’ institutional quarantine for all Covid-19 cases in Delhi

The Delhi Disaster Management Authority (DDMA), headed by lieutenant governor Anil Baijal, on Friday evening controversially ordered a mandatory five-day institutional quarantine for “each case” under home quarantine in the city, in an unexpected move that could strain the Capital’s already-stretched health care infra and workers, discourage people from undergoing tests, and inconvenience around 8,500 people currently under home isolation.

The move was immediately criticised as “arbitrary” by the state government, which, in a statement, pointed out its success in running a home quarantine programme and the challenges that will come with adding “thousands of quarantine rooms and finding additional doctors and nurses and health workers” to manage these facilities. The statement also questioned why this change in guidelines was being made only for Delhi. “We have treated thousands of mild and asymptomatic cases at home so far through daily monitoring and counselling,” it added.

According to experts, home quarantine is preferred, if the home meets certain conditions. Most countries in the world recommend it for mild cases. Experts also point to the risks of infections from crowded quarantine facilities.

“I am a big believer of home isolation as at least 90% of the cases, according to me are mild enough to not require hospitalisation. As long as precautions are taken and there is regular medical consultation, it is a good idea. Why unnecessarily burden the health infrastructure that anyway gets overwhelmed when there is surge in cases? Medical beds should be kept for serious patients needing specialised care, otherwise where will you keep your serious patients whose lives we have to save? Home can be the best isolation facility so long as all protocols are followed,” said T Jacob John, the former head of virology at CMC, Vellore.

DDMA said in its order that it fears “home isolation without physical contact to monitor the patients may be a reason for the increase in the spread of Covid-19 infections in Delhi”. Total infections breached the 50,000 mark on Friday, up from 20,000 on June 2.

According to the government’s June 18 bulletin, 5,400 of its 10,900 Covid-19 beds were vacant, and roughly 5,000 beds were available (out of 6,300) in Covid care and health centres. “This availability of resources is mainly because of the success of our home quarantine scheme for patients who are not badly infected and have space to be safely isolated at home,” a senior state government official said.

“Entire manpower of the Delhi government is already stretched. Now, large quarantine centres would need to be made to house thousands of asymptomatic people. Thousands of patients are being treated at home at the moment. After this order, we would immediately need thousands of beds in quarantine centres,” the Delhi government said in a statement. Going by Thursday’s numbers, the 8,500 in home quarantine and the 2,877 new cases would completely fill up the 10,000-odd beds free at present.

There have also been concerns about a shortage of health care workers in hospitals and care facilities. HT reported on Wednesday that the plan to add 23,800 beds this month for Covid-19 patients will require roughly 2,000 doctors and 3,000 nursing staff – resources that it at present has not been able to secure.

The DDMA order discontinued the services of the company hired to manage the home quarantine, Portea Medical, which contacted individuals through phone calls.

“We have been completely supportive of the Central Government in our collective fight against Corona, but this arbitrary decision will seriously harm Delhi. They should reconsider this decision,” the Delhi government said in its statement. “Home isolation encouraged a lot of people with minor symptoms to come out and test as they knew that they will not to be taken to a hospital or quarantine centre forcibly.”

The DDMA, which is authorised to take decisions on all Covid-related-matters, is chaired by the lieutenant governor and chief minister Arvind Kejriwal is the body’s vice-chairman.

Interestingly, home quarantine for patients has been approved by the Union government as an effective way to preserve health care infrastructure for future challenges, under certain guidelines.

To be eligible for it, a Covid-19 patient must fulfil seven criteria, according to a Union health ministry circular issued on May 10. One, they should be clinically declared as mild or pre-symptomatic by a treating medical officer; two, they should have requisite facility at home to be self-isolated and for quarantining family contacts; three, a caregiver should be available for 24x7 care and should be in direct contact with a hospital; four, the caregiver and other family contacts should take Hydroxychloroquine as a prophylaxis; five, the patient should download the Aarogya Setu app and keep it active at all times; six, they should monitor their health and regularly inform the status to designated surveillance officers; and seven, give a written undertaking that all these guidelines will be followed.

On June 19, the health ministry reiterated these guidelines while writing to all states asking for their strict adherence and saying that some states were not following them in “letter and spirit”. The letter, sent by Lav Agarwal, joint secretary in the Union health ministry, wrote: “…it is highlighted that that instances have come to our notice wherein home isolation is allowed in routine in certain states. This may lead to spread of the disease within the family members and neighbours. This is particularly true for dense urban agglomerations.”

The letter, sent a few hours before the DDMA’s order was issued, pointed to the Union government’s May 10 guidelines, and added: “It is requested to ensure strict implementation of the guidelines on home isolation at the field level.”

Atishi, a legislator from the Kalkaji constituency and a spokesperson of the Aam Aadmi Party (AAP) who tested positive for Covid-19 two days ago and is currently under home isolation, said it has emotional and psychological benefits.

“There is a lot of comfort attached to home isolation compared to institutional quarantine because you have your own room and most importantly, your own washrooms. Besides, putting every Covid-19 positive patient in institutional quarantine is also illogical because there isn’t so much of manpower available to nurse so many people. In home isolation, you have your family to look after you. But of course, who do not have the liberty to isolate themselves in their homes must be sent for institutional quarantine,” she said.

Atishi added that if institutional quarantine is made mandatory then fewer people will opt for testing of Covid-19. “Police, along with medical staff, will come to pick even asymptomatic people up and take them to quarantine centres. People will be scared with all this and many will fear themselves from getting tested,” she said.

Virender Kumar Yadav (51), a government school teacher who recovered on May 28 said the biggest advantage of being under home isolation is diet. “One can avail the healthiest diet at home -- which may or may not be possible in a quarantine centre. I ate a lot of green vegetables and fruits during the isolation period and it evidently worked. In case someone’s health deteriorates, there is always the provision of informing the surveillance officials and getting oneself checked and moved to a hospital, if needed,” Yadav said.

The Delhi government’s home isolation management system was launched on May 8. The first 5000 patients were onboarded in Delhi government’s home isolaton system on May 26. At present, 8,480 asymptomatic and mild Covid positive patients are under home isolation in Delhi. As many as 5,748 patients have recovered under home isolation so far and 367 had to be shifted to hospitals because their condition worsened.