With COVID-19 cases in Kerala showing a disturbing spike, Chief Minister Pinarayi urged asymptomatic COVID-19 patients and their families to embrace home isolation in a big way.

Earlier there were reports that even symptomatic patients in rural and coastal areas were unwilling to shift to hospitals and COVID First-Line Treatment Centres (CFLTCs). From what the Chief Minister said during his sunset briefing on Wednesday it appears that the reverse is also happening.

Twin gains of home isolation

Vijayan said families and neighbours were imploring even asymptomatic COVID positive patients to seek treatment in hospitals when they should be opting for home isolation.

"Asymptomatic cases are allowed to be in home isolation. But certain asymptomatic patients, even those with sufficient facilities at home, are not ready for this," the chief minister said, and added: "Such a situation is the result of unnecessary fear and misunderstanding. There is no need for concern if asymptomatic persons stay at home adhering to the guidelines issued by the Health Department."

He also said that it had come to the government's notice that family members and neighbours were forcing even asymptomatic patients to shift to hospitals.

The Chief Minister pointed out two major advantages of opting for home isolation. One, staying at home would considerably reduce disease-induced stress. "They will also get focused care in a family atmosphere," Vijayan said.

Two, facilities at hospitals can as far as possible be devoted exclusively for symptomatic and those with underlying conditions.

Rural-urban divide

"Most of the confirmed cases in Kerala, over 60 per cent, are made up of asymptomatic cases. Some cases have been detected even in the pre-symptomatic phase," a top Health official said. "When cases rise, as is happening now, it would be prudent for the asymptomatic to stay at home so that the health system is not unnecessarily stretched," he said.

Initially, there was a clamour for home quarantine. "But as cases increased, panic seems to have set in. There is neighbourhood pressure, too, in urban areas. Fact is, asymptomatic will be safer at home," the health official said.

The situation in financially backward and coastal regions is different. "They are unwilling to even take tests, fearing they would be shifted from their homes and prevented from earning their daily wages," the official said. "Irony is, in these poor homes with not enough rooms and crowding, home isolation is not an option even for asymptomatic," the official noted.

At what point home isolation

According to the Health Department advisory, a decision to 'home isolate' asymptomatic patients in an area should be taken once 70 per cent of the beds in the nearby CFLTC are full.

Now, the government says there is no need to wait for the CFLTCs to get 70 per cent full. "Any confirmed asymptomatic with good facilities at home should opt for home isolation right away," the health official said.

'Good facilities' include a house with road access and communication facilities like land or mobile connection, and also a room with an attached bathroom for the patient alone. Many middle-class urban homes in Kerala will tick these 'good facilities' boxes.

Trouble with 'good facilities'

However, there are other guidelines that could make home isolation difficult for patients in homes with 'good facilities'. One of them, for instance, says that all vulnerable individuals in the family (elderly and people with comorbidities) should be moved to a separate house in the neighbourhood.

"Many homes where an asymptomatic case has been detected have elderly people with conditions like diabetes and cardiovascular problems and when we suggest they move to a friend's or relative's house, there is immediate objection," said the secretary of a highly affected panchayat in Thiruvananthapuram. "They say it would be much easier, safer and more convenient for the patient to shift to the hospital," he added.

Home isolation also requires the constant presence of a healthy adult to monitor the patient. "For many middle and lower middle class families this is unthinkable as the healthy adults supposed to look after the patient would have to go out for work," a government doctor working at a Community Health Centre in the outskirts of Thiruvananthapuram said.

Dangers of self monitoring

Daily self monitoring for danger symptoms is also not a risk many family members are unwilling to take. Doctors say 'red flag signs' include altered sensorium (inability to think clearly or concentrate), breathlessness, chest pain, drowsiness, excessive fatigue, syncope (loss of consciousness caused by fall in blood pressure) and palpitation.

"It is not clear how many of these symptoms could be noticed by a non-expert person," said Dr Harrison Albert, a respiratory physician.

Having a finger pulse oxymeter at home to check the oxygen saturation could be helpful. "If the value is less than or equal to 94 per cent or the pulse rate is more than 90 beats per minute while at rest, it is time to call the ambulance," Dr Albert said. "Problem is, hypoxia or fall in oxygen level happens abruptly in the case of COVID. At home, there are chances that you could miss this sudden change," he added.