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COVID-19 - Home Isolation and Quarantine

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COVID-19 - Home Isolation and Quarantine

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To prevent the spread of COVID-19, suspected and infected patients are kept away from others. Read the article to know about quarantine and isolation.

Medically reviewed by

Dr. Sagar Ramesh Makode

Published At May 18, 2020
Reviewed AtJuly 12, 2023

The WHO (World Health Organization) declared the COVID-19 outbreak as a public health emergency of international concern. All countries aim at detecting COVID-19 cases early, isolating such cases, managing their symptoms, and tracing their contacts, to prevent the spread of SARS-CoV-2, the virus that is responsible for this pandemic. According to the WHO, the best way to contain this virus is by isolation of infected patients and quarantining their contacts.

Over the last two years, it has been observed that the majority of COVID-19 cases are either asymptomatic or have extremely minor symptoms both internationally and in India. These cases normally improve with minimum intervention and can be handled at home with good medical supervision and monitoring.

Isolation and Quarantine:

Isolation and quarantine prevent the spread of the virus to the population from individuals who have or may have been infected by COVID-19.

  1. Isolation - It is when a person who has tested positive for the new coronavirus is separated from people who are not infected.

  2. Quarantine - It is when a person, who is not sick yet but might have been exposed to the virus (contact), is separated to check if they become sick and produce symptoms.

When Is Home Isolation Needed?

According to WHO’s recommendations, all patients who have tested positive for COVID-19 should be isolated. This instruction is applicable to vaccinated individuals as well.In addition, CDC (Center for Disease Control and Prevention) says individuals should isolate themselves if they feel sick and have doubts about being COVID positive but awaiting the test results. So, if it shows COVID positive after receiving the test results, one should continue with the isolation. On the other hand, if test results are negative, isolation should be ended. If an individual tests positive for COVID-19, they should isolate themselves from fellow housemates for at least five days. The affected individuals are probably the most contagious during these first five days.

How Are Isolation Days Counted?

If someone is undergoing isolation because of COVID-19, the isolation days are counted in the following ways:

1. If No Symptoms Are Present:

  • If the affected individual does not exhibit any symptoms of COVID-19, then day zero will be the day they were tested, not the day when they get the positive COVID reports.
  • The first full day after the affected individual was tested will be considered day one.
  • If the individual develops symptoms within 10 days after being tested, the clock will reset to zero on the day of the appearance of symptoms.

2. If Symptoms Are Present:

  • If symptoms are present, then day zero of the isolation will be considered the day when symptoms appear first, irrespective of the day when the COVID results came positive.
  • Day one of isolation will be considered the first full day after the onset of symptoms.

If isolation in a healthcare facility is not possible for all cases, then the doctors are advised to hospitalize those who are most likely to have a bad prognosis. This includes patients with critical illness and those with comorbidities.

If the hospitals are overwhelmed with COVID-19 patients, then patients with mild illness and no risk factors can be isolated in temporary isolation facilities until they test negative for the virus. In some cases, for patients with no or mild illness and no risk factors, the doctor might suggest home isolation.

An individual who is confirmed to have been infected with the new coronavirus can be under home isolation if he or she:

  • Is not showing severe symptoms, such as breathing problems.

  • Has a separate room where they can stay alone and recover.

  • Has access to personal items and food.

  • Has a healthy caregiver at home.

  • Has the necessary protective equipment like gloves and masks.

  • Do not live with people who are at increased risk of complications from COVID-19, such as older adults (above 65 years of age, children, pregnant women, and people with chronic illnesses).

If individuals have to travel from the hospital or airport to their house for isolation, they should avoid using public transport. In these cases, use of ambulance services or a car is recommended to avoid exposure to others. If someone has been advised to stay in home isolation, they should not leave their houses to go to work, school, or public gatherings. No one except the caregiver should be allowed to visit the house where the affected individual had been isolated.

When Is Home Quarantine Needed?

Home quarantine is necessary for all contacts of confirmed or suspected COVID-19 cases. The following people should be home quarantined:

  • People who traveled to countries that have a high number of COVID-19 patients.

  • Doctors and other healthcare workers who treated a patient, who tested positive later, without personal protective equipment (PPE) or a possible breach of PPE.

  • People living in the same house as COVID-19 patients.

  • Individuals who had direct physical contact with COVID-19 patients.

  • People who were in a closed environment with a COVID-19 case (including air travel).

What Are the Precautions to Be Taken by the Caregiver During Home Isolation or Quarantine?

All caregivers of COVID-19 patients at home or in a quarantine facility should strictly adhere to the following advice. A caretaker should be accessible at any time each day, (preferably someone who has finished his COVID-19 immunization program). For the course of home isolation, a communication link between the caregiver and a Medical Officer is essential.

It is important to limit the contact of the caregiver with the patient, as this virus spreads between people in close contact (about a meter) through respiratory droplets of the patient. To limit contact:

  • Keep the patient in a well-ventilated and separate room. Open all the windows and turn on the fan to increase airflow.

  • Do not let the patient move around the house.

  • Other members of the house should stay in a different room and maintain at least one meter distance from the infected person.

  • Only one caregiver, who is in good health and has no underlying conditions, should care for the patient.

  • No visitors should be allowed until the patient tests negative for COVID-19.

Food:

  • Make sure that the affected individuals eat in different rooms.

  • Always wash the utensils used by the infected person with hot water and soap while wearing gloves and a mask.

  • Wash hands properly after handling cups and dishes used by the patient.

Personal Items:

  • Never share cups, spoon, plate, towels, bedsheets, or mobile phones with the infected person.

Mask and Gloves:

Always wear a mask and gloves under the following conditions:

  • While entering the infected person’s room.

  • While touching the person’s blood, urine, vomit, mucus, or saliva.

  • While washing personal items used by the patient.

Once the caregivers finish caring for the patient, the masks and gloves should be thrown after cutting them up and placing them in a paper bag for at least 72 hours. After that, they should carefully wash their hands with soap and warm water. It is advised not to touch the eyes, face, or mouth without washing hands. Avoid touching and adjusting the masks too.

Washing Hands:

The best way to prevent getting infected is to wash the hands. Hands should be washed with warm water and soap for at least 40 seconds, or an alcohol-based hand sanitizer should be used.The alcohol content in the sanitizer should be at least 60 percent. Make sure to properly clean the back of the hands, wrist, and nails also.

Cleaning Patient’s Items:

The patient’s clothes, towels, bed linen, etc., should be washed using hot water and soap or detergent. This includes cloth masks or bandanas used by the caregiver. If they are washing it by hand, then they should not forget to wear gloves and masks.The caregivers can also wash the infected clothes in washing machine using regular laundry soap at 60 to 90°C. It is recommended to dry the clothes for at least for five hours under the sun.

Keep the Following Things in Mind:

  • Avoid shaking dirty or wet laundry.

  • Use disposable gloves while touching the dirty items.

  • Make sure to use the hottest setting in the washing machine.

  • If sun drying is not possible, then dry laundry using the dryer.

  • Do not forget to clean and disinfect the laundry bag and then washing the hands.

Disinfect the House:

Disinfect high-contact surfaces, such as tabletops, doorknobs, light switches, toilets, faucets, and electronics daily. The caregivers can use soap and water to clean the dirty surface and then use a disinfectant. They can use 0.1 percent sodium hypochlorite or an EPA-registered disinfectant. Mobile phones should be cleaned using alcohol-based (70 percent alcohol) wipes or spray.

In case of sharing a bathroom with the patient, the toilet should be disinfected after every time he or she uses it.

Disposing Gloves and Masks:

Gloves, masks, and other disposable protective wear should be discarded in a closed bin. The waste should then be carefully disposed of as infectious waste.

Utility or reusable gloves and aprons should be cleaned with water and soap and then disinfected with 0.1 percent sodium hypochlorite solution. It is best to use disposable gloves.

Checking Oneself Regularly:

Take the body temperature readings every day. As the caregivers come in close contact with the infected person on a regular basis, contact a doctor immediately in case of occurence of fever, cough, breathing difficulty, or any other symptoms.

How to Care for a COVID-19 Patient?

Keeping the above precautionary measures in mind, care for the patient. One can:

  • Help him or her follow the doctor’s instructions and medicines.

  • Make them drink plenty of water and fluids to prevent dehydration.

  • Get groceries, medicines, and other things he or she needs.

  • Keep the doctor informed about the patient’s progress.

  • Call the ambulance or get help immediately if the patient has:

    • Breathing difficulty.

    • Chest pain or pressure.

    • Bluish lips.

How Can the Quarantined or Isolated Person Help?

If someone is in home quarantine or isolation for suspected or confirmed COVID-19, they should:

  • Wear a surgical mask at all times, especially when the caregiver is close. This will limit the spread of the virus.

  • Change your mask every six to eight hours and throw it in a covered bin.

  • Never reuse a disposable mask.

  • Stay away from older adults, children, pregnant women, and people with chronic illnesses.

  • Avoid moving around the house.

  • Never attend any social gathering.

  • Wash hands using soap and water as often and as thoroughly as possible.

  • Do not share glasses, cups, towels, etc., with others.

  • In case one develop new symptoms or if the condition is worsening, immediately inform the doctor.

How Is Biomedical Waste Disposed at Home?

The used masks, tissue swabs contaminated with blood or body fluids, gloves, used syringes, medicines, etc., of COVID patients, should be considered biomedical wastes. To avoid the spread of COVID-19 from the household to the community, they should be handed to the waste collector separately in the yellow bag. They should be disposed of with appropriate deep burial pits as they can prevent access to dogs or rodents.

How to Treat Patients with Mild or Asymptomatic Disease in Home Isolation?

The patients with mild or asymptomatic disease in home isolation are treated by:

  1. Communicate with the medical officer if there is any deterioration.

  2. Continue taking the regular medicines you take for any other diseases or comorbidities.

  3. Utilize the teleconsultation platform that is made available by the district administration.

  4. Gargle with warm water or take steam inhalation thrice a day.

  5. Consult a doctor if the fever is not controlled with the tablet Paracetamol 650 mg four times a day.

  6. Do not self-medicate.

  7. Steroids should not be self-administered and are not advised for mild cases.

When Should People Who Are Home Isolated or Quarantined Reach the Doctor?

Home isolated or quarantined people should reach the doctor if they develop serious signs or symptoms. They are:

  1. Unresolved high-grade fever for more than three days.

  2. Difficulty in breathing.

  3. Decrease in oxygen saturation (SpO2 ≤ 93%) or respiratory rate > 24/min.

  4. Persistent chest pain or pressure.

  5. Mental confusion.

  6. Severe fatigue and myalgia.

When and How to End Home Isolation or Quarantine?

Ending isolation totally depends on the severity and longevity of the symptoms. For example, if the individuals do not have any symptoms, they can end isolation after day five.

If they had symptoms but showed improvement, then isolation could be ended after day five. However, if symptoms are not improving, CDC recommends continuing isolation until the individual does not get a fever for 24 hours without the use of medicines or they see an improvement in the symptoms.

If the individuals had symptoms and experienced moderate illness such as trouble breathing or shortness of breath, they are advised to isolate through day ten. However, if they have a serious illness, like being hospitalized or having weak immunity, they are advised to isolate through day ten. In addition to this, they have to consult the concerned doctor before ending their isolation, as they would suggest some tests to confirm their COVID status.

No matter when people end isolation, until day 11, one must follow the following guidelines:

  • Avoid being in close proximity to those who are more susceptible to COVID-19.
  • Always remember to use a quality mask when staying indoors or in public places.
  • In the meantime, the individual should not go to the places where they are unable to wear a mask until they are able to discontinue wearing one.

In addition, if COVID-19 symptoms reappear or worsen after ending isolation, in that case, one has to start the isolation again at day zero.

What Are the Guidelines Regarding Wearing Mask After Isolation?

The CDC guidelines clearly say there is a need to wear a mask through day ten after ending isolation. However, antigen testing should be used if they are accessible. If one gets two consecutive negative test results 48 hours apart, they can remove the mask before day 10.

However, one has to wear a mask beyond day ten if their results come positive because positive antigen results indicate that the affected individual is still contagious. In this case, one has to continue undergoing antigen testing at least 48 hours apart till they receive two consecutive negative results.

These guidelines can vary depending on the country and government rules. An individual should always ensure to cover their nose and mouth, maintain social distancing, and wash their hands properly.

Frequently Asked Questions

1.

What Do the COVID Home Quarantine Guidelines Say?

The WHO guidelines for quarantine suggest:
- Allocation of a separate room for the infected individual.
- Maintain at least a one-foot distance from family members.
- Avoid sharing bathrooms.
- Avoid any visitors.
- Frequent hand washing with soap for at least 20 seconds.
- Ensure alcohol-based hand hygiene.
- Avoid touching the face with unwashed hands.
- Monitor the body temperature.
- Dispose of the masks and gloves properly and avoid reuse.
- Separate utensils, towels, linens, bedding, etc., must be provided for the infected person, and they must be washed with soap and water after every use.

2.

How Long Does the Omicron Quarantine Last?

Omicron quarantine is recommended to last for ten days. But with the increased penetration of COVID vaccination, the expected severity has decreased significantly, and the isolation time has been decreased to seven days with a positive report if the patients show no signs of fever for three consecutive days.

3.

What Should Be the Duration of the COVID Quarantine?

The duration of COVID quarantine should last for five days in case of asymptomatic patients or resolving patients, which should then be followed by five days of wearing masks to avoid spreading the infections.

4.

When Is It Safe to End the Isolation?

It is safe to step out of isolation after about seven days of testing positive only if there are no symptoms and three days of no fever. But the individual may still be contagious, so it is obligatory to wear a mask around other people along with other hygiene measures.

5.

What Can Be Done to Quarantine the Family?

The transmission of COVID is quite rampant, so it is possible for numerous members of the family or the entire family to be infected simultaneously. If possible, all family members should be isolated in separate rooms and use separate bathrooms, utensils, bedding, linens, etc. If co-quarantine must be done in the same room, there should be at least a one-meter distance between the individual, and hygiene protocols like handwashing and sanitization should be diligently followed (both in individual and co-quarantine). All individuals must stay in quarantine for at least five days of being asymptomatic and lacking fever.

6.

For How Long Does Omicron Tests Positive in an Individual?

The omicron COVID variant remains positive even on a rapid antigen test (RAT) for five days after the onset of symptoms. About 80 percent of infected individuals still test positive for RAT after five days.

7.

Can COVID Be Contagious After Ten Days of Quarantine?

Individuals may recover from COVID after five days, but the immune system and response widely vary among individuals. So, individuals must diligently follow masking and hand hygiene protocols from day six through ten as the risk of viral spread is very variable. Masking and hand hygiene can significantly mitigate the risk.

8.

After How Long Does COVID Worsens?

 
COVID symptoms begin as mild symptoms but may worsen over time from day five or seven with worsening cough and shortness of breath and may progress to pneumonia. The severity varies among individuals, and the symptoms can rapidly worsen.

9.

Can Omicron Be Detected in Rapid Tests?

Rapid test kits (RAT) can detect omicron and BA. 5 variants of the COVID-19 virus. But it is possible to obtain false negative results as the RATs are seemingly less sensitive to the newer variants, including omicron. Highly infectious cases can be detected by the RAT.

10.

What Is the Timespan of COVID?

The COVID virus can infect the individual for varying timespans, depending on the individual’s immune response and virus severity. Mild cases usually recover within one to two weeks, whereas severe cases can last for up to six weeks. For some, there can be very extensive symptoms with or without cardiopulmonary damage.

11.

Is It Possible to Have COVID and Still Test Negative?

Negative COVID reports usually mean an individual is non-infectious. However, a negative report does not assure that the virus is out of the body. There are possibilities of false negatives and low titers of viral concentrations. In such cases, the patient remains infectious and asymptomatic.

12.

Is It Possible to Have COVID Without Fever?

Pertaining to the body's immune response, the degree of presentation of symptoms can vary widely between individuals. It is possible to have no fever or very low-grade fevers. The fevers may last for just a few days. The lack of fever does not absolutely guarantee a lack of infection.

13.

What Is the Reason to Keep Testing Positive for COVID?

One is likely to keep testing positive for COVID even after long periods of quarantine. This means there is still enough titer of the virus in the body that keeps turning the tests positive. RAT tests can test positive multiple times due to their low sensitivity to newer variants. The absolute answer is as clear as mud, as positive reports may even result from dead or mangled viruses.
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Dr. Sagar Ramesh Makode
Dr. Sagar Ramesh Makode

Cardiology

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