INTERACTIVE: Strict home quarantine SOP for Covid-19 patients and household crucial to avoid wider Covid-19 transmission

PETALING JAYA: Proper home isolation procedures and strict monitoring of Covid-19 patients and their household members are most important if home quarantines are allowed, say health experts.

They are two of the most important home isolation regulations imposed by more than 30% of countries worldwide for Covid-19 patients who are either asymptomatic or have only mild symptoms.

While many of these countries, like Malaysia, made their decision based on the need to ease the burden on their healthcare systems due to the spiralling number of infections, strict regulations have to be enforced.

The measures are to avoid potential transmission to family members, and to prevent these Covid-19 patients’ health from deteriorating further.

Patients in some countries receive home visits by health workers who will inspect the suitability of the patient’s homes and give guidelines for the patient and household members to observe.

The use of mobile apps are often required to monitor the patient’s location, as well as to follow up on their health condition.

The Star’s analysis found that out of 82 countries, 87% are implementing home isolation for Covid-19 patients with strict regulations for household members, while 13% implement mandatory quarantine at designated facilities.

While a home quarantine is widely accepted in many countries, those which have successfully contained community transmissions such as Vietnam and Taiwan have designated quarantine facilities for close contacts and confirmed cases.

Hong Kong has also kept its cases low by having mandatory isolation protocols and quarantine centres for people with Covid-19 and their close contacts.

However, many countries have insufficient designated quarantine centres due to the hike in infections.

Australia may be one of the few successful countries to allow home quarantines, yet able to control the spread of community transmissions.

This is thanks to its serious testing regimen, effective contact tracing, and ability to build hospital capacity when needed.

Since Jan 12, Malaysia has been allowing home quarantines. But health experts said that a clear standard operating procedure has to be in place, not only for those found positive, but the entire household.

The Health Ministry’s decision to allow home quarantines for Category One and Two cases, which refer to individuals who are asymptomatic and those showing mild symptoms, came after patients experienced delays in hospital transfers as healthcare facilities reached their capacity.

Malaysia has been recording a four-digit hike in the number of daily cases since Dec 10. As of Jan 22, total active cases in the country came up to 42,814.

Information on home quarantines is available on the Health Ministry’s social media pages and on the MySejahtera app, where Covid-19 patients are required to conduct a daily self-assessment of their health condition.

Patients would be quarantined at home for 10 days and a screening test would be conducted on them on the last day.

Covid-19 assessment centres (CACs) have also been set up nationwide to determine which patients can be treated at home, while random door-to-door checks by the police will be conducted to ensure compliance.

Universiti Malaya epidemiologist Prof Datuk Dr Awang Bulgiba Awang Mahmud said home isolation signals a major shift in the Health Ministry’s overall Covid-19 strategy.

“It means they recognised that the containment strategy has failed and we are now moving to mitigation,” he said.

He warned that proper isolation of the infected person is crucial to prevent other family members from being infected, even though asymptomatic patients may have a lower risk of infectivity.

“Small homes will make this difficult, so the built-up area as well as the availability of separate bedrooms, bathrooms and ability to sanitise parts of the dwelling need to be considered.

“Meals will need to be taken separately by the patient,” he said.

Since household members risk being infected, Dr Awang recommends that these people be tested and monitored.

“A clear SOP (standard operating procedure) needs to be communicated to them too as they are considered to be close contacts of the infected person,” he said, cautioning that laxity in following home isolation rules can result in wider community transmission.

He urged the ministry to take extra precautions and lengthen the home isolation period to 14 days, as various mutations have emerged in other countries which bring the risk of higher infectivity.

The Malaysian Medical Association (MMA) said that a proper system for home quarantine is crucial.

“There have been a number of cases where travellers have flouted the home quarantine. With the number of cases expected to increase, there could be more such incidents,” said its president Datuk Dr M. Subramaniam.

He suggested heavier penalties be imposed on those flouting their home quarantine to ensure strict compliance.

Dr Subramaniam also warned that the home quarantine SOP can also be flouted at home if the patient merely leaves his room to mingle with other occupants.

“The occupants of the house must ensure they don’t invite the patient to join them for a meal,” he said.

A former Covid-19 patient, who only wanted to be known as Zack, expressed concern over the lack of information conveyed to him and his family when they were left to self-isolate at home while waiting for further instructions from the district health office.

Zack tested positive on Jan 8 after taking a swab test at a private hospital in the Klang Valley. His wife had been confirmed positive several days earlier.

He and his wife experienced mild symptoms such as cough, fever and flu.

The couple ended up doing their own research on how to self-isolate, such as not sharing plates or utensils with other family members.

“We were told by the hospital that if we had any difficulty breathing, we were to call 999 for an ambulance,” he said.

Zack’s worries about being in home quarantine was that if his condition deteriorated, he would not receive immediate medical attention as he would have if he was being treated at a designated quarantine facility.

“My hope now is that the ministry would give clearer guidelines on how to self-isolate,” he said, adding that he only received a call from the district health office eight days after he tested positive and was not issued a wristband when undergoing home quarantine.

He was issued a release letter by the district health office on Jan 18,10 days after undergoing home quarantine.

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