How workable and safe is the home quarantine policy announced recently in the Punjab?
Last Sunday, Chief Minister Usman Buzdar gave his approval for keeping Covid-19 patients in home quarantine provided they follow standard operating procedures (SOPs) devised under a policy. The proposal had been under review for some time. There was a realization in the government that the decision might backfire if the SOPs were not followed properly and that Covid-19 patients, especially the asymptomatic ones, might contribute to an accelerated transmission of the disease.
The government has now concluded that in the existing circumstances allowing home quarantine is not a bad idea. But there is a big ‘if’ regarding the mechanism developed for it which depends on people properly following the SOPs and the timely availability of reports to special committees formed for this purpose.
Iqtedar Gilani, a senior journalist covering health, tells The News on Sunday that while SOPs have been formulated, he believes that very few people would be able to follow those. He says the responsibility to monitor what goes on in a house where a Covid-19 patient is quarantined lies more with the government than the inmates.
Gilani says it is not going to be easy to check on families living in multi-storey buildings and disinfect the premises every day.
He says the experience has shown that things get out of control as soon as the number of people quarantined becomes large. “When a few people raise a voice to protest substandard facilities at a quarantine centre, hundreds join them. This can potentially lead to ruckus. As many as 600 to 700 people at one isolation centre are enough to lead to unrest.”
Gilani says one cannot say definitively at this point whether the home quarantine decision is going to prove right or wrong because the outcome is subject to actual conditions. He says Sindh had opted for this approach early as it has fewer hospitals than the Punjab. Theoretically, this means less burden on public sector as private hospitals are engaged for paying patients. In the Punjab, he says, the entire load had been on the public sector. This had created difficulties for both public health facilities and the patients.
The SOPs, prepared by the Punjab Primary and Secondary Health Department, are at the heart of this discussion. These are exhaustive - to the point of appearing ambitious. Many familiar with these believe, therefore, that very few patients will be allowed to quarantine at home. A home-isolation committee has been set up to make sure that these are followed.
The SOPs, prepared by the Punjab Primary and Secondary Health Department, are at the heart of this discussion. These are exhaustive - to the point of appearing ambitious. Many familiar with these believe, therefore, that very few patients will be allowed to quarantine at home.
It has been recommended that the building in which the patient is to be kept in home isolation be disinfected daily and solid waste disposed of in accordance with given guidelines. Home isolation patients are to be provided food in disposable utensils. Home isolation would not take effect where there is a danger of spreading virus due to cooling systems that have blowers installed in them.
Other requirements to qualify for home isolation are a separate room, a separate washroom, a caregiver, transport and education of family. The patient’s home must not be more than an hour away from a high dependency unit (HDU). Patients admitted to hospitals without coronavirus symptoms can submit applications to the home isolation committee.
Speaking on the condition of anonymity, a medical expert working for the Punjab government, says that only the affluent will qualify under the rules. He says the poor will not be able to isolate at home under these SOPs. Vigilance committees formed at union council level will ensure there is no oversight or violation. He says people living in joint family systems may have to spare rooms to accommodate their patients.
Dr Mahmood Shaukat, chairman of Punjab’s Corona Expert Advisory Group, supports the idea of home quarantine. He says a separate room for the patient is enough and a separate toilet is not required. While not everybody can follow the SOPs entirely, he says, a large number of people can avoid remote isolation centres and live closer to their families. Shaukat tells TNS many experts had been pushing for this policy for more than a month.
He says a Covid-19 patient is not a ‘serious’ patient and the purpose of isolation is to separate them so that others do not contract the infection. “This is being practised in other countries. So, why can’t we follow this here carefully?” The purpose of home quarantine policy, he says, is to provide comfort to patients. He says currently there is no bed shortage at the hospitals. At the time of filing this report, the number of Covid-19 patients in the Punjab was around 11,500 whereas 32,000 quarantine beds were available at public facilities.
Dr Salman Kazmi, secretary general of the Young Doctors’ Association (YDA) Pakistan, says that deputy commissioners have not yet issued notifications in this regard (till the filing of this report). Because of this, he says, patients eligible under the policy cannot go home and are confused and desperate. “Unfortunately, not a single Covid-19 patient has been able to go home for quarantine under this policy due to the delay in issuance of the notification,” an agitated Dr Kazmi tells TNS.
Dr Ashraf Nizami, president of the Pakistan Medical Association (PMA), says this policy was necessary because Covid-19 had become a social stigma and families of patients are being treated as ‘untouchables’. The way people infected or suspected to have been infected by this disease are being treated is a blot on humanity, he says. “Allowing these patients to live with their families will change this image.” Nizami says more than anything else he is worried about the stigmatisation of the patients. He recalled some incidents when houses of suspected patients were raided by police and Rescue 1122. “Even if a patient is unable to follow the SOPs, he or she must be sympathised with, not demonised.”