Outcomes of COVID Positive Patients Under Home Isolation in an Urban Slum of Bengaluru

Introduction

The Novel Corona Virus infection has led to major catastrophic health implications and human miseries throughout the globe. It was first detected in Karnataka on March 8, 2020. The strategies to control and tackle COVID-19 include 5Ts of tracing, testing, tracking, treatment and technology. A robust surveillance system with an elaborate contingency plan is in place for limiting the spread of the disease.

The treatment strategy includes home isolation for asymptomatic/ mild symptomatic cases and hospital admission for moderate/ severe cases. Out of total 440435 active cases in Karnataka, 103059 cases were in home isolation as on May 23, 2021.¹ The idea of ‘isolation’ in infectious diseases alludes to the concept of separating infected people (or those suspected to be infected) from the wider population, and has been used to control and prevent the spread of infectious diseases. During epidemics, isolation has been directed to majority of patients, lasting until the individual has been cured or is not contagious.²

Laboratory confirmed cases without any symptoms and those who have oxygen saturation of more than 94% at room air are deemed as asymptomatic cases, whereas, patients with upper respiratory tract symptoms (&/or fever) without shortness of breath and having oxygen saturation of more than 94% at room air are mild cases. The patients eligible for isolation should be kept in a room with adequate ventilation and cross-ventilation and wear at all times triple-layer medical mask. Rest, adequate fluid intake, along with frequent hand washing and respiratory etiquette is a must to such patients. It is recommended that these patients monitor temperature and SpO2 daily.

The medical treatment as per guidelines should be completed. In case of development of breathing difficulty, SpO2 < 94% on room air, persistent pain/ pressure in the chest and/ or mental confusion or inability to arouse, medical attention has to be sought immediately. Patient under home isolation will stand discharged and end isolation after at least 10 days have passed from the onset of symptoms (or from date of sampling for asymptomatic cases) and no fever for 3 days.³ This study was conducted to assess the outcome of COVID positive patients under home isolation in urban slum of Bengaluru.

Materials and Methods

A cross-sectional study was conducted in 12 urban slums of a ward in South Bruhat Bengaluru Mahanagara Palike (BBMP) from March 2020 to April 2021. All COVID-19 positive cases under home isolation in the study area were included. A total of 609 COVID-19 cases who met the inclusion criteria were included in the study and the outcome of these patients was noted. Data was entered in Microsoft Excel and analysed for descriptive statistics using SPSS version 20.0.

Results

A total of 609 patients were detected COVID positive in 12 urban slums of Sudham Nagar ward of South BBMP since March 2020. Out of total cases, 175 (28.7%) were females and the remaining 71.3% were males. Among them, 17 (2.7%) belonged to the age group <18 years and 16.7% belonged to the elderly age group. The majority (88.5%) of COVID positive cases recovered at the end of 10 days of home isolation, while 54 (8.9%) cases developed moderate severity symptoms leading to hospitalization in CCC/ DCHC. However, 16 (2.6%) cases developed severe symptoms leading to death (Figure 1, 2).

An average delay of 2-4 days was observed from start of symptoms to isolation of patient, which may be mainly due to ignorance of symptoms leading to delayed testing.

Conclusion

Isolation practices are an important facet of strategies aiming to prevent the spread of COVID-19 infection. The effectiveness of isolation and contact-tracing methods hinges on two key epidemiological parameters viz. the number of secondary infections generated by each new infection and the proportion of transmission that occurs before symptom onset.4,5 Majority of asymptomatic/ mild severity cases under home isolation recover without further extension of the duration of home isolation.

Recommendations

Extensive testing and early diagnosis will lead to early detection of cases and increased early home isolation which will help in preventing the spread of virus. In addition, vaccination is an important public health tool in the prevention of disease.