MUMBAI: People in Mumbai above the age of 50 testing positive for Covid-19 won’t be allowed to self-isolate at home and will be strongly pursued to opt for institutional isolation. A very high mortality rate seen among those getting hospitalised after 4-5 days of home isolation has warranted the change in protocols, BMC officials said. A staggering 83% of Covid deaths in Mumbai have come from the age groups above 50, though they account for 42% of total cases.
In a circular issued on August 19, the public health department recommended that anybody above 50, irrespective of having comorbidities or symptoms, must be shifted to a Covid Care Centre (CCC2). Earlier, the BMC had issued a guideline advising mandatory hospitalisation for people above 60, which it has now revised.
High mortality rate among 50-plus patients behind BMC move: Docs
The inclusion was driven by the fact that one in five infections and one in four deaths in the city was from the age-bracket of 50-59. The new recommendations are not rules but they are guidelines for ward-level officers who evaluate patients before advising on hospitalisation or home isolation.
Executive health officer Dr Mangala Gomare said that while nobody can be coerced to get hospitalised, every effort will be made to counsel and shift the person infected to a Covid centre. “Our analysis has shown high mortality rate among who are those above 50 years old. We urge people to get admitted, screened and stay under observation till they have fought the infection,” she said.
When asked if monitoring for those under home isolation was an issue, Dr Gomare said that it was a matter under evaluation. Of the 17,917 active cases in the cityat the moment, over 8,700 people are currently under home isolation.
Assistant municipal commissioner of the Brihanumbai Municipal Corporation Suresh Kakani said that home isolation has worked well for the young who are without comorbidities. “Those who are above 50 years old should reach hospitals early as that also ensures faster recovery,” he said.
Doctors and civic officials have raised concerns that people who had tested positive for the novel coronavirus and who were under home isolation were not seeking hospitalisation at the right time after deterioration in their condition. Dr Shashank Joshi, a member of the state Covid task force, said that institutional quarantine was highly recommended for those above 50 years of age, with comorbidities and symptoms. “It is because the second week can be tricky for a patient. One may become happy hypoxic (dip in oxygen levels) without realising it. Vigilance for home isolation has to be very high and the question is how many people are able to do it effectively,” he said.
Dr Jitendra Jadhav, the medical health officer of L ward, said that there have been cases where people who have been under home isolation have delayed coming to a hospital. “I have seen a few preventable deaths where the patients made a rush for critical care beds at the last minute,” he said.
Some doctors, however, have called it an extreme step to reduce mortality. “If patients above 50 are forcefully put in hospitals, there may be reluctance and fear to get tested. It will also put pressure on health infrastructure,” said Dr Deepak Baid, president, Association of Medical Consultants. As most cases now come from affluent pockets, it’s not jumbo facilities but private hospitals that will get filled up, creating bed shortage, he said.
As per revised norms, home isolation will now only be allowed in asymptomatic, mild or pre-symptomatic persons who are below 50 and have no comorbidities such as diabetes, hypertension, kidney disease, among others, as well as have separate toilets. The solid waste management department has also been told to carry out sanitization at least once when a case in detected in a society, including the person’s home and the society.