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                        Representational image. (AP File)
                        Representational image. (AP File)

                        • paco rabona,best player of kabaddi,50 riyal in indian rupees,Covid-19: A look at Delhi’s health apparatus for patients in home isolation

                          At the peak of the pandemic, Delhi recorded 8,593 cases on November 11. There has been a fresh spike in cases with the number of active Covid-19 cases increasing from 1,404 on March 1 to 10,498 on April 1

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                                By Abhishek Dey

                                1. UPDATED ON APR 02, 2021 10:19 PM IST

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                                      Manoj Jha, 53, a Delhi government schoolteacher, makes phone calls throughout an eight-hour shift and records details of Covid-19 patients under isolation. They tell him about breathlessness and other complications, which may need immediate medical intervention.

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                                            “The details have to be accurate,” said Jha. “Name, address, pulse rate, oxygen saturation levels, type of symptoms, etc. All patients isolated at their residences are given pulse oximeters. Last November was madness. It looks like we are headed towards another such phase.”

                                                  At the peak of the pandemic, Delhi recorded 8,593 cases on November 11. There has been a fresh spike in cases with the number of active Covid-19 cases increasing from 1,404 on March 1 to 10,498 on April 1. With the rising numbers, the government is investing in strengthening the home isolation monitoring system to keep the pressure off the health infrastructure system, officials said.

                                                    People such as Jha and health officials posted in government dispensaries are part of the lowest rung of a multi-layered monitoring system that oversees home isolated patients.

                                                  • Delhi has 11 revenue districts. Each district has one such control room. Also, there are 260 government dispensaries.

                                                          Also Read | Fresh restrictions in Maharashtra, Chhattisgarh districts amid Covid-19 surge

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                                                              • “When cases increase, our daily routines get more hectic,” said Praveen Kumar, another teacher, who has also been working as a home isolation control room operator.

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                                                                    Of the 10,498 active Covid-19 cases in Delhi as of April 1, as many as 5,698 were in home isolation. As of March 1, the home isolation number was 739.

                                                                    • On Thursday, Delhi recorded 2,790 new cases, the highest in nearly four months. As the numbers go up, strengthening the home isolation system essentially means scaling up preparedness for handling a higher number of follow up cases a day, maintaining a quick, simple and efficient system to deal with emergencies, and building up a stronger check and balance system to ensure that people are not violating isolation rules.

                                                                        More cases mean an increased probability of emergency situations. The emergency handling system for home isolation cases operates stage by stage in Delhi. It involves control room doctors, nurses in dispensaries, primary health nursing officers in sub-divisions, doctors engaged by the government for home isolation, and bureaucrats monitoring the system.

                                                                            Over 300,000 Covid-19 patients have recovered at their homes. While 43 of them died last year – either at home or while being taken to hospital or in less than 24 hours of hospitalisation, there have been no such deaths so far this year.

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                                                                                Home isolation is for Covid-19 patients with mild or no symptoms who can afford to isolate themselves from other family members at their residences. Patients in home isolation are supposed to remain isolated for 10 days after the onset of symptoms -- or testing positive, in case there are no symptoms – provided they do not have fever for three consecutive days.

                                                                                  What happens when a patient suddenly develops symptoms, which need medical intervention and hospitalisation?

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                                                                                  2. “Emergency contact numbers are shared with each patient in home isolation. They have to either call up their nearest dispensary from which they receive health check calls or call up the district control room. These are the first contact points. Dispensaries operate from 9am to 5pm. Beyond these hours, the control room is the only contact point in case of an emergency,” said Aman Prasad, a nodal officer for home isolation cases.

                                                                                    On receiving emergency calls, dispensary officials and control room operators are supposed to note down details thoroughly and then share the contact numbers of a public health nursing officer (PHNO) for further help. In case the patients fail to connect PHNOs, the dispensary officials and control room operators have to ensure that the PHNOs call the patients at the earliest.

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                                                                                      “But it is easier said than done,” said a nurse with a government dispensary, who did not wish to be identified. “Once a patient called up saying he needed medical help immediately. It was evident from his voice that he was suffering from breathlessness. While I checked for the concerned PHNO during the call, I could hear the patient’s voice go weak. It was around 2am. I was sweating with anxiety. But we finally managed. The patient was moved to a hospital and later recovered from Covid-19.”

                                                                                      Each revenue district has three subdivisions. Each subdivision has two to three such nursing officers. PHNOs are supposed to brief patients about what to do and connect them with a doctor.

                                                                                      “As the doctor takes up the case, the PHNOs start arranging for oxygen concentrators and an ambulance to be sent to the patient’s residence. They do not have to wait for the doctor’s approval for that. The aim is to save time. Every district has stocks of oxygen concentrators and a few reserved ambulances. The doctors are supposed to assess if the patients need hospitalisation and help with arrangements in that regard,” said a PHNO, who did not wish to be identified.

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                                                                                            While PHNOs and doctors form the middle rungs of the hierarchy in the multi-layered monitoring system of home isolation cases, bureaucrats are at the top of it.

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                                                                                                “We have to constantly look out for gaps to be plugged and strategies to make the emergency system more efficient. This is one aspect of home isolation management. We also have to ensure that there are teams to conduct surprise checks on home isolation patients to check for potential violation of rules. We have teams to ensure that essentials are delivered to their residence,” said Dharmendra Kumar, additional district magistrate (West Delhi).

                                                                                                    Chief secretary Vijay Dev said Delhi was one of the first states to implement a home isolation model. “With time we have further invested in the system, plugged gaps, and scaled up surveillance. The results are visible. We have a better and stronger model in place now. We have had a successful home isolation model in Delhi because each stage of the system -- from the point at which one tests positive to the point at which the patient recovers -- is closely monitored and there is a systematic way to deal with any kind of emergency. Consequently, there have been no deaths in the last three months in the robust home isolation system being followed in Delhi.”

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                                                                                                      Lalit Kant, a former head of the division of epidemiology and communicable diseases at the Indian Council of Medical Research, said a strong and efficient home isolation model is important to ensure that people do not hesitate to get tested for Covid-19, especially when cases are increasing. “But it is also essential to carefully assess the feasibility of each home isolation case. There has to be a separate room, a washroom, and another person in the same house to help during potential emergencies. Improper home isolation assignments can lead to higher transmission of the disease. Also, there should be strong checks and balances in place to ensure that people adhere to home isolation rules.”

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