Pakistan's guidelines on home isolation against WHO, Chinese recommendations

Updated April 10, 2020

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A railway cart turned into an isolation facility. — Dawn/File
A railway cart turned into an isolation facility. — Dawn/File

LAHORE: The federal government’s new guidelines to the provinces to isolate confirmed Covid-19 patients at homes are against the recommendations of the World Health Organisation (WHO) and the `strong advice’ of a Chinese team which visited Pakistan recently.

It has recommended treatment of only serious patients at health facilities and insisted on home isolation for confirmed patients with mild infections.

“Asymptomatic and mild cases can be managed at home under the home isolation criteria”, read the guidelines of the federal government.

According to a senior health official, the five-page guidelines are largely beyond the comprehension of common patients, primarily the semi-literate and uneducated.

He said in their meetings with Pakistani counterparts, the Chinese experts had rejected the idea of home isolation of confirmed patients.

Similarly, the World Health Organization (WHO) has also recommended isolation of patients carrying virus at proper health facilities.

The Chinese delegation had told the local experts that the doctors in Wuhan, China, had made the same blunder by keeping positive patients at homes in the early days of the spread of the coronavirus virus that led to worst epidemic.

“Both the WHO and Chinese experts had strongly recommended isolation of the confirmed patients at field hospitals/quarantines or at least at well-equipped hospitals to make sure they are treated under strict protocols,” the official said.

The federal government on the other hand wants the provincial governments to implement its directions in letter and spirit.

A senior official told Dawn the matter came under discussion at various high-level meetings of the Punjab government when some senior experts declared the guidelines of the federal health ministry ‘controversial and risky’.

They cited some recent cases in Punjab where patients during home isolation not only arranged private functions but also met relatives, transmitting virus among healthy people.

The experts quoted a case of Gujrat district as a strong reference where four Covid-19 patients coming from abroad had infected over 40 healthy people.

Such cases were also noted among Tableeghi Jamaat members when they left the annual congregation at Raiwind Markaz and returned to their home districts where several confirmed cases were reported later.

During the last week, Punjab witnessed an alarming spike in the confirmed cases and the reason is said to be the local transmission of the virus when patients are isolated at homes, the official said.

He said the Punjab government had made serious efforts to enhance capacity for the patients by establishing 1000-bed field hospital in Lahore, and providing quarantine centres at various districts besides allocating beds at major state-run hospitals across the province.

“The purpose is to accommodate the maximum number of confirmed patients at these facilities to stop transmission of the virus,” he said, adding, in the presence of such facilities, the federal government’s policy of home isolation was mindboggling.

During inquiries, he said, it transpired that the patients testing positive for the virus and quarantined at homes had blatantly violated the protocols risking lives of others.

The Ministry of National Health Services, Regulations & Coordination (NHSR&C) had issued 40-point guidelines on March 26 titled “home isolation during Covid-19 outbreak”.

Later, it sent revised guidelines on April 2, recommending isolation of the confirmed patients of Corona at home.

The official said the Chinese experts had shared their experiences of combating Covid-19. The Corona Expert Advisory Group (CEAG) of Punjab discussed with them the issue of home isolation for asymptomatic or mild cases which is a social demand by educated and affluent families .

“The Chinese experts warned that there is risk of noncompliance to isolation SOPs associated with home isolation and can lead to family clusters causing further spread of the disease”, said the official.

The Chinese experts also recommended that these patients should only be discharged if two PCR samples were tested negative 24 hours apart and they should be further quarantined at home for another two weeks as a preventive measure.

The PCR of these patients should be repeated at day 28 to rule out the possibility of false negative test.

The WHO guidelines circulated worldwide on March 17 said: “All laboratory confirmed cases be isolated and cared for in a health care facility.”

It further said: “If all mild cases cannot be isolated in health facilities, then those with mild illness and no risk factors may need to be isolated in non-traditional facilities, such as repurposed hotels, stadiums or gymnasiums where they can remain until their symptoms resolve and laboratory tests for COVID-19 virus are negative”, further read the WHO guidelines.

PM’s adviser on health services Dr Zafar Mirza did not respond to phone calls and text messages when Dawn tried to get his comment.

Published in Dawn, April 10th, 2020