The Telangana government has come up with home isolation guidelines for COVID-19 patients who have mild symptoms or are asymptomatic. The guidelines, issued by the Health, Medical and Family Welfare department, require the patients to have access to a separate room and toilet. Researchers say the guidelines do not take into account patients living in densely populated parts of the city nor those who have difficulty accessing water and toilets.
Instructing patients to undergo a 17-day home isolation, the guidelines call for preferably a separate well-ventilated room and a separate toilet for the COVID-19 patient.
The guidelines also call for a caregiver or attendant to be available 24x7 to take care of the patient. If patient care is not available, those under isolation can reach out to 1800-599-4455 for assistance.
However, the helpline does not provide patient care as advertised. Speaking to TNM, the officer handing the call centre says, “No, we don’t provide patient care. We call the patient daily for 17 days to check on their health status. If the patient has fever, cold, cough, breathing difficulty, we dial 108 and shift them to Gandhi Hospital.”
Munawar Chand, a social worker from Hyderabad’s Bolakpur locality working for slum development, takes a look at the guidelines and wonders, “How can a family of eight living in 35 square yards of space and dependant on community toilets follow these home isolation guidelines?”
The guidelines do not take into account lakhs of citizens who live in both notified and unnotified slums in Hyderabad. “It is possible to adhere to these rules only if you’re living in a house or apartment that is 600 or more square feet in size. It is for the rich,” Munawar adds.
“The home isolation guidelines are for the rich. For the poor we have to look at it differently,” says Amir Ullah Khan, an economics and development policy expert. He points to how Kerala used schools in urban localities to house those under isolation. “There are schools every half a kilometre in urban areas. The simple thing to do would be to move patients to schools and indoor stadiums,” he adds.
The state said that out of the 393 patients discharged from Gandhi Hospital on June 8, 310 of them who had a separate room for isolation, were sent to home quarantine while the rest of them were sent to a government-run centre. However, it has not given out any further details on how people can avail the facility.
Indivar Jonnalagadda, a researcher from the University of Pennsylvania, says, “The state government has set up isolation wards in government hospitals and promised infrastructure of that kind. These home isolation guidelines are not complete without mentioning those resources. Where are the isolation wards? How can one access them? Make the process transparent. Encourage people to use them by guaranteeing quality care.”
The researchers also raise questions on the assumptions made in the guidelines on how typical Indian households function. “They say a separate well-ventilated room and a separate toilet is preferable, but this will be difficult even for many middle-class households or people living in shared accommodations, so there needs to be clarity on safety measures in the absence of such facilities. The risk will be faced not only by the primary caregiver but also by other members of the household,” reasons Indivar.
Another notable rule in the guideline is the need for a 24x7 caregiver. “This is again difficult for many people such as single mothers with young children, young professionals, independent senior citizens, etc,” points out the researcher. “The guidelines give a number to call in case there is no caregiver, but what assistance can they provide? Also, who will the burden of care fall on? Most likely on the women in the household,” he adds.
There should be special guidelines for women and special schemes for their care, points out Indivar. “In well-to-do households, it could be a domestic worker who is the care provider, which raises questions of safety for the worker’s family,” he adds.
Amir Ullah Khan is supportive of the Telangana government’s approach to home isolation but also wants the state to provide options for the poor to isolate themselves.
“The state should allow the poor to isolate themselves at government facilities that are presently not in use. It will cost the state barely Rs 10 crore to feed a few thousand patients for 100 days… it earns over Rs 70 crore in a single day of liquor sales. Money is not the problem here,” he opines, while adding that the Telangana government has been doing a decent job in patient care.