A day after mandating five-day institutional quarantine for each COVID-19 case in Delhi, Lieutenant Governor Anil Baijal withdrew the order on Saturday, 20 June, stating, “Regarding institutional isolation, only those COVID positive cases which do not require hospitalisation on clinical assessment and do not have adequate facilities for home isolation would be required to undergo institutional isolation.”
The initial order would have meant that every person who tests positive with the disease in the national capital will have to observe at least five-day institutional quarantine - even if they are asymptomatic or mildly infected - before they can undergo home isolation.
Several experts FIT spoke to, however, expressed concern regarding this earlier decision and said it could be counter-productive.
‘Should Reconsider this Decision’: Delhi Govt
Reacting sharply to the decision, the Delhi government had released a statement saying, “Entire manpower of Delhi govt is already stretched. Now, large quarantine centres would need to be made to house thousands of asymptomatic people. Thousands of patients are being treated at home at the moment. After this order, we would immediately need thousands of beds in quarantine centres.”
“Further, Delhi has already seen escalating number of cases and has to prepare for patients from the entire region. In addition to the 80,000 beds being planned for serious patients in July, we will have to add thousands of quarantine rooms.”Delhi Government
“ICMR guidelines are still applicable to the rest of India, then why are there different parameters for Delhi?”, it had added.
Experts Disagree With the Order
Speaking to FIT, Dr Shahid Jameel, a virologist and CEO of Wellcome Trust DBT India Alliance, had said, “Testing compliance would go down considerably because of the fear of quarantine.”
Dr Arvinder Soin, Chairman, Medanta Liver Institute, had raised some important concerns relating to the ways this could affect testing, access to care and recovery of patients. “People who have acceptable circumstances at home for self-isolation, are best off there. If you force institutional quarantine, they may get dissuaded from getting tested. They’ll want to ‘sit it out’ even if they experience mild symptoms. Second, those who can isolate at home will unnecessarily occupy institutional quarantine facilities and displace needy patients who can’t isolate at home.”
“Third, those who can afford beds in private hospitals would rush to book them. This way, they will be occupying facilities that are required to cater to people with more serious symptoms who necessarily need hospitalisation and care, or who may not find it possible to isolate at home. This will just lead to under-utilised capacities at homes.”Dr Arvinder Soin
Dr Sumit Ray, a critical care specialist in Delhi spoke about the absurdity of the five-day clause in the order, “There seems to be no scientific basis to mandating a five-day quarantine - it should either be for the entire duration of the infection or none at all. But even otherwise, forcing institutional quarantine doesn't make sense. The option should certainly be there for those who need it, but for people who are perfectly comfortable at home and can follow the protocol, it shouldn’t be mandated. This would just burden the healthcare system when it is already stretched thin.”
Dr Soin pointed out how this could five-day clause could lead to unnecessary movement of people while they are COVID positive.
“An infected person is first moved out of their home to go to a government facility, and then expected to return after five days if they are doing okay. It’s a whole lot of movement for no reason.”Dr Arvinder Soin
He felt that the ‘5 day period’ is arbitrary, and not scientifically sound as an infected person sheds the virus for 3-4 weeks.
It must be mentioned here that according to the state government’s daily health bulletin, over 10,000 people have been quarantined at home in Delhi. Questioning the order, AAP MLA Raghav Chadha said, "As per our calculation, Delhi needs 15,000 beds by June 30 but after this order, now we need 90,000 by June 30. From where will we get these beds?", NDTV reported.
Dr Khan Amir Maroof, Associate Professor, Community Medicine, UCMS and GTB Hospital, Delhi stressed on this in conversation with FIT.
“The concern of feasibility is exactly what had led to the decision to allow mild and asymptomatic people to opt for home isolation in the first place. You need to be practical. A positive trend in terms of testing is being observed in Delhi. Now as we are testing more, the number of cases will also increase and more patients will be detected.”Dr Khan Amir Maroof
“The government is already working towards making centres and quarantine facilities to cater to the rising numbers. But when people can comfortably isolate at home, why would you force them to come to government facilities? In fact, for some patients, the comfort of their homes is the only solace, and staying at home may help them cope with the challenging times.”
He added, “We need to look at these social, individual as well as practical concerns. Look at it from a common person’s point of view. People would either start hiding their status, or would just avoid getting tested if you force them to get quarantined elsewhere when they can easily isolate at home.”
“The intention of mandatory institutional quarantine may be noble, but we also have to accept the fact that it is a pandemic. We are trying our best to manage it, but it isn’t possible to just curtail it completely and suddenly. This is why our policies need to be practical for the long-run.”Dr Khan Amir Maroof
Dr Soin also explains that instead of this, the approach should be to enforce and monitor home isolation properly. Educate people, send out guidelines, involve RWAs and depute our forces for random checks. “Implementing the current policy would be much more efficient than replacing it altogether.”
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