Home isolation deaths during the third wave of COVID-19 pandemic in Kerala - a descriptive study
Globally, coronavirus disease 2019 (COVID-19) is one of the major causes of mortality in this century. 1 As of 3rd February 2022, COVID-19 accounted for 5.7 million deaths worldwide and 0.49 million deaths in India.2 The State of Kerala which reported the first case of COVID 19 in India has recorded 56,100 deaths with a case fatality rate of 0.09%.3 The highly transmissible Omicron (B.1.1.529), variant of SARS-CoV-2 resulted in sharp rise of cases globally with mild or no symptoms. In Kerala this marked the beginning of the third wave of the pandemic by the end of November 2021, even before the second wave touched the base line. Anticipating a peak in the number of cases and to decongest the COVID-19 designated hospitals in order to provide appropriate intensive care services to patients who are in real need, Government of Kerala revised the home isolation (HI) guidelines with effect from 5th January 2022.
The state had been undertaking diverse measures to contain the transmission of COVID-19 since the commencement of the pandemic.4,5 Isolation of the infected person, was one of the prominent strategies adopted, despite its challenges in terms of compliance, cost, productivity and quality.6 A structured approach was adopted to ensure isolation at facility and home by developing guidelines and by establishing a monitoring mechanism. The medical officers (MOs) of the concerned primary health centre (PHC) through the concerned rapid response team (RRT) monitored the patients under HI and ensured safe practices. According to the revised criteria, the PHC MOs were authorized to permit patients with mild or no symptoms without any comorbidities, but with necessary facility for self-isolation at their residence to follow HI.
However, it has been found that during the third wave, around 7% of deaths were reported among those who were under HI either at home or during transit to hospital.12 This unforeseen situation elicited the need to examine HI deaths in-depth.
Moreover, there was not much evidence in this regard from elsewhere. By analysing the patterns and pathways of COVID-19 deaths during HI, the need for revisiting the guidelines for HI or enhancing the monitoring mechanism for HI could be brought out thus providing insights to improve outcomes for persons undergoing HI. Such information might help state/district administrators to plan and implement other interventions to prevent fatalities in future. The objective of this study, therefore, was to describe the characteristics of COVID-19 HI deaths reported in Kerala for a period of one month from January 15th, 2022 to February 15th 2022 and the circumstances that led to such deaths.
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