Home Isolation during the COVID-19 Pandemic

• As the new wave of the COVID-19 pandemic leads to greater numbers of infected patients, recovering in home isolation or “hospitel” have become viable options for asymptomatic patients or those with mild symptoms. These options can also increase overall safety by reducing further transmission to close contacts in the household and community.
• Asymptomatic patients isolating at home, those with mild symptoms being treated at a hospitel, and even uninfected persons may need advice or have their questions answered in order to take good care of their health. Help is now more accessible through telehealth or telemedicine services, which have been key tools during the COVID-19 pandemic.

At the onset of the 2019 coronavirus pandemic in Thailand, all infected patients had to be admitted to a hospital or field hospital, regardless of symptoms, in order to ensure they received proper care as well as to control the spread of the virus.

However, the latest wave in Thailand, which has so far lasted more than 3 months (information as of July 2021), has led to a sharp rise in the number of new COVID-19 cases and the situation has not yet shown any signs of ending. This increase in the number of patients has overwhelmed many hospitals and field hospitals which have reached full capacity, leaving infected patients waiting for beds and without the proper treatment they require, which can be fatal. Therefore, authorities have introduced home isolation for asymptomatic or mildly symptomatic patients, as well as designated hotels—“hospitels”—where patients can receive appropriate treatment while being isolated to prevent the spread of the virus to their family and community.

Home isolation is a suitable option for asymptomatic patients who are able to take care of themselves while isolating from other members of their household. Once a COVID-19 infection has been diagnosed, medical staff will assess the suitability of a 14-day or longer period home isolation. The patients should be under 60 years of age, in generally good health, not obese (BMI ≤ 30 kg/m2 or weight ≤  90 kg), and not suffering from any of the following conditions: chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), cardiovascular disease, cerebrovascular disease, uncontrollable diabetes, or other conditions that may be considered by doctors to be a risk. Patients must agree to strictly isolate themselves from others. This means they must not reside in a location with an uninfected person and, if possible, stay alone. The official guidelines for practicing home isolation are as follows:

• Do not leave the house and do not receive any visitors.
• Strictly avoid contact with the elderly or children.
• Stay in a separate room with your own belongings and dine in your own room.
• Patients unable to stay in a separate room must maintain a separate sleeping area. Air conditioning should not be used, and windows should be kept open to ensure a steady air flow.
• Wear a facemask at all times when leaving the room.
• Regularly wash hands with soap or an alcohol-based gel, including washing them before and after touching any objects that are shared with others.
• Keep your garbage separate as contaminated/infected waste. Clothes, towels and bed linen should also be washed separately.
• Use a separate bathroom. If that isn’t possible, infected patients should be the last person to use the bathroom and thoroughly clean the area once they have finished.
• Those residing in a condominium or apartment complex should notify the owner or juristic person responsible for the upkeep of the location.
• Patients in home isolation should wear a facemask when picking up any deliveries, avoid close contact with delivery drivers and wash hands thoroughly before and after receiving the delivery.
• Importantly, all those isolating—whether home alone or with their families—should always adhere to the following 3 key hygiene principles: wear a facemask, regularly wash your hands, and practice social distancing.

• Assess the infected patient’s suitability for home isolation.
• Register the patient as being infected with COVID-19.
• Take a baseline chest X-ray on the first day (if possible).
• Provide medications as appropriate, such as paracetamol, cough medicines, nasal decongestants, etc., and medical supplies, such as a thermometer and pulse oximeter to monitor body temperature and oxygen level, which can be reported daily to healthcare personnel through telemedicine services.
• Create an action plan for hospital transfer if the patient’s condition deteriorates.

• Oxygen saturation < 96%
• Temperature > 38 degrees Celsius
• Shortness of breath or difficulty breathing
• Constant pain, aching or tightness of the chest
• Loss of consciousness
• Bluish color or paleness of the nails or lips

Patients in hospitel will receive treatment and be monitored by medical professionals for a period of no less than 10 days. Patients in any of the following groups may be admitted to a hospitel:

1. A confirmed COVID-19 infection with no serious symptoms, Sp02 levels > 96%, with or without underlying health conditions, and less than 75 years of age.

2. A confirmed COVID-19 infection with no serious symptoms, Sp02 levels > 94%, with or without underlying health conditions, and less than 65 years of age.

3. A confirmed COVID-19 infection with mild symptoms, Sp02 levels > 92%, no underlying health conditions, and less than 60 years of age.

4. A confirmed COVID-19 infection with serious symptoms which has improved after treatment in the hospital for 7–10 days and is in stable condition; these patients can be transferred to a hospitel in order to complete their 14-day isolation.

• They must be able to communicate effectively, take care of themselves, and have no psychiatric illness.
• They must be able to manage their regular medications for existing underlying diseases.

*In case of full capacity, physicians may adjust the criteria at their discretion, being sure to hold all patients’ safety as their top priority.

The following are examples of the underlying health conditions referred to above:

1. Obesity (BMI > 30kg/m2 or weight > 90 kg)

2. Chronic obstructive pulmonary disorder (COPD)

3. Asthma

4. Severe allergies

5. Chronic kidney disorder (CKD)

6. Cardiovascular disease, including congenital heart disease

7. Cerebrovascular disease

8. Uncontrollable diabetes

9. Liver cirrhosis

10. Immunodeficiency disorders

11. Lymphocytes less than 1,000 cells/cubic meter

• Assess the infected patient’s suitability for treatment at a hospitel.
• Register the patient as being infected with COVID-19.
• Take a baseline chest X-ray on the first day (if possible).
• A thermometer, pulse oximeter, and blood pressure monitor will be made available to every patient, with oxygen generator devices made available when necessary.
• Provide medications as appropriate to each patient, such as antiviral drugs, paracetamol, decongestants, cough medicines, etc. as determined by the doctor.
• Organize the channel of communication between the patient and medical staff using telemedicine services.
• Create an action plan for hospital transfer if a patient’s condition deteriorates.

Latest information is correct as of 22 July 2021.

Studies into the spread of COVID-19 have shown that infected patients are capable of transmitting the virus to others for 14 days following their infection, after which the chance of transmission is significantly reduced. However, complications can occur during the 14-day period of infection or even after. Patients are educated and advised to carefully monitor their own symptoms to ensure their safety.

Besides the anxiety that can occur, having to isolate for an extended period of time can increase loneliness and stress. This makes finding relaxing activities particularly important for those isolating at home or in a hospitel. Such activities include the following:

• Keep in regular contact with friends and family over the phone or through social media.
• Exercise with simple activities that can be done safely at home, such as dancing, yoga, and body weight training, can help to relieve stress and improve physical health.
• Engage in hobbies or activities that can be performed during isolation, including watching movies, catching up on the latest TV series, and listening to music.
• Make a plan of activities you would like to do during 10–14 days of isolation and stick to it as much as possible.
• Ensure you eat healthy meals, drink plenty of fluids, and avoid alcohol.
• Maintain a positive mindset.
• Have a plan in place should an emergency situation occur.

In addition to COVID-19 patients isolating at home or hospitel, uninfected people who are in good health should remain careful, continue social distancing, and avoid unnecessary contact or travel to high-risk areas as much as possible.

Telehealth services have played a key role providing remote health care in order to minimize the chance of exposure to the COVID-19 virus facilitating care for patients who might not be able to physically travel to the hospital. The following services are now available:

• Consultations, monitoring of symptoms, and test results and analysis through Samitivej Virtual Hospital.
• Blood tests, health check-ups, vaccinations, medication delivery, physiotherapy, wound dressing, and other personal health services.
• Care for patients with chronic health conditions, such as stroke or cerebrovascular disease, through the use of health monitoring devices which can help prevent recurrence or complications.

Telehealth services, especially telemedicine, have become more prevalent in Thailand. However, their use is still limited to simple and uncomplicated conditions because one of the major limitations is that the doctor cannot perform a direct physical examination, making definitive diagnosis and appropriate treatment more difficult.

Nevertheless, there are now handheld examination kits available, such as TytoCare, innovative equipment including a built-in digital stethoscope to perform basic health assessments. This single device can be used by patients at home to listen to their heart and lungs; examine their ears, nose, throat, and skin; and measure their temperature, with the results sent to medical staff without the need for person-to-person contact. The TytoCare device has been certified by both the Thai and American Food and Drug Administrations. As such, its users can be confident that the quality of health screening it provides is reliable and trustworthy.

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