In line with the sudden surge in the number of COVID-19 cases in the Philippines by the start of the year, and as foreseen until the end of January, the Department of Health (DOH) released an advisory regarding the updated COVID-19 protocols for home quarantine and isolation. The new set of guidelines allows and shortens the duration of home quarantine and isolation for individuals who have been infected or had exposure with a person infected with the Coronavirus disease (COVID-19). This action also aims to keep hospitals and health facilities from being congested as these new cases continue to increase. Moreover, the need for these adaptive measures is emphasized to ensure the continued availability of health and essential services.
As written in the DOH Department Circular No. 2022-0002 dated January 06, 2022, under the COVID-19 Policies, isolation is allowed for the “management of probable and confirmed COVID-19 cases with no symptoms, mild symptoms, or moderate symptoms”. Moreover, on the new guidelines, home quarantine is allowed for the “Step-down management of COVID-19 cases from hospitals who are recovering and presenting with mild or no symptoms but shall need to finish the indicated isolation period.”.
Before knowing the new and updated protocols or guidelines for home quarantine isolation, we should first discuss the definition of these terms. Quarantine refers to the separation and movement restrictions of people who were exposed to the virus or had close contact with an infected one to observe if they become sick. Isolation refers to the separation of an ill or infected person from other people to prevent the transmission of the virus or contamination.
Requirements for Home Isolation
The minimum infrastructure requirements for home quarantine and isolation, as stated in the said department circular, include the availability of a separate room and toilet dedicated only for the infected individual, and oversight of a healthcare provider or local government unit.
1. Infrastructure
- Well-ventilated room
- The line for communication with family and health workers
- Utilities such as electricity, portable water, cooking sources, etc.
- Solid waste and sewage disposal
2. Accommodations
Ability to provide a separate bedroom for the patient, or separate bed with enough distance (> 3 feet or 1 meter) so long as there are no vulnerable persons in the household
Accessible bathroom in the residence; if multiple bathrooms are available, designate a specific bathroom to be used by the patient only
3. Resource for Patient Care and Support
- Primary caregiver to be the contact person of the patient:
- Must remain in the residence during the whole duration of the quarantine/isolation
- Must be fully vaccinated and not at high risk for complications
- Must be educated on proper precautions
- Medications for pre-existing conditions as needed Meal preparation
4. Personal Protective Equipment
- For the patient: surgical mask per day for each day of isolation
- For all other household members: surgical mask per day for each day of isolation
- Disinfection materials: gloves, alcohol, etc.
5. Home Monitoring Kit
- Thermometer
- Pulse Oximeter
- Vital signs recording mechanism
- Psychosocial support materials or proposed activities during isolation
- Medicines to manage common symptoms of COVID-19
- Vitamins
Quarantine Protocols for Asymptomatic Close Contact
For fully vaccinated asymptomatic individuals who had close contact with the suspect, probable, or confirmed cases are required to quarantine for at least five (5) days from the date of the last exposure under the new home quarantine guidelines. While as for partially vaccinated (those who have received one dose of a two-dose series of vaccine) or unvaccinated asymptomatic individuals who had close contact with the suspect, probable, or confirmed cases are required to quarantine for at least fourteen (14) days from the date of the last exposure. Regardless of the vaccination status, quarantine can be discontinued at the end of the set quarantine period if they have remained asymptomatic during the whole advised quarantine period, regardless if testing has been done in between and resulted negative.
All asymptomatic individuals who had close contact with the suspect, probable or confirmed cases are not required to test unless symptoms will develop, and should immediately isolate regardless of the test result. Despite the shortened home quarantine period of the new guidelines, all asymptomatic close contacts should still monitor their symptoms for at least 14 days. They should strictly comply with the minimum public health standards such as physical distancing, washing of hands, coughing and sneezing into the elbow, wearing of masks, etc., regardless of their vaccination status.
As for healthcare workers and certain authorized sectors, in coordination with their corresponding hospital Infection Prevention and Control Committees (IPCC), are authorized to implement further shortening of quarantine period up to 0 days for their fully vaccinated workers with boosters who had close contact based on the institution’s individualized risk and needs assessment.
Isolation Protocols for Asymptomatic Case
Fully vaccinated individuals who tested positive for COVID-19 but asymptomatic are required to isolate for at least seven (7) days from the sample collection date. While partially vaccinated (those who have received one dose of a two-dose series of vaccine) or unvaccinated asymptomatic individuals who tested positive for COVID-19 but asymptomatic are required to isolate for at least ten (10) days from the sample collection date. Regardless of the vaccination status, isolation can be discontinued without the need for another testing, provided that they have remained asymptomatic during the whole required isolation period. If symptoms develop within or after the recommended period, the individual must complete the required days of isolation depending on the severity of symptoms.
Isolation Protocols for Symptomatic, Suspect, Probable or Confirmed Case with MILD symptoms
Mild symptoms of COVID-19 cases include three (3) or more of the following condition: fever, cough, coryza, sore throat, diarrhea, anorexia/nausea/vomiting, loss of sense of smell or taste, general weakness/body malaise/fatigue, headache, or myalgia. Individuals must not have pneumonia or desaturation.
Fully vaccinated individuals who are suspect, probable, or confirmed COVID-19 cases with mild symptoms are required to isolate for at least seven (7) days from the onset of signs and symptoms. While for partially or unvaccinated individuals who are suspect, probable, or confirmed COVID-19 cases with mild symptoms are required to isolate for at least ten (10) days from onset of signs and symptoms. Regardless of the vaccination status, isolation can be discontinued without the need for another testing, provided that they do not have fever for the last 24 hours without the use of any antipyretic medications, and shall have improvement of respiratory signs and symptoms.
Isolation Protocols for Symptomatic, Suspect, Probable or Confirmed Case with MODERATE symptoms
Moderate symptoms for COVID-19 cases can show pneumonia but has no difficulty of breathing or shortness of breath or without pneumonia but with risk factors for progression: elderly (60 years old and above) and/or with comorbidities.
Regardless of the vaccination status, all individuals who are suspect, probable, or confirmed COVID-19 cases with moderate symptoms are required to isolate for at least ten (10) days from the onset of signs and symptoms. Isolation can be discontinued without the need for another testing, provided that they do not have fever for the last 24 hours without the use of any antipyretic medications, and shall have improvement of respiratory signs and symptoms.
Isolation Protocols for Symptomatic, Suspect, Probable or Confirmed Case with SEVERE and CRITICAL symptoms
Regardless of the vaccination status, all individuals who are suspect, probable, or confirmed COVID-19 cases with severe and critical symptoms are required to isolate for at least twenty-one (21) days from the onset of signs and symptoms. Isolation can be discontinued without the need for another testing, provided that they do not have fever for the last 24 hours without the use of any antipyretic medications, and shall have improvement of respiratory signs and symptoms.
Isolation Protocols for Symptomatic IMMUNOCOMPROMISED Confirmed Cases
Immunocompromised cases include those with autoimmune disease, HIV, cancer/Malignancy, transplant patients, undergoing steroid treatment, patients with poor prognosis/bed-ridden patients.
Regardless of the vaccination statutes, all immunocompromised cases with symptoms are required to isolate for at least twenty-one (21) days from the onset of signs and symptoms. Isolation can be discontinued after the recommended isolation period, provided that they do not have fever for the last 24 hours without the use of any antipyretic medications, and shall have improvement of respiratory signs and symptoms. Repeat RT-PCR testing is recommended for these patients. Patients with negative results can be discharged from isolation while patients who will test positive must be referred to an Infectious Disease Specialist who can issue clearance and discharge if warranted.
Written by Bianca Batobato
