Covid-19, home isolation. The ISS instructions
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Fiduciary home isolation - in the event of a positive Covid-19 or close contact with an infected person - is a fundamental public health measure. To prevent further propagation of a virus which, please note, is very contagious. And avoid overloading the hospital system. The instructions of the Istituto Superiore di Sanità (ISS) for isolated people and their cohabitants, to follow. (1)
Home isolation, when does it trigger?
The subjects to be submitted at home isolation are:
1) positive people to the coronavirus. Even following discharge from the hospital (in case of hospitalization) and in any case of recovery, until a new test fails,
2) their close contacts. That is to say in all cases of:
- domestic partnership with a COVID-19 positive subject,
- direct physical contact with an infected person (even if asymptomatic, even just a handshake),
- unsecured interaction with the secretions of a Covid-19 patient (e.g. handling without gloves of handkerchiefs or other used objects),
- contiguity vis-à-vis with an infected person, at a distance of less than 2 meters, for at least 15 minutes,
- coexistence in a closed environment (e.g. classroom, meeting room, waiting room) with a Covid-19 case, at a distance of less than 2 meters, for at least 15 minutes,
- direct assistance to a Covid-19 case or handling of its Covid-19 samples without the use of recommended personal protective equipment (PPE) (or through the use of unsuitable PPE),
- previous trip by plane in the two adjacent seats (in the 4 directions) to a Covid case. Isolation should be extended to assistants and crew members, even to all passengers in cases of severe symptoms of the infected passenger or his movements inside the vehicle during the trip.
How long does isolation last?
In the absence of symptoms, the isolation must be maintained for (at least) 14 days from the last contact of the isolated person with the coronavirus positive one.
In case of symptoms, the insulation depends on the result of the buffer:
- if the test is positive, the isolation continues until the test is negative and the symptoms disappear,
- if negative, the asymptomatic procedure is followed (14 days from the last contact with an infected person).
Respiratory hygiene
Respiratory hygiene it must be followed by all, in this phase of emergency. All the more so in cases of respiratory tract infection symptoms. In particular, the isolated subject must:
- use the mask surgical in the presence of other people, (2)
- cover your nose and mouth with handkerchiefs in case of sneezing and coughing (or coughing in the elbow). The handkerchiefs, preferably in paper, must be disposed of in a double waterproof bag to be placed in a closed dustbin that does not require contact with the hands for opening (e.g. pedal opening). If the handkerchiefs are made of fabric, they must be handled with gloves and washed in the washing machine at 60-90 ° using common detergent. After using the handkerchief, hands must be washed immediately with soap and water or rubbed with hydro-alcoholic product. (3)
Isolation, the ISS instructions
The subject in isolation must scrupulously follow the instructions provided by the ISS, in compliance with international guidelines:
1) limit any type of contact (direct and indirect). The person subjected to isolation must limit movements in the common areas of the house to the minimum necessary, keep a distance of at least one meter and avoid any direct contact with others,
2) live in isolation. The subject must remain in a dedicated and well-ventilated room, sleep alone, use a dedicated bathroom where possible. Otherwise, after use by the isolated person, disinfect its surfaces with a solution with 0,5% active chlorine (eg bleach. See note 4) or hydroalcoholic (70% alcohol),
3) no shared objects. Avoid all possible routes of exposure through shared objects (eg towels, washcloths or sheets, plates, glasses, cutlery, etc). The dishes should be washed carefully, in the dishwasher if possible.
Hygiene of the isolation environment
4) constant cleaning. At least once a day, the surfaces of the rooms used by the person in isolation must be cleaned with detergents and subsequently disinfected. (5) Whoever carries out the cleaning must:
- ventilate the room before entering it (note added by the writer),
- to wear a disposable gown (or a dedicated apron to be stored separately after use) and disposable gloves (or reusable thick rubber gloves, to be disinfected after use),
- wash carefully hands first, then face with soap and water or hydroalcoholic hand solution, (3)
Monitor for symptoms
5) self-monitoring of health conditions. The person in isolation must:
- to measure and write down your body temperature 2 times a day,
- report to the general practitioner (the 'health insurance doctor') or to the pediatrician of free choice (and to the public health operator) the onset of new symptoms or significant changes in pre-existing symptoms,
- in case of aggravation, must wear the surgical mask and move away from cohabitants, remaining in their room with the door closed, awaiting transfer to the hospital where necessary and possible,
6) limit contact with animals. There is currently no evidence that animals such as dogs or cats can also transmit the virus. For purely precautionary purposes, isolated people are advised to limit contact with animals, as is done with family members.
Cohabitants, the necessary precautions
The cohabitants and the people assisting the person in isolation must in turn take appropriate precautions to avoid contagion:
- reduce to the essential minimum direct contact with the isolated subject,
- use gloves in case of contact with respiratory secretions, faeces or urine. Arrange for their disposal (in a double waterproof bag) in a closed dustbin and then carefully wash your hands. (3)
Recommendations for caregivers
Those who attend the person in isolation at close range - i.e. taking care of the removal and replacement of linen - must wear:
- a device personal protective equipment (PPE) to cover the face (N95 respirator type FFP2 or FFP3. Or a surgical mask, in its absence. See note 2). Be careful not to touch it during use, dispose of it in a closed container or sanitize it (in case of unavailability of spare parts) after use, (6)
- a pair of gloves (to be disposed of in a closed container, if disposable, or disinfected if made of thick rubber).
The linen of the subject in isolation must be placed in a closed bag and managed separately from that of the cohabitants. It must be washed in the washing machine at 60 ° for at least 30 minutes, or at higher temperatures in a shorter time, with common detergent.
Waste products from the person in isolation or from the assistance provided to him must be disposed of in double plastic bags to be closed and disposed of in a closed dustbin.
The tasks of the public health worker
Healthcare workers competent for the territory prescribe home isolation and provide surgical masks to the subjects who are subjected to it. The healthcare professional must:
- to ascertain the health conditions (any fever or other symptoms) of the person to be placed in isolation and any cohabitants,
- inform the person on symptoms, contagiousness and mode of transmission, measures to be implemented to protect any cohabitants.
Monitoring daily health conditions of subjects in isolation at home is the responsibility of the public health operator, in collaboration with the general practitioner or pediatrician of free choice.
Public health services competent for the territory must guarantee a telephone number available to subjects in home isolation, to facilitate monitoring and shorten response times to a minimum.
Dario Dongo and Martina Novelli
Note
(1) Istituto Superiore di Sanita (ISS), Working Group on Infection Prevention and Control. Interim indications for carrying out isolation and home health care in the current Covid-19 context, 19.1.20,
(2) Masks, which ones to use and how,
(3) Hand washing and use of gloves,
(4) NB: products based on chlorine (sodium hypochlorite) are available under the name of bleach (or bleach, bleach) at a variable concentration. The 0,5% solution of active chlorine you can get it with:
- 1 unit (e.g. 100 ml) of 5% chlorine bleach and 9 units (e.g. 900 ml) of water, or
- 1 unit (e.g. 50 ml) of 10% bleach and 18 units (e.g. 900 ml) of water
(6) Sanitation and reuse of masks and respirators in case of unavailability of spare parts,
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
