Analysis of Facility and Home Isolation Strategies in COVID 19 Pandemic: Evidences from Jodhpur, India

Pankaj Bhardwaj,1 Nitin Kumar Joshi,1 Manoj Kumar Gupta,1 Akhil Dhanesh Goel,1 Suman Saurabh,1 Jaykaran Charan,2 Prakash Rajpurohit,3 Suresh Ola,4 Pritam Singh,5 Sunil Bisht,5 NR Bishnoi,6 Balwant Manda,5 Kuldeep Singh,7 Sanjeev Misra8 1Community Medicine & Family Medicine and School of Public Health (SPH), All India Institute of Medical Sciences, Jodhpur, India; 2Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India; 3District Collector Office, Jodhpur, India; 4Jodhpur Municipal Corporation, Jodhpur, India; 5Medical & Health Department, Jodhpur, India; 6Administrative Office, All India Institute of Medical Sciences, Jodhpur, India; 7Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India; 8Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, IndiaCorrespondence: Pankaj BhardwajDepartment of Community Medicine & Family Medicine, School of Public Health, AIIMS, Jodhpur, IndiaTel +918003996903Email [email protected]: Jodhpur administration directed its efforts to control and mitigate COVID 19 infection by implementing and monitoring facility isolation (FI) and home isolation (HI) measures. This study is conducted with a hypothesis that there is no difference in the quality of life and cost-effectiveness of mildly symptomatic or asymptomatic patients in HI and FI.Patients and Methods: A mixed-method study was conducted in Jodhpur in September 2020. The purposive sampling technique was used and data from 120 individuals admitted in HI and FI were collected. The information about the status and functioning of isolation facilities was collected from various sources. Multi-stakeholder interactions with 15 personnel engaged in managing isolation facilities were done. EQ-5D version (EQ-5D-5L) which consists of the EQ-5D descriptive system and the EQ visual analog scale (EQ-VAS) was used to assess health-related quality of life.Results: The strength of HI strategy is demonstrated by its ability to provide psychological and social support with minimal logistic requirements but the issue of sufficient household infrastructure, adequate family and societal support for implementing this strategy is of concern. The strength of FI strategy includes its ability to provide support to patients who have issues of sufficient household infrastructure, adequate family and societal support, but this strategy poses a threat of increasing human resource constraints and financial load on the health system. The respondents from HI obtained a mean EQ-5D index score of 0.90 and a mean VAS score of 85, whereas it was 0.80 and 78.5, respectively, for FI. The cost estimated for home isolation was Rs 549 (7.43 US $) per person, whereas it was Rs 2440 (33.02 US$) for facility Isolation.Conclusion: Though HI seems advantageous in terms of a better quality of life and cost-saving over FI, both the strategies are context-specific having their own trade-offs.Keywords: COVID 19, patient isolation, quality of life, public health, cost saving