Prabhakar Abhilash Kundavaram Paul, James Ranjit Immanuel, Paul Hema Eunice, Murugesan Malathi, Abraham Deepak Thomas, Christopher Jeyalinda, Valsan Annie, Mammen Joy John, Rupali Priscilla, Jesudoss Ilavarasi, Selvan Senthamil, Mathews Prasad, Peter John Victor
Professor & Head (Emergency Medicine), Christian Medical College, Vellore, Tamil Nadu, India.
Assistant Professor (Forensic Medicine & Toxicology), Christian Medical College, Vellore, Tamil Nadu, India.
Med J Armed Forces India. 2022 Sep 2;80(3):327-34. doi: 10.1016/j.mjafi.2022.06.022.
The rapidity of spread of COVID-19 infection during the second wave of the pandemic placed tremendous stress on healthcare resources. This study evaluated the effectiveness of a monitored home isolation (HI) program.
In this descriptive longitudinal study, symptomatic patients were screened in the HI clinic and eligible patients were followed up at home using tele-consultation, until recovery or hospitalization. HI failure was defined as need for hospitalization. Factors associated with HI failure were assessed using logistic regression analysis and expressed as odds ratio (OR) with 95% confidence interval (CI).
During April and May 2021, 1957 RT-PCR confirmed patients (984 male) with mean (SD) age 40 (13.5) years were enrolled; 93.3% (n = 1825) were successfully managed at home. Of the 132 patients (6.7%) who failed HI, 57 (43.2%) required oxygen therapy and 23 needed intensive care admissions. Overall mortality was 0.4% (7/1957). On adjusted analysis, factors associated with HI failure were age ≥60 years (OR 2.24; 95%CI 1.26-3.99), male gender (OR 2.26; 95%CI 1.44-3.57), subjective reporting of breathing difficulty (OR 3.64; 95%CI 2.08-6.37), history of cough (OR 2.08; 95%CI 1.37-3.17), and higher heart rate (OR 1.04; 95%CI 1.02-1.05). Although patient status (non-healthcare workers), no prior vaccination and ≥2 comorbidities were associated with HI failure on unadjusted analysis, these were non-significant on adjusted analysis.
Monitored HI program can be used successfully during a pandemic wave to judicially use scare hospital resources. Older male patients presenting with breathlessness or cough may warrant closer monitoring.
在第二波疫情期间，新冠病毒感染传播迅速，给医疗资源带来了巨大压力。本研究评估了一项居家隔离监测计划的有效性。
在这项描述性纵向研究中，有症状的患者在居家隔离监测诊所接受筛查，符合条件的患者通过远程会诊在家中接受随访，直至康复或住院。居家隔离监测失败定义为需要住院治疗。使用逻辑回归分析评估与居家隔离监测失败相关的因素，并以比值比（OR）和95%置信区间（CI）表示。
2021年4月至5月，共纳入1957例经逆转录聚合酶链反应（RT-PCR）确诊的患者（984例男性），平均（标准差）年龄为40（13.5）岁；93.3%（n = 1825）的患者在家中成功接受管理。在132例（6.7%）居家隔离监测失败的患者中，57例（43.2%）需要吸氧治疗，23例需要入住重症监护病房。总体死亡率为0.4%（7/1957）。经校正分析，与居家隔离监测失败相关的因素包括年龄≥60岁（OR 2.24；95%CI 1.26 - 3.99）、男性（OR 2.26；95%CI 1.44 - 3.57）、主观报告有呼吸困难（OR 3.64；95%CI 2.08 - 6.37）、咳嗽史（OR 2.08；95%CI 1.37 - 3.17）以及心率较高（OR 1.04；95%CI 1.02 - 1.05）。尽管在未校正分析中，患者身份（非医护人员）、未接种过疫苗以及合并≥2种疾病与居家隔离监测失败相关，但在经校正分析中这些因素并不显著相关。
在疫情期间，居家隔离监测计划可成功用于合理利用稀缺的医院资源。出现呼吸急促或咳嗽的老年男性患者可能需要更密切的监测。
