Home isolation deaths during the third wave of COVID-19 pandemic in Kerala: a descriptive study


  • Veetilakath Jithesh Executive Director, State Health Systems, Resource Centre-Kerala, Department of Health Services, Government of Kerala, India
  • Rekha Meleparambil Ravindran Senior Research Officer, State Health Systems Resource Centre- Kerala, Department of Health Services, Government of Kerala, India
  • Anjali Krishnan Retnakala Research Officer, State Health Systems Resource Centre, Kerala, India
  • Ameena Subair Raheela Research Officer, State Health Systems Resource Centre- Kerala, Department of Health Services, Government of Kerala, India
  • Divya Indira Kumari State Health Systems Resource Centre, Kerala, India
  • Chinnu Rema Nair State Health Systems Resource Centre, Kerala, India
  • Aswathy Kuttappan Nair Lathika State Health Systems Resource Centre, Kerala, India
  • Hiran Mohan Das State Health Systems Resource Centre, Kerala, India




COVID-19, Home deaths, In-transit deaths, Mortality


Background: The state government directed its efforts to mitigate transmission of new variant SARS-CoV-2 called Omicron. This study aimed to describe pathways and characteristics of home isolation (HI) deaths reported in Kerala during third wave of pandemic.

Methods: The study adopted retrospective cross sectional descriptive approach, conducted among HI patients who died from January15th to February 15th 2022. The sociodemographic, clinical characteristics and the events that happened prior to deaths were collected through verbal autopsy. The state declared 106 HI deaths with case fatality rate of 2% (95% CI 1.5-2.50%). After screening, 70 HI deaths (54 home deaths and 16 in-transit deaths) were studied.

Results: Majority were home deaths (84.29%) followed by in-transit deaths (15.71%). Mortality was higher among older persons (94.28%), females (51.42%), unemployed (68.57%) and patients in rural community. Majority had comorbidities (80%) mainly diabetes mellitus (55.35%). The median interval from symptom onset to death was five days (IQR) 4-8) and that from diagnosis to death was four days (IQR 2-8). Majority reported red flag signs (83.07%) commonly breathlessness (83.34%). Most of the deceased (80%) did not monitor oxygen saturation. The study identified four patterns of HI deaths, primarily due to delay in identification of red flag signs and hospitalization.

Conclusions: Non-compliance to oxygen monitoring, slow response towards red flag signs and delay in hospitalization were the main reasons for HI deaths. Stringent monitoring mechanism for HI patients at primary health care and meteoric referral strategy can prevent fatalities in future.

Author Biography

Veetilakath Jithesh, Executive Director, State Health Systems, Resource Centre-Kerala, Department of Health Services, Government of Kerala, India

Resaerch Officer, Public Health


Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924.

WHO Coronavirus (COVID-19) Dashboard. Available at: https://covid19.who.int. Accessed on 3 June 2022.

GoK Dashboard. Official Kerala COVID-19 Statistics. Available at: https://dashboard.kerala.gov. in/covid/. Accessed on 3 June 2022.

Responding to COVID-19- Learnings from Kerala. Available at: https://www.who.int/india/ news/feature-stories/detail/responding-to-covid-19---learnings-from-kerala. Accessed on 3 June 2022.

Chathukulam J, Tharamangalam J. The Kerala model in the time of COVID-19: rethinking state, society and democracy. World Dev. 2021;137:105207.

Bhardwaj P, Joshi NK, Gupta MK, Goel AD, Saurabh S, Charan J, et al. Analysis of facility and home isolation strategies in COVID-19 pandemic: evidences from Jodhpur, India. Infect Drug Resist. 2021;14:2233-9.

Guidelines-Summary-Of-Covid-19-quarantine-and-isolation-.pdf Available at: https://arogyakeralam. gov.in/wp-content/uploads/2020/03/guidelines-Summary-Of-Covid-19-quarantine-and-isolation-.pdf. Accessed on 3 June 2022.

Directorate of Health Services; Advisory DHS. Available at: https://dhs.kerala.gov.in. Accessed on 3 June 2022.

New Covid variant- Omicron - spells bad news for Kerala: Experts- The New Indian Express. Available at: https://www.newindianexpress.com/ states/kerala/2021/nov/27/new-covid-variant-omicron-spells-bad-news-for-kerala-experts-2388621.html. Accessed on 3 June 2022.

Islam MR. The SARS‐CoV‐2 Omicron (B.1.1.529) variant and the re‐emergence of COVID‐19 in Europe: An alarm for Bangladesh. Health Sci Rep. 2022;5(2):e545.

Guidelines for home isolation and discharge criteria from home isolation of SARS-cov-2. Advisory- DHS. Available at: https://dhs.kerala.gov.in/wp-content/uploads/2022/01/Guidelines-Home-Isolation-and-Discharge.pdf. Accessed on 3 June 2022.

Directorate of Health Services. Government of Kerala. Available at: https://dhs.kerala.gov. in/dailybulletin. Accessed on 3 June 2022.

Fried TR, van Doorn C, O’Leary JR, Tinetti ME, Drickamer MA. Older persons’ preferences for home vs hospital care in the treatment of acute illness. Arch Intern Med. 2000;160(10):1501-6.

Mat Din H, Adnan RNE, Nor Akahbar SA, Ahmad SA. Characteristics of COVID-19 related deaths among older adults in Malaysia. Malays J Med Sci. 2021;28(4):138-45.

Damayanthi HDWT, Prabani KIP, Weerasekara I. Factors associated for mortality of older people with COVID-19: a systematic review and meta-analysis. Gerontol Geriatr Med. 2021;7:23337214211057392.

Yanez ND, Weiss NS, Romand JA, Treggiari MM. COVID-19 mortality risk for older men and women. BMC public health. 2020 Dec;20(1):1-7.

Jin JM, Bai P, He W, Wu F, Liu XF, Han DM, et al. Gender differences in patients with COVID-19: focus on severity and mortality. Front Public Health. 2020;8.

Beaney T, Clarke J, Jain V. Measuring the toll of the COVID-19 pandemic in rural Bangladesh. JAMA Netw Open. 2021;4(11):e2133167.

Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health. 2013;38(5):976-93.

Zhang B, Zhou X, Qiu Y, Song Y, Feng F, Feng J, et al. Clinical characteristics of 82 cases of death from COVID-19. PloS One. 2020;15(7):e0235458.

Elezkurtaj S, Greuel S, Ihlow J, Michaelis EG, Bischoff P, Kunze CA, et al. Causes of death and comorbidities in hospitalized patients with COVID-19. Sci Rep. 2021;11(1):4263.

Webber M, Joubert J, Fendt-Newlin M, Madavanakadu Devassy S, Scaria L, Benny AM, et al. Towards the development of an intervention to address social determinants of non-communicable disease in Kerala, India: a mixed methods study. Int J Environ Res Public Health. 2020;17(22):8636.

Hypoxia: All India Institute of Medical Sciences (AIIMS) turns its focus on silent hypoxia now. The Economic Times. Available at: https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/all-india-institute-of-medical-sciences-aiims-focus-is-on-silent-hypoxia-now/articleshow/77898122.cms?from=mdr. Accessed on 22 June 2022.

Foroozanfar Z, Zamanian M, Moradzadeh R, Hajiabadi F, Ahmadzadeh J, Hosseinkhani Z. Isolation compliance and associated factors among COVID-19 patients in North-West Iran: a cross-sectional study. Int J Gen Med. 2020;13:1697-703.

Luks AM, Swenson ER. Pulse oximetry for monitoring patients with COVID-19 at home. Potential pitfalls and practical guidance. Ann Am Thorac Soc. 2020;17(9):1040-6.

Dhillon RA, Qamar MA, Gilani JA, Irfan O, Waqar U, Sajid MI, et al. The mystery of COVID-19 reinfections: A global systematic review and meta-analysis. Ann Med Surg. 2021;72:103130.

Wang J, Kaperak C, Sato T, Sakuraba A. COVID-19 reinfection: a rapid systematic review of case reports and case series. J Investig Med. 2021;69(6):1253-5.

García‐Azorín D, Trigo J, Talavera B, Martínez‐Pías E, Sierra A, Porta‐Etessam J, et al. Frequency and type of red flags in patients with Covid‐19 and headache: a series of 104 hospitalized patients. Headache J Head Face Pain. 2020;60(8):1664-72.

Baker Rogers J, Modi P, Minteer JF. Dyspnea in Palliative Care. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan.

Hentsch L, Cocetta S, Allali G, Santana I, Eason R, Adam E, et al. Breathlessness and COVID-19: A Call for Research. Respiration. 2021;100(10):1016-26.

Ramanayake RPJC, Basnayake BMTK. Evaluation of red flags minimizes missing serious diseases in primary care. J Fam Med Prim Care. 2018;7(2):315-8.




How to Cite

Jithesh, V., Ravindran, R. M., Retnakala, A. K., Raheela, A. S., Kumari, D. I., Nair, C. R., Nair Lathika, A. K., & Das, H. M. (2022). Home isolation deaths during the third wave of COVID-19 pandemic in Kerala: a descriptive study. International Journal Of Community Medicine And Public Health, 9(10), 3775–3782. https://doi.org/10.18203/2394-6040.ijcmph20222571



Original Research Articles