Coronavirus disease (COVID-19) technical guidance by WHO Home care for patients with COVID-19

Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts Interim guidance 17 March 2020 Background those with mild disease and risk for poor outcome (age >60 years, cases with underlying co-morbidities, e.g., chronic cardiovascular disease, chronic respiratory disease, diabetes, cancer). WHO has developed this interim guidance to meet the need for recommendations on safe home care for patients with suspected COVID-19 who present with mild symptoms a and on public health measures related to the management of their contacts. If all mild cases cannot be isolated in health facilities, then those with mild illness and no risk factors may need to be isolated in non-traditional facilities, such as repurposed hotels, stadiums or gymnasiums where they can remain until their symptoms resolve and laboratory tests for COVID-19 virus are negative. Alternatively, patients with mild disease and no risk factors can be managed at home. This document was adapted from the interim guidance on Middle East respiratory syndrome coronavirus (MERS-CoV) infection that was published in June 2018 1 and is informed by evidence-based guidelines published by WHO, including Infection prevention and control of epidemic- and pandemic- prone acute respiratory diseases in health care, 2 and based on current information on COVID-19. Home care for patients with suspected COVID-19 who present with mild symptoms This rapid advice has been updated with the latest information and is intended to guide public health and infection prevention and control (IPC) professionals, health care managers and health care workers (HCWs) when addressing issues related to home care for patients with suspected COVID-19 who present with mild symptoms and when managing their contacts. This guidance is based on evidence about COVID-19 and the feasibility of implementing IPC measures at home. For the purpose of this document, “caregivers” refers to parents, spouses, and other family members or friends without formal health care training. For those presenting with mild illness, hospitalization may not be possible because of the burden on the health care system, or required unless there is concern about rapid deterioration. 3 If there are patients with only mild illness, providing care at home may be considered, as long as they can be followed up and cared for by family members. Home care may also be considered when inpatient care is unavailable or unsafe (e.g. capacity is limited, and resources are unable to meet the demand for health care services). In any of these situations, patients with mild symptoms 1 and without underlying chronic conditions − such as lung or heart disease, renal failure, or immunocompromising conditions that place the patient at increased risk of developing complications − may be cared for at home. This decision requires careful clinical judgment and should be informed by an assessment of the safety of the patient’s home environment. b2 Please refer to the Global Surveillance for human infection with coronavirus disease (COVID-19) for case definitions. Please refer to Infection prevention and control during health care when COVID-19 is suspected for guidance on IPC at the health care facility level. Where to manage COVID-19 patients In cases in which care is to be provided at home, if and where feasible, a trained HCW should conduct an assessment to verify whether the residential setting is suitable for providing care; the HCW must assess whether the patient and the family are capable of adhering to the precautions that will be recommended as part of home care isolation (e.g., hand hygiene, respiratory hygiene, environmental cleaning, limitations on movement around or from the house) and can address safety concerns (e.g., accidental ingestion of and fire hazards associated with using alcohol-based hand rubs). WHO recommends that all laboratory confirmed cases be isolated and cared for in a health care facility. WHO recommends that all persons with suspected COVID-19 who have severe acute respiratory infection be triaged at the first point of contact with the health care system and that emergency treatment should be started based on disease severity. WHO has updated treatment guidelines for patients with ARI associated with COVID-19, which includes guidance for vulnerable populations (e.g., older adults, pregnant women and children). In situations where isolation in a health care facility of all cases is not possible, WHO emphasizes the prioritization of those with highest probability of poor outcomes: patients with severe and critical illness and If and where feasible, a communication link with health care provider or public health personnel, or both, should be established for the duration of the home care period – that is, until the patient’s symptoms have completely resolved. More a Mild illness may include: uncomplicated upper respiratory tract viral infection symptoms such as fever, fatigue, cough (with or without sputum production), anorexia, malaise, muscle pain, sore throat, dyspnea, nasal congestion, or headache. Rarely, patients may also present with diarrhoea, nausea, and vomiting. b A sample checklist for assessing environmental conditions in the home is available in the Annex C of reference 2. 1