Decision 4038/QD-BYT 2021 temporary guidance on home-based management of people infected with COVID-19

DECISION

On promulgating the "Temporary guidance on home-based management of people infected with COVID-19"

____________

THE MINISTER OF HEALTH

Pursuant to the 2007 Law on Prevention and Control of Infectious Diseases;

Pursuant to the 2009 Law on Medical Examination and Treatment;

Pursuant to the Government's Decree No. 75/2017/ND-CP dated June 20, 2017, defining the functions, tasks, powers, and organizational structure of the Ministry of Health;

Pursuant to the Prime Minister's Decision No. 170/QD-TTg dated January 30, 2020, on the establishment of the National Steering Committee for prevention and control of acute respiratory infections caused by a new strain of the Corona virus;

At the proposal of the Director of the Administration of Medical Examination and Treatment under the Ministry of Health.

HEREBY DECIDES:

Article 1. To promulgate together with this Decision the "Temporary guidance on home-based management of people infected with COVID-19".

Article 2. The "Temporary guidance on home-based management of people infected with COVID-19" shall be applied by the grassroots-level health sector under the direction of the Departments of Health of provinces and centrally run cities, and the local Steering Committees for COVID-19 Prevention and Control.

Article 3. To assign the Departments of Health of provinces and centrally-run cities, based on the developments of the COVID-19 pandemic in their respective localities when the capacity of providing resources and setting up facilities for receiving, quarantining, managing and treating COVID-19 patients is outpaced, to advise the Steering Committees for COVID-19 Prevention and Control of the provinces and centrally-run cities to decide on the time, place and scope of application of the "Temporary guidance on home-based management of people infected with COVID-19".

Article 4. This Decision takes effect from the date of its signing.

Article 5. The Chief of Office of the Ministry of Health, Chief Inspector of the Ministry of Health, General Directors of General Departments and Directors of Departments under the Ministry of Health, Directors of Health Departments of provinces and centrally-run cities, Directors of Hospitals directly run by the Ministry of Health, leaders in charge of health of all sectors shall be responsible for implementing this Decision./.

For the Minister

The Deputy Minister

NGUYEN TRUONG SON

THE TEMPORARY GUIDANCE

ON HOME-BASED MANAGEMENT OF PEOPLE INFECTED WITH COVID-19

(Issued together with the Decision No. 4038/QD-BYT dated August 21, 2021)

LIST OF THE EDITORIAL BOARD
OF THE “TEMPORARY GUIDANCE ON HOME-BASED MANAGEMENT OF PEOPLE INFECTED WITH COVID-19”

TABLE OF CONTENTS

I. GENERAL INFORMATION

1. Purposes

2. Target users

II. SUBJECTS OF HOME-BASED MANAGEMENT

1. Clinical criteria for people infected with COVID-19

2. The self-care ability of people infected with COVID-19

III. DUTIES OF FACILITIES IN CHARGE OF MANAGING PEOPLE INFECTED WITH COVID-19 AT HOME

1. To identify and make lists of people infected with COVID-19 subject to their home-based management

2. To provide guidance to people infected with COVID-19 on monitoring their health at home

2.1. Guidance on health monitoring

2.2. Guidance on diet and daily routines

2.3. Guidance on performing medical quarantine at home

3. To conduct medical examination and health monitoring of people infected with COVID-19

3.1. Daily health monitoring

3.2. Checkup and prescription for home-based treatment

4. To take samples for COVID-19 test

5. To carry out emergency treatment and hospital transfer

APPENDIX 01

APPENDIX 02

APPENDIX 03

THE TEMPORARY GUIDANCE

ON HOME-BASED MANAGEMENT OF PEOPLE INFECTED WITH COVID-19

I. GENERAL INFORMATION

1. Purposes

“The temporary guidance on home-based management of people infected with COVID-19” was compiled with the aim of providing guidelines and regulations on the home-based management, support and care of people infected with SARS-CoV-2 and mild COVID-19 patients (hereinafter referred to as people infected with COVID-19).

2. Target users

a) Health stations of communes, wards and townships; Mobile health stations; District-level health centers and clinics; Emergency transportation centers and facilities assigned to manage people infected with COVID-19 at home (hereinafter referred to as facilities in charge managing people infected with COVID-19).

b) Steering Committees for COVID-19 prevention and control in communes, wards and townships; Steering Committees for COVID-19 prevention and control in districts and towns.

c) Employees involved in the home-based management of people infected with COVID-19.

II. SUBJECTS OF HOME-BASED MANAGEMENT

1. Clinical criteria for people infected with COVID-19

a) Being people infected with COVID-19 (with positive results of Real-time RT-PCR tests or rapid antigen tests) without clinical symptoms; or have mild clinical symptoms, such as fever, dry cough, sore throat, stuffy nose, fatigue, headache, muscle aches, or tongue numbness;

b) Showing no signs of pneumonia or lack of oxygen, respiratory rate ≤ 20 breaths/minute, SpO2 ≥ 96% when breathing air; no abnormal breathing, such as groaning while breathing, chest indrawing, nasal flapping, wheezing, inspiratory wheezing.

c) Satisfying at least one of the following two criteria:

- Having got full 2 doses, or 1 dose, of COVID-19 vaccines after 14 days, OR

- Having full 03 following factors: (1) Age: Children over 1 year of age, adults < 50 years of age; (2) No underlying medical conditions (The list of underlying medical conditions is provided in Appendix 01); (3) Not pregnant.

2. The self-care ability of people infected with COVID-19

a) Being able to take care of themselves, such as eating, bathing, washing clothes, cleaning, etc.

b) Being able to contact medical staff for monitoring and supervision of them, and in emergency cases such as being able to communicate normally and having available means of communication, such as phones, computers, etc.

c) In cases where people infected with COVID-19 are unable to take care of themselves, their families must have caregivers who meet the criteria mention in the above Items a and b.

III. DUTIES OF FACILITIES IN CHARGE OF MANAGING PEOPLE INFECTED WITH COVID-19 AT HOME

1. To identify and make lists of people infected with COVID-19 subject to their home management

a) Facilities in charge of managing people infected with COVID-19 at home, or health facilities assigned by the provincial/municipal Departments of Health, shall evaluate the infected people based on the criteria specified in Section 1, Part II.

b) They shall make lists of people infected with COVID-19 subject to their home management (by using the form in Appendix 02).

2. To provide guidance to people infected with COVID-19 for monitoring their health at home

2.1. Guidance on health monitoring:

a) Facilities in charge of managing people infected with COVID-19 at home shall guide the people infected with COVID-19 to self-monitor their health and fill out the health monitoring sheets (made by using to the form in Appendix 03) twice a day in the morning and afternoon, or when they show signs and symptoms that require emergency hospital transfer and treatment as prescribed in Section c, Part 2.1.

b) Health conditions to be monitored daily

- Indicators: Respiratory rate, pulse rate, temperature, SpO₂ (if possible) and blood pressure (if possible).

- Symptoms: Fatigue, cough, cough with mucus, chills/cold, conjunctivitis (pink eyes), loss of taste or smell, diarrhea (loose stools/liquid bowel movements); hemoptysis, shortness of breath or difficulty breathing, chest pain, drowsiness, narcolepsy; Other symptoms, such as sore throat, headache, dizziness, anorexia, nausea and vomiting, muscle aches, etc.

c) Upon detecting any one of the following signs, they must immediately report to the facilities in charge of managing people infected with COVID-19 at home; the health stations of communes and wards; or mobile health stations, emergency transportation centers, etc. to hospitalize them for emergency treatment and timely hospital transfer:

1) Shortness of breath, difficulty breathing, or children with signs of abnormal breathing: groaning while breathing, chest indrawing, nasal flapping, wheezing, inspiratory wheezing.

2) Respiration rate

- Adults: Respiration rate ≥ 21 breaths/minute

- Children from 1 to under 5 years of age: Respiration rate ≥ 40 breaths/minute,

- Children from 5 to under 12 years of age: Respiration rate ≥ 30 breaths/minute

(Note: For children, their breaths in 1 minute shall be counted when they stay still without crying).

3) SpO₂ ≤ 95% (if it is possible to measure), (upon detecting abnormality, measure again after 30 seconds to 1 minute; it shall be measured at the same position).

4) Tachycardia > 120 BPM or bradycardia less than 50 BPM.

5) Low blood pressure: Systolic blood pressure < 90 mmHg, Diastolic blood pressure < 60 mmHg (if measurable).

6) Frequent chest pain, feeling of tightness in the chest and the pain that increases when taking a deep breath.

7) Changes in consciousness: Confusion, narcolepsy, lethargy, very tired/exhausted, children being fussy, anaemic, difficult to wake, or convulsions

8) Blue lips, peripheral cyanosis, pale skin, discolored lips, cold fingers and toes.

9) Inability to drink or poor/reduced suck reflex, poor appetite, vomiting (for children). Manifestations of multisystem inflammatory syndrome in children: High fever, pink eyes, red lips, strawberry tongue, swollen fingers and toes, erythema, etc.

10) Additional acute diseases: dengue fever, hand-foot-and-mouth disease, etc.

11) Any unhealthy condition of people infected with COVID-19 that needs to be reported to medical facilities.

2.2. Guidance on diet and daily routines

People infected with COVID-19 should rest and do light physical activities (suitable for their health conditions); practice breathing for at least 15 minutes a day; drink water regularly, not wait until they are thirsty; not skip meals; enhance nutrition: eat enough nutrients, eat fruits and drink fruit juice etc., think positively, and maintain the comfortable mentality.

2.3. Guidance on performing medical quarantine at home

Performing medical quarantine at home in accordance with the provisions of Section 4 "Requirements for people under home medical quarantine" in “Temporary guidance for home medical quarantine for people with close contacts (F1 cases) to prevent and control the COVID-19 pandemic”, which is promulgated together with the Ministry of Health’s Official Dispatch No. 5599/BYT-MT dated July 14, 2021. They are not allowed to go out of their houses during the home medical quarantine.

3. To conduct medical examination and health monitoring of people infected with COVID-19

3.1. Daily health monitoring

a) Recording and updating information on the health conditions of people infected with COVID-19 on a daily basis and recording it in the health monitoring sheets of such people (as in Appendix 03); or in the software for management of health of people infected with COVID-19.

b) Answering phone calls and advising people infected with COVID-19 and their caregivers.

c) The staff of facilities in charge of managing people infected with COVID-19 at home shall be responsible for going to the houses of such people to provide them direct support, in the following cases:

- The people infected with COVID-19 suffer emergency conditions, of which the situation needs to be determined to have appropriate treatment.

- They do not receive reports on health conditions from the people infected with COVID-19 and cannot contact such people.

3.2. Checkup and prescription for home treatment

a) Symptomatic treatment: Prescribing and offering medicines to treat symptoms

- Fever:

+ With regard to adults with body temperature > 38.5^oC or getting headache, severe body aches: Take 1 tablet of antipyretics such as paracetamol 0.5g each time and can re-take the medicine after every 4-6h, with no more than 4 tablets in a day, drink oral rehydration solution (ORESOL) if suffering poor/reduced drinking ability or drink it instead of water.

+ With regard to children with body temperature > 38.5⁰C: Take antipyretic medicines, such as paracetamol, at a dose of 10-15mg/kg/time, can re-take the dose after every 4-6 hours, with no more than 4 doses a day.

If after taking antipyretic medicines twice, the patients do not get better, please immediately notify the facilities in charge of managing people infected with COVID-19 at home for help.

- Cough: Take cough relievers.

b) Prescribing and offering medicines for outpatient treatment: Comply with the Guidance for diagnosis and treatment of COVID-19 caused by SARS-CoV-2, which is issued by the Ministry of Health together with Decision No. 3416/QD-BYT dated July 14, 2021.

c) Medical examination and treatment at home by mobile health stations/teams: Based on the number of cases and the area with cases in a ward or commune to establish mobile health stations/teams which are ready to provide emergency support to patients at their homes.

4. To take samples for COVID-19 test

a) Taking samples for home testing (by Real-time RT-PCR method; or Rapid Antigen Test) for people infected with COVID-19 on the 14^th day to prepare for the end of home-based quarantine.

b) Carrying out tests for caregivers or people living in the same house with patients with symptoms suspected of COVID-19 infection.

5. To carry out emergency treatment and hospital transfer

a) Facilities in charge of managing people infected with COVID-19 at home shall guide the infected people when they suffer structural effects and emergency symptoms to immediately contact the facilities or emergency transportation centers for assistance in emergency hospitalization and hospital transfer.

b) While waiting for hospital transfer, the facilities in charge of managing people infected with COVID-19 at home shall provide the patients with guidelines and emergency treatment.

APPENDIX 01

LIST OF UNDERLYING HEALTH CONDITIONS (RISK OF INCREASING THE SEVERITY OF COVID-19)

1. Diabetes

2. Chronic obstructive pulmonary disease and other lung diseases

3. Cancers (especially hematological malignancies, lung cancer and other metastatic cancers)

4. Chronic kidney diseases

5. Organ transplant or hematopoietic stem cell transplant

6. Obesity, overweight

7. Cardiovascular diseases (heart failure, coronary artery disease or cardiomyopathy)

8. Cerebrovascular diseases

9. Down syndrome

10. HIV/AIDS

11. Neurological diseases (including dementia)

12. Sickle cell anemia, thalassemia, other chronic hematological diseases

13. Asthma

14. Hypertension

15. Immune deficiency

16. Liver diseases

17. Substance use disorder

18. Currently under treatment with corticosteroids or other immunosuppressive drugs.

19. Systemic diseases.

20. Other pathologies for children: Primary or secondary pulmonary hypertension, congenital heart disease, congenital inherited metabolic disorder, congenital/acquired endocrine disorders.

* Other Appendices are not translated herein.