Decision No. 4156/QD-BYT 2021 promulgating Guidance on home care of COVID-19 patients

DECISION

Promulgating Guidance on home care of COVID-19 patients

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 of June 20, 2017 on functions, tasks, powers, and organizational structure of the Ministry of Health;

At the proposal of Director of Medical Services Administration, Ministry of Health,

DECIDES:

Article 1. Promulgate together with this Decision the Guidance on home care of COVID-19 patients, including:

1. Guidance on home care of COVID-19 patients.

2. Guidance on nutrition for COVID-19 patients undergoing home treatment.

Article 2. The Guidance on home care of COVID-19 patients is applied in establishments assigned to implement home-based management of COVID-19 patients to provide instructions for COVID-19 patients and their caregivers.

Article 3. Health Departments of provinces and centrally run cities and health sector shall implement the Guidance on home care of COVID-19 patients in health establishments assigned to implement home-based management of COVID-19 patients. The Guidance on home care of COVID-19 patients shall be applied on the effective date of the Decision No. 4038/QD-BYT of August 21, 2021 of Minister of Health on promulgating the “Temporary guidance on home-based management of people infected with COVID-19”.

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

Article 5. Chief of Ministry Office, Chief of Ministry Inspectorate, Directors of Departments of the Ministry of Health; Heads of Steering Committees for COVID-19 prevention and control of provinces and cities; directors of hospitals and institutes of the Ministry of Health; directors of Departments of Health of provinces and centrally run cities; heads of health sector shall be responsible for implementation of this Decision./.

For the Minister
The Deputy Minister
Nguyen Truong Son

MEMBER OF THE EDITORIAL BOARD

OF THE GUIDANCE ON HOME CARE OF COVID-19 PATIENTS
(Issued together with Decision No. 4156/QD-BYT dated August 28, 2021)

GUIDANCE

ON HOME CARE OF COVID-19 PATIENTS

HANOI, AUGUST 2021

TABLE OF CONTENTS

ABOUT COVID-19 PANDEMIC

TARGETS OF HOME CARE OF COVID-19 PATIENTS

COVID-19 PATIENTS ELIGIBLE FOR HOME QUARANTINE AND MONITORING

1. LEVEL OF INFECTION AND CHARACTERISTICS OF COVID-19 PATIENTS

2. SELF-CARE ABILITY OF COVID-19 PATIENTS

NECESSARY PREPARATIONS

SELF-MONITORING OF COVID-19 PATIENTS UNDERGOING HOME TREATMENT  

HEALTH MONITORING

USE OF THERMOMETER

TREATMENT OF CERTAIN SYMPTOMS

STRESS AND RESPONSES TO STRESS

PHYSICAL EXERCISES TO IMPROVE HEALTH

RECOMMENDATIONS FOR COVID-19 PATIENTS WITH DISABILITIES

RECOMMENDATIONS FOR ELDERLY COVID-19 PATIENTS

RECOMMENDATIONS FOR COVID-19 PATIENTS WITH MENTAL ILLNESSES

CARE OF COVID-19 PATIENTS BEING CHILDREN

RECOMMENDATIONS FOR COVID-19 PATIENTS WITH UNDERLYING DISEASES AND PREGNANT WOMEN INFECTED WITH COVID-19

PREVENTION OF COVID-19 INFFECTION IN FAMILY

GENERAL RECOMMENDATIONS

SPECIFIC ACTIVITIES

LIST OF UNDERLYING DISEASES REQUIRING HOSPITALIZATION FOR COVID-19 TREATMENT

SELF-MONITORING FORM FOR COVID-19 PATIENTS UNDERGOING HOME TREATMENT

SPECIFIC PHYSICAL EXERCISES

- Via physical contact:

+ Direct contact with COVID-19 patients such as: handshake, hugging, kissing.

+ Indirect contact: People touch their mouth, eyes or nose after touching surfaces that have been contaminated by the virus.

- Via droplets: People are in close contact (under 2 meters) with COVID-19 patients who speak, cough, or sneeze and the patients’ droplets containing the virus are inhaled or come directly into contact with the eyes, nose, or mouth.

- Via the air: People inhale aerosols containing the virus which remain suspended in the air when they are in poorly ventilated settings or perform health care.

• COVID-19 patients may experience severe complications, life-threatening situations, and decease. Many infected people with no symptom or mild symptoms can recover from COVID-19 without receiving any treatment but are an infection source difficult to control.

• COVID-19 patients with no symptom or mild symptoms that have no underlying diseases, and satisfy all health and quarantine requirements may be received home care and monitoring.

• Closely monitor and promptly detect more symptoms showing a worsening of the disease to request medical assistance or promptly transfer COVID-19 patients to hospitals.

• Improve patients’ physical conditions, nutrition, and mental health to help improve immunity.

• Ensure safe care and prevent the risk of transmitting the virus to others in the home and community.

Competent agencies shall issue decisions on home quarantine and monitoring for COVID-19 patients meeting all following conditions:

• Showing no symptoms or mild symptoms (no respiratory failure: SpO2 ≥ 96%, Respiratory rate ≤ 20 breaths/minute).

• Being aged more than 12 months and under 50 years.

• Having no underlying diseases (See the List of underlying diseases in Page 20).

• Not being pregnant.

• Being capable of caring for themselves such as eating, washing clothes, performing personal hygiene, etc.

• Being capable of measuring body temperature.

• Being capable of contacting health staff to be supervised and monitored. Having communications devices such as phones, computer, etc. and being able to use them.

• Being capable of taking their medicine as per prescriptions of their doctors.

• In case COVID-19 patients are incapable of caring for themselves, at least a family member must be healthy and have the knowledge about care of infected people infection prevention in order to assist patients in performing contents specified in this section. However, the number of caregivers must be restricted.

• Saving phone numbers of pandemic prevention and control hotline and staff assigned to monitor the patient’s health; and other necessary phone numbers.

• Determining and reach an agreement with the family about the patient’s separate spaces.

• Assigning the most appropriate person to care for the patient (if necessary).

• Preparing necessary items:

- Disposable medical face masks (sufficient for the family for 2-3 weeks);

- Clean medical gloves (sufficient for caregivers for at least 2-3 weeks);

- Thermometer: mercury thermometer or electronic thermometer, sphygmomanometer;

- Containers of infectious waste with lids and lined with yellow nylon bags;

- Personal belongings for the patient: toothbrush, towel, face towel, plastic basins for bathing and washing clothes, silverware, soap and laundry detergent, washing machine (if any), clothes dryers or essential laundry equipments;

- Medicine currently taken by the patient with underlying diseases such as: hypertension, diabetes mellitus, gout, etc. sufficient to take for at least 30 days;

- Medicine and prescriptions of doctors for patients (if any).

NOTE:

• When a member in the family is infected with COVID-19, other family members are at risk of infection and therefore must comply with home quarantine to avoid the infection in the community.

• Do not worry about stocking up with foods and other necessities. The local authorities, relatives, forces and organizations shall assist the family during the home quarantine duration.

• Filling in the self-monitoring form twice per day in the morning and in the afternoon. Seeing the self-monitoring form in page 21.

• Signs to be monitored on a daily basis:

- Respiratory rate, heart rate, temperature, oxygen saturation – SpO2 (if possible) and blood pressure (if possible).

- Symptoms: Fatigue, coughing, coughing with sputum, shivering, conjunctivitis (pink eye), loss of taste or smell, diarrhea (loose, watery stools); coughing up blood, pant or difficulty breathing, prolonged chest pain, drowsy, lack of sanity;

- Other symptoms such as: Sore throat, headache, vertigo, anorexia, nausea and vomiting, muscle pain, etc.

• Symptoms that must be immediately reported to health staff:

If patients displaying ANY of the following symptoms, immediately report to health staff in charge for solutions and timely hospitalization:

1) Dyspnea, shortness of breath or symptoms of irregular breathing in children: grunting, chest indrawing, nose flaring, wheezing, inspiratory wheezing.

2) Rising respiratory rate:

- Adult: respiratory rate ≥ 21 breaths/minute

- Children aged from 1 years to under 5 years: respiratory rate ≥ 40 breaths/minute,

- Children aged from 5 years to under 12 years: respiratory rate ≥ 30 breaths/minute

 (Attention: when counting respiratory rate of children, to count all breaths taken in 1 minute when the children lie, stay still and do not cry).

3) SpO₂ ≤ 95% (if measurable). Upon detecting any irregularity, measure after 30 seconds to 1 minute for the second time at the same position. Remove nail polish (if any) before measuring.

4) Tachycardia > 120 beats/minute or bradycardia of less than 50 beats/minute.

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. Children breastfeed poorly, eat poorly, vomit.

10) For children, the following symptoms are shown: High fever, pink eyes, red lips, strawberry tongue, swollen fingers and toes with erythema, petechial, etc.

11) Any conditions that make caregivers feel nervous about.

• 2 thermometers is highly recommended: One for patients and the other for the remaining persons.

• Always measuring body temperature of patients at least twice a day in the morning and in the afternoon; in case of any abnormal symptoms, recording in the self-monitoring form.

Should do:

• Following attached instructions when using electronic thermometer.

• Washing hands and sanitizing thermometer with alcohol-soaked cotton before and after each use.

• Contacting health staff in charge of support of the family in case a family member has fever (above 38^oC) or hypothermia (under 36^oC).

Instructions of thermometer use:

1. Washing hands carefully with soap and water in at least 20 seconds and drying hands.

2. Sanitizing thermometer with cotton soaked in 70^o alcohol before and after each use.

3. For mercury thermometer, shaking the thermometer down a few times to drop mercury level down below 36.5^oC before measuring.

4. Following attached instructions to read the temperature. For mercury thermometer, when having difficulty reading temperature, tilting the thermometer to read the temperature.

5. Washing hands and sanitizing the thermometer. Storing thermometer in a safe location.

In case of simple symptoms, proceed as follows:

1. In case of fever:

• With regard to adults with body temperature > 38.5^oC or getting severe headache, body aches: Taking a tablet of antipyretics such as paracetamol 0.5 g each time and can re-take the medicine every 4-6 hours 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 > 38.5^oC, taking antipyretics such as paracetamol at a dose of 10-15 mg/kg/time, can re-take the medicine  every 4-6 hours, with no more than 4 times per day.

• If after taking antipyretics twice, the patients do not get better, immediately notifying the health staff in charge of managing for patients handling.

2. In case of coughing: Take cough relievers as per prescription of doctors ands

3. Patients may take vitamin as per a prescription of doctors.

• When a member is infected with COVID-19, other members in the family may feel nervous and anxious.

• A COVID-19 patient may face nervous situations such as:

- Fear and worry for his/her health and other members’ health.

- Change to sleeping habit, Difficulty falling asleep, or difficulty concentrating.

- Eat poorly, anorexia.

- Chronic diseases such as stomach diseases, cardiovascular diseases, etc. are more severe.

- Mental illnesses may be worsened.

- Consume alcoholic drinks, smoke cigarettes, or take other medicine more frequently.

Responses to stress

• Avoiding reading, watching, or listening to news on COVID-19, specially the one posted on social media such as: zalo, facebook, youtube, tiktok, etc.

• Caring for physical and mental health:

- Taking deep breaths or practicing meditation.

- Eating with a healthy diet and balancing on nutrition.

- Doing exercises regularly and do not stay up late.

- Refraining from using alcoholic drinks, cigarette, and food and drink containing stimulants.

• Spending time resting and relaxing. Doing hobbies such as: reading books, drawing, watching movies, listening to music, working on models, cooking (if possible), etc.

• Contacting health staff in charge if the stress affects daily activities in many consecutive days.

• Strengthen communication with other persons. Talking about worries.

• Connecting with community organizations, religious organizations, or social forums.

• Admitting that being worried is normal and asking for help is nothing to be ashamed of.

In addition to appropriate nutrition and care, COVID-19 patients must perform breathing exercises and daily physical exercises with positive mental health. Practicing and doing exercises during this period for the following purposes:

• Expanding chest and improving airflow in the lungs and practicing breathing better.

• Expelling sputum for cases of increased sputum production.

• Increasing effectiveness of motor capacity and respiratory muscles.

• Preventing physical decline and improving mental health.

A number of breathing exercises and physical activities include:

• Breathing exercises.

• Exercises in bed

• Muscle stretching exercises

• Endurance exercises

Detailed instructions for exercises are from page 22 to page 25.

• If having any abnormal symptoms such as: fatigue, dyspnea or increased chest pain during exercises, ceasing exercises and monitoring body conditions. If such symptoms increase even when resting, immediate notify health staff for promptly monitoring.

• In addition to taking care in similar manner to other people, COVID-19 patients with disabilities need the special care, particularly for people with difficulties in performing daily activities, etc.

• Being confident and believe in yourself, we will overcome the pandemic with the knowledge on COVID-19 pandemic prevention and control and at-home quarantine and treatment.

• A number of persons with severe disabilities need caregivers.

• Persons with disabilities may be at greater risk of severe illness from COVID-19 and thus their caregivers must anticipate cases in which contacting health staff is required; closely monitor patients’ symptoms and transfer the patients to COVID-19 treatment establishments in localities when their symptoms show emergency signs.

• Combining with rehabilitation, mental, and physical exercises to make up for restriction on outside activities, anxiety, depression, disappointment.

• Regularly sanitizing aids of persons with disabilities before and after use.

• Providing information about COVID-19 pandemic prevention and control and quarantine suitable for persons with disabilities that are promulgated by the Ministry of Health and are available on youtube and on the website http://kcb.vn

• The elderly may be at greater risk of severe illness from COVID-19 than any other age groups. The older a person gets, the more severe of COVID-19 infection he/she potentially gets.

• The elderly and their caregivers must have the knowledge and carry out the monitoring to prevent any complication and transfer the patients to hospitals in localities when their symptoms show emergency signs.

• Following healthy and scientific lifestyle.

• Having a nutritious, balanced and healthy diet (1,700-1,900 Kcal/day) with lots of vegetables. Guaranteeing 3-4 meals per day; when not having sufficient meals, taking 1-2 cups of supplementary milk per day.

• Strictly complying with diet and medicine available as per prescription of doctors (do not stop taking medicine).

• Increase doing exercises in quarantine rooms or in bed on a case-by-case basis with rehabilitation exercises, massages, and supports to improve health.

Detailed instructions for exercises are from page 22 to page 25.

In cases of taking care of COVID-19 patients with mental illnesses at home, in addition to the above care recommendations, patients with mental illnesses and their caregivers must implement the following tasks:

• Preparing every items necessary for quarantine, especially medicine for mental illnesses for 1 - 3 months.

• Not deliberately ceasing taking or dropping medicine. If re-examination appointment is delayed due to pandemic, performing remote consultation with health staff as per appointment.

• Performing simply physical and rehabilitation exercises on a daily basis.

• Maintaining hobbies and daily activities as much as possible or create new hobbies in new environment such as: exercises, proper hygiene, etc.

• Strengthen connection with relatives (via phones, e-mail, social media devices, or via video calls).

• For patients addicted to opioids and receiving replacement treatment with methadone or buprenorphine, informing treatment establishments for appropriate medicine provision plans.

• Their caregivers and family members must monitor and detect any emergency such as: seizure, suicidal thoughts or behavior, refusing to eat or drink, drug withdrawal or drug poisoning. Contacting health staff to receive guidance .

• The parents must keep calm and believe in their caring capacity when their children are infected with COVID-19.

• Paying attention to whether the children change behavior, especially:

- Crying or being grumpy (for kids).

- Overly worrying or depressing.

- Possessing unhealthy eating or sleeping habit.

- Being grumpy and "acting inappropriately" (for teenagers).

- Having poor learning results or avoiding online classes.

- Having difficulty paying attention and concentrating.

- Ceasing to participate in activities that the children used to enjoy.

- Having headache or body aches with unknown reason.

- Drinking alcohol, smoking cigarettes, or using other drugs (for children).

To-do list to support and care for COVID-19 children:

• Talking and calming the children down about COVID-19 pandemic.

• Answering questions and sharing information on COVID-19 pandemic to prevent the children from misunderstanding and becoming panic.

• Restricting talking about COVID-19 news and events that maybe make them panic and fear.

• Maintaining regular hobbies and scientific routine. Preparing timetable for studying, resting, and recreational activities.

• Instructing children to perform daily routine to reduce the infection such as: washing hands regularly; using tissues or elbow to cover the mouth when coughing or sneezing, and then removing the tissues in waste containers.

• Allowing children to participate in appropriate recreational activities in quarantine rooms such as online games or playing with parents, etc.

All COVID-19 patients having underlying diseases, being pregnant, overweight, patients aged above 50 years, and patients being children under 12 months of age must receive treatment at hospitals.

In the meantime for transfer to hospitals:

• They must receive care and undergo infection prevention similar to the one applicable to other patients.

• Closely monitoring to detect all abnormal symptoms.

• Contacting health staff in charge of monitoring family’s health or contacting local authority, or dial the hotline when any abnormal symptom is shown.

• Carrying available medicine to hospitals to use and informing admitting doctors about their underlying diseases and medicine.

• Their family must motivate and console the patients.

To prevent infection for family members and community members, members of a family must comply with the followings:

• Isolating patients from other people

•Regularly cleaning hands

• Wearing face masks and gloves appropriately

• Cleaning cutlery

• Cleaning all surfaces thoroughly

• Processing linens and other items in accordance with regulations

• Managing wastes and expelled fluid appropriately

1. Quarantine patients from other people

• Assigning patients with separate bedrooms and bathrooms, or mark separate spaces of patients

• Do not share cutlery, glasses, dishes, towels, or bed sheets with other people in the family.

2. Ensure well-ventilated houses

• Keeping windows open and doorways (if possible) to keep the air being refreshed.

• Do not share central air-conditioning unit with other rooms.

• Do not allow airflow to go from rooms of patients to common spaces.

• Using fans and air purifiers.

3. Wash hands on a regular basis

• After coughing, sneezing, blowing nose.

• After touching items and surfaces.

• After using the restroom.

• After collecting wastes.

Steps of washing hands with soap:

1. Wetting hands under running tap (with warm or cold water), turn off the tap.

2. Rubbing soap onto hands and scrub both hands. Rubbing soap onto the back of the palm, in between fingers, and under the nails.

3. Scrubbing both hands for at least 30 seconds.

4. Rinsing both hands under running tap carefully.

5. Wiping with clean towel or let dry naturally.

Wash hands with hand sanitizer containing alcohol:

1. Extracting a small amount of hand sanitizer onto the palm.

2. Rubbing both hands and scrubbing all fingers, palms, back of the palms, and gaps between fingers until the sanitizer dries: about 30 seconds.

3. Letting dry naturally, hands must be completely dry before touching items.

Note when washing hands with hand sanitizer:

• Leaving hand sanitizer containing alcohol outside of reach of children. Guiding children to use hand sanitizer.

• Do not touch eyes, mouth, or nose after using hand sanitizer to prevent allergic reactions.

• Do not use hand sanitizer before cooking with fire since the alcohol component is combustible.

• Do not store hand sanitizer in areas with high temperature.

Who ARE NOT required to wear face masks?

• Children aged under 2 years

• Persons having difficulty breathing, persons incapable of removing face masks without assistance.

When to wear face masks?

• Caregivers: Caregivers must wear face masks when staying in the same room or space with patients and other people.

• Patients: Patients must wear face masks as frequent as possible, even when being quarantined to reduce risk of infecting other people.

• Family members: Other family members must wear face masks when sharing the same room or space with other people.

Methods of choosing face masks

• Disposable medical face masks are highly recommended.

Methods of wearing face masks:

1. Thoroughly washing hands with soap or hand sanitizer in 30 seconds

2. Picking up face masks by gripping one side with one hand

3. Raising facemasks to the face front of the face masks (in darker color) points outward, the side lined with metal nose clip must be positioned upwards.

4. Holding the face masks fixed on the face with one hand and using the other hand to wrap the strap over one ear and do the opposite for the other side.

5. Adjusting face masks:

- Using 2 index fingers to adjust the metal nose clip to closely wrap the nose bridge and face.

- Pinching the lower edges of the face masks with both index fingers and both thumbs and pulling downwards slightly and inwards to allow the face masks to closely hug the face under the chin.

Remove face masks:

1. Cleaning hands

2. Holding the face mask straps with both hands from behind the ears, removing them from the ears, while still gripping on the straps, taking the masks off the face, and placing in waste containers.

Note: Only touch the straps when removing the face masks. Do not touch the front of the face masks.

3. Cleaning hands again.

Do not wear face masks as shown below:

• Nose is exposed

• Chin is exposed

• Face mask is fully lowered below the chin

• Touching the outside of the face masks while wearing.

• COVID-19 patients must wash their dishes in their rooms. If caregivers are required, the caregivers shall wear gloves when gathering foods and washing dishes.

• Dishes and cutlery of patients must be placed in separate location after washing. Placing in rooms of patients is highly recommended.

7. Process linens safely

• Removing gloves and washing hands after processing linens of patients.

• Clothing items of patients must be washed separately from those of other people.

• Do not shake dirty clothes to limit risks of dispersing the virus.

• Using separate cleaning equipment for areas of patients.

• May wrap electronic appliances with nylon sheet and clean the outside surface.

• Removing gloves and washing hands after cleaning.

• Cleaning surfaces at least once a day.

Methods of mixing disinfectant solution:

• Chloramine B 25% powder: 5 teaspoons of the powder + 1 liter of water, or

• 5% Javel water: Mix 10 parts Javel water according to instructions on the label and 1 part water

• 1:10 mix of bleach and water: 5 teaspoons or 1/3 cup + 250 ml of water

NOTE:

• Prepared solutions must be used up within 24 hours.

• DO NOT mix chemicals or cleaning solutions with each other.

• DO NOT put the products in direct sunlight.

• DO NOT put cleaning or sanitizing products directly on the skin.

• DO NOT use cleaning or sanitizing products for food.

• Do not touch the face while wearing gloves, the outside of the glove may be contaminated with the virus.

Methods of removing gloves

1. While both hands are wearing the glove, pinching one glove at the wrist level to remove it, without touching the bare skin.

2. Peeling downwards, away from the wrist, turning the glove inside-out.

3. Holding the removed glove in the gloved hand.

4. Sliding the ungloved hand insides between the glove and the wrist.

5. Removing the second glove by rolling it down the hand and fold into the first glove.

6. Discarding safely the removed gloves – do not reuse.

7. Performing hand hygiene by washing with soap and water

11. For families with pets

12. Prevent infection when purchasing food, groceries, and other essentials

Persons with the following underlying diseases upon being infected with COVID-19 must be monitored and treated at hospitals:

1. Diabetes mellitus.

2. Chronic obstructive pulmonary disease and other pulmonary diseases.

3. Cancer.

4. Chronic kidney disease

5. Organ transplantation or hematopoietic stem cell transplantation.

6. Obesity, overweight.

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

8. Cerebrovascular disease.

9. Down syndrome.

10. HIV/AIDS.

11. Neurological disorders (including dementia).

12. Sickle cell anemia, thalassemia, other chronic blood disorders.

13. Bronchial asthma.

14. Hypertension.

15. Immunodeficiency.

16. Liver diseases.

17. Substance use disorder.

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

19. Systemic diseases.

20. Childhood diseases: Primary or secondary pulmonary hypertension, congenital cardiac defects, inherited metabolic disorders, congenital or acquired endocrine disorders.

Name of patient: _______ Date of birth: __/__/___ Gender: □ Male □ Female Phone number: __________

Name of caregivers: _______  Date of birth: __/__/____ Phone number: _____

Other symptoms: Sore throat, headache, vertigo, anorexia, nausea and vomiting, muscle pain, etc. should be added to the “Note” section

Note:……………………………………………………………………………………………………………………………

………………………………………………………………………………………………………….………………………

1. Breathing exercises:

- Help to improve dyspnea condition

- Some breathing exercises such as: pursed lip breathing, diaphragmatic breathing, belly breathing. For patients having a lot of sputum, practice active breathing cycle technique and coughing techniques.

• Pursed lip breathing

• Diaphragmatic breathing:

• Belly breathing

- Placing one hand on the chest and the other hand on the belly (to feel movement of the chest and the belly)

- Taking a breath in through the nose (pursed lips) and expanding the belly (feeling the hand on the belly rise)

- Breathing out slowly via the mouth with pursed lips (in a manner similar to whistling) and flatten the belly (Feeling the hand on the belly flatten)

• NOTE:

- When inhaling and exhaling, great effort is not required.

- Combining pursed lip breathing with belling or chest breathing with hands in a single breath and practicing regularly (at least three times/day, with 5-10 minutes per time)

- The two motions can be performed even when sitting or lying (when lying, placing pillow under head and under the knees)

• Effective coughing techniques

- Pursed lip breathing: implement in 5-10 minutes to move sputum from small bronchus to larger bronchus

- Exhaling through the mouth: implement 5-10 times with increasing speed to remove sputum from the trachea

- Coughing: take a deep breath, hold your breath, and cough 1-2 times. Cough lightly the first time and intensively to expel all the sputum.

• Active cycle of breathing technique   - Breathing control: breathe gently for 20-30 seconds   - Thoracic expansion: take 3 to 5 deep breaths in, through the nose. Pause at the end of each breath in for 2-3 seconds, then breathe out gently. - Huff: take a deep breath in, hold your breath for 2-3 seconds. Pause at the end of the breath in for 2-3 seconds, then exhale breath forcefully out through the mouth. Perform 1-2 huffs together.

2. Resting position

In case the SpO2 level is under 94% or the symptom of fatigue or dyspnea arises, the patients may lie on the belly with the head raised above the body. Continue to monitor SpO₂ level after changing the position.

• Proning position

Keep your head lower than your body and turned to one side for easy breathing

Keep proning position for 1-2 hours every 4 hours but not exceeding 14 hours per day.

• NOTE:

- Cease performing exercises and monitor body conditions if having the symptoms such as fatigue, dyspnea or increased chest pain during exercises. If such symptoms increase even when resting, immediately notify health staff for timely monitoring.

3. Physical exercise in bed

COVID-19 patients with mild to moderate symptoms should rest in bed and do suitable physical exercises.

Exercise to support digestion, improve blood circulation, and help relax.

4. Exercises for improving physique function and endurance 



 

GUIDANCE

ON NUTRITION FOR COVID-19 PATIENTS
UNDERGOING HOME TREATMENT
(Issued together with Decision No. 4156/QD-BYT dated August 28, 2021 of Minister of Health)

Hanoi, 2021


 

Compilation director

Assoc. Prof. Ph.D. Nguyen Truong Son, Deputy Minister of Health.

Chief author

Assoc. Prof. Ph.D. Luong Ngoc Khue, Director of Medical Services Administration, Ministry of Health.

Compilation and evaluation members

1. Ph.D. Vuong Anh Duong, Deputy Director of Medical Services Administration - Ministry of Health.

2. Ph.D. Chu Thi Tuyet, Nutrition Department of Friendship Hospital.

3. Ph.D. Luu Ngan Tam, Head of Nutrition Department of Cho Ray Hospital.

4. Ph.D. Luu Thi My Thuc, Director of Clinical Nutrition Department of Vietnam National Children’s Hospital.

5. Level-2 Spec. Doctor Nguyen The Thanh, Deputy Director of Nutrition Center of Bach Mai Hospital.

6. Ph.D. Nguyen Thanh Ha, Head of Nutrition Department, National Lung Hospital

7. Ph.D. Nguyen Thi Thuy Linh, Deputy Director of Nutrition Department, Hanoi Medical University Hospital.

8. MSc. Ha Thi Kim Phuong, Director of Nursing - Nutrition - Infection Control Agency, Medical Services Administration, Ministry of Health.

9. MSc. Ha Thanh Son, Official of Nursing - Nutrition - Infection control Agency, Medical Services Administration, Ministry of Health.

10. MSc. Nguyen Hong Nhung, Official of Nursing - Nutrition - Infection Control Agency, Medical Services Administration, Ministry of Health.

TABLE OF CONTENTS

General information

ROLE AND GENERAL PRINCIPLES OF NUTRITION FOR COVID-19 PATIENTS UNDERGOING HOME TREATMENT

Role of nutrition in home treatment of COVID-19 patients

General principles regarding nutrition for F0

Food choice

DIET FOR COVID-19 PATIENTS UNDERGOING HOME TREATMENT

Nutrition principles for adults

Nutrition principles for children

Practice of nurturing care for children

APPENDIX 1. REFERENCE MENU FOR ADULTS

APPENDIX 2. REFERENCE MENU FOR CHILDREN

APPENDIX 3. ILLUSTRATIONS FOR FOOD ESTIMATION

I. GENERAL INFORMATION

The COVID-19 pandemic is seriously threatening citizens’ health and killed millions of people in the world. COVID-19 is a class-A acute infectious disease caused by SARS-CoV-2 virus. COVID-19 patients often suffer the erratic and complicated disease. In the early stage, the disease develops slowly without any symptoms. But after that, many patients with COVID-19 rapidly progress to a severe condition, require noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation, lead to multiple organ failure, and eventual death, especially for elderly, persons with chronic diseases, immunodeficiency, co-infection and superinfection with other pathogens such as bacteria and fungus.

To avoid serious and dangerous symptoms, patients must be regularly monitored and have a healthy diet. The proper diet is necessary for COVID-19 patients with no or mild symptoms undergoing home treatment to improve resistance by supporting and improving human barriers such as immune cells, antibodies, skin, respiratory mucous membrane, and stomach mucous membrane to improve resistance.

COVID-19 patients usually suffer a sudden loss of smell or taste which reduce palate and thus, they must be supplemented with a suitable diet.

All COVID-19 patients have increased nutrition demand due to increased energy consumption. They may suffer from severe malnutrition if the patients are not receiving adequate nutrition. Malnutrition results in the increased risk of superinfection, severe condition, prolonged period of mechanical ventilation, and increased treatment expenses.

Sufficient nutrition for COVID-19 patients with mild and no symptoms is, therefore, necessary to improve physique, improve resistance, and limit complications.

II. ROLE AND GENERAL PRINCIPLES OF NUTRITION FOR COVID-19 PATIENT TREATMENT

1. Role of nutrition for treatment of COVID-19 patients with mild and no symptoms

- Malnutrition negatively affects functions of immune system and reduce effectiveness of immune system. Malnutrition affects severity of the infection, recovery time, complication rate, and mortality rate.

- A suitable diet associated with the treatment shall prevent, assist, remediate infection, prevent COVID-19 pandemic, and save up expenses and resources of healthcare system, patients, and patients’ family.

Purpose of nutrition measures:

- Providing an adequate and proper diet to balance energy and micronutrients required by each age group, medical conditions, and tolerance.

- Preventing muscle atrophy and malnutrition.

- For children, maintaining their growth and development. 

 

Image 1. Connection between malnutrition, immunodeficiency, and susceptibility to SARS-COV-2 infection

2. General principles of diet for COVID-19 patients with mild and no symptoms

- Eating normally and balance nutrients with a variety of foods (if possible) to maintain adequate physique and conditions.

- Adding 1 to 2 additional meals such as milk or dairy products, especially in cases of reduced palate due to fever, coughing, fatigue, etc.

- Consuming protein foods (such as lean meats and fish, etc. beans and peas) to prevent muscle atrophy and increase resistance.

- Consuming more fresh fruit or juice, vegetables, and spices (such as garlic and ginger) to increase resistance.

- Drinking enough water (2 liters/day on average) or more if having symptom of fever, diarrhea.

2.1. Adequate and balanced diet

- Ensuring adequate food groups such as: starchy carbs, milk or dairy products, fats, fruit and vegetables, meats and fish, eggs, nuts, dark green vegetables and orange vegetables.

- Eating 3 main meals and additional meals.

- Do not have too much sweetened foods (added sugars should be less than 10% of the total daily calories).

- Do not refuse to eat certain foods if not having food allergy reactions or not being advised by doctors.

- People with thin body and children must have more food supplying energy and high-quality protein such as milk and dairy products. 

Image 2. Food pyramid

2.2. Safe diets

- Refusing foods and drinks with a lot of sugar, salt, alcohol, and beer.

- Foods must be safe and hygienic. Do not use spoiled, rancid, or expired foods.

- Maintaining hygiene upon processing foods. Washing hands before and after processing foods.

- Using necessary dietary supplements as per instruction of nutritionists.

3. Food choice

3.1. Recommended foods

- Rice, wheat, corn, potato, cassava, etc.

- Nuts: beans, sesame seeds, peanuts, etc.

- Milk and dairy products: powdered milk, fresh milk, yogurt, etc.

- Meats, fish, shrimp, etc.

- Eggs and egg products: chicken eggs, duck eggs, quail eggs, etc.

- Vegetable oil, olive oil, fish oil, etc.

- All types of vegetables.

- All types of fresh fruits.

3.2. Foods to limit

- Animal fats, animal viscera.

- Foods high in salt (canned food, pickles, etc.).

- Sparkling drinks, confectionery products.

- Psychostimulants such as: alcohol, beer, coffee, cigarette.

3.3. Foods rich in vitamin and minerals to increase physical conditions

3.4. Equivalent substitute

Use equivalent substitute to diversify the meals

3.4.1. Protein: 100 g of lean pork is equivalent to

3.4.2. Starchy carbs: 100 g of rice is equivalent to

- 400 g of fresh tuber (potato, sweet potato, taro, cassava)

- 100 g of dry rice noodle, noodle, vermicelli, fresh corn, wheat

- 170 g of bread

- 250 g of fresh rice noodle

- 200 g of fresh corn

3.4.3. Fats: 1 spoon of cooking oil (5 ml) is equivalent to 8 g of peanuts, 8 g of sesame seeds.

3.4.4. Fruit: 200 g of papaya is equivalent to 200 g of pomelo, 200 g of guava, 160 g of kiwi, 400 ml of fresh orange juice, 200 g of mandarin, 150 g of pineapple, 200 g of mango, 130 g of persimmon; 300 g of wax apple, 200 g of soursop

3.4.5. Salt: 1 g of salt is equivalent to 1 yogurt spoon of salt; 1.5 spoon of soup powder; 5 ml of fish sauce; 7.5 ml of soy sauce.

III. DIET FOR COVID-19 PATIENTS WITH MILD AND NO SYMPTOMS

1. Nutrition principles for adults

- Demand of calories: 30-35 kcal/kg of weight/day, 15-20% of the total daily calories from protein, 20-25% of the total calories from fat, 50-65% of the total calories from starchy carb.

- Providing all vitamin and minerals according to age groups. Use more foods rich in Vitamins A, C, D, and E; foods rich in zinc and selenium. 300 g of vegetables per day, 200 g of fruit per day.

- Fiber: 18-20 g per day.

- Salt 5g per day.

- Drinking sufficient amount of water (40-45 ml/kg of weight/day), drinking warm water and drinking water throughout the day are recommended, refraining from waiting until thirsty to drink, water and juice are recommended. Patients who have fever are recommended to take oral rehydration solution (ORESOL) to supply water and electrolytes.

2. Nutrition principles for children

- On a periodic basis, monitor diet of children via weight and food intake.

- A balanced diet consists of 4 major components: lipids (animal lipids and plant lipids), vitamins and minerals, energy components (proteins, lipids, carbohydrates), and proteins (animal proteins and plant proteins). Children must have at least one meal with balanced diet per day.

- On a daily basis, have at least 5 out of 8 food categories (groups of starchy carbs, milk and dairy products, fats, vegetables, meats and fish, eggs, nuts, orange and dark green vegetables).

- Do not have too much foods with added sugar (added sugar should be less than 5% of the total energy intake).

- Do not eat too much salt.

- Drinking sufficiently water, especially juice, and avoid soda.

- Encouraging children aged 1-2 years to drink at least 600 ml of infant formula/day (for children not being breastfed) and children > 2 years of age to drink at least 500 ml of infant formula/day to have sufficient nutrients and balanced diet (multi micronutrients are not necessary). In case children fail to eat as per recommendations, use oral supplement with high energy density (1 Kcal/ml) to replace infant formula entirely or partly.

- Using flavors palatable, digestible and highly nutritious food to avoiding symptom of vomiting or nausea for children.

3. Practice of nurturing care for children

3.1. Periodic nutrition monitoring for children to determine whether the children suffer from severe acute malnutrition or not

- Monitoring weight of children on a periodic basis, once every 3-5 days if possible. If children lose 1-2% of weight/week, immediately notify health staff for appropriate guidance.

- Assessing digestive tract on a daily basis via symptoms such as anorexia, diarrhea, nausea, vomiting, and stomach ache which will greatly reduce amount of food intake and reduce the nutrient absorption.

- Monitoring amount of food intake per day. If amount of food intake <70% of the regular demand in the group age, consult health staff.

3.2. Nutrition demand for children by age

Table 1. Water demand for children

Table 2. Children’s demand of vegetables and fruits/day

3.3. Diet for children in different age groups

Note: Conversion of “amount” and equivalent is for reference purposes due to difference among food and containers such as bowl, dish, spoon, etc.

Children of 12-24 months of age: continue to be breastfed or got infant formula for the appropriate age if breastfeeding is not available and feed 3 meals of concentrated porridge with each meal consisting of 250 ml and 60-100 ml of crushed fruits.

Formula of 250 ml of porridge (1.5 bowls of rice)

 (Calories: 240 Kcal P:L:G= 10.3g:8.7g:30g)

Note: If scale is not available, use regular spoon with scoop section of 4x6 cm in dimension to measure foods

APPENDIX 1. REFERENCE MENUS FOR ADULTS

APPENDIX 1.1. MENUS FOR PEOPLE WEIGHING 45 – 50 kg

Calories: 1,350 – 1,450 kcal

APPENDIX 1.2. MENUS FOR PATIENTS WEIGHING 50 – 55 kg

Calories: 1,500 – 1,600 kcal/day

APPENDIX 1.3. MENUS FOR PATIENTS WEIGHING 60 – 70 kg

Calories: 1,800 – 2,000 kcal/day