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