Decision 604/QD-BYT 2022 promulgating the Guidance on home-based management of people infected with COVID-19

THE GUIDANCE ON HOME-BASED MANAGEMENT OF

PEOPLE INFECTED WITH COVID-19

1. GENERAL INFORMATION

1.1. Purposes

"The Guidance on home-based management of people infected with COVID-19" was compiled with the aim of providing guidelines for the home-based management of people 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 (hereinafter referred to as facilities in charge of managing people infected with COVID-19 at home).

b) Medical staff and people involved in the home-based management of people infected with COVID-19.

c) People infected with COVID-19 subject to home-based management or their caregivers, and accommodation establishments with people infected with COVID-19.

2. CRITERIA FOR PEOPLE INFECTED WITH COVID-19 SUBJECT TO HOME-BASED MANAGEMENT

2.1. Clinical criteria

a) Being COVID-19 cases confirmed to be infected with SARS-CoV-2 by real-time RT-PCR test or rapid antigen test that is conducted by themselves or by their caregivers at home or by medical staff and health establishments.

- Showing no symptoms or mild clinical symptoms such as fever, dry cough, sore throat, stuffy nose, fatigue, headache, muscle aches, tongue numbness, diarrhea, runny nose, loss of smell or taste; Normal respiration rate for age, SpO2 ≥ 96% when breathing air, no shortness of breath, no respiratory failure;

- Having no underlying disease, or having an underlying disease but being treated stably.

b) Being COVID-19 patients who have been treated by health examination and treatment establishments but have not yet met the criteria for COVID-19 recovery and have met the standards for home-based management. In such cases, they may be transferred home for further care.

2.2. Criteria for health care and monitoring

a) Being able to take care of themselves (such as eating, bathing, washing clothes, cleaning, etc.) and monitor their health status;

b) Being able to contact medical staff and having available means of communication such as phones, computers, etc. to contact them for guidance and treatment in emergency cases;

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 mentioned in the above Sections a and b.

3. HEALTH DECLARATION

1. Persons infected with COVID-19 or their caregivers or medical staff and medical facilities shall evaluate people infected with COVID-19 subject to home-based management in accordance with Section 2 above.

2. People infected with COVID-19 or their caregivers shall notify health stations of communes and wards or facilities in charge of managing people infected with COVID-19 at home in accordance with local guidelines on personal information, time of COVID-19 infection, subjects of home-based management, and termination of the home-based isolation and treatment period.

3. Health stations of communes and wards or facilities in charge of managing people infected with COVID-19 at home shall collect information and make lists of people infected with COVID-19 subject to home-based management in accordance with the form specified in Appendix 01.

4. NECESSARY PREPARATION

4.1. Necessary items at home

a) Thermometer;

b) SpO2 Pulse Oximeter for personal use (if any);

c) Medical facemasks;

d) Hand sanitizer;

dd) Necessary personal items;

e) Containers for infectious waste with lids.

g) Means of communication, including phones and phone numbers of medical facilities (such as health stations, district-level health centers, emergency transportation centers, doctors, community counseling groups, rapid response teams, and hospitals).

4.2. Medicine for home-based treatment

a) Antipyretic medicine: paracetamol for adults: 500mg tablets that are sufficient for use within 3-5 days. Paracetamol for children (depending on weight and age): powders or granules for suspensions or tablets with the content of 80mg, 100mg, 150mg or 250mg, 325mg, 500mg that are sufficient for use within 3-5 days.

b) Electrolyte balancing solution: Oresol, rehydration solution, and other electrolytes.

c) Cough suppressants (depending on symptoms): Herbal medicine, or normal cough suppressants, or cough suppressants combined with antihistamine, etc. that are sufficient for use within 5-7 days. Note the indications, contraindications and warnings while using medicine.

d) Nasal sprays: 0.9% natriclorua that are sufficient for use within 5-7 days.

dd) Medicine for treatment of underlying conditions according to prescriptions that are being used for patients (if necessary, sufficient for use within 01-02 weeks).

4.3. Isolation

Creating a separate space for the purpose of isolation. The isolation area shall have good ventilation and no central air conditioner. The windows of the isolation area shall always be opened.

5. GUIDANCE ON HOME-BASED MANAGEMENT

5.1. Health monitoring of people infected with COVID-19

5.1.1. Children under 5 years old

a) Monitoring the following signs: mental health, breastfeeding and eating, measuring body temperature at least 2 times/day, respiration rate, pulse rate, SpO2 (if possible), skin color, mucous membranes, and digestive disorders.

b) Abnormal signs: In cases of detecting any of the following signs, immediately reporting to the facilities in charge of managing people infected with COVID-19 at home: health stations of communes and wards; or mobile health stations, emergency transportation centers, etc. to receive medical examination, emergency treatment and timely hospital transfer, or taking children infected with COVID-19 to health facilities for medical examination and treatment.

(1) Mental: children are fussy, anaemic, difficult to wake, or have convulsions.

(2) Continuous fever >39◦C and it is difficult to lower body temperature by antipyretic medicine + applying warm water. The fever does not improve after 48 hours

(3) Rapid respiration rate:

- Children under 2 months old: ≥ 60 breaths/minute

- Children from 2 to under 12 months old: ≥ 50 breaths/minute

- Children from 1 to under 5 years old: ≥ 40 breaths/minute

(4) Children with signs of abnormal breathing: Shortness of breath, nasal flapping, indrawing of chest and intercostal muscles.

(5) SpO2 < 96% (if it is possible to measure)

(6) Cyanosis

(7) Signs of dehydration: dry lips, sunken eyes, thirst, and little urination.

(8) Vomiting

(9) Children cannot breastfeed, eat or drink

(10) Children with other diseases such as dengue fever, hand, foot and mouth disease, etc.

(11) Any unhealthy condition of children that requires medical examination and treatment.

5.1.2. Children from 5 to 16 years old

a) Monitoring the following signs: mental health, measuring body temperature at least 2 times/day, respiration rate, pulse rate, SpO2 (if possible), skin color, mucous membranes, eating, cough, chest pain, abdominal pain, diarrhea (loose stools/liquid bowel movements), loss of smell and hearing.

b) Abnormal signs: In cases of detecting any of the following signs, immediately reporting to the facilities in charge of managing people infected with COVID-19 at home: health stations of communes and wards; or mobile health stations, emergency transportation centers, etc. to receive medical examination, emergency treatment and timely hospital transfer, or taking children infected with COVID-19 to health facilities for medical examination and treatment.

(1) Rapid respiration rate:

Children from 5 to under 12 years old: ≥ 30 breaths/minute, children from 12 years old: ≥ 20 breaths/minute

(2) Abnormal breathing: indrawing of chest and intercostal muscles.

(3) SpO2 < 96% (if it is possible to measure)

(4) Shortness of breath

(5) Continuous cough

(6) Chest pain

(7) Being unable to eat/drink

(8) Vomiting

(9) Diarrhea

(10) Being tired and fussy

(11) High fever that does not go down or does not improve after 48 hours

(12) Any unhealthy condition of children that requires medical examination and treatment.

5.1.3. Adults (over 16 years old)

a) Monitoring the following signs:

- Indicators: Respiratory rate, pulse rate, body temperature, SpO2 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.

b) Abnormal signs: In cases of detecting any of the following signs, immediately reporting to the facilities in charge of managing people infected with COVID-19 at home/accommodation facilities: health stations of communes and wards; or mobile health stations, emergency transportation centers, etc. to receive medical examination, emergency treatment and timely hospital transfer, or taking people infected with COVID-19 to health facilities for medical examination and treatment.

(1) Shortness of breath or difficulty breathing.

(2) Respiration rate ≥ 20 breaths/minute.

(3) SpO2 ≤ 96%.

(4) Tachycardia > 120 BPM or < 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) Blue lips, peripheral cyanosis, pale skin, discolored lips, cold fingers and toes.

(8) Changes in consciousness: Confusion, narcolepsy, lethargy, being very tired/exhausted, or convulsions.

(9) Being unable to eat or drink due to vomiting.

(10) Any unhealthy condition of people infected with Covid-19 that requires medical examination and treatment.

5.2. Treatment

a) With regard to people with body temperature ≥ 38.5⁰ C or getting severe headache, take antipyretic medicines as follows:

- Adults: Take 1 tablet of paracetamol 500mg or 10-15mg/kg each time and can re-take the medicine after every 4-6h. The total dose shall not be more than 4g (4000mg)/day.

- Children: Take paracetamol at a dose of 10-15 mg/kg/time (oral or rectal), and can re-take the medicine after at least 4-6h if necessary (or use doses depending on their age if there's no information about their weight as specified in Appendix No. 02). The total dose shall not be more than 60 mg/kg/day.

b) With regard to people suffering dehydration (due to high fever, diarrhea or fatigue), drink electrolyte balancing solution: The people infected with COVID-19 are encouraged to drink plenty of water, juice or Oresol (mix and drink according to instructions). If they don't want to drink Oresol, COVID-19 patients can drink cooled boiled water or fruit juice. Do not use industrial soda solutions (not produced from fruit) to rehydrate;

c) Enhance nutrition, eat enough nutrients, eat more fresh fruits and vegetables.

d) Take medicines to treat symptoms when necessary:

- Cough: Take herbal cough suppressants, or normal cough suppressants, or cough suppressant combined with antihistamine, etc. Pay attention to the indications, contraindications and warnings while using medicine.

- Nasal congestion and runny nose: Use nasal spray or nasal drops with 0.9% sodium chloride solution.

- Diarrhea: Take microbial products beneficial to the intestines (probiotics), or digestive enzymes.

dd) With regard to people who are using outpatient prescription medicines for underlying medical conditions: Continue to use such medicines as directed.

e) Other medicines: antiviral drugs that may be used when there is indication or prescription according to current regulations.

g) Note:

- Do not arbitrarily use antiviral, antibiotic, anti-inflammatory medicines when there is no indication or prescription.

- Do not steam children.

5.3. Diet and daily routines

a) Drink water regularly, do not wait until they are thirsty;

b) Enhance nutrition: eat enough nutrients, eat fruits and drink fruit juice. Do not skip meals.

c) Take rest and do light physical
activities (suitable for their health conditions); practice breathing for at least 15 minutes a day, think positively, and maintain a comfortable mentality.

5.4. Measures to prevent infection

People infected with COVID-19 and their caregivers or people living in the same household shall take infection control and prevention measures, as follows:

a) People infected with COVID-19 must avoid leaving the isolation area. If leaving the isolation area, they must wear facemasks and keep a safe distance from others.

b) Caregivers or family members living in the same household must always wear facemasks and keep a safe distance when they have to come into contact with people infected with COVID-19.

c) The isolation area shall be kept well ventilated and restricted from the use of difficult-to-clean items (stuffed animals, paper, paperboard) in this area.

d) Washing or disinfecting hands frequently. Disinfecting frequently touched items and surfaces such as countertops, doorknobs, hand-held devices, toilets, and sinks on a daily basis and when they are dirty.

dd) Classifying and collecting infectious waste in accordance with regulations.

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

6.1. Making lists of people infected with COVID-19 subject to home-based management

a) Evaluating people infected with COVID-19 subject to home-based management in accordance with the criteria specified in Section 2.

b) Making lists of people infected with COVID-19 subject to home-based management (according to the form specified in Appendix 01).

6.2. Providing testing or guiding self-testing for people infected with COVID-19 subject to home-based management or their caregivers and family members in the same household as they show any symptoms of COVID-19 infection in accordance with current regulations.

6.3. Providing guidance and counseling for people infected with COVID-19 and their caregivers on home-based management of COVID-19 patients.

6.4. Prescribing and offering medicines for outpatient treatment in accordance with the Guidance on diagnosis and treatment of COVID-19 of the Ministry of Health and relevant guiding documents.

6.5. Conducting emergency treatment and providing instructions for people infected with COVID-19 or their caregivers to transfer patients to health facilities when there are abnormal signs subject to emergency, medical examination and treatment or when there are emergency conditions for other diseases such as the risk of obstetric complications, trauma, stroke, etc. that are beyond the examination and treatment capacity of facilities.

6.6. Confirming the COVID-19 recovery and performing other tasks in accordance with current regulations.