Official Dispatch 151/SYT-NVY HCMC 2022 “Guidance on medical bags for COVID-19 patients at home” Version 1.7

On November 23, 2021, the Department of Health issued the Official Dispatch No. 8728/SYT-NVY, on updating the “Guidance on medical bags for COVID-19 patients undergoing treatment at home” (Version 1.6).

Pursuant to the Ministry of Health's Decision No. 5525/QD-BYT dated December 01, 2021, promulgating the Guidance on classification the risk of infection with SARS-CoV-2 and orientation for handling, isolation and treatment; the Ministry of Health's Official Dispatch No. 10815/BYT-DP dated December 21, 2021, providing guidance on management and protection of people at risk of infection with COVID-19; the Ministry of Health's Official Dispatch No. 11011/BYT-KCB dated December 28, 2021, regarding tests for detection of COVID-19 cases and tests for patients discharged from hospitals, the Department of Health updates the “Guidance on medical bags for COVID-19 patients undergoing treatment at home” (Version 1.7) applicable to establishments managing COVID-19 patients undergoing treatment at home (establishments that are assigned to manage COVID-19 patients at home such as medical centers of Thu Duc City and other districts, medical stations of wards, communes and townships; mobile medical stations; community-based COVID-19 patient care teams, etc.). Accordingly, the Department of Health changes conditions for eligibility for home quarantine, adds Favipiravir - an oral antiviral drug to the prescription for COVID-19 treatment at home.

The Department of Health hereby requests units assigned to provide healthcare and manage F0 cases undergoing treatment at home to implement in a safe and effective manner.

Any difficulties arising in the course of implementation should be reported to the Department of Health (the Medical and Professional Division - telephone: 028.3930.9981) for guidance./.

APPENDIX 1.

GUIDANCE ON MEDICAL BAGS FOR COVID-19 PATIENTS UNDERGOING TREATMENT AT HOME (VERSION 1.7)
(Attached to the Department of Health's Official Dispatch No. 151/SYT-NVY dated January 06, 2022)

1. People to be managed at home

a) People infected with COVID-19 (F0 cases) who have a positive test result for SARS-CoV-2 (by RT-PCR or rapid antigen test) under the Ministry of Health’s instructions given in the Official Dispatch No. 11042/BYT-DP dated December 29, 2021, and are eligible for home quarantine.

b) Conditions for eligibility for home quarantine:

- Fully meeting 2 clinical criteria:

(1) Asymptomatic or mild symptoms (without respiratory distress: SpO₂ ≥ 97% when breathing air, respiratory rate ≤ 20 breaths per minute).

(2) From 3 months to 64 years old, without underlying medical conditions, pregnancy, or obesity, having received full doses of vaccines. Those who do not fully satisfy the above-mentioned conditions may be quarantined at home, provided that they have a stable underlying medical condition, don't have any abnormal symptoms, have received full doses of COVID-19 vaccines or have received the first dose of COVID-19 vaccine for 14 days and wish to be quarantined at home.

- Ability to self-care of F0 cases: F0 cases may take care of themselves (such as eating, taking a bath, washing clothes, etc.); check their body temperature by themselves; be able to take medicines according to the doctors’ prescription; be able to contact medical staff for monitoring and in emergency cases. For F0 cases are children or persons who cannot take care of themselves, the caregivers are required.

Attention: If an F0 case fully meets the above-mentioned criteria but there is a person classified in the risk group (including persons with high-risk underlying medical conditions as provided in the Ministry of Health's list of underlying medical conditions, people over the age of 50, pregnant women, and people over the age of 18 who have not received full doses of COVID-19 vaccines) in his/her household, he/she is encouraged to quarantine at another place (at a place where there is no one in the list of at-risk people or at a concentrated establishment) to minimize the risk of transmission to other members in the family, especially the ones in the risk group.

c) The permission for F0 cases who are in the risk group to be quarantined and monitored at home or the treatment establishments shall be considered on the basis of their status, disease; conditions for taking care and treatment at home; support from medical staff; and wishes of F0 cases or their families.

2. Healthcare activities for F0 cases who are quarantined at home

Activity 1. Identification and making of the list of F0 cases subject to home quarantine in localities

1. Medical stations of wards, communes and townships shall take responsibility for receiving and updating the list of F0 cases in localities from different sources, such as “Communicable disease system” and “Quarantined people and COVID-19 patient management system” software; People’s Committees of wards, communes and townships; community-based COVID-19 prevention teams; community-based COVID-19 patient care teams and information provided by citizens (who conduct tests by themselves).

In case there is no evidence proving that a person is infected with COVID-19, medical stations of wards, communes and townships, mobile medical stations shall re-conduct test for such person by a rapid test kit licensed by the Ministry of Health (such test must be conducted directly by medical staff or the patient under the medical staff's direct supervision or indirect supervision through remote devices).

2. Upon receiving information about F0 cases, such information shall be updated on the “Quarantined people and COVID-19 patient management system” software. Information about F0 cases shall be transmitted to establishments managing COVID-19 patients undergoing treatment at home as assigned on the software or excel file within 4 - 6 hours.

3. The list of people in the risk group (with telephone number) shall be transmitted to the “accompanying physician network” for consultancy, periodic medical examination and guidance on taking care of underlying medical diseases (if any).

Activity 2. Guidance on self-care and home monitoring for F0 cases

1. Upon receiving the list of F0 cases, the recipient shall make a quick assessment of the conditions for home quarantine (clinical criteria and the ability to self-care of F0 cases); evaluate and classify risks in accordance with the Ministry of Health's Decision No. 5525/QD-BYT directly or indirectly through remote devices. If an F0 case is eligible for home quarantine, he/she shall be provided with guidance on requirements, self-care and home monitoring. To be specific:

a) Preparation of necessary equipment for home quarantine, including: Thermometer, pulse oximeter, sphygmomanometer (if any), medical mask; hand sanitizer; physiological saline solution for nasal irrigation or throat gargling; personal items, infectious waste containers with lids.

b) Preparation of drugs for treatment at home, including: Drugs for COVID-19 treatment that are provided; drugs for underlying medical diseases (hypertension, diabetes, heart disease, asthma, etc.) for use in one month.

c) Things F0 cases should do when being quarantined at home

- Avoiding pessimism, keep the mind at ease. Contacting medical staff for remote consultation when facing troubles.

- Self-monitoring of health: Checking body temperature, counting breaths, measuring SpO₂ (if a pulse oximeter is available) at least twice a day, or when feeling tired or short of breath.

- Continuing to use drugs for underlying medical diseases under the doctors’ prescription.

- Always wearing masks, washing hands or disinfecting hands regularly.

- Rinsing sinuses or gargling throat on a daily basis with physiological saline solution.

- Regularly practicing breathing exercises, exercising to improve the health.

- Drinking enough water or more in case of fever or diarrhoea.

- Avoiding skipping meals, increasing nutrition, eating enough nutrients, increasing fresh fruits and vegetables.

- Making health declarations at least once a day or when showing any abnormal symptoms via the “Y te HCM” app or the self-monitoring information sheet.

- The place for quarantine must be well ventilated; no central air conditioners are allowed; surfaces, utensils and toilets must be regularly cleaned.

- Disinfecting utensils and touched surfaces such as table surfaces, doorknobs, toilets, sinks, etc. Classifying and collecting infectious waste in accordance with regulations.

- Having telephone number of medical staff working at establishments managing COVID-19 patients undergoing treatment at home in case of necessity; “1022” switchboard; “accompanying physician network” or rapid response teams of wards, communes, townships or districts.

d) Things to avoid

- Avoiding arbitrarily leaving quarantine rooms during the quarantine period.

- Avoiding sharing utensils with others.

- Avoiding eating and drinking with others.

- Avoiding close contact with others or pets.

In case where a caregiver is required, the caregiver must wear a mask, face shield and wash hands before and after taking care of the patient.

e) F0 cases or F0 cases’ caregivers must immediately report the establishments managing COVID-19 patients undergoing treatment at home if F0 cases show any of the following symptoms:

- Dyspnoea or rapid breathing (> 21 breaths per minute for adults; ≥ 40 breaths per minute for children from 1 to under 5 years old; ≥ 30 breaths per minute for children from 5 to under 12 years old).

Peripheral oxygen saturation (SpO₂) < 97% (if measure is taken).

- Tachycardia: Heart rate > 120 beats per minute or < 50 beats per minute. Systolic blood pressure < 90 mmHg, diastolic blood pressure < 60 mmHg (if equipment is available).

- Constant pain in the chest, feeling of tightness in the chest, pain increases when taking a deep breath.

+ Altered mental status: Confusion, narcolepsy, vague, extreme fatigue/exhaustion; fussiness, lethargy difficult to wake, convulsion in children.

- Lips, fingernails, toenails and skin turn blue, pale lips, cold fingertips and toes.

- Unable to drink.

- Children with the following symptoms: Fever over 38°C, sore throat, cough, diarrhea, fatigue, refusal to play, chest tightness, feeling dyspnoea, SpO₂ < 97% (if equipment is available), poor feeding, etc.

2. Within 24 hours after receiving the list of F0 cases, establishments managing COVID-19 patients undergoing treatment at home that are assigned to manage F0 cases must distribute drugs for the treatment of COVID-19 according to regulations (immediately provide the bag A to asymptomatic F0 cases; immediately provide the bag A-C for F0 cases with mild symptoms).

a) For F0 cases in the risk group: Giving priority to immediately provide the bag of medicines C when there is a positive SARS-CoV-2 test result (including asymptomatic F0 cases and F0 cases with mild symptoms), instructing patients to immediately take antiviral drugs before considering and allowing the patient to be isolated at home or in a treatment establishment. In case the patient is transferred to the treatment establishment, he/she shall be instructed to continue using provided antiviral drugs; clearly record the drug use information on the hospital transfer letter or notify the receiving establishment for further monitoring.

b) Drugs for the treatment of COVID-19 may be provided and distributed at home, or the F0 cases’ relatives shall contact the medical stations or mobile medical stations for drug distribution.

Activity 3. Monitoring of F0 cases’ health and medical examination at home

1. Monitoring of F0 cases’ health

a) F0 cases’ health shall be monitored on a daily basis, and updated on the “Quarantined people and COVID-19 patient management system” software.

b) Always be ready to receive phone calls from F0 cases for consultation or home treatment in case medical intervention is required or F0 cases cannot be contacted.

2. Home treatment and prescription (Appendices 2 and 3)

a) Drugs for COVID-19 treatment at home include 3 bags (A, B, C): The bag A includes common drugs such as antipyretics drugs and supplements; The bag B includes anti-inflammatories and anticoagulant; The bag C includes an antiviral drug used under the Ministry of Health's Program on the controlled use of Molnupiravir in the community for COVID-19 patients with mild symptoms.

In which, oral anticoagulants (Rivaroxaban, Apixaban, Dabigatran) and antiviral drugs (Molnupiravir, Favipiravir) have been included in the latest COVID-19 diagnosis and treatment guidelines, version 7 issued by the Ministry of Health on October 06, 2021.

b) When an F0 case has mild symptoms or is classified in the risk group, the doctor of the establishment managing COVID-19 patients undergoing treatment at home must assess his/her health. In case an F0 case is indicated to use antiviral drugs, such establishment shall provide him/her the bag C. When receiving Molnupiravir, F0 case must sign a commitment according to the Ministry of Health’s Program on the controlled use of Molnupiravir in the community for COVID-19 patients with mild symptoms.

c) When feeling dyspnoea (shortness of breath or dyspnoea increases during exercise, resting breathing rate > 20 breaths/minute or measuring SpO₂ < 97%), F0 cases must immediately contact their managing establishments for consultation and support. Doctors shall assess the patients’ condition, if hospitalization is indicated, the doctors shall give the patients a single dose (bag B) before transferring such patients to the hospital.

Activity 4. Testing for F0 cases undergoing home quarantine

1. F0 cases who are quarantined and treated at home shall be lifted from home quarantine and treatment if they have been quarantined and treated for full 10 days, and have a positive SARS-CoV-2 antigen test result, in which, rapid test kits must be licensed by the Ministry of Health, such tests must be conducted by medical staff or by the patients under the supervision of medical staff directly or indirectly through remote devices.

2. Establishments assigned to manage F0 cases shall make a list of F0 cases who have recovered from COVID-19 for certification, and report it to the Steering Committee for COVID-19 Prevention and Control of wards, communes and townships to issue a certificate of completion of the prescribed quarantine period; and at the same time issue a certificate of leave of absence enjoying social insurance to employees according to the Department of Health’s instructions provided in the Official Dispatch No. 9000/SYT-NVY dated December 02, 2021 (in case F0 cases are employees).

3. Conducting tests for SARS-CoV-2 for F0 cases’ caregivers or persons living in the same house as F0 cases who showing suspected symptoms.

Activity 5. First aid treatment and transfer of F0 cases to hospital

1. When there are signs of severe symptoms in F0 cases who are undergoing home quarantine. The establishment managing COVID-19 patients undergoing home quarantine shall provide instructions and first aid treatment, and at the same time, contact the rapid response teams of wards, communes, townships, districts, Thu Duc City for assistance in emergency treatment and transfer the patients to the nearest hospital.

2. Signs of severe symptoms:

- For adults: Dyspnoea manifested by shortness of breath, tachypnea over 25 breaths per minute, lethargy, languor, lips, fingertips and toes turn blue, SpO₂ < 94%.

- For children: Tachypnea by age (children aged 1 to 5 years: ≥ 40 breaths per minute, children aged 5 to 12 years: ≥ 30 breaths per minute, children over 12 years old: ≥ 20 breaths per minute), nasal flaring, chest indrawing, lethargy, languor, refusal to feed/eat, fingertips and toes turn blue, SpO₂ < 95% (if measure is taken).

APPENDIX 2.

INSTRUCTIONS FOR USE OF DRUGS FOR COVID-19 TREATMENT AT HOME FOR PERSONS AGED ABOVE 18 YEARS
(Attached to the Department of Health's Official Dispatch No. 151/SYT-NVY dated January 06, 2022)

Medical bags for COVID-19 treatment at home include 3 bags A, B and C. To be specific: The medical bag A includes common drugs such as antipyretics and supplements; the medical bag B includes anti-inflammatory drugs and anticoagulants for special use only; the medical bag C contains antiviral drugs with the dosage according to the approved clinical trial protocol description.

MEDICAL BAG A (used within 07 days) immediately given to a F0 case upon receiving the information about such F0 case.

1. Paracetamol 500mg

Take 01 tablet when the body temperature rises above 38.5°C, take 01 tablet every 4 to 6 hours if fever is still present.

2. Vitamins (multivitamins or vitamin C)

Multivitamins: Take 01 tablet once a day.

OR

Vitamin C 500mg: Take twice a day, one tablet in the morning and the other by noon.

MEDICAL BAG B (Only use such medical bag upon a doctor’s order in accordance with Guidance on COVID-19 diagnosis and treatment in the Ministry of Health’s Decision No. 4689/QD-BYT dated October 06, 2021)

Instruct the patients that when they feel shortness of breath (shortness of breath, shortness of breath increased upon exercise, the respiration rate > 20 breaths/minute for the patients at rest or SpO2 < 97%), they must contact a doctor immediately for advice and support. Doctors shall assess the patients’ conditions, if hospitalization is indicated, the doctors will give the patients a single dose (the medical bag B) before the patients are transferred to the hospital.

Take once, 12 tablets (equivalent to 06 mg)

OR

Attention: The drugs No. 3 and No. 4 should NOT be used in the following cases: Pregnant women and breastfeeding women, people with one of the diseases (Peptic ulcers, liver failure, kidney failure, diseases that easily cause gastrointestinal bleeding, bleeding in the urinary tract and other diseases causing bleeding).

MEDICAL BAG C (Used for 5 days)

The bag includes an antiviral drug indicated for F0 cases with mild symptoms that is provided by the Ministry of Health in the Controlled Community Intervention Program for people aged 18 years or more. People in the risk group should be given it as soon as there is a positive SARS-CoV-2 test result (including asymptomatic persons and persons with mild symptoms).

5. Molnupiravir capsules 200mg or Molnupiravir capsules 400mg

Take twice a day: 800mg in the morning, 800mg in the afternoon for 5 consecutive days.

OR

Favipiravir tablets 200mg

Take in the first day: 1,600mg in the morning, 1,600mg in the afternoon.

From the second to seventh day: Take 600mg in the morning, 600mg in the afternoon.

Attention:

- When indicating Molnupiravir for F0 cases: Medical establishments guide F0 cases to sign the form of consent to participation in the Program on the controlled use of Molnupiravir in the community for COVID-19 patients with mild symptoms before distributing the drug.

- Molnupiravir should NOT be used for women who are pregnant or trying to get pregnant or breastfeeding. People with liver failure, acute viral hepatitis, kidney failure, acute or chronic pancreatitis should consult a doctor before use.

- Favipiravir should NOT be used for women who are pregnant or trying to get pregnant, breastfeeding, have severe liver or kidney failure.

APPENDIX 3.

INSTRUCTIONS FOR USE OF MEDICAL BAGS FOR COVID-19 TREATMENT AT HOME FOR CHILDREN AGED ABOVE 1 YEAR
(Attached to the Department of Health's Official Dispatch No. 151/SYT-NVY dated January 06, 2022)

❖ Guidance on treatment for children with mild COVID-19 at home

- Stay in a private room.

- Apply standard precautions, wear masks with children aged 2 years or more.

- Symptomatic treatment:

+ Reduce fever when the body temperature of children is 38.5°C or above: Paracetamol with the dosage of 10-15mg/kg/time every 6 hours.

+ Cough medicine: Prefer herbal cough medicine.

- Drink a lot of water.

- Ensure nutrition: The children are breastfed and eat sufficiently.

- Hygiene of body, mouth, nose and throat.

- Exercise on the spot and practice breathing for at least 15 minutes/day (for older children).

- Monitoring:

+ Measure the children’s body temperature at least twice a day or when feeling that the children are feverish.

+ Measure SpO2 (if the device for SpO2 measurement is available) at least twice a day or when feeling that the children are tired, have the symptom of tachypnea/shortness of breath.

- Make daily health declaration via the application “Y te HCM” or by fill in the health self-monitoring sheet, notify the medical staff when there are warning symptoms.

❖ Instructions for use of medical bags for COVID-19 treatment at home for children (used for 7 days):

* Note: Take Paracetamol when the body temperature rises above 38.5°C, take it every 4 to 6 hours if fever is still present.

❖ Warning symptoms:

■ Abnormal symptoms should be reported to the medical staff of a medical station or mobile medical station:

■ If the children show signs of severe symptoms, call 115 or contact rapid response teams of wards, communes or townships to receive first aid at home or take the children to the hospital right away:

* Note: Tachypnea by age: For children aged from 1 to 5 years: ≥ 40 breaths/minutes, for children aged from 5 to 12 years: ≥ 30 breaths/minutes, for children aged above 12 years: ≥ 20 breaths/minutes.