Differentiating between adult patients with COVID-19 eligible for home care management vs requiring hospital admission
Version 1: 19-03-2020
Eligibility
Treatment and Management
Discharging patients to home
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Patient can be discharged when clinically indicated.[9]
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Decision to discharge requires careful consideration of future risk for medical intervention vs ongoing risk to HCW exposure. Early discharge may result in transfer back to hospital if patient deteriorates at home. This may result in additional risk of exposure during transport.[10]
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Decision to discharge is made in consultation with patient’s healthcare team, Public Health and should consider patient’s suitability for homecare, as well as risk of secondary transmission to household members with immunocompromising conditions.[9]
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Isolation should be continued at home if patient returns home before the decision to discontinue transmission-based precautions is made.[9]
When to discontinue isolation protocols?
Case-by-case evaluation and should consider disease severity, illness signs and symptoms and lab testing for COVID-19 in respiratory specimens.[9] This is determined by Public Health; refer to most recent recommendations.
Summary: eligibility for home care vs hospital admission
References:
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Novel, C. P. E. R. E. (2020). The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua liu xing bing xue za zhi= Zhonghua liuxingbingxue zazhi, 41(2), 145.
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Shi, Y., Yu, X., Zhao, H., Wang, H., Zhao, R., Cai, Q., ... & Duan, J. Host susceptibility to severe COVID-19: a retrospective analysis of.
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Velavan, T. P., & Meyer, C. G. (2020). The COVID‐19 epidemic. Tropical Medicine & International Health
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World Health Organization. (2020). Home care for patients with suspected novel coronavirus ( COVID-19) infection presenting with mild symptoms, and management of their contacts: interim guidance, 04 February 2020 (No. WHO/nCov/IPC/HomeCare/2020.3). World Health Organization.
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Gong, J., Dong, H., Xia, S. Q., Huang, Y. Z., Wang, D., Zhao, Y., ... & Lu, F. (2020). Correlation Analysis Between Disease Severity and Inflammation-related Parameters in Patients with COVID-19 Pneumonia. medRxiv; https://www.ncbi.nlm.nih.gov/books/NBK554776/#article-52171.s7
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Ruan, Q., Yang, K., Wang, W., Jiang, L., & Song, J. (2020). Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Medicine, 1-3.
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World Health Organization. (2020). Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance, 13 March 2020 (No. WHO/2019-nCoV/clinical/2020.4). World Health Organization.
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Interim Guidance for Discontinuation of Transmission-Based Precautions and Disposition of Hospitalized Patients with COVID-19. (2020, March 14). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html
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Marchand-Senécal, X., Kozak, R., Mubareka, S., Salt, N., Gubbay, J. B., Eshaghi, A., ... & Ozaldin, O. (2020). Diagnosis and Management of First Case of COVID-19 in Canada: Lessons applied from SARS. Clinical Infectious Diseases.