Quyết định 261/QD-BYT

DECISION

ON THE PROMULGATION OF THE “GUIDELINES ON MANAGEMENT OF COVID-19 PATIENTS AT HOME”

THE MINISTER OF HEALTH

Pursuant to the Law on Prevention and Control of Infectious Diseases 2007;

Pursuant to the Law on Medical Examination and Treatment 2009;

Pursuant to Decree No. 75/2017/ND-CP dated June 20, 2017 of the Government on functions, duties, entitlements, and organizational structure of the Ministry of Health;

Pursuant to Resolution No. 86/NQ-CP dated August 6, 2021 on urgent solutions for COVID-19 prevention and control to implement Solution No. 30/2021/QH15 dated July 28, 2021 of the 15^th National Assembly;  

According to the opinion of the Professional Council on the acceptance of the Guidelines on management of persons infected with SARS-CoV-2 and mild COVID-19 patients at home established in accordance with Decision No. 3838/QD-BYT dated August 10, 2021 of the Minister of Health;

At the request of the Director of the Vietnam Administration of Medical Services and the Ministry of Health.

DECISION:

Article 1. The “Guidelines on management of COVID-19 patients at home” is promulgated with this Decision.

Article 2. The "Guidelines on management of COVID-19 patients at home" applies to grassroots level according to the directive of the Departments of Health of provinces or centrally affiliated cities and Steering Committees for COVID-19 Prevention and Control of localities.

Article 3. Departments of Health of provinces or centrally affiliated cities shall, in consideration of COVID-19 situation in their provinces, provide guidelines on the management of COVID-19 patients at home of the Ministry of Health in order to develop and implement this document in their provinces.  

Article 4. This Decision comes into force as of its date of signing. This Decision replaces Decision No. 4038/QD-BYT dated August 21, 2021 of the Minister of Health on the temporary guidelines on management of COVID-19 patients at home and Decision No. 4109/QD-BYT dated August 26, 2021 of the Minister of Health on the list of medicines for outpatient treatment at home for COVID-19 patients.  

Article 5. Chiefs of the Ministry Offices, Chief Inspectors of Ministries, General Directors and Directors of Departments affiliated to the Ministry of Health, Directors of Departments of provinces and centrally affiliated cities, Directors of Hospitals affiliated to the Ministry of Health, Healthcare Directors of Authorities shall implement this Decision ./.

GUIDELINES

ON MANAGEMENT OF COVID-19 PATIENTS AT HOME
(Promulgated with Decision No. 261/QD-BYT dated January 31, 2022 of the Minister of Health)

LIST OF EDITORS

“GUIDELINES ON MANAGEMENT OF COVID-19 PATIENTS AT HOME”

GUIDELINES

ON MANAGEMENT OF COVID-19 PATIENTS AT HOME

I. GENERAL INFORMATION

1. Purposes

The “Guidelines on management of COVID-19 patients at home” is developed in order to provide guidelines and regulations on management, support, and care for persons infected with SARS-CoV-2 and mild COVID-19 patients at home (hereinafter referred to as “COVID-19 patients”).

2. Users

a) Commune, ward, and town-level healthcare stations; mobile healthcare stations; district health centers and clinics; emergency transportation centers and facilities assigned to participate in the management of COVID-19 patients at home (hereinafter referred to as “management facilities”).

b) Steering Committees for COVID-19 Prevention and Control of communes, wards, and towns; Steering Committees for COVID-19 Prevention and Control of districts and towns.

c)  Employees involved in the management of COVID-19 patients at home.

II. PATIENTS ELIGIBLE FOR HOME TREATMENT

1. Clinical criteria for COVID-19 patients include the following 3 criteria:  

a) Is a COVID-19 patient (confirmed to be infected with SARS-CoV-2 by RT-PCR test or quick antigen test according to current regulations) without clinical symptoms; or with mild clinical symptoms such as fever, cough, pharyngitis, nasal congestion, fatigue, cephalgia, myalgia, tongue numbness; diarrhea, rhinorrhea, anosmia, and ageusia.

b) Do not have signs of pneumonia or hypoxia; breathing rate < 20 times/minute; SpO2 > 96% when breathing normally; do not have abnormal breathing such as groaning, intercostal retractions, nose flaring, grunting, and wheezing during inspiration.

c) Do not have underlying conditions, or such conditions are under stable treatment.

2. The ability of COVID-19 patients to take care of themselves

a) The patient can take care of him/herself such as eating, bathing, washing, cleaning and self-monitor his/her health under the guidance of medical staff.

b) The patient has the ability to contact medical staff to be monitored and supervised. The patient has the ability to communicate and means of communication such as cellphones, computers, etc. in case his/her condition worsens.

c) In case a COVID-19 patient cannot take care of him/herself, his/her family must have a caretaker who meets the criteria of sections a and b above.

 III. DUTIES OF MANAGEMENT FACILITIES

1. Determine and make a list of COVID-19 patients to manage at home

a) Management facilities or facilities assigned by the Department of Health shall evaluate COVID-19 patients according to the criteria prescribed in Section 1 Part II.  

b) Make a list of COVID-19 patients undergoing home treatment (according to the form prescribed in Appendix No. 1).

2.  Provide guidance on health self-monitoring for COVID-19 patients at home

2.1. Health monitoring

a) Management facilities shall provide instruction for COVID-19 patients to self-monitor their health and fill their information in the health monitoring sheet for COVID-19 patients undergoing home treatment (according to the form prescribed in Appendix No. 2) 2 times/day in the morning and afternoon or when there are signs or symptoms that require emergency hospitalization and treatment in accordance with regulations prescribed in Section c Part 2.1.

b) Content of daily health self-monitoring

- Indicators: breathing rate, pulse, temperature, SpO2, and blood pressure (if possible).

- Symptoms: fatigue, cough, cough with phlegm, chills/shiver, conjunctivitis (red eye), anosmia or ageusia, diarrhea (loose stools/defecation); hemoptysis, dyspnea, panting, prolonged chest pain, stupor, delirium; other symptoms such as pharyngitis, cephalgia, dizziness, anorexia, nausea, vomiting, myalgia, etc.

c) If any of the following symptoms are detected, immediately report to the management facilities, healthcare stations of communes or wards, mobile healthcare stations, emergency transportation centers, etc. for timely emergency care and hospitalization:

1) Dyspnea or children with abnormal breathing signs: groaning, intercostal retractions, nose flaring, grunting, wheezing during inspiration.

2) Breathing rate

- Adults: 20 times/minute

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

- Children from 5 to under 12 years old: 30 times/minute

(Notes for children: count enough breathing rate in a minute when they are lying still and not crying).

3) SpO2 ≤ 96% (if the SpO2 level is abnormal, it needs to be measured again after 30 seconds to 1 minute; when measuring, hold still the position of measurement).

4) Heart rate > 120 beats/minute or < 50 beats/minute.

5) Hypotension: maximum blood pressure < 90 mmHg, minimum blood pressure < 60 mmHg (if it is possible to measure).

6) Frequent chest pain, feeling of tightness in the chest, or increase of pain when taking a deep breath.

7) Change of consciousness: dementia, hypersomnia, stupor, fatigue/exhaustion; children with constant crying, convulsions, or are hard to wake up. 

8) Cyanosis in lips, fingertips, fingernails, or skin; pale lips and coldness in fingertips or toes.

9) Unavailability to drink or breast refusal, poor appetite, and vomiting (in children). Children with signs of multisystem inflammatory syndrome: high fever, red eyes, strawberry tongue, swollen fingers and toes with erythema, etc.

10) Contracting other acute diseases: Dengue fever, hand-foot-and-mouth disease, etc.

11) Any unusual condition that the COVID-19 patient thinks it is necessary to report to healthcare facilities.

2.2. Guidance on diet and living

COVID-19 patients should rest and do light physical activities (suitable for their health condition); practice breathing at least 15 minutes per day; regularly drink water and do not wait until having thirst; do not skip meals; increase nutrition: eat nutritional meals and fruits, drink juice, etc. and have positive thinking and maintain a comfortable mental state.

2.3. Guidance on medical isolation at home

Comply with guidelines of the Ministry of Health and local regulations.

3.  Provide examinations and monitor the health of COVID-19 patients

3.1. Daily health monitoring

a) Record and update information about the health condition of COVID-19 patients daily in the health monitoring sheet for COVID-19 patients (Appendix No. 2); or the health management software of COVID-19 patients.

b) Evaluate and respond according to the guideline on the classification of SARS-CoV-2 infection risk of the Ministry of Health

c) Receive phone calls and provide counsel for COVID-19 patients or caretakers.

d) Employees of management facilities have the duty to come to the house of a COVID-19 patient to provide direct support in the following cases:  

- The COVID-19 patient needs emergency care.

- The employee does not receive reports on the health condition of the COVID-19 patient and cannot contact that patient or his/her caretaker.

3.2. Examination and prescription for treatment at home

a) Symptom treatment: prescribe and dispense medicines for the treatment

- Fever:

+ For adults with a fever > 38,5^oC or headache and body pain: take 1 antipyretic pill like paracetamol 0.5g each time and may repeat every 4-6 hours and no more than 4 tablets per day; take ORESOL if appetite is poor/reduced and may use it as a water replacement.

+ For children that have a fever > 38,5^oC: take antipyretic pills such as paracetamol at a dose of 10-15 mg/kg/time, may repeat every 4-6 hours, and no more than 4 times per day.

If after taking antipyretic pills 2 times without getting better, COVID-19 patients shall immediately inform the management facility for handling.

- Cough: use cough suppressants when having intense dry cough.

b) Prescription and dispensing of medicines for outpatient treatment: comply with guidelines on the diagnosis and treatment of COVID-19 promulgated by the Ministry of Health.

c) Examination and treatment at home by the mobile healthcare station or mobile healthcare team: establish mobile healthcare stations or mobile healthcare teams for emergency support for patients at home based on the number of infection cases and areas with infection cases in the ward and commune.  

d) The list of medicines for outpatient treatment for COVID-19 patients at home is prescribed in Appendix No. 3 promulgated with this Decision.

3.3. Detect and handle abnormal development related to underlying diseases

a) After the examination and evaluation on underlying diseases, if any abnormal development is detected, advise the patient to transfer to the healthcare facility for management and monitoring.

b) Consult with upper-level healthcare experts for cases with difficult and complicated underlying diseases and unavailability of immediate transfer to the healthcare facility.

c) Provide guidance for caretakers and COVID-19 patients on transferring patients to healthcare facilities when there are emergency situations regarding other medical conditions such as the risk of obstetric complications, trauma, stroke, etc. while informing healthcare facilities that receive these patients of their COVID-19 infection status.

4. Provide COVID-19 test to end the medical isolation:

a) Comply with guidelines on the diagnosis and treatment of COVID-19 promulgated by the Ministry of Health.

b) Conduct tests or provide guidance on self-testing at home for caretakers or housemates of = COVID-19 patients (RT-PCR test or quick antigen test) when there are symptoms of potential COVID-19 infection.

5. Handle emergency situations and hospitalization

a) Management facilities shall instruct COVID-19 patients when there are emergency signs or symptoms to immediately contact them or emergency transportation centers for emergency handling and timely hospitalization.  

b) While waiting for the hospitalization, management facilities shall instruct and provide emergency handling for COVID-19 patients.

APPENDIX NO. 1

LIST OF COVID-19 PATIENTS UNDERGOING HOME TREATMENT
(Promulgated with Decision No. 261/QD-BYT dated January 31, 2022 of the Minister of Health)

Cover

Left page

 LIST OF COVID-19 PATIENTS UNDERGOING HOME TREATMENT

Right page

 LIST OF COVID-19 PATIENTS UNDERGOING HOME TREATMENT

APPENDIX NO. 2

HEALTH MONITORING SHEET FOR COVID-19 PATIENTS UNDERGOING HOME TREATMENT
(Promulgated with Decision No. 261/QD-BYT dated January 31, 2022 of the Minister of Health)

Full name: : _________________________________ Born on: ___/___/_____

Sex: Male Female, Phone number: ____________________

Full name of the caretaker: __________________________________

Born on: ___/___/____ Phone number: ___________________

Other symptoms: pharyngitis, cephalgia, dizziness, anorexia, nausea, vomiting, myalgia, etc. should be added in the “Ghi chú” (Note) session

Note:

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

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

APPENDIX NO. 3

LIST OF MEDICINES FOR OUTPATIENT TREATMENT AT HOME FOR COVID-19 PATIENTS
(Promulgated with Decision No. 261/QD-BYT dated January 31, 2022 of the Minister of Health)

1. Groups of medicines in the List include:

2. Notes on antiviral drugs, corticosteroid anti-inflammatory medicines, and anticoagulants:

a) Prescribe medicines for treatment in accordance with regulations of Circular No. 52/2017/TT-BYT dated December 29, 2017 of the Ministry of Health on prescription of pharmaceutical drugs and biological products in outpatient treatment and Circular No. 18/2018/TT-BYT dated August 22, 2018 of the Ministry of Health on Amendments to Circular No. 52/2017/TT-BYT.

b) Use antiviral drugs as soon as possible after receiving confirmed diagnosis of COVID-19. It is best to use antiviral drugs within five days from the date of onset.  Prioritize antiviral drugs for cases with symptoms or high risks of severe disease progression, such as people above 65 years old, people who have yet to be fully vaccinated, people with unstable underlying diseases, etc.

c)  Designate treatments combined with corticosteroid anti-inflammatory medicines and anticoagulants when a COVID-19 patient show one of the early signs of respiratory failure; only prescribed medicines for treatment within 1 day during the wait for the transfer to a facility that treats COVID-19 patients.

Signs of respiratory failure:

(1) Dyspnea or dyspnea that increases when exercising (standing up, walking in the house) or abnormal breathing signs in children: groaning, intercostal retractions, nose flaring, grunting, wheezing during inspiration, and/or

(2) Breathing rate (for children: count adequate breathing rate in a minute when they are lying still and not crying):  

≥ 20 times/minute in adults;

≥ 30 times/minute in children from 5 to below 12 years old;

≥ 40 times/minute in children from 1 to below 5 years old;  

and/or

(3) SpO2 ≤ 96% (if the SpO2 level is abnormal, it needs to be measured again after 30 seconds to 1 minute; when measuring, hold still the position of measurement).

d) When prescribing medicines, carefully check the contraindications and utilize information about medicines the patient is using to avoid serious drug interactions. Advise patients or caretakers on how to identify some important side effects of medicines for timely detection and handling during use.