Công văn 519/BYT-KCB

MINISTRY OF HEALTH -------	SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness ---------------
No. 519/BYT-KCB Re: guidelines for organization of receipt, diagnosis, treatment and management of nCoV-2019 patients	Hanoi, February 06, 2020

 

To:	- Directors of hospitals affiliated to the Ministry of Health; - Departments of Health; - Health units of central authorities.

Implementing Decision No. 237/QD-BYT dated 31/01/2020 by the Minister of Health on promulgation of plan for response to the novel coronavirus pneumonia (nCoV) epidemic at various levels; following Official Dispatch No. 362/BYT-KCB dated 28/1/2020 by the Ministry of Health, to ensure that healthcare establishments are prepared to receive, manage and treat patients as appropriate to each situation and prevent patient deaths, the Ministry of Health requests directors of hospitals affiliated to the Ministry of Health; Directors of Departments of Health and health units of central authorities to seriously direct healthcare establishments to prepare for response, receipt, diagnosis, treatment and management of confirmed and suspected nCoV-2019 cases. To be specific:

- Seriously organize emergency aid, admission and treatment in health units.

- Organize quarantine, treatment and management of nCoV-2019 cases, and ensure the safety of healthcare workers, patients’ families and communities according to regulations. Isolated treatment areas shall be divided into three units: an area for suspected cases, an area for confirmed cases and an area where patients stay before discharge.

- Be prepared to classify patients immediately when they register for medical examination at healthcare establishments: classify and provide separate examination rooms for patients with symptoms of acute respiratory tract infection (cough, fever, etc.); pay attention to those living in or coming from China within the past 14 days.

- Healthcare establishments having inpatient beds (hospitals at district level and equivalent and higher) shall receive, treat, manage, monitor and isolate suspected nCoV-2019 cases.

- All hospitals must have a plan for patient transport upon referral order. When a patient's condition worsens beyond the hospital’s technical capacity, refer the patient to the appropriate level of care (according to Appendix 1).

- Seriously treat the disease following guidelines on nCoV-2019 diagnosis and treatment enclosed with Decision No. 322/QD-BYT dated 6/2/2020 by the Minister of Health.

- Collect and send samples from suspected cases to local Institutes of Hygiene and Epidemiology and Pasteur Institutes for confirmatory testing as follows:

+ Healthcare establishments shall collect, transport and preserve samples from suspected nCoV-2019 cases in accordance with guidelines for nCoV-2019 monitoring and prevention from the Ministry of Health.

+ Sample receiving units:

(1) Laboratories of National Institute of Hygiene and Epidemiology shall receive samples from Northern provinces.

 (2) Laboratories of Ho Chi Minh City Pasteur Institute shall receive samples from Southern and Central Highlands provinces.

(3) Laboratories of Central Highlands Institute of Hygiene and Epidemiology shall receive samples from Central Highlands provinces.

(4) Laboratories of Nha Trang Pasteur Institute shall receive samples from Central provinces.

(5) Other laboratories permitted to receive samples by the Ministry of Health.

+ Sample testing units:

(1) Laboratories of National Institute of Hygiene and Epidemiology shall test samples from Northern provinces.

 (2) Laboratories of Ho Chi Minh City Pasteur Institute shall test samples from Southern and Central Highlands provinces.

(3) Laboratories of Central Highlands Institute of Hygiene and Epidemiology shall test samples from Central Highlands provinces.

(4) Laboratories of Nha Trang Pasteur Institute shall test samples from Central provinces.

(5) Depending on the nCoV-2019 situation and testing capacity of units, the Ministry of Health will consider allowing hospitals affiliated to the Ministry of Health and provincial hospitals and CDCs to perform confirmatory tests where necessary.

- Strictly control infection and prevent cross-contamination in healthcare establishments according to guidelines in Official Dispatch No. 96/KCB-DD&KSNK dated 24/01/2020 by Medical Services Administration on nCoV-2019 prevention and control in hospitals. Take all protective measures for health officials directly participating in patient examination, treatment and care to prevent transmission to health officials.

- nCoV-2019 rapid response teams of central and tertiary hospitals (according to Decision No. 225/QD-BYT dated 30/1/2020 by the Minister of Health) shall be ready to support hospitals of lower levels of care when mobilized by the Ministry of Health.

- Always prepare plans and resources to admit more patients and respond promptly when the disease starts spreading.

- Establish and properly maintain a Tele-Medicine system to carry out online briefings, medical consultations and professional exchanges between hospitals in the network.

- Continue to raise the awareness of patients and their families about personal protective measures (face masks, regular hand washing, etc.) and of health officials about procedures for infection control and personal protection in healthcare establishments.

For your reference and compliance. Consolidated reports on confirmed cases, patient developments and deaths in healthcare establishments shall be submitted to the Ministry of Health (Medical Services Administration) on a daily basis in accordance with the guidelines in Appendix 2.

 

P.P. THE MINISTER THE DEPUTY MINISTER DEPUTY HEAD OF NATIONAL STEERING COMMITTEE FOR nCoV-2019 PREVENTION AND CONTROL Nguyen Truong Son

 

APPENDIX 1

GUIDELINES ON CLASSIFICATION OF TREATMENT BASED ON OUTBREAK LEVELS

1. Classification of treatment for outbreak level 2:

(1) All healthcare establishments (at district level and equivalent and higher) shall prepare a separate area for patient management and treatment. Suspected cases shall be received, monitored and completely isolated in isolated treatment areas. When a patient's condition worsens beyond the hospital’s technical capacity, refer the patient to the appropriate level of care.

(2) Provincial hospitals shall:

- Prepare an isolated treatment area for at least 20 nCoV-2019 patients in the infectious disease department of the provincial general hospital or provincial tropical disease hospital/ tuberculosis and lung disease hospital.

- Suspected cases shall be received, monitored and completely isolated in isolated treatment areas. When a patient's condition worsens beyond the hospital’s technical capacity, refer the patient to the appropriate tertiary hospital; or report to the Ministry of Health, which will mobilize the nCoV-2019 rapid response team for assistance.

(3) Tertiary hospitals:

- In the North:

+ National Hospital for Tropical Diseases (Kim Chung branch, 500 beds) shall receive patients from Ha Tinh province northwards.

+ If all backup beds of National Hospital for Tropical Diseases are occupied, patients shall be transferred to Bach Mai Hospital and National Children’s Hospital. For the time being, these hospitals shall prepare facilities for isolated treatment units with 30-60 beds.

- In the Central:

+ Hue Central Hospital shall receive patients from Central and Central Highlands provinces (from Quang Binh province to Phu Yen province).

+ If all backup beds of Hue Central Hospital are occupied, patients shall be transferred to Da Nang General Hospital. Hue Central Hospital (branch 2) shall prepare an isolated treatment unit with 30-60 beds (for adults and children) ready to accept patients.

- In the South:

+ Ho Chi Minh City Hospital for Tropical Diseases shall receive patients from Khanh Hoa province southwards.

+ If all backup beds of Ho Chi Minh City Hospital for Tropical Diseases are occupied, patients shall be transferred to Cho Ray Hospital (tropical disease department with 30-60 beds), Children Hospital No. 2 (30-60 beds) and Ho Chi Minh City Children Hospital (Department of Infectious Disease D: 30-60 beds).

Note: Where necessary, healthcare establishments may transfer severe cases to hospitals besides those abovementioned and shall concurrently report to the Ministry of Health and National Steering Committee for nCoV-2019 Prevention and Control .

2) Classification of treatment for outbreak level 3:

 (1) All healthcare establishments (at district level and equivalent and higher) shall prepare a separate area for patient management and treatment. Suspected cases shall be received, monitored and completely isolated in isolated treatment areas. When a patient's condition worsens beyond the hospital’s technical capacity, refer the patient to the appropriate level of care.

(2) Provincial hospitals shall:

- Prepare an isolated treatment area for at least 20 nCoV-2019 patients in the infectious disease department of the provincial general hospital or provincial tropical disease hospital/ tuberculosis and lung disease hospital.

- Suspected cases shall be received, monitored and completely isolated in isolated treatment areas. When a patient's condition worsens beyond the hospital’s technical capacity, refer the patient to the appropriate tertiary hospital; or report to the Ministry of Health, which will mobilize the nCoV-2019 rapid response team for assistance.

- Receive, admit, treat, manage, monitor and completely isolate nCoV-2019 cases in provinces (in the infectious disease department, provincial general hospital or provincial tropical disease hospital/ tuberculosis and lung disease hospital); and only refer patients whose condition worsens beyond the hospital’s technical capacity to the tertiary hospital.

(3) Tertiary hospitals:

In the North:

+ National Hospital for Tropical Diseases (700 beds), Central Lung Hospital (50 beds), Bach Mai Hospital and National Children’s Hospital shall prepare additional treatment units to receive patients and support lower levels of care (20-50 beds).

+ Hospitals in Hanoi such as Bac Thang Long Hospital, Duc Giang Hospital, Saint Paul Hospital, Dong Da Hospital, Thanh Nhan Hospital and Ha Dong Hospital shall receive patients and support treatment. Patients with milder clinical symptoms or having passed the critical stage and awaiting discharge will be transferred from National Hospital for Tropical Diseases, Bach Mai Hospital and National Children’s Hospital to the abovementioned hospitals.

+ E Hospital, Thai Nguyen National Hospital, Uong Bi Vietnam - Sweden Hospital, Hai Phong Vietnam - Czech Hospital, Thai Binh General Hospital and Thanh Hoa General Hospital shall receive nearby patients (each hospital shall have 20-50 isolated and fully equipped beds and a backup isolated area with 20-50 beds in case of large local outbreak).

In the Central:

- The isolated area in the infectious disease department of Hue Central Hospital shall be expanded to receive 50 patients (both adults and children).

- General hospitals of Da Nang, Binh Dinh, Khanh Hoa and Dac Lac shall receive and treat nCoV-2019 patients. Each hospital shall prepare 30 isolated and fully equipped beds and 30 backup isolated beds in the infectious disease department.

In the South:

+ Ho Chi Minh City Hospital for Tropical Diseases: 50 beds

+ Cho Ray Hospital: 30-60 beds

+ People’s Hospital 115: 50 beds

+ Children’s Hospital No. 2: 30 beds

+ City Children’s Hospital: 30 beds

+ Can Tho Central General Hospital: 20-50 beds

+ Kien Giang General Hospital: 30 beds

- + Internal isolated treatment facilities shall be established in schools, factories, office buildings, military units, etc. having confirmed cases.

- Mobilize human and material resources (equipment, medications, materials, etc.) for treatment units. Provide technical and workforce assistance for localities with complicated situation.

3) Classification of treatment for outbreak level 4:

- Maintain continue operation of hospitals at central, provincial and district levels to ensure provision of essential medical services, including services for vulnerable groups such as children, pregnant women, the elderly and persons with chronic diseases.

- Increase number of health units receiving patients, classify patients at each level of care, avoid referring patients to higher levels of care to prevent overload.

- Establish temporary hospitals when there is community transmission, some public facilities (schools, factories, etc.) are required to close or local hospitals at all levels are overloaded and unable to admit more severe cases.

- Expand morgues to receive deceased patients. Launch plans for funerals in the event of high number of deaths.

- In unaffected localities

(1) Provincial central general hospitals:

Each hospital shall prepare an isolated treatment area in the infectious disease department and may mobilize additional personnel and equipment from the intensive care unit and pediatrics department. Each hospital shall prepare at least 20 isolated beds for admission and treatment (depending on its capacity).

(2) Provincial general hospitals:

Each hospital shall prepare an isolated treatment area in the infectious disease department and may mobilize additional personnel and equipment from the intensive care unit and pediatrics department. Each hospital shall prepare at least 20 isolated beds for admission and treatment (depending on its capacity).

(3) Provincial hospitals for tropical diseases and hospitals for tuberculosis and lung diseases:

Each hospital shall prepare an isolated treatment area in the intensive care unit. Each hospital shall prepare at least 20 isolated beds for admission and treatment (depending on its capacity).

(4) District-level hospitals:

Each hospital shall prepare an isolated treatment area in the intensive care unit. Each hospital shall prepare at least 10 isolated beds for admission and treatment (depending on its capacity).

When a patient's condition worsens beyond a district-level hospital’s capacity, refer the patient to a tertiary hospital after notifying the tertiary hospital in advance to prevent overload.

(5) Hospitals of central authorities:

The following hospitals of central authorities shall join the treatment network upon a large outbreak:

- 19/8 Hospital, 30/4 Hospital and 199 Hospital (Ministry of Public Security)

- Agriculture Hospital I (Ministry of Agriculture and Rural Development)

- National Transport Hospital and regional transport hospitals

- Hospital of Post and Telecommunications I

- Construction Hospital, etc.

Each hospital shall prepare at least 10 isolated beds (depending on its capacity). These hospitals shall join the fight against nCoV-2019 when a large outbreak happens in their localities and receive equipment, medications and materials from the national reserve.

(6) Role of polyclinics and commune-level health stations:

Detect and send suspected cases to hospitals for treatment and notify local centers for disease control and prevention to take measures against nCoV-2019. Give instructions on measures to prevent the disease from spreading to family members and other people, use of face masks and respiratory hygiene to patients.

 

APPENDIX 2

nCoV-2019 INFORMATION AND REPORTING SYSTEM

1. Reporting hospitals:

All hospitals where suspected nCoV-2019 cases are monitored, isolated, tested, supervised and treated must submit reports.

2. Regular data collecting period:

• According to shifts, from 7:30 AM of the reporting day to 7:30 AM of the following day.

3. Regulations on reporting time:

• Hourly reports shall be submitted before 8:30 AM of every day.

• The following cases shall be reported on within 2 hours:

• When patients are admitted, discharged or deceased

• When test results are available

• When a patient’s condition worsens or improves

4. Regulations on reporting period:

• The system shall not replace the infectious disease reporting system.

• Guiding documents from the Ministry of Health shall be followed throughout the period where the Ministry of Health declares a state of emergency.

5. Account:

• Website for online epidemic reporting: cdc.kcb.vn

• The username is identical to the one used for the infectious disease reporting system (managed by General Department of Preventive Medicine); default password: “123456a”

• Support email: mailto:[email protected]

• Support phone number: posted on online software

6. Report form

6.1 Form of general report on examination and treatment of confirmed or suspected nCoV-2019 cases

For healthcare establishments where suspected nCoV-2019 cases are monitored, isolated, supervised and treated

Is there any development related to nCoV-2019 in the hospital?

[default] [ ] No [ ] Yes

If yes, report using the following form:

Item	Daily tally	Cumulative sum
1. Number of suspected nCoV-2019 cases visiting for examination [1 ]
Number of cases visiting for examination having epidemiologic factors related to nCoV-2019 [2]
2. Number of suspected cases admitted
3. Total number of patients receiving treatment in isolation
3.1- Number of severe cases (noninvasive ventilation)
3.2- Number of severe cases (mechanical ventilation, emergency, ICU)
4. Number of discharged patients
4.1 - Recovered and improved
4.2 - Referred to higher level or care or specialized department
4.3 - Referred to lower level of care
4.3 - Deceased
4.4 - Severe and ask to return home
4.5 - Escaped
5. Number of cases whose samples have been collected (5.1 + 5.2 + 5.3)
- Genetic sequencing
- Realtime PCR
- Other tests
5.1 Number of cases having positive result
- Genetic sequencing (+)
- Realtime PCR (+)
- Other tests
5.2. Number of cases having negative result
- Genetic sequencing (-)
- Realtime PCR (-)
- Other tests
5.3 Number of cases pending test result
7. Note / Detailed description:
• Description of progression, treatment and result or detailed description of patient condition etc. • Other recommendation (if any)
Attached documents (multi-files): • More detailed report or summary of medical record etc.

8. Contact (daily)

7.1 nCoV-2019 prevention hotline [defend, editable]

7.2 Full name of reporter

Phone number

Email

7.3 Name of leader of nCoV-2019 prevention operations

Phone number

Email

Report number

Report recipient

Receiving emails (separated by “ ; “)

[1] Having clinical symptoms such as cough, fever, breathing difficulty, respiratory tract infection, etc.

[2] Having clinical symptoms and epidemiological factors (having returned from infected areas, having contact with confirmed cases, etc.)

 

6.2. Detail on suspected nCoV-2019 cases being monitored, isolated, supervised and treated

1. Patient number

2. Full name

3. Age/ Date of birth

4. Sex

5. Place of residence

6. Telephone number

7. Email

8. Reason for admission

9. Epidemiological factors: within 14 days prior to the onset of symptoms, did you

a. Live in or travel to or from an infected locality?

[ ] Yes               [ ] No                [ ] Don’t know

If yes, specify the address:

b. Have direct contact with or give care to a confirmed or suspected nCoV-2019 case?

[ ] Yes               [ ] No                [ ] Don’t know

c. Live or work with a confirmed or suspected nCoV-2019 case?

[ ] Yes               [ ] No                [ ] Don’t know

d. Sit near a confirmed or suspected nCoV-2019 case in an automobile/ train/ plane?

[ ] Yes               [ ] No                [ ] Don’t know

e. Return from Wuhan City/ China?

[ ] Yes               [ ] No                [ ] Don’t know

f. Have a family member who returned from Wuhan City/ China?

[ ] Yes               [ ] No                [ ] Don’t know

10. Confirmatory test results

1. Have not collected sample [ ]           2. Have collected sample [ ]

No.	Type of sample	Date of sample collection	Laboratory	Date of result announcement	Method	Result	If (-), write “good result”	Edit
	1. Throat swab 2. Nasal swab 3. Sputum 4. Tracheal swab 5. Inhaled body in airway 6. Alveolar wash 7. Blood 8. Feces 9. Other				- Genetic sequencing - Realtime PCR (-)	- Negative - Positive - Suspected

11. Primary diagnosis (ICD-10) [ICD-10 list]

12. Comorbidity diagnosis (ICD-10) [ICD-10 list] (multiple comorbidities)

13. Complication diagnosis (ICD-10) [ICD-10 list] (multiple complications)

14. Current condition (Insert New, update daily):

No.	Time of change	Development	Description (in case of severe condition or death)
	Hour - Date	Stable • Improved • Severe, complication: oxygen therapy • Severe, complication: noninvasive ventilation • Severe, complication: invasive ventilation • Severe, complication • Death • Severe, ask to return home • Other development

15. Treatment: [Paragraph]

16. Condition upon discharge

• Stable

• Improved

• Severe and referred

• Discharged

• Deceased

17. Note/ Detailed description:

• More detailed description

18. Attached documents (summarized medical record, clinical case report, etc.)

9. Responsibility

8.1. Hospital

- Assign a standing official to report

- Promptly report according to guidelines and regulations

- Take responsibility for data quality

8.2. Department of Health

• Expedite inspection

• Aggregate data of the whole province and data from hospitals of Ministries and central authorities in its province

• Take measures against nCoV-2019 according to collected data

8.3. Ministry of Health

• Develop report consolidation tools and guidelines

• Supervise compliance

• Supervise data quality

• Consolidate reports and share data

10. Features

• Log in

• Authorize

• Add new / Delete and change data

• Confirm submission of hospital-level reports, confirm submission of department-level reports

• View and print daily, weekly and monthly reports

• Review data via Email

• Review data via SMS

• Provide map according to patient’s current address

• Dashboard and application sharing data with leaders, and API sharing data with other Websites

• Expand to include other infectious diseases

11. Guidelines for clinical coding

• WHO temporary assigns the ICD-10 code of U07.1 to “2019-nCoV acute respiratory disease”.

• The disease is named nCoV-2019  for the time being. WHO will announce the official name of the disease after virus isolation.

• The U07 code group has been renamed to "Emergency care".