Công văn 5718/SYT-NVY

On 15/8/2021, the Department of Health promulgated Official Dispatch No. 5627/SYT-NVY on update on “Guidelines for home-based care of F0 cases” (version 1.2).

Following directions given by the Minister of Health in the meeting with the steering committee for COVID-19 prevention and control of HCMC on 17/8/2021, the Department of Health updated the “Guidelines for home-based care of F0 cases” (version 1.3).

Heads of hospitals and medical centers shall organize the implementation of these guidelines to ensure safe and effective care of COVID-19 cases.

Any difficulty arising during implementation should be reported to the Department of Health (Medical Operation Office - phone number: 028.3930.9981).

“Guidelines for home-based care of F0 cases” (version 1.3) is enclosed therewith./.

GUIDELINES FOR HOME-BASED CARE OF F0 CASES

(Version 1.3)

(Enclosed with Official Dispatch No. 5718/SYT-NVY dated August 17, 2021 by Department of Health)

1. Targets: confirmed COVID-19 cases (F0 cases) recently found in the community and eligible for home isolation as per regulations.

2. Conditions for home isolation of F0 cases:

- The F0 case is asymptomatic or experiences mild symptoms (no respiratory failure: SpO2 ≥ 96%, respiratory rate ≤ 20 per minute), is under 50 years old, has no underlying condition, is not pregnant and is not obese.

- The F0 case can take care of themselves: they can eat, practice personal hygiene, wash clothes, etc. by themselves; have a personal SpO₂ monitor to monitor SpO₂ regularly; and can contact healthcare workers for monitoring and upon emergency. Children and people who cannot take care of themselves must have caregivers when they are isolated at home.

- Facilities: there is a separate room for the F0 case with a window that provides proper ventilation, a separate toilet and a private phone that has the phone numbers of a healthcare facility and the quick response team of the district to call where necessary. There are a chair or table in front of the isolated room to receive food and necessary personal items; and a separate garbage bin with a lid and lined with a garbage bag. There are hand sanitizer and surface disinfectant, throat wash or saline water (0,9%), medical masks and a thermometer.

3. Home-based care activities for F0 cases

Activity 1: identify and list local home-isolated F0 cases

- Trace and manage list of home-isolated F0 cases in the district or commune using the “người cách ly” (“isolated persons”) function on the “Hệ thống Quản lý người cách ly và người bệnh COVID-19” (“COVID-19 patient and quarantined person management system”) software.

- Manage those self-declared as F0 cases (via the “khai báo y tế điện tử” (“electronic health declaration”) application, phone calls to healthcare facilities, etc.) due to self-testing and persons with suspicious symptoms but not yet screened reported by community COVID-19 teams.

Activity 2: instruct F0 cases on home-based self-care

- Regularly wear a mask, except for during mealtime and personal hygiene. Change mask twice a day or where necessary and sanitize hands with alcohol before removing the mask.

- Regularly sanitize hands; disinfect items and surfaces such as table surfaces, doorknobs, toilets, washbasins, etc.

- Take body temperature and measure SpO₂ (if applicable) at least twice a day or upon experiencing fever or breathing difficulty. Make health declaration at least once a day or upon developing any unusual symptom via the “khai báo y tế điện tử” (“electronic health declaration”) application or self-monitoring form (respiratory rate, body temperature and SpO₂).

- Have a balanced diet and drink a lot of water. Exercise on the spot and practice breathing at least 15 minutes daily.

- Have the phone number of healthcare workers for when advice or support is needed (the “1022” center or phone number of the quick response team of the commune, district or Thu Duc City).

- All people living together with the F0 case must make health declaration via the “khai báo y tế điện tử” (“electronic health declaration”) application at least once a day or where necessary.

Activity 3: examine and monitor health condition

- The mobile healthcare team (affiliated to the medical station) or quick response team shall make home visits, prioritizing symptomatic F0 cases found via health declaration or F0 cases suspected to be facing high risk in the area under its management (elder people living alone, mentally ill people, etc.) to promptly take these cases to treatment facilities.

- Based on daily electronic health declarations, the medical station shall formulate home-isolated F0 case monitoring records, call/message symptomatic F0 cases to check on them, screen serious symptoms and promptly notify the quick response team of the commune or district to have the patients transported to a district-level hospital for treatment.

Activity 4: give instructions on the prescription for home-based COVID-19 treatment

- Drugs used for home-based treatment include antipyretic drugs, physical condition improving drugs (vitamins, micro-nutrients and traditional medicines), antiviral drugs, and corticosteroid anti-inflammatory drugs and oral anti-coagulant drugs for certain situations.

- Indications for corticosteroid anti-inflammatory drugs and oral anti-coagulant drugs: patients showing early symptoms of respiratory failure (having difficulty breathing and/or respiratory rate > 20 per minute and/or SpO2 < 95% if applicable) AND unable to contact a healthcare worker for advice or support.

a. One of the following corticosteroid anti-inflammatory drugs may be used:

- Dexamethasone

+ Dosage (for adults): 6mg/dose/day after a meal (best taken in the morning).

If Dexamethasone is not available, substitute it with any of the following drugs:

- Prednisolone

+ Dosage (for adults): 40 mg/dose/day after a meal (best taken in the morning).

- Or: Methylprednisolone

+ Dosage (for adults): 16 mg every 12 hours after a meal (in the morning and the evening).

Note:

+ Persons with a stomach disease should take the drug with drugs for the disease.

+ If responding well to the drug, take the drug for no more than 07 days.

b. One of the following oral anti-coagulant drugs may be used (*):

- Rivaroxaban

+ Dosage: 10mg for once a day.

- Or: Apixaban

+ Dosage: 2,5mg for twice a day.

- Or: Dabigatran

+ Dosage: 220mg for once a day.

Note:

+ Take the drug for no more than 07 days.

+ The drug should only be used by persons aged 18 or older and used with caution in persons older than 80.

+ Contraindications: pregnant women, breastfeeding women, persons having liver failure, renal failure, a history of gastrointestinal hemorrhage or urinary tract hemorrhage, and diseases prone to bleeding.

+ Look out for signs of hemorrhage (such as subcutaneous hemorrhage, gingival bleeding, gastrointestinal hemorrhage, etc.) when using the drug.

Activity 5: testing for home-isolated F0 cases

- Collect a sample (for rapid or PCR testing) from the F0 case at their house on the 14th day to prepare for the isolation’s end.

- Instruct the caregiver or people living with the F0 case to visit a healthcare facility for a screening test if they develop suspicious symptoms.

Activity 6: provide health advice and emergency support for home-isolated F0 cases

- When developing any symptom such as fever higher than 38°C, cough, throat pain, diarrhea, loss of smell/taste, chest pain, heavy chest or breathing difficulty, contact a healthcare worker via the “1022” center (press number “3” for advice from HCMC Medical Association or number “4” for advice from “Thầy thuốc đồng hành” (“supportive physicians”)).

- When developing worse symptoms such as shortness of breath, rapid breathing (more than 30 per minute), lethargy, blue lips, blue limbs and SpO2 < 95% (if an SpO2 monitor is available at home), immediately call the “115” center or quick response team of the commune or district for emergency aid and transport to a hospital.

- Establish SpO₂ measuring and oxygen providing stations in neighborhoods to provide oxygen for F0 cases while they wait for the quick response team.

 (*) The COVID-19 diagnosis and treatment guidelines of the Ministry of Health (according to Decision No. 3416/QD-BYT dated 14/7/2021) recommend subcutaneous heparin injection for moderate and more severe cases. The antiviral drug Molnupiravir and oral anti-coagulant drugs (Rivaroxaban, Apixaban, Dabigatran) are being tested for their effectiveness against COVID-19. As there is a large outbreak with an increased number of worsening home-isolated F0 cases, experts recommend the use of these drugs according to the abovementioned instructions to prevent symptoms from worsening in home-isolated cases. The Department of Health encourages hospitals to further research the use of these drugs in COVID-19 treatment to contribute to the body of knowledge of the sector and provide the basis for proposing the addition of these drugs to COVID-19 diagnosis and treatment guidelines to the specialized council of the Ministry of Health.

GUIDELINES ON PRESCRIPTION FOR HOME-BASED COVID-19 TREATMENT (FOR ADULT PATIENTS)

1. Molnupiravir 400mg

Take the drug twice a day for 05 consecutive days: 01 tablet in the morning and 01 tablet in the afternoon.

2. Paracetamol 500mg

Take 01 tablet when fever is higher than 38°C; take a tablet every 04 to 06 hours if fever persists.

3. Vitamins (multivitamin, vitamin C)

Take the drug twice a day: 01 tablet in the morning and 01 tablet in the afternoon.

If you have difficulty breathing or SpO₂ is under 95% but are unable to contact a healthcare worker for support, you can take the following drugs:

4. Dexamethasone 0,5mg

Take the drug once a day: 12 tablets in the morning after a meal (equivalent to 06 mg/day).

OR

Methylprednisolone 16mg

Take the drug twice a day: 01 tablet in the morning and 01 tablet in the afternoon (after a meal).

OR

Prednisolone 5mg

Take the drug once a day: 08 tablets in the morning after a meal (equivalent to 40 mg/day).

5. Rivaroxaban 10mg

Take the drug once a day: 01 tablet in the morning.

OR

Apixaban 2,5 mg

Take the drug twice a day: 01 tablet in the morning and 01 tablet in the afternoon.

OR

Dabigatran 110 mg

Take the drug twice a day: 01 tablet in the morning and 01 tablet in the afternoon.

Note:

- This prescription should be used for patients aged 18 or older.

- Drug No. 1 is a controlled drug and is provided under the Ministry of Health’s program.

- Drug No. 4 and drug No. 5 may NOT be used for the following cases: pregnant women, breastfeeding women and persons having any of the following conditions: gastric and duodenal ulcers, liver failure, renal failure, diseases prone to gastrointestinal or urinary tract bleeding and diseases prone to bleeding.

- If you are receiving treatment for an underlying condition, consult your doctor before using this prescription.