Công văn 6002/SYT-NVY

Pursuant to Decision No. 4038/QD-BYT dated August 21, 2021 of Ministry of Health on Provisional guidelines on management of COVID-19 patients at home;

Pursuant to remarks of Consulting experts for treatment of COVID-19 of Ho Chi Minh City at the meeting on August 25, 2021;

The Department of Health hereby updates version 1.4 of the “Guidelines on healthcare package for F0 at home”, which includes activities of mobile medical stations, conditions for quarantine at home, and adjustment to instruction on how to use medicine at home for F0.

The Department of Health hereby requests hospitals, medical centers of Thu Duc City, districts medical stations of wards, communes, and towns to organize implementation in order to ensure safety and effectiveness for COVID-19 patients.

Difficulties that arise during implementation should be reported to Department of Health (Department of Medical Profession - Phone number: 028.3930.9981).

Version 1.4 of the “Guidelines on healthcare package for F0 at home” is attached hereto./.

GUIDELINES ON HEALTHCARE PACKAGE FOR F0 AT HOME

(Version 1.4)

(Attached to Official Dispatch No. 6002/SYT-NVY dated August 25, 2021 of Department of Health)

1. Regulated entities: new COVID-19 patients (F0) who are tested positive by the RT-PCR test or quick antigen test, detected within the community, and eligible for quarantine at home as per the law.

2. Conditions for quarantining F0 at home

- F0 must meet all following conditions: Display no symptoms or mild symptoms (no dyspnea: SpO₂ ≥ 96% when breathing naturally, breathing rate ≤ 20 times/minutes). In addition, at least 1 of the following conditions must be met: (1) from 1 to 50 years of age, having no underlying medical conditions, not currently pregnant, not overweight; (2) receiving 2 shot or past 14 days from the first COVID-19 vaccine shot.

- F0 is capable of taking care of themselves: Can take care of themselves (such as eating, cleaning, washing, sanitizing, etc.); can contact medical personnel to be supervised and monitor, and when facing medical emergency. In case F0 are children or people who are incapable of taking care of themselves, assistants are required.

- Facility requirements: Have separate rooms for F0 where windows, separate bathrooms, and phones are installed with phone number of medical facilities and phone number of rapid response teams of districts available for contact when necessary. Have individual table or chair positioned in front of quarantine rooms to receive food and necessary personal items; have personal garbage bins with cover and bags. Have hand sanitizer, surface sanitizer, mouthwash or 0.9% saline solution, medical facemasks, and thermometer.

3. Healthcare activities for F0 under quarantine at home

Activity 1: Identify and prepare list of local F0 under quarantine at home

- Trace and manage list of F0 under quarantine at home within districts, wards, communes via the function “người cách ly” (quarantined individuals) on the software “Hệ thống Quản lý người cách ly và người bệnh COVID-19” (System for managing quarantined individuals and COVID-19 patients).

- Manage individuals who declare to be F0 (via the application for “electronic medical declaration”, phone calls to medical facilities, etc.) after conducting the test themselves and individuals who display suspected symptoms but have not been screened and tested via reports of community COVID-19 teams.

Activity 2: Instruct F0 on how to take care at home

- Wear masks regularly, except for when eating and personal hygiene. Replace face masks twice per day or when necessary, sanitize hands with alcohol prior to removing face masks.

- Regularly sanitize hands; sterilize items and surfaces such as tabletop, door knobs, toilets, sinks, etc.

- Measure body temperature, SpO₂ (if possible) at least twice per day or when feeling signs of fever and/or dyspnea. Perform medical declaration at least once per day or when displaying irregular symptoms via the application for “Electronic medical declaration” or via health monitor check form (breathing rate, body temperature, SpO₂).

- Rest, perform mild physical exercises (depending on health conditions); perform breathing exercises at least 15 minutes per day; drink water regularly instead of waiting for the thirst; do not skip meals; increase nutrient consumption; consume fruits, fruit juice, etc. think positively, and maintain comfortable mindset.

- Prepare phone number of medical personnel to contact when requiring advice and/or assistance (hotline “1022”, phone number of medical stations, mobile medical stations, or rapid response teams of wards, communes, towns, Thu Duc City).

- All members staying in the same house with F0 must perform health declaration via the software for “electronic medical declaration” at least once per day or when necessary.

Activity 3: Conduct medical examination and monitor health

- Mobile medical stations shall manage list of F0 under quarantine at home that they are assigned to oversee (medical centers of districts shall rely on number of new F0 to assign local mobile medical stations).

- Mobile medical stations shall organize physical examination and health monitor at home for F0, promptly detect cases where F0 display symptoms, and cases where F0 are classified as high risks (the elderly living alone, individuals having mental illnesses, etc.) to promptly transfer to quarantine facilities for treatment.

- Instruct F0 to declare health conditions on a daily basis via the application for electronic medical declaration, produce health monitor check list, promptly detect cases of severe symptoms to cooperate with rapid response teams of communes, wards, districts to transfer patients to district hospitals for treatment.

- Instruct F0 to dial “1022” and press number “3” to receive advice from Ho Chi Minh City Medical Association or press number “4” to receive advice from “accompanying pharmacists”.

- Update information on health conditions of F0 on a daily basis on the software “Hệ thống Quản lý người cách ly và người bệnh COVID-19” (System for managing quarantined individuals and COVID-19 patients).

Activity 4: Provide guidelines on using treatment medicine at home

- Medicine for treatment at home includes: antipyretic, vitality boosters (vitamins, micro-nutrients, traditional medicine), antiviral drugs, corticoid anti-flammatory drugs, and anticoagulant for oral administration for certain recommended situations.

- Oral antiviral drug (Molnupiravir) recommended for F0 who displays mild symptoms and provided by Ministry of Health under Controlled community intervention program.

- Corticoid anti-flammatory and oral anticoagulant recommended when patients display early symptoms of respiratory failure (dyspnea, breathing rate > 20 breaths/minute, SpO₂ < 95%) but have not been able to contact medical personnel for assistance. F0 must not take medicine on their own for more than 3 days, during which period, patients must contact physicians and/or doctors to receive support and, depending on patients' conditions, physicians and/or doctors will advise patients to continue with said medicine until 7-day mark.

Activity 5: Test F0 under quarantine at home

- Collect specimen at home (for quick test or RT-PCR) for F0 on the 14^th day to prepare for finishing the quarantine.

- Test caretakers and/or individuals staying in the same house with infected individuals when showing suspected signs of COVID-19.

Activity 6: Provide emergency medical aid for F0 under quarantine at home

Instruct F0 to dial “115” or call phone number of mobile medical stations, rapid response teams of communes, wards, districts upon showing signs of worsening namely dyspnea (short breath, rapid breath more than 30 breaths/minutes), lethargy, pale lips and/or extremities, SpO₂ < 95% to receive emergency medical aid and be transported to hospitals on a timely manner.

(*) Antiviral drug (Molnupiravir) and oral anticoagulants (Rivaroxaban, Apixaban, Dabigatran) are currently researched by countries around the world to assess their efficacy in treating COVID-19 patients. Given the widespread of the epidemic with numerous worsened cases, domestic experts recommend these drugs for use as mentioned above to limit percentage of worsened COVID-19 cases at home. Department of Health advises hospitals to boost research speed for application of these drugs in treating COVID-19 in order to contribute to science database of the sector and serve as the basis for requesting the Specialized Council of Ministry of Health to include in Guidelines for COVID-19 diagnosis and treatment.

PRESCRIPTION FOR COVID-19 TREATMENT AT HOME

(FOR INDIVIDUALS ABOVE 18 YEARS OF AGE)

Medicine for COVID-19 treatment at home consists of 3 packs (A, B, and C): Pack A consists of common medicine, including antipyretic and vitality boosters; Pack B consists of medicine for limited use in particular situations, including anti-flammatory drugs and anticoagulant; Pack C consists of antiviral drugs which are under special control.

PACK A (for use in 7 days)

1. Paracetamol 500 mg

Administer 1 tablet when body temperature exceeding 38.5 ^oC, may re-administer every 4 to 6 hours if the fever persists.

2. Vitamins (mixed vitamins or vitamin C)

Administer twice per day: 1 tablet in the morning, 1 tablet in the afternoon/evening.

PACK B (for use in 3 days)

If facing difficulty breathing (breathing rate at rest > 20 breaths/minute or SpO₂ < 95%), IMMEDIATELY CONTACT physicians and/or doctors for assistance. If physicians and/or doctors cannot be reached, patients may take anti-flammatory drugs (the 3^rd medicine) and anticoagulant (the 4^th medicine) for NO MORE THAN 3 DAYS. During this period, patients must CONTINUE TO ATTEMPT TO CONTACT physicians and/or doctors to receive assistance and, depending on patients’ health, physicians and/or doctors shall decide to continue with these medicine.

3. Dexamethasone 0.5 mg

Administer once per day: 12 tablets in the morning after meal (equivalent to 6 mg/day).

OR

Methylprednisolone 16 mg

Administer twice per day: 1 tablet in the morning, 1 tablet in the evening after meal (equivalent to 32 mg/day).

OR

Prednisolone 5 mg

Administer once per day: 08 tablets in the morning after meal (equivalent to 40 mg/day).

4. Rivaroxaban 10 mg

Administer once per day: 1 tablet in the morning.

OR

Apixaban 2.5 mg

Administer twice per day: 1 tablet in the morning, 1 tablet in the afternoon/evening.

OR

Dabigatran 110 mg

Administer twice per day: 1 tablet in the morning, 1 tablet in the afternoon/evening.

Note: The 3^rd and 4^th medicines MUST NOT BE used by: Pregnant women, breast-feeding women, and individuals suffering from any of the following conditions: gastric ulcer, liver failure, kidney failure, conditions that can cause bleeding within gastrointestinal tract, urinary tract, and other conditions that can cause bleeding.

PACK C (for use in 5 days)

This is antiviral drug recommended for F0 who display mild symptoms and provided by Ministry of Health under Control community intervention program, patients must sign Medicine use commitment in order to receive and use this medicine.

5. Molnupiravir 200 mg tablet or 400 mg tablet

Administer twice per day: 800 mg in the morning and 800 mg in the afternoon/evening for 5 consecutive days.

Note: As per recommendations of Ministry of Health, if patients who are using Molnupiravir must administer anti-flammatory drugs and anticoagulant as per guidelines above, the patients must STOP USING Molnupiravir./.