Home care for patients with suspected or confirmed COVID-19 and management of their contacts
For those presenting with mild illness, hospitalization may not be required unless there is concern about rapid deterioration
Criteria for home care:
- Patients with mild symptoms such as low-grade fever; cough; malaise; runny nose; or sore throat without any warning signs
- Patients who are symptomatic but no longer require hospitalization
- When inpatient care is unavailable or unsafe (e.g., capacity is limited, and resources are unable to meet the demand for healthcare services)
- Without underlying chronic conditions − such as lung or heart disease, renal failure or immune-compromising conditions that place the patient at increased risk of developing complications
Role of Health Care Worker (HCW):
The decision to isolate and monitor a COVID-19 patient at home should be made on a case-by-case basis. Their clinical evaluation should include:
- careful clinical judgment after assessment of safety of patient’s home environment
- assessment of whether the patient and the family are capable of adhering to the precautions that will be recommended as part of home care isolation (e.g., hand hygiene, respiratory hygiene, environmental cleaning, limitations on movement around or from the house)
- establishing a communication link with the patient’s caregiver or the patient. Monitoring should continue for the duration of the home care period – that is, until the patient’s symptoms have completely resolved
- educating patients and household members should be educated about personal hygiene, basic Infection Prevention and Control (IPC) measures and how to care for the member of the family suspected of having COVID-19 disease as safely as possible to prevent the infection from spreading to household contacts
- reviewing the health of contacts regularly by phone but, ideally and if feasible, through daily in-person visits, so specific diagnostic tests can be performed as necessary
Monitor for worsening symptoms regularly
- Advise the COVID-19 patients and their caregivers about the signs and symptoms of complications or how to recognize a deterioration in their health status that require medical attention.
- Monitor these regularly, ideally once a day. For example, if a patient’s symptoms become much worse (such as light headedness, difficulty breathing, chest pain, dehydration, etc.) from the initial clinical assessment, he or she should be directed to seek urgent care.
- Caregivers of children with COVID-19 should also monitor their patients for any signs and symptoms of clinical deterioration requiring an urgent re-evaluation. These include difficulty breathing/fast or shallow breathing, blue lips or face, chest pain or pressure, new confusion as well as an inability to wake up, interact when awake, drink or keep liquids down. For infants these include: grunting and an inability to breastfeed.
- Home pulse oximetry is a safe, non-invasive way to assess oxygen saturation in the blood and can support the early identification of low oxygen levels in patients with initially mild or moderate COVID-19 or silent hypoxia, when a patient does not appear to be short of breath but his or her oxygen levels are lower than expected. Home pulse oximetry can identify individuals in need of medical evaluation, oxygen therapy or hospitalization, even before they show clinical danger signs or worsening symptoms
Role of patient and family
Patients and families should adhere to the following recommendations.
- Place the patient in a well-ventilated single room (i.e., with open windows and an open door).
- Limit the movement of the patient in the house and minimize shared space. Ensure that shared spaces (e.g., kitchen, bathroom) are well-ventilated (e.g., keep windows open).
- Household members should stay in a different room or, if that is not possible, maintain a distance of at least 1 m from the ill person (e.g., sleep in a separate bed).
An exception may be made for breastfeeding mothers. Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother can continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby. She will also need to follow the other hygiene measures
- Limit the number of caregivers. Ideally, assign one person who is in a good health and has no underlying chronic or immune-compromising conditions. Visitors should not be allowed until the patient has completely recovered and has no signs and symptoms.
- Perform hand hygiene after any type of contact with patients or their immediate environment. Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet and whenever hands look dirty. If hands are not visibly dirty, an alcohol-based hand rub can be used. For visibly dirty hands, use soap and water.
- When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use cloth towels and replace them frequently.
- To contain respiratory secretions, a medical mask should be provided to the patient and worn as much as possible. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene − that is, coughing or sneezing into a bent elbow or tissue and then immediately disposing of the tissue followed by hand hygiene. Materials used to cover the mouth and nose should be discarded or cleaned appropriately after use (e.g., wash handkerchiefs using regular soap or detergent and water).
- Caregivers should wear a tightly fitted medical mask that covers their mouth and nose when in the same room as the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty from secretions, it must be replaced immediately with a new clean, dry mask. Remove the mask using the appropriate technique – that is, do not touch the front, instead untie it. Discard the mask immediately after use and perform hand hygiene.
- Avoid direct contact with patient’s body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves and a mask when providing oral or respiratory care and when handling stool, urine and other waste. Perform hand hygiene before and after removing gloves and the mask.
- Do not reuse masks or gloves (unless gloves are reusable utility gloves).
- Use dedicated linen and eating utensils for the patient; these items should be cleaned with soap and water after use and may be re-used instead of being discarded.
- Clean and disinfect surfaces that are frequently touched in the room where the patient is being cared for, such as bedside tables, bedframes and other bedroom furniture at least once daily. Regular household soap or detergent should beused first for cleaning, and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite (i.e., equivalent to 5000 pm or 1 part bleach 5 to 9 parts water) should be applied.
- Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite should be applied.
- Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid contaminated materials coming into contact with skin and clothes.
- Clean the patient’s clothes, bed linen, and bath and hand-towels using regular laundry soap and water or machine wash at 60–90 °C with common household detergent, and dry thoroughly.
- Either utility or single-use gloves along with protective clothing (e.g., plastic aprons) should be used when cleaning surfaces or handling clothing or linen soiled with body fluids. After use, utility gloves should be cleaned with soap and water and decontaminated with 0.5% sodium hypochlorite solution. Single-use gloves (e.g., nitrile or latex) should be discarded after each use. Perform hand hygiene before and after removing gloves.
- Gloves, masks and other waste generated during at-home patient care should be placed into a waste bin with a lid in the patient’s room and later disposed of as infectious waste in strong bags or safety boxes as appropriate, closed completely and removed from the home
- Avoid other types of exposure to contaminated items from the patient’s immediate environment (e.g., do not share toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths or bed linen).
- When HCWs provide home care, they should perform a risk assessment to select the appropriate personal protective equipment and follow the recommendations for droplet and contact precautions.
Management of contacts
A contact is a person who has experienced any one of the following exposures during the two days before and the 14 days after the onset of symptoms of a probable or confirmed case:
- face-to-face contact with a probable or confirmed case within 1-metre and for at least 15 minutes
- direct physical contact with a probable or confirmed case
- direct care for a patient with probable or confirmed COVID-19 disease without using recommended personal protective equipment
- other situations as indicated by local risk assessments. Contacts should remain in quarantine at home and monitor their health for 14 days from the last day of possible contact with the infected person
Releasing COVID-19 patients from isolation at home
- COVID-19 patients who have been discharged from hospital may continue to be cared for at home. This may include individuals who have clinically recovered from severe or critical illness and who may no longer be infectious.
- Patients who are cared for at home should be isolated until they are no longer infectious.
- 10 days after testing positive for asymptomatic persons
- a minimum of 10 days after symptom onset, plus at least 3 additional days without symptoms (including without fever and without respiratory symptoms) for patients receiving home-based care or those who have been discharged from hospital •
- Health workers need to establish a means of communicating with the caregivers of individuals with COVID-19 for the duration of the isolation period.