Courtesy Adaderana

As Sri Lanka’s daily COVID-19 cases count continues to soar, the Ministry of Health has decided to triage the virus-infected patients for hospitalization on priority basis.

Accordingly, a set of guidelines has been issued by the ministry on providing home-based care for asymptomatic or mildly symptomatic patients.

These low-risk patients will be allowed to home-quarantine at their own discretion.

As per the guidelines:

01. MOH in the area is responsible for triaging the virus-infected individuals who need home-based care and institutional health care.

02. The patients eligible for home-based care;
– Should be aged between 02 – 65 years
– Should be isolated in a separate room with sanitary facilities and adequate ventilation allocated for them
– Should not have uncontrolled comorbidities such as morbid obesity (BMI>30), diabetes, hypertension, chronic heart/lung/renal diseases or other medical conditions
– Should not be suffering from immunocompromised status or not on long-term immunosuppressive therapy
– Should have adequate self-care or caregiver support at home
– Should have proper communication facilities and the ability to communicate (patient or caregiver)
– Should have given informed consent
– *in the case of a pregnant woman, the gestational period should be less than 24 weeks

03. The MOH of the area should register the low-risk patients in the Patient Home Isolation and Management System (PHIMS). The MOH will then hand over the responsibility of the patient to the Call Centre and the Medical Care Team through the PHIMS.

04. These teams will be supervised by the Consultant Family Physicians in coordination with the other specialists in relative specialities.

05. The call centre will coordinate with the patient and a medical care team assigned for home-care management. An assigned medical officer in the medical care team will conduct an initial assessment and daily monitoring of the patient.

06. This remote assessment and daily monitoring care carried out through the telephone consultations by the Standardized Screening Tool and the findings will be recorded in the PHIMS. Subsequent remote assessment will be done daily or more frequently as required.

07. Following parameters will be assessed and recorded in the PHIMS by the medical care team:
– PCR/RAT positive date or date of initial symptoms
– Fever
– Breathing difficulty on rest or mild exertion
– Feeling unwell or any other significant symptoms
– Symptoms of dehydration
– Symptoms of uncontrolled underlying comorbidities

08. Following red flag symptoms will be considered for immediate admission to a hospital:
– Progressive worsening of persisting symptoms
– Difficulty in breathing at rest or after mild exertion
– SpO2 at rest is below 96% or less than 94% after mild exertion (if pulse oximeter is available)
– Persistent chest pain or heaviness
– Symptoms of dehydration
– Altered mental state (confusion/drowsiness.irritability)

09. Patients in the PHIMS requiring hospitalization will be identified early by a medical care team supervised by a Consultant Family Physician and will be handed over to a Specialist Medical Officer/Medical Officer nominated by the Regional Director of Health Services. This medical officer will arrange the patient’s transportation to the hospital in coordination with the relevant hospitals which have appropriate facilities.

10. The patients who are in the home-based management will be given the following instructions:
– Reassurance
– Advice on important non-pharmacological management (rest, fluid and balanced diet)
– Advice on pharmacological management for symptoms
– Encourage for proper monitoring and control of comorbidities and continuation of optimized treatment
– NOT take any NSAIDs or Systemic Steroids
– If a patient is on long-term steroids, it should be continued and specialised opinions need to be taken.
– If a caregiver provides services to a patient, she/he should wear personal protective equipment and take other hygienic measures
– Any caregiver should avoid contact with potentially contaminated items (such as towels, clothes) and hand hygiene should be maintained
– Advise the patient to contact the call centre through 1390 if any emergency arises

11. Appropriate waste disposal should be ensured by the Public Health Inspector (PHI) of the area to prevent spread of infection within the household.

12. The home-quarantined patient can be discharged on the 14th day of illness. If symptoms persist, the patient will be monitored until the symptoms resolve.

13. Patients who violate health instructions during the home care management will be admitted to ICC or hospital by the MOH. If a patient refuses to get admitted, the MOH can evacuate the patient without any consent and take legal action according to the Quarantine Ordinance. The MOH could seek the assistance of the police in the area if required.

14. Duration of home-quarantine period for other household members of the patient is 14 days from the positive PCR date of index case. However, if a household member becomes a first contact of the patient during the period of quarantine, he or she should undergo an extended period of quarantine for 14 days from the date of becoming the first contact. Exit RAT should be done for the negative members at the end of quarantined period.

15. Symptoms of possible post COVID syndrome should be advised to every patient on discharge from home-based care and the patient should be asked to report to the MOH of the area without any delay if such symptom appears.