Case management in Facilities
Date: 19 March 2020 Source: WHO
Contents
Background
This document is intended for health ministers, health system administrators, and other decision-makers. It is meant to guide the care of COVID-19 patients as the response capacity of health systems is challenged; to ensure that COVID-19 patients can access life-saving treatment, without compromising public health objectives and safety of health workers. It promotes two key messages:
- Key public health interventions regardless of transmission scenario; and
- Key action steps to be taken by transmission scenario to enable timely surge of clinical operations.
The public health objectives at all stages of the preparedness and response plan are to:
- Prevent outbreaks, delay spread, slow and stop transmission.
- Provide optimized care for all patients, especially the seriously ill.
- Minimize the impact of the epidemic on health systems, social services, and economic activity.
Based on the largest cohort of COVID-19 patients, about 40% of patients with COVID-19 may have mild disease, where treatment is mostly symptomatic and does not require inpatient care; about 40% of patients have a moderate disease that may require inpatient care; 15% of patients will have severe disease that requires oxygen therapy or other inpatient interventions, and about 5% have a critical disease that requires mechanical ventilation.[1] However, the evolution of the outbreak in some countries has shown a higher proportion of severe and critical cases and the need to rapidly increase surge capacity to prevent the rapid exhaustion of biomedical supplies and staff. In some countries, doubling rates of cases every 3 days has been observed.[2]
Scenarios of transmission
Countries or subnational areas will have to respond rapidly to one or more epidemiological scenarios. Currently, four transmission scenarios are observed:[3]
- Countries with no cases (no cases);
- Countries with one or more cases, imported or locally acquired (sporadic cases);
- Countries experiencing cases clusters in time, geographic location, or common exposure (clusters of cases);
- Countries experiencing larger outbreaks of local transmission (community transmission).
Countries will experience one or more of these situations at the subnational level and must tailor their approach to the local context. For clinical care, six major interventions must be put into place immediately and then scaled up according to epidemiologic scenarios (see Table 3).
Scenario and strategic priorities
Table 1
| Case severity, risk factors | Recommendations |
|---|---|
| Mild Moderate with no risk factors | Patient should be instructed to self-isolate and contact COVID-19 information line for advice on testing and referral. Test suspected COVID-19 cases according to diagnostic strategy. Isolation/ cohorting in: Health facilities, if resources allow; Community facilities (e.g. stadiums, gymnasiums, hotels) with access to rapid health advice (i.e. adjacent COVID-19 designated health post/EMT-type 1, telemedicine)4; Self-isolation at home according to WHO guidance. |
| Moderate, with risk factors Severe Critical | Patient should be instructed to self-isolate and call COVID-19 hotline for emergency referral as soon as possible. Hospitalization for isolation (or cohorting) and inpatient treatment. Test suspect COVID-19 cases according to diagnostic strategy. |
References
- ↑ Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020. doi: 10.1001/jama.2020.2648. [Epub ahead of print]
- ↑ Ministero della Salute. Nuovo coronavirus: Cosa c’è da sapere. http://www.salute.gov.it/portale/documentazione/p6_2_8.jsp?lingua=italiano (accessed 18 March 2020).
- ↑ World Health Organization. Critical preparedness, readiness and response actions for COVID-19.
