Patients seeking healthcare services for potential COVID-19 should preferably phone ahead of time to their doctor, clinic, emergency room, or closest testing centre, so that adequate precautions can be taken. Patients should wear masks while in transit to the hospital (cloth masks can suffice until they are given a surgical mask on arrival). Patients who do not self-identify as potentially having COVID-19 should be screened and identified as soon as possible upon arriving at a health facility, to avoid prolonged contact with other patients and healthcare workers.
A suspected COVID-19 case includes any person presenting with an acute (≤14 days) respiratory tract infection
other clinical illness compatible with COVID-19,
an asymptomatic person who is a close contact to a confirmed case*.
In the context of COVID-19, the key respiratory syndrome consists of ANY of:
Shortness of breath
Anosmia or dysgeusia
... with or without other symptoms
(which may include fever, weakness, myalgia, or diarrhoea)
*Note: Although asymptomatic close contacts are classified as suspected cases, they should not routinely be tested.
Atypical manifestations are increasingly being recognised, including large vessel strokes in young patients, unexplained abdominal pain, various dermatological manifestations, and a multisystem inflammatory syndrome in children.
A close contact is defined as a person having had face-to-face contact (≤1 metre) or having been in a closed space with a confirmed COVID-19 case for at least 15 minutes. This includes, amongst others:
All persons living in the same household as a COVID-19 case, and people working closely in the same environment as a case.
Healthcare workers or other people providing direct care for a COVID-19 case while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, N95 respirator, eye protection).
A contact in an aircraft sitting within two seats (in any direction) of the case, travel companions or persons providing care, and crew members serving in the section of the aircraft where the case was seated.
Asymptomatic close contacts should not routinely be tested. However, under certain circumstances (e.g. in institutions such as care homes) testing of asymptomatic contacts may be indicated. (Further guidance on this topic is expected shortly.)
Measures that may facilitate early identification of suspected COVID-19 cases include: Posters, pamphlets, billboards or staff members outside and within the healthcare facility asking patients who fulfil criteria for a PUI to identify themselves to healthcare workers as soon as possible (rather than remaining in line in a waiting area).Including a screening questionnaire for COVID-19 as part of the standard triage form at healthcare facilities.
Anyone who fulfils the clinical criteria for a suspected COVID-19 case should immediately have the following measures taken:
- Give them a medical (surgical) mask (N95 respirators are NOT required for patients).
- Direct them to a separate area, preferably an isolation room if available.
- Where an individual isolation room is not available, a 2 metre distance should be kept between suspected COVID-19 cases and other patients.
- Instruct them to cover their nose and mouth during coughing or sneezing with a tissue or a flexed elbow. They should perform hand hygiene after contact with respiratory secretions (wash hands or use alcohol-based hand rub, which should be readily available at the point of triage).
- Limit their movement (e.g. use portable X-rays rather than sending the patient to the X-ray department). If they have to be moved, ensure that they wear a surgical mask at all times.
-The patient should ideally have a specifically allocated bathroom (where this is possible).
Symptomatic suspected cases should be quickly triaged using standard emergency department triage systems. This facilitates:
- Rapid initiation of supportive therapy (e.g. supplementary oxygen)
- Recognition of patients who can be allowed home to await results of the COVID-19 testing
- Protection of both patients and staff.
Table 1 – Criteria for “mild” disease
Criteria for "mild" disease (all must apply)
SpO2 ≥95% on room air
Respiratory rate <25
Heart rate <120
Mental status normal
*** For age <12, use paediatric criteria
Source: Clinical Management of Suspected or Confirmed COVID-19 Disease, Version 4 (May 2020)