In order that appropriate IPC measures and an appropriate level of supportive care can be commenced:
Patients not meeting the criteria for mild disease will require admission on medical grounds.
Patients with mild disease may be managed at home, provided they are able to safely self-isolate (see criteria in table 2 below). Patients at risk of developing severe disease do not necessarily require hospitalisation if they have only mild COVID-19 disease.
If patients are to be managed at home, it is imperative that all appropriate measures are taken to prevent transmission of the disease to others
Those patients with mild disease who are unable to safely self-isolate at home may be considered for isolation at a designated government facility if available.
Some patients initially assessed as having “mild” disease may continue to worsen over the course of a week or more and subsequently require hospitalisation. In one study by Wang et al., those who required hospitalisation developed dyspnoea a median of 5 days after symptom onset, required hospitalisation on day 7, and were assessed as having ARDS by a median of day Any deterioration in the ability to perform activities of daily living at home as a result of dyspnoea should prompt re-evaluation at a healthcare facility. Patients managed at home need to be given the contact details of their doctor or healthcare facility in case of any clinical worsening. This is particularly important for those at high risk for deterioration (e.g. age >65, cardiac or pulmonary comorbidities and/or diabetes mellitus).
Table 2 - Criteria for management at home (for age >12 years)
Respiratory rate <25
Mental status normal
Able to safely self-isolate
Separate bedroom available for patient to self-isolate in
Able to maintain physical distancing at home
Able to maintain hand hygiene
Patient able to contact, and return to, healthcare facility in case of deterioration
See Management of Children with COVID-19 in the EMGuidance guidelines
Answers extracted from: Clinical management of suspected or confirmed COVID-19 disease (Version 4, May 2020)