MINISTRY OF HEALTH | SOCIALIST REPUBLIC OF VIETNAM |
No. 261/QD-BYT | Hanoi, January 31, 2022 |
ON THE PROMULGATION OF THE “GUIDELINES ON MANAGEMENT OF COVID-19 PATIENTS AT HOME”
THE MINISTER OF HEALTH
Pursuant to the Law on Prevention and Control of Infectious Diseases 2007;
Pursuant to the Law on Medical Examination and Treatment 2009;
Pursuant to Decree No. 75/2017/ND-CP dated June 20, 2017 of the Government on functions, duties, entitlements, and organizational structure of the Ministry of Health;
Pursuant to Resolution No. 86/NQ-CP dated August 6, 2021 on urgent solutions for COVID-19 prevention and control to implement Solution No. 30/2021/QH15 dated July 28, 2021 of the 15th National Assembly;
According to the opinion of the Professional Council on the acceptance of the Guidelines on management of persons infected with SARS-CoV-2 and mild COVID-19 patients at home established in accordance with Decision No. 3838/QD-BYT dated August 10, 2021 of the Minister of Health;
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DECISION:
Article 1.The “Guidelines on management of COVID-19 patients at home” is promulgated with this Decision.
Article 2.The "Guidelines on management of COVID-19 patients at home" applies to grassroots level according to the directive of the Departments of Health of provinces or centrally affiliated cities and Steering Committees for COVID-19 Prevention and Control of localities.
Article 3.Departments of Health of provinces or centrally affiliated cities shall, in consideration of COVID-19 situation in their provinces, provide guidelines on the management of COVID-19 patients at home of the Ministry of Health in order to develop and implement this document in their provinces.
Article 4.This Decision comes into force as of its date of signing. This Decision replaces Decision No. 4038/QD-BYT dated August 21, 2021 of the Minister of Health on the temporary guidelines on management of COVID-19 patients at home and Decision No. 4109/QD-BYT dated August 26, 2021 of the Minister of Health on the list of medicines for outpatient treatment at home for COVID-19 patients.
Article 5.Chiefs of the Ministry Offices, Chief Inspectors of Ministries, General Directors and Directors of Departments affiliated to the Ministry of Health, Directors of Departments of provinces and centrally affiliated cities, Directors of Hospitals affiliated to the Ministry of Health, Healthcare Directors of Authorities shall implement this Decision ./.
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ON MANAGEMENT OF COVID-19 PATIENTS AT HOME
(Promulgated with Decision No. 261/QD-BYT dated January 31, 2022 of the Minister of Health)
LIST OF EDITORS
“GUIDELINES ON MANAGEMENT OF COVID-19 PATIENTS AT HOME”
Compilation director
Assoc. Prof. PhD. Nguyen Truong Son
Deputy Minister of Health
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Lead editor
Assoc. Prof. PhD. Luong Ngoc Khue
Director of the Vietnam Administration of Medical Services - Ministry of Health
Co-editor
Assoc. Prof. PhD. Nguyen Lan Hieu
Director of Hanoi Medical University Hospital
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Participants in compilation and appraisal
Assoc. Prof. PhD. Pham Thi Ngoc Thao
Vice Director of Cho Ray Hospital
Specialist level II Doctor. Nguyen Trung Cap
Vice Director of Central Hospital for Tropical Diseases
PhD. Nguyen Van Vinh Chau
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Specialist level II Doctor. Nguyen Minh Tien
Vice Director of the Children’s Hospital of Ho Chi Minh city
PhD. Nguyen Trong Khoa
Vice Director of the Vietnam Administration of Medical Services
PhD. Vuong Anh Duong
Vice Director of the Vietnam Administration of Medical Services
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Assoc. Prof. PhD. Do Huy Cuong
Director of Tropical Disease Center – Bach Mai Hospital
Assoc. Prof. PhD. Le Thi Anh Thu
President of Ho Chi Minh City Infection Control Society
Dr. Bui Nghia Thinh
Chief of Intensive Care Department – Thu Duc District Hospital of Ho Chi Minh city
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Specilist of the Office of WHO in Vietnam
PhD. Duong Huy Luong
Head of Quality Management – Line Directive – Vietnam Administration of Medical Services
MD. Nguyen Thi Thanh Ngoc
Person in charge of the Department of Professional Competence – Inspection – Protection of Health of Officers, Vietnam Administration of Medical Services
MD. Ha Thi Kim Phuong
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PhD. Ta Anh Tuan
Head of Department of Internal Medicine Intensive Treatment – Central Children’s Hospital
Specialist level II Doctor. Do Chau Viet
Head of Infection Department – Children’s Hospital 2 of Ho Chi Minh city
Specialist level II Doctor. Du Tuan Quy
Head of Neuro - Infection Department – Children’s Hospital 1 of Ho Chi Minh city
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Specialist level II Doctor. Bui Nguyen Thanh Long
Deputy Head of Professional Medical Department - Department of Health of Ho Chi Minh city
PhD. Nguyen Quoc Thai
Tropical Disease Center – Bach Mai Hospital
MD. Truong Le Van Ngoc
Deputy Head of the Department of Professional Competence – Inspection – Protection of Health of Officers, Vietnam Administration of Medical Services – Ministry of Health
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Specialist of the Department of Professional Competence – Inspection – Protection of Health of Officers, Vietnam Administration of Medical Services – Ministry of Health
Editor secretaries
PhD. Nguyen Quoc Thai
Tropical Disease Center – Bach Mai Hospital
MD. Truong Le Van Ngoc
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Pharmacist. Do Thi Ngat
Specialist of the Vietnam Administration of Medical Services – Ministry of Health
GUIDELINES
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1. Purposes
The “Guidelines on management of COVID-19 patients at home” is developed in order to provide guidelines and regulations on management, support, and care for persons infected with SARS-CoV-2 and mild COVID-19 patients at home (hereinafter referred to as “COVID-19 patients”).
2. Users
a) Commune, ward, and town-level healthcare stations; mobile healthcare stations; district health centers and clinics; emergency transportation centers and facilities assigned to participate in the management of COVID-19 patients at home (hereinafter referred to as “management facilities”).
b) Steering Committees for COVID-19 Prevention and Control of communes, wards, and towns; Steering Committees for COVID-19 Prevention and Control of districts and towns.
c) Employees involved in the management of COVID-19 patients at home.
II. PATIENTS ELIGIBLE FOR HOME TREATMENT
1. Clinical criteria for COVID-19 patients include the following 3 criteria:
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b) Do not have signs of pneumonia or hypoxia; breathing rate < 20 times/minute; SpO2 > 96% when breathing normally; do not have abnormal breathing such as groaning, intercostal retractions, nose flaring, grunting, and wheezing during inspiration.
c) Do not have underlying conditions, or such conditions are under stable treatment.
2. The ability of COVID-19 patients to take care of themselves
a) The patient can take care of him/herself such as eating, bathing, washing, cleaning and self-monitor his/her health under the guidance of medical staff.
b) The patient has the ability to contact medical staff to be monitored and supervised. The patient has the ability to communicate and means of communication such as cellphones, computers, etc. in case his/her condition worsens.
c) In case a COVID-19 patient cannot take care of him/herself, his/her family must have a caretaker who meets the criteria of sections a and b above.
III. DUTIES OF MANAGEMENT FACILITIES
1. Determine and make a list of COVID-19 patients to manage at home
a) Management facilities or facilities assigned by the Department of Health shall evaluate COVID-19 patients according to the criteria prescribed in Section 1 Part II.
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2. Provide guidance on health self-monitoring for COVID-19 patients at home
2.1. Health monitoring
a) Management facilities shall provide instruction for COVID-19 patients to self-monitor their health and fill their information in the health monitoring sheet for COVID-19 patients undergoing home treatment (according to the form prescribed in Appendix No. 2) 2 times/day in the morning and afternoon or when there are signs or symptoms that require emergency hospitalization and treatment in accordance with regulations prescribed in Section c Part 2.1.
b) Content of daily health self-monitoring
- Indicators: breathing rate, pulse, temperature, SpO2, and blood pressure (if possible).
- Symptoms: fatigue, cough, cough with phlegm, chills/shiver, conjunctivitis (red eye), anosmia or ageusia, diarrhea (loose stools/defecation); hemoptysis, dyspnea, panting, prolonged chest pain, stupor, delirium; other symptoms such as pharyngitis, cephalgia, dizziness, anorexia, nausea, vomiting, myalgia, etc.
c) If any of the following symptoms are detected, immediately report to the management facilities, healthcare stations of communes or wards, mobile healthcare stations, emergency transportation centers, etc. for timely emergency care and hospitalization:
1) Dyspnea or children with abnormal breathing signs: groaning, intercostal retractions, nose flaring, grunting, wheezing during inspiration.
2) Breathing rate
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- Children from 1 to under 5 years old: 40 times/minute
- Children from 5 to under 12 years old: 30 times/minute
(Notes for children: count enough breathing rate in a minute when they are lying still and not crying).
3) SpO2 ≤ 96% (if the SpO2 level is abnormal, it needs to be measured again after 30 seconds to 1 minute; when measuring, hold still the position of measurement).
4) Heart rate > 120 beats/minute or < 50 beats/minute.
5) Hypotension: maximum blood pressure < 90 mmHg, minimum blood pressure < 60 mmHg (if it is possible to measure).
6) Frequent chest pain, feeling of tightness in the chest, or increase of pain when taking a deep breath.
7) Change of consciousness: dementia, hypersomnia, stupor, fatigue/exhaustion; children with constant crying, convulsions, or are hard to wake up.
8) Cyanosis in lips, fingertips, fingernails, or skin; pale lips and coldness in fingertips or toes.
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10) Contracting other acute diseases: Dengue fever, hand-foot-and-mouth disease, etc.
11) Any unusual condition that the COVID-19 patient thinks it is necessary to report to healthcare facilities.
2.2. Guidance on diet and living
COVID-19 patients should rest and do light physical activities (suitable for their health condition); practice breathing at least 15 minutes per day; regularly drink water and do not wait until having thirst; do not skip meals; increase nutrition: eat nutritional meals and fruits, drink juice, etc. and have positive thinking and maintain a comfortable mental state.
2.3. Guidance on medical isolation at home
Comply with guidelines of the Ministry of Health and local regulations.
3. Provide examinations and monitor the health of COVID-19 patients
3.1. Daily health monitoring
a) Record and update information about the health condition of COVID-19 patients daily in the health monitoring sheet for COVID-19 patients (Appendix No. 2); or the health management software of COVID-19 patients.
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c) Receive phone calls and provide counsel for COVID-19 patients or caretakers.
d) Employees of management facilities have the duty to come to the house of a COVID-19 patient to provide direct support in the following cases:
- The COVID-19 patient needs emergency care.
- The employee does not receive reports on the health condition of the COVID-19 patient and cannot contact that patient or his/her caretaker.
3.2. Examination and prescription for treatment at home
a) Symptom treatment: prescribe and dispense medicines for the treatment
- Fever:
+ For adults with a fever > 38,5oC or headache and body pain: take 1 antipyretic pill like paracetamol 0.5g each time and may repeat every 4-6 hours and no more than 4 tablets per day; take ORESOL if appetite is poor/reduced and may use it as a water replacement.
+ For children that have a fever > 38,5oC: take antipyretic pills such as paracetamol at a dose of 10-15 mg/kg/time, may repeat every 4-6 hours, and no more than 4 times per day.
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- Cough: use cough suppressants when having intense dry cough.
b) Prescription and dispensing of medicines for outpatient treatment: comply with guidelines on the diagnosis and treatment of COVID-19 promulgated by the Ministry of Health.
c) Examination and treatment at home by the mobile healthcare station or mobile healthcare team: establish mobile healthcare stations or mobile healthcare teams for emergency support for patients at home based on the number of infection cases and areas with infection cases in the ward and commune.
d) The list of medicines for outpatient treatment for COVID-19 patients at home is prescribed in Appendix No. 3 promulgated with this Decision.
3.3. Detect and handle abnormal development related to underlying diseases
a) After the examination and evaluation on underlying diseases, if any abnormal development is detected, advise the patient to transfer to the healthcare facility for management and monitoring.
b) Consult with upper-level healthcare experts for cases with difficult and complicated underlying diseases and unavailability of immediate transfer to the healthcare facility.
c) Provide guidance for caretakers and COVID-19 patients on transferring patients to healthcare facilities when there are emergency situations regarding other medical conditions such as the risk of obstetric complications, trauma, stroke, etc. while informing healthcare facilities that receive these patients of their COVID-19 infection status.
4. Provide COVID-19 test to end the medical isolation:
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b) Conduct tests or provide guidance on self-testing at home for caretakers or housemates of = COVID-19 patients (RT-PCR test or quick antigen test) when there are symptoms of potential COVID-19 infection.
5. Handle emergency situations and hospitalization
a) Management facilities shall instruct COVID-19 patients when there are emergency signs or symptoms to immediately contact them or emergency transportation centers for emergency handling and timely hospitalization.
b) While waiting for the hospitalization, management facilities shall instruct and provide emergency handling for COVID-19 patients.
LIST OF COVID-19 PATIENTS UNDERGOING HOME TREATMENT
(Promulgated with Decision No. 261/QD-BYT dated January 31, 2022 of the Minister of Health)
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NAME OF HEALTHCARE FACILITY
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LIST OF
COVID-19 PATIENTS UNDERGOING HOME TREATMENT
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Year: 202…
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LIST OF COVID-19 PATIENTS UNDERGOING HOME TREATMENT
No.
Full names of COVID-19 patients
Date of birth
Sex
Addresses
Phone numbers of COVID-19 patients
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LIST OF COVID-19 PATIENTS UNDERGOING HOME TREATMENT
Full names of relatives
Phone numbers of relatives
Date of confirmed diagnosis of COVID-19/date of onset
End date of management at home
Date of hospitalization and place of hospitalization
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HEALTH MONITORING SHEET FOR COVID-19 PATIENTS UNDERGOING HOME TREATMENT
(Promulgated with Decision No. 261/QD-BYT dated January 31, 2022 of the Minister of Health)
Full name: : _________________________________ Born on: ___/___/_____
Sex: Male Female, Phone number: ____________________
Full name of the caretaker: __________________________________
Born on: ___/___/____ Phone number: ___________________
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↓ Content of a monitoring day
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Immediately contact medical staff if there is one of the following signs: SpO2 ≤96%, breathing rate ≥20 times/minute, pulse <50 or >120 times/minute, blood pressure <90/60 mmHg
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Pulse (time/minute)
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Daily temperature (Celsius)
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Breathing rate
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SpO2 (%)
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Maximum blood pressure (mmHg) (if it is possible to measure)
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Minimum blood pressure (mmHg) (if it is possible to measure)
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6.
NO SYMPTOMS
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Pay attention to your health. If you have any symptom, write (C) for YES or (K) for NO below for each daily symptom.
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Fatigue
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Cough
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Cough with phlegm
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Chill/shiver
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Conjunctivitis (red eyes)
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anosmia or ageusia
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Diarrhea (loose stools/defecation)
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Immediately contact medical staff if you have one of the following symptoms
14.
Hemoptysis
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14.
Dyspnea or panting
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
15.
Prolonged chest pain
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16.
Stupor, delirium
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Other symptoms: pharyngitis, cephalgia, dizziness, anorexia, nausea, vomiting, myalgia, etc. should be added in the “Ghi chú” (Note) session
Note:
…………………………………………………………..……………………………..……………
…………………………………………………………..……………………………..……………
LIST OF MEDICINES FOR OUTPATIENT TREATMENT AT HOME FOR COVID-19 PATIENTS
(Promulgated with Decision No. 261/QD-BYT dated January 31, 2022 of the Minister of Health)
1. Groups of medicines in the List include:
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Medicine name
1.
Antipyretics and Analgesics
Paracetamol:
- For children: powder package or pellets mixed with oral suspension with 80 mg, 100mg, 150 mg, or 250 mg;
- For adults: 250 mg or 500 mg tablet.
2.
Antiviral drugs: select one of the following medicines:
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Favipiravir 200 mg, 400 mg (tablet).
Molnupiravir 200 mg, 400 mg (tablet).
3.
Corticosteroid anti-inflammatory medicine for oral administration: Medicines shall not be provided for COVID-19 patients right away but prescribed by doctors according to regulations of the guideline on COVID-19 diagnosis and treatment promulgated by the Ministry of Health. Doctors shall only prescribe medicine within 1 day during the wait for the transfer to a facility that treats COVID-19 patients. Select one of the following medicines:
- Dexamethasone 0,5 mg (tablet)
- Methylprednisolone 16 mg (tablet)
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Anticoagulant for oral administration: Medicines shall not be provided for COVID-19 patients right away but prescribed by doctors according to regulations of the guideline on COVID-19 diagnosis and treatment promulgated by the Ministry of Health. Doctors shall only prescribe medicine within 1 day during the wait for the transfer to a facility that treats COVID-19 patients. Select one of the following medicines:
- Rivaroxaban 10 mg (tablet).
- Apixaban 2,5 mg (tablet).
2. Notes on antiviral drugs, corticosteroid anti-inflammatory medicines, and anticoagulants:
a) Prescribe medicines for treatment in accordance with regulations of Circular No. 52/2017/TT-BYT dated December 29, 2017 of the Ministry of Health on prescription of pharmaceutical drugs and biological products in outpatient treatment and Circular No. 18/2018/TT-BYT dated August 22, 2018 of the Ministry of Health on Amendments to Circular No. 52/2017/TT-BYT.
b) Use antiviral drugs as soon as possible after receiving confirmed diagnosis of COVID-19. It is best to use antiviral drugs within five days from the date of onset. Prioritize antiviral drugs for cases with symptoms or high risks of severe disease progression, such as people above 65 years old, people who have yet to be fully vaccinated, people with unstable underlying diseases, etc.
c) Designate treatments combined with corticosteroid anti-inflammatory medicines and anticoagulants when a COVID-19 patient show one of the early signs of respiratory failure; only prescribed medicines for treatment within 1 day during the wait for the transfer to a facility that treats COVID-19 patients.
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(1) Dyspnea or dyspnea that increases when exercising (standing up, walking in the house) or abnormal breathing signs in children: groaning, intercostal retractions, nose flaring, grunting, wheezing during inspiration, and/or
(2) Breathing rate (for children: count adequate breathing rate in a minute when they are lying still and not crying):
≥ 20 times/minute in adults;
≥ 30 times/minute in children from 5 to below 12 years old;
≥ 40 times/minute in children from 1 to below 5 years old;
and/or
(3) SpO2 ≤ 96% (if the SpO2 level is abnormal, it needs to be measured again after 30 seconds to 1 minute; when measuring, hold still the position of measurement).
d) When prescribing medicines, carefully check the contraindications and utilize information about medicines the patient is using to avoid serious drug interactions. Advise patients or caretakers on how to identify some important side effects of medicines for timely detection and handling during use.
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66