Decision No. 3646/QD-BYT dated July 31, 2021 on criteria for classifying SARS-CoV-2 infection risk

DECISION

CRITERIA FOR CLASSIFYING SARS-COV-2 INFECTION RISK

MINISTER OF HEALTH

Pursuant to the Law on Medical Examination and Treatment dated November 23, 2009;

Pursuant to Decree No. 75/2017/ND-CP dated June 20, 2017 of Government on functions, tasks, powers, and organizational structure of Ministry of Health;

Pursuant to Decision No. 447/QD-TTg dated April 1, 2020 on declaring COVID-19 Epidemic;

At request of Director of Vietnam Administration of Medical Services, Ministry of Health.

HEREBY DECIDES:

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Article 2.“Criteria for classifying SARS-CoV-2 infection risk” applies on a nationwide scale to medical personnel and other individuals assigned by medical personnel to assess the risk.

Article 3.Vietnam Administration of Medical Servicesshall act as contact point and cooperate with Department of Preventive Medicine and Health Environment Management Agency in directing, guiding, inspecting, monitoring, and supervising implementation of Risk classification criteria.

Article 4.This Decision comes into effect from the day of signing.

Article 5.Director of Department of Medical Examination and Treatment, Director of Department of Preventive Medicine, Director of Health Environment Management Agency, Chief of the Ministry Office, Chief Ministry Inspector, directors of departments and agencies affiliated to Ministry of Health; directors of hospitals and facilities providing hospital beds affiliated to Ministry of Health; Directors of Departments of Health of provinces and central-affiliated cities, heads of relevant entities; heads of medical sector of ministries are responsible for implementation of this Decision. /.

PP. MINISTER
DEPUTY MINISTER




Nguyen Truong Son

CRITERIA FOR CLASSIFYING SARS-COV-2 INFECTION RISK AND GUIDELINES FOR INTIAL RESPONSE

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1. PREFACE

The COVID-19 epidemic outbreak is going on in many countries around the world and in Vietnam. Every single medical sector braces themselves for the rise in number of SARS-CoV-2 cases. Effective risk classification will allow medical system to avoid overload and confusion in treatment. In addition, correct classification will allow identification of SARS-CoV-2 infected individuals with different risks thereby identifying demand for treatment, care and support for each individual, improving treatment effectiveness, and saving resources of medical sector and society. Thus, the development of criteria for classifying risks and guidelines for initial response are vital in this stage.

2. OBJECTIVES AND PRINCIPLES OF ADOPTING THE CRITERIA

2.1. General objectives

Assess risks of individuals infected with SARS-CoV-2 in order to accurately identify treatment demand thereby assigning said individuals to appropriate treatment establishments in order to achieve satisfaction of the individuals infected with SARS-CoV-2, minimize resources and maintain effective epidemic management.

2.2. Purpose of classification

1. Assess specific risks for each patient.

2. Classify patients based on risks appropriately and rapidly in order to provide a response suitable to specific risk.

3. Detect cases with severe development for timely interventions.

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1. Select treatment establishments appropriately for individuals infected with SARS-CoV-2 in different risk categories;

2. Guarantee adoption of safe and thorough isolation in order to prevent infection to other individuals;

3. Comply with guidelines for response to and treatment stringently, minimize severe development of patients in inappropriate treatment establishments.

3. CRITERIA FOR RISK CLASSIFICATION AND RESPONSE

No.

Color and classification of risk

Details/criteria/signs

Solutions

1

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≤ 45 years of age and having no underlying medical conditions (Annex 1);

OR

Having received 2 shots of COVID-19 vaccine at least 12 days before being tested positive;

OR

No health irregularities, SpO₂ at 97% or higher.

1. Transfer to facilities within “The first storey of treatment pyramid”, concentrated quarantine facilities for F0 individuals, initial COVID-19 treatment establishments

OR

Designate outpatient treatment in residence under inspection and confirmation of medical personnel regarding adequate conditions for outpatient treatment (such as villas, detached houses, under supervision of other individuals, etc.).

2. Request individuals infected with SARS-CoV-2 to monitor their health and report to local medical personnel on a daily basis.

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4. Conduct reassessment of risk category on a daily basis and change color/risk level accordingly.

2

Yellow
Moderate risk

46-64 years of age and having no underlying medical conditions (Annex 1);

OR

Health irregularities such as fever (37.5 ^oC or higher), coughing, sore throat, chest pain, etc. (Annex 2);

OR SpO₂ ranging from 95% to 96%;

OR

≤ 45 years of age and having any of the underlying medical conditions (Annex 1).

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2. During the period awaiting hospitalization, request individuals infected with SARS-CoV-2 to continue to monitor their health; provide guidelines for immediate communication with medical personnel in case of emergency (Annex 3).

3. Conduct reassessment of risk category on a daily basis and change color/risk level accordingly.

3

Orange
High risk

65 years of age or higher and having no underlying medical conditions (Annex 1);

OR

Pregnant women;

OR

Children under 5 years of age

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1. Recommend hospitalization as soon as hospital, transfer to hospitals in “The third storey of treatment pyramid”, hospitals that provide treatment for severe COVID-19 cases.

2. Provide guidelines for immediate communication with medical personnel in case of emergency (Annex 3).

3. Conduct reassessment of risk category on a daily basis and change color/risk level accordingly.

4

Red
Very high risk

65 years of age or higher and having any of the underlying medical conditions (Annex 1);

OR

Patients at any age in state of emergency (Annex 3);

OR

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OR

Patients are:

- receiving mechanical ventilation

- having tracheostomy tubes placed

- quadriplegia

- receiving chemotherapy

1. Recommend hospitalization in “The third storey of treatment pyramid”, hospitals that provide treatment for severe COVID-19 cases.

2. Deal with state of emergency before, during, and after transferring patients to hospitals.

NOTE:

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Medical personnel must rapidly classify individuals infected with SARS-CoV-2 and prioritize transferring individuals who fall under the category of “very high risk” to the nearest appropriate medical facilities. In case the patients experience state of emergency and require immediate intervention during classification, disregard all responses under guidelines above and instead transferring and arranging hospitals beds in appropriate hospitals for patients in a timely manner.

ANNEX 1 – HIGH RISK UNDERLYING MEDICAL ILLNESSES

1. Diabetes mellitus

2. Chronic obstructive pulmonary disease and other pulmonary diseases.

3. Cancer (especially malignant tumors regarding hematology, lung cancer, and other metastasis cancers).

4. Chronic kidney illness

5. Organ transplant or stem cell transplant

6. Overweight

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8. Cerebrovascular conditions

9. Down syndrome

10. HIV/AIDS

11. Neurological conditions, including dementia

12. Sickle cell disease

13. Asthma

14. Hypertension

15. Immunodeficiency

16. Liver diseases

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18. Use of corticosteroid or other immunosuppressive drugs

19. Systemic illness

ANNEX 2 – SIGNS AND SYMPTOMS OF SARS-COV-2 INFECTION

1. Coughing

2. Fever (above 37.5 ^oC)

3. Headache

4. Sore throat

5. Rhinorrhea, nasal congestion

6. Dyspnea

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8. Body aches, muscle pain

9. Loss of taste

10. Loss of smell

11. Stomachache, nausea

12. Diarrhea

ANNEX 3 – STATE OF EMERGENCY

1. Disorders of consciousness

2. Dyspnea, rapid ventilation (> 25 times/minute) or SpO₂ < 94%

3. Rapid heart rate > 120 beats/minute

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5. Any other irregularity advised for treatment by medical personnel.