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Translation of Abstract from MINSA's COVID-19 Action Plan

 

VIII. HOME CARE (HOUSEHOLDS, HOSTELS AND OTHER COMMUNITY SETTINGS).
A. General
Taking as reference the WHO interim guidance outlined in the document:

"Home care for patients allegedly infected with the new coronavirus who have mild symptoms and contact management", published on January 20, 2020, we designed the guidelines to be followed by the rapid response team (ERR) at home, shelters and other community settings and promptly clinicians caring for patients with respiratory infection infected with COVID-19.

It is important that the physician who is going to determine the patient's home isolation fully applies the definition of a mild case, as described below:
Patients with acute respiratory disease evaluated in the outpatient clinic of health institutions or at home who do not require hospitalization (that is, patients who are medically stable on medical examination and can receive care at home) or, patients who are given discharge after a hospitalization with a confirmed diagnosis of COVID-19.

If the patient meets the definition of a mild case and does not suffer from comorbidities that may increase the risk of complications, they can be attended at home, in a shelter or in other community settings, as appropriate, for observation over a period of 14 days, during which MINSA will make recommendations related to the subject for the patient, their family and caregivers. (SEE ANNEX 2)

The same principle of home care can also be applied to post-discharge patients so that they can complete their recovery period at home up to 14 days. The decision must be made based on careful clinical judgment and based on the evaluation of the safety of the patient's family and home environment.

B. Guidelines to follow:

* Home isolation should be carried out with strict monitoring of the patient, so that the transmissibility between the patient and his contacts is limited, remembering that for COVID-19 the transmissibility is from 2 to 5
* The safety of the patient's home and family environment must be evaluated, so that it does not constitute a limitation to avoid the spread of the virus and for the care and recovery of the patient.

* Patients who have mild symptoms and do not suffer from underlying chronic diseases (heart disease, lung disease, kidney failure or disorders associated with immunosuppression), which increase the risk of complications, may be cared for at home. The doctor must decide according to careful clinical criteria.

* Ensure that the patient and the people with whom they live have clear and precise information on personal and collective hygiene and basic infection prevention and control measures, and that there is the capacity at home to execute them.
* Provide constant support, information, training, and monitoring to ensure that the patient and caregivers have the necessary skills to use personal protective equipment (EPP) to prevent contagion to contacts at home, shelter or other community setting.
* Establish a continuous communication channel through a home visit, carrying out diagnostic tests when necessary and following up by telephone until the patient fully

recovers
* Maintain epidemiological surveillance in the patient's environment, in order to detect symptoms among their contacts.

C. Patient education

Family and caregivers

The patient and people living in the same home must be educated about the infectious agent and its mode of transmission and the best way to care for the infected patient.
It is recommended to be very didactic in the instruction of the use of masks, gloves and respiratory hygiene and hand washing measures.

The written recommendations will be delivered after explaining to them in detail about respiratory hygiene, followed by hand hygiene, among other things. Once the instruction is finished, make sure that it has been understood. You can ask questions or request that they demonstrate the use of PPE.

The address and telephone contact details of the patients and family members must be recorded and the patient’s care will be explained and monitored by the health personnel in order to ensure the care of their health and their family at home.

D. Patient follow-up

In order to maintain an open communication channel for the entire duration of the care of the patient with respiratory symptoms, a suspected case or a confirmed case at home, a CALL CENTER 169 has been set up, centralized in the Ministry of Health, whose purpose is:

- Respond to user calls by providing clear, accurate information on personal hygiene, basic infection prevention and control measures. Respond when questions or concerns arise.

- Link with those responsible in each province and / or health region of the rapid response teams who will be in charge of activating the teams for home care and constant monitoring so that both patients and caregivers have the knowledge and the skills necessary to use PPE and to prevent contagion from contacts at home.

Annex 1. DEFINITION OF COVID-19 CASE

The detection of COVID-19 case will be made according to the following definitions:

Suspect

1. Acute respiratory illness (fever and at least one sign / symptom of respiratory illness (e.g. cough, shortness of breath) in a person who, within 14 days prior to the onset of symptoms, was exposed in any of the following ways:

i. Visited or worked in a country with community or sustained1 transmission of the virus

ii. Close physical contact2 with a confirmed case of COVID-19;
2. Person with fever of 38 ° C or more and cough that requires hospitalization (Severe acute respiratory infection), without another etiology that fully explains the clinical condition and that presents with any of the following conditions:

i. Travel history or a person who stayed in a country with community or sustained1 transmission of the virus; in the 14 days prior to the onset of symptoms.

ii. If the symptomatology occurs in health personnel who have worked in an

environment where acute respiratory infections are treated, regardless of the place of residence or travel history.

iii. The person develops an unusual or unexpected clinical condition, especially sudden deterioration despite appropriate treatment, regardless of place of residence or travel history, even if another etiology has been identified that fully explains the clinical presentation.

1 Countries with community or sustained Transmission: China, South Korea, Italy, Japan and Iran as of March 3, 2020.
2 “Close or close contact” is defined as:
- Exposure associated with: medical care, including direct care for patients with COVID- 19; working with health personnel infected with the SARS-CoV-2 virus; visiting patients or staying in the same close environment with a confirmed patient with COVID-19.

- Work in close proximity or sharing the same work or school area with a COVID-19 confirmed patient
- Travel together with a confirmed COVID-19 patient on any means of transportation. - Live at the same address as a confirmed patient with COVID-19.

The epidemiological link may have occurred within a period of 14 days prior to the onset of symptoms or after the onset of illness in the case under consideration.

Confirmed

All patients who meet the definition of a suspected case and present positive laboratory results for SARS-CoV-2, endorsed by the National Reference Laboratory for Public Health at the Gorgas Institute for Health Studies and the Department of Virology.

Discarded

A case that does not show evidence of the presence of SARS-CoV-2 by laboratory techniques endorsed by the reference laboratory will be considered a discarded case.

Imported

An imported case will be considered as any confirmed case that after the epidemiological investigation shows that the infection according to the risk of exposure was acquired outside of Panama.

Annex 2. HOME CARE STRATEGY FOR PATIENTS INFECTED BY COVID-19 WHO HAVE MILD SYMPTOMS
The WHO recommends the following actions for home care:
PRIOR TO SENDING A PATIENT TO THE HOME, YOU MUST VERIFY IF YOU CAN GUARANTEE THE FOLLOWING:

The patient

1. You should limit your movement and minimize your access to shared spaces (e.g. kitchen, bathroom).
2. To contain the patient's respiratory secretions, you must use a surgical mask, which must be worn at all times if it is well tolerated. For those who do not tolerate the mask, you must strictly comply with respiratory hygiene and cough etiquette (if you have

sneezes or coughs, cover your nose and mouth with your forearm or a disposable handkerchief, discard the handkerchief immediately and do hand hygiene)
The room
1. If there is no room to separate the patient during his isolation, the other people who share the home with him must maintain a distance of more than one meter from the patient (for example, sleeping in separate beds).

2. The toilet must be well ventilated (for example, leaving windows open).
3. Do not allow visits.

The caregiver
1. Must be a person in good health who does not have diseases such as hypertension, diabetes, asthma or lung problems, low defenses.

Caregiver skills

1. To enter the patient's room, the caregiver must wear a tight-fitting surgical mask to the face.
2. When less than a meter away, directly caring for the patient, the caregiver should wear a surgical mask, gloves, and a gown or apron when sensing that any splashing may occur. Perform hand hygiene before and after the use of personal protective equipment.

3. The mask should not be touched or manipulated while wearing it, if it gets wet or stained with secretions, it should be changed immediately by disposing of it in the garbage container. You should wash your hands well and dry them.
4. You should carry out hand hygiene with soap and water or alcohol gel, frequently, mainly after any contact with the patient or his immediate environment, as well as before and after preparing food, before eating, after using the bathroom and whenever there is dirt on the hands.

5. To dry your hands, use a paper towel, if not, you can use a cloth towel exclusively for that purpose. You must change it when it is wet.
6. If the hands are not very dirty you can use alcohol-based gel alcohol
7. To clean and handle surfaces, clothing or sheets stained with body fluids, you must. avoid contact especially with oral and respiratory secretions and with the patient's faeces, for this you must wear disposable gloves, surgical mask and plastic apron, apply hand hygiene before and after removing gloves.

Skills for people who live at home

1. All people living at home should follow respiratory hygiene or cough etiquette at all times, especially those who are ill, when coughing or sneezing. Do it with the angle of the arm or with a disposable handkerchief; throw it in the trash and perform hand hygiene immediately.

2. People with respiratory symptoms should use a disposable mask to contain secretions. 3. Avoid contact of healthy people with contaminated objects of the patient (do not share toothbrushes, cigarettes, plates, cutlery, drinks, towels, sheets, among other things.) Utensils such as plates and cutlery must be washed with water and detergent properly after each use, and set aside for control.

Cleaning and disinfection measures at home.

1. All the waste generated in the patient's room (gloves, masks, handkerchiefs, among others) should be placed in a container with a bag inside the room, and later disposed of with the rest of the household waste.
2. Avoid direct contact with the patient's body fluids, especially oral and respiratory

secretions, and feces.
3. Apply hand hygiene before and after removing gloves.
4. Gloves, scarves, masks and all waste generated by the patient or patient care must be placed in a disposable bag located inside the garbage can.
5. Dishes and silverware should be washed with soap and water or detergent after
each use, or with a preparation of 5.25% sodium hypochlorite. To prepare

this solution, add 100 cc of 5.25% sodium hypochlorite and 900 cc of water to a one liter container.
6. Wash clothes, sheets, towels, etc. sick people with ordinary soap and water, or machine at 60 ° -90 ° C with ordinary detergent, and allow them to dry well

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