Enhanced rules for hospitalization of patients with COVID-19: estimates and suggestions



Enhanced rules for hospitalization of patients with COVID-19: estimates and suggestions

There are hypotheses and calculations that if in Ukraine they tested with the same intensity as, say, in Iceland, then now we would have almost 19 thousand patients

The Center for Public Health explained the new rules for hospitalizing patients with COVID-19 – patients with a mild form of the disease will be treated at home and moderate and severe patients will be hospitalized. This decision was taken due to the fact that the number of patients in Ukraine is increasing and that there are simply not enough places in hospitals. Meanwhile, stories appear on the web that patients are denied hospitalization. For example, such a refusal was written by the chief doctor of the hospital in Borispol Evgeny Cherenok on April 2, then by the wife of a suspected coronavirus patient who died on April 6: they agreed to hospitalize the man only the third time. So what are the new rules for hospitalization now, and what do the specialists think about it?

When is hospitalization indicated?

In accordance with updated standards for the provision of medical care to patients with COVID-19, to patients with a mild form of the disease, who are not at risk of complications, and to convalescent physicians who no longer need a permanent supervision of doctors, it is recommended to be treated on an outpatient basis, that is to say at home. At the same time, the doctors constantly monitor the condition of the patient and his contacts by telephone and can conduct consultations on the spot in compliance with the infection control rules. AMBULATORY TREATMENT (AT HOME) IS STRICTLY FORBIDDEN IF THE PATIENT IS IN THE RISK GROUP for the development of complications or has symptoms characterizing a moderate to severe course.

The hospitalization decision, depending on the patient’s condition, is made by the doctor. Hospitalization is indicated for patients with suspected / confirmed COVID-19 if:

  • the course of the disease is moderate or severe (signs of pneumonia and / or respiratory failure in the presence of pneumonia confirmed radiologically);
  • there are clinical and instrumental data on acute respiratory distress syndrome;
  • there are clinical and laboratory data on sepsis and / or septic shock;
  • there are clinical and laboratory data on organic / systemic failures, except respiratory;
  • the patient, whatever the severity of the disease, risks developing complications: diabetes mellitus, chronic pathology of the respiratory and cardiovascular systems, renal failure, autoimmune diseases, serious allergic diseases, cancer, etc.
  • in a patient, regardless of the severity of the condition, there is a temperature increase greater than 38 ° C, which is difficult to correct.

Patients with a confirmed severe course of COVID-19 receive monitoring and correction of therapeutic measures, depending on the pathological conditions that accompany them.

Experienced family doctor will decide in favor of the patient

On how the decision is made to hospitalize the patient in practice and enough of these criteria to protect the patient, Ukrinform asked the practitioner, family physician Daria Dmitrievskaya. She says that although she does not agree with the test criteria, considering that it is necessary to test those who have a mild course of the disease, similar to COVID-19, but have no comments on the rules of hospitalization.

Enhanced rules for hospitalization of patients with COVID-19: estimates and suggestions

It is also necessary to test those who have a mild course of a disease similar to COVID-19

“However, hospitalization, not just for the coronavirus, involves certain risks of nosocomial infection. If a person with a complicated course of acute respiratory viral infections is hospitalized in the hospital and does not have coronaviral disease, there is a risk that the person will also get COVID-19. Therefore, we always look at the balance of advantages and disadvantages of such a decision. If, for example, there is a high temperature that does not get lost, shortness of breath or signs suggesting the rapid development of pneumonia, we understand that the benefits of hospitalization when a person is monitored 24 hours a day are higher than the other risks, “says Daria Dmitrievskaya.

In addition, the doctor agrees that the hospitalization of a large number of people will quickly overload the health system. “Among my patients, only two were hospitalized, but no coronavirus was found among them at the time according to the test results. If we find that a person has more complex manifestations of the disease, or pathology, or concomitant diseases that can complicate the course very quickly, then we decide on hospitalization, “says Dmitrievskaya. But he adds that sometimes there are cases where the human body, even with the normal course of a certain disease, not only COVID-19, reacts with an unexpected deterioration. “Unfortunately, we cannot predict this and hospitalize all people with a temperature of 37.5. Therefore, it is IMPORTANT THAT A PERSON CONSTANTLY IS IN CONNECTION WITH THEIR DOCTOR AND KNOWS THAT EVEN NIGHT CAN CONTACT IT IN THE EVENT OF A CHANGE OF STATE. And, perhaps, it is better that the doctor calls an ambulance, because he will better clarify the patient’s condition with his colleagues, “says Dmitrievskaya.

We also ask when a home patient under treatment should be wary and recruit his doctor. “The patient must immediately inform the doctor if he has changed the clinical picture, there are certain complaints, a subjective deterioration. Anyway, I ask my patients to talk about it and we decide together on hospitalization. For example, ONE OF THE SIGNS ON WHICH IT IS P deserves to be followed – IF BREATHING BECOMES MORE FREQUENT. It is necessary to measure the respiratory rate in the most relaxed state (the main thing here is not to succumb to panic, it affects the respiratory rate). If the frequency is 25 to 30 cycles per minute (one cycle is inhalation-expiration) or more, this indicates shallow breathing. In other words, there should be shortness of breath which cannot be confused. The main thing is the doctor’s communication with the patient and the doctor’s knowledge of his patients, which is who is most likely to panic, ”explains the family doctor.

There is an opinion: this strategy does not quite suit us, but the “lungs” must also be hospitalized

Enhanced rules for hospitalization of patients with COVID-19: estimates and suggestions

Vadim Aristov

Vadim Aristov, director of the Revival Institute for Future, strategist, infectious disease specialist, change management consultant, expressed a slightly different opinion in Ukrinform’s commentary. He says that not sending patients with a moderate course of COVID-19, so as not to burden hospitals, is a global practice that makes sense, but in case of a high influx of patients. “When these rules were introduced in Ukraine, a wave of patients was expected, as in Italy, and therefore a heavy burden for doctors. But so far there are severe patients and an average burden, and not even in all areas. Of course, this is a result, first of all, of the efficiency of quarantine. and secondly, a consequence of our screening problems, because we do not see the actual number of patients.

The Revival Institute has calculated what the actual numbers should be. We took the country with the highest number of tests per capita (among the countries where the number of recorded cases is more than 1000) – Iceland (100,000 tests per 1 million inhabitants). The number of deaths in Iceland (6) was compared to the number of patients (1675). While maintaining the proportion, since there are 69 deaths in Ukraine, there should be approximately 19,000 cases of COVID-19. In other words, we would probably get such data if we tested at the same level as in Iceland, “said Aristov.

Aristov points out that following the example of many countries, in particular the success of South Korea, such a system of in-depth testing and identification of infected people, which must be sent in isolation, avoids a total quarantine for the whole country.

He continues: if it turns out that even with a sufficient level of testing, we will not have a wave of patients, then we will have to revise the hospitalization strategy. “After all, we test people, we see that they are infected, but have no moderate or severe course, so we let them go home. And then, as these people have nothing to eat, we’re opening pawnbrokers so they can go to the pharmacy, the stores … But it’s worse that these people infect their loved ones. Data from China has shown that around 70% of new cases are due to infection in the family. Poor housing is a hallmark of poor countries. Because in Britain, for example, the hospital refusal strategy for mild cases is designed so that people have separate rooms where they can be isolated and have enough money to order food. In other words, a person can isolate themselves at home. But most of us live bored when several generations can v drunk in the same apartment dormitories … In other words, we send the infected people into a large group, and although the introduction of quarantine on the one hand, most likely, has significantly reduced the rate of occurrence of new diseases , but at the same time, due to the return of cases to the home, mild cases occur rhenium morbidity. Therefore, it all depends on which of these two factors will be stronger, ”explains the expert.

As an example of solving the problem, he remembers the Poltava region, where local authorities have allocated places in a full-treatment rehabilitation hospital for those who return from abroad for observation, as well as for those who receive a diagnosis of COVID-19 (if patients are afraid of endangering their loved ones). “WE ARE A POORLY POOR COUNTRY – BLIND COPIES OF PROTOCOLS AND STRATEGIES FROM MANY DEVELOPED COUNTRIES, BUT IT DOESN’T WORK.” It’s like with the TB clinics that we close without assessing the social conditions of these patients. Therefore, in my opinion, the time has come to reconsider such a strategy and to bring the problems of disease control and prevention of local solutions to the centralized vertical as a whole, “said Aristov. He adds that since the rejection of planned hospitalization during quarantine has released a significant number of places in hospital departments, you must use these places to isolate the lungs of patients.

Julia Gorban, Kiev

P. S. Well, when in Ukraine they start testing more massively, it will become clearer which strategy we will guide in the future. In the meantime, we are giving recommendations from the Ministry of Health on the home management of a patient with COVID-19.

  • For people with mild manifestations of the disease, the doctor may recommend staying at home by self-isolation. In this case, it is necessary to respect a certain number of rules.
  • Place the patient in a well ventilated area.
  • It is advisable to take care of a person who is not related to people at risk of complications. Patient visits are prohibited.
  • Family members should be in a separate room or be at least 1 m from the patient. The exception is for nursing mothers. They should wear a medical mask when near the child and wash their hands with warm water and soap for 20 to 40 seconds before contact.
  • It is necessary to limit the movement of the patient to public places.
  • I must remind you that the caregiver must wear a medical mask when in the same room as the patient. Rules for using the mask:
  • Wash your hands after contact with the patient or their immediate environment. After washing your hands with soap, wipe them off with disposable paper towels.
  • Use disposable medical gloves for patient care and room cleaning. Wash your hands before and after removing the medical gloves.
  • Gloves, masks and other waste after patient care should be stored in a separate container (plastic bag) in the same room where the patient is, before disposal.
  • After individual use, the dishes must be washed with a detergent. Do not throw the dishes.
  • It is necessary to daily clean and disinfect surfaces in the immediate environment of the patient, as well as the bathroom and toilets with a household cleaning and disinfection product.
  • You can wash the patient’s belongings with ordinary soap. For machine washing, a temperature of 60 to 90 ° C and normal detergents are recommended. Contaminated items should not be shaken, but may be collected in a common bag.
  • People with symptoms should stay at home until the clinical signs are gone and a negative laboratory test result is obtained.
  • If a family member develops symptoms of an acute respiratory infection (fever, cough, sore throat, difficulty breathing), they should be treated as suspected of SARS-CoV-2 infection.
  • In case of early symptoms of SARS, contact your family doctor immediately. If you are unsure who to contact, call the Center for Public Health of Ukraine hotline for advice on a new coronavirus infection: 0-800-505-840.

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