Coronavirus disease (COVID-19) technical guidance by WHO Home care for patients with COVID-19

Home care for patients with COVID-19 presenting with mild
symptoms and management of their contacts
Interim guidance
17 March 2020
Background
those with mild disease and risk for poor outcome (age >60
years, cases with underlying co-morbidities, e.g., chronic
cardiovascular disease, chronic respiratory disease, diabetes,
cancer).
WHO has developed this interim guidance to meet the need
for recommendations on safe home care for patients with
suspected COVID-19 who present with mild symptoms a and
on public health measures related to the management of their
contacts.
If all mild cases cannot be isolated in health facilities, then
those with mild illness and no risk factors may need to be
isolated in non-traditional facilities, such as repurposed hotels,
stadiums or gymnasiums where they can remain until their
symptoms resolve and laboratory tests for COVID-19 virus
are negative. Alternatively, patients with mild disease and no
risk factors can be managed at home.
This document was adapted from the interim guidance on
Middle East respiratory syndrome coronavirus (MERS-CoV)
infection that was published in June 2018 1 and is informed by
evidence-based guidelines published by WHO, including
Infection prevention and control of epidemic- and pandemic-
prone acute respiratory diseases in health care, 2 and based on
current information on COVID-19.
Home care for patients with suspected
COVID-19 who present with mild symptoms
This rapid advice has been updated with the latest information
and is intended to guide public health and infection
prevention and control (IPC) professionals, health care
managers and health care workers (HCWs) when addressing
issues related to home care for patients with suspected
COVID-19 who present with mild symptoms and when
managing their contacts. This guidance is based on evidence
about COVID-19 and the feasibility of implementing IPC
measures at home. For the purpose of this document,
“caregivers” refers to parents, spouses, and other family
members or friends without formal health care training.
For those presenting with mild illness, hospitalization may
not be possible because of the burden on the health care
system, or required unless there is concern about rapid
deterioration. 3 If there are patients with only mild illness,
providing care at home may be considered, as long as they
can be followed up and cared for by family members. Home
care may also be considered when inpatient care is
unavailable or unsafe (e.g. capacity is limited, and resources
are unable to meet the demand for health care services).
In any of these situations, patients with mild symptoms 1 and
without underlying chronic conditions − such as lung or heart
disease, renal failure, or immunocompromising conditions
that place the patient at increased risk of developing
complications − may be cared for at home. This decision
requires careful clinical judgment and should be informed by
an assessment of the safety of the patient’s home
environment. b2
Please refer to the Global Surveillance for human infection
with coronavirus disease (COVID-19) for case definitions.
Please refer to Infection prevention and control during health
care when COVID-19 is suspected for guidance on IPC at the
health care facility level.
Where to manage COVID-19 patients
In cases in which care is to be provided at home, if and where
feasible, a trained HCW should conduct an assessment to
verify whether the residential setting is suitable for providing
care; the HCW must assess whether the patient and the family
are capable of adhering to the precautions that will be
recommended as part of home care isolation (e.g., hand
hygiene, respiratory hygiene, environmental cleaning,
limitations on movement around or from the house) and can
address safety concerns (e.g., accidental ingestion of and fire
hazards associated with using alcohol-based hand rubs).
WHO recommends that all laboratory confirmed cases be
isolated and cared for in a health care facility. WHO
recommends that all persons with suspected COVID-19 who
have severe acute respiratory infection be triaged at the first
point of contact with the health care system and that
emergency treatment should be started based on disease
severity. WHO has updated treatment guidelines for patients
with ARI associated with COVID-19, which includes
guidance for vulnerable populations (e.g., older adults,
pregnant women and children). In situations where isolation
in a health care facility of all cases is not possible, WHO
emphasizes the prioritization of those with highest probability
of poor outcomes: patients with severe and critical illness and
If and where feasible, a communication link with health care
provider or public health personnel, or both, should be
established for the duration of the home care period – that is,
until the patient’s symptoms have completely resolved. More
a
Mild illness may include: uncomplicated upper respiratory tract
viral infection symptoms such as fever, fatigue, cough (with or
without sputum production), anorexia, malaise, muscle pain, sore
throat, dyspnea, nasal congestion, or headache. Rarely, patients may
also present with diarrhoea, nausea, and vomiting.
b A sample checklist for assessing environmental conditions in the
home is available in the Annex C of reference 2.
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