Ideally, all patients with COVID-19 are cared for in a healthcare facility. However, there may be some circumstances where patients may not require hospitalization or inpatient care is unavailable or unsafe, such as when capacity is insufficient to meet the demand for healthcare services. Patients should be assessed on a case-by-case basis by the health worker to determine where their care needs can best be met.
Patients with mild or moderate disease can be considered for home care if the home setting is suitable for the isolation and care of a COVID-19 patient, and if the patient is under the age of 60, does not smoke, is not obese, and does not have other diseases such as cardiovascular disease, diabetes mellitus, chronic lung disease, cancer, chronic kidney disease, immunosuppression. An assessment about home care for each patient should be based on the following factors:
If adequate isolation from others in the home and infection prevention control measures cannot be ensured, then isolation in designated community facilities or a health facility may need to be arranged, with consent from the patient and in agreement with the caregiver and household members.
It is important to note that in areas with other endemic infections that cause fever, such as influenza, malaria, dengue, etc., febrile patients should seek medical care, be tested and treated for those endemic infections per routine protocols, irrespective of the presence of respiratory signs and symptoms.
Home care does not replace healthcare by professionals. Those patients who receive homecare should be regularly monitored by health workers.
There are a number of environmental and social factors to consider for patients to safely remain at home with their families or household members. An overall needs assessment of the patient and family that includes the availability of trained health workers for support should be conducted. A detailed description is available in the Appendix, Box 2, of the guidance.
Health workers should take the following precautions:
Pregnant women with mild or moderate disease can be considered for home care if the home setting is suitable for the isolation and care of a COVID-19 patient, if they do not smoke, are not obese, and do not have other diseases such as cardiovascular disease, diabetes mellitus, chronic lung disease, cancer, chronic kidney disease, immunosuppression. An assessment about home care for each patient should be based on the following factors:
Children should be kept together with their parents or caregivers wherever possible. Children with mild or moderate disease can be considered for home care if the home setting is suitable for the isolation and care of a COVID-19 patient, if they are not obese, do not smoke, and do not have other conditions such as cardiovascular disease, diabetes mellitus, chronic lung disease, cancer, chronic kidney disease, or immunosuppression.
Caregivers of children with COVID-19 should monitor for signs and symptoms of clinical deterioration requiring urgent re-evaluation. These include difficulty breathing/fast or shallow breathing (for infants: grunting, inability to breastfeed), blue lips or face, chest pain or pressure, new confusion, inability to awaken/not interacting when awake, inability to drink or keep down any liquids.
If caregivers are suspected or have confirmed COVID-19 infection, medical and non-medical factors must be taken into account due to the negative and possible long-term consequences of even a short period of family separation.
Community protection focal points and caseworkers should help families plan–in advance–agreements for the care of children in case the caregiver becomes ill. Children living with primary caregivers who are elderly, disabled or have underlying health conditions should be prioritized.