Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts
WHO has developed this rapid advice note to meet the need for recommendations on the safe home care for patients with suspected novel coronavirus (2019-nCoV) infection presenting with mild symptoms and public health measures
related to management of asymptomatic contacts.
Home care for patients with suspected 2019-nCoV infection presenting with mild symptoms
In view of the currently limited knowledge of the disease caused by 2019-nCoV infection and its transmission patterns, WHO recommends that suspected cases of 2019-nCoV infection be isolated and monitored in a hospital setting. This would ensure both safety and quality of health care (in case patients’ symptoms worsen) and public health security.
However, for several possible reasons, including situations when inpatient care is unavailable or unsafe (i.e. limited capacity and resources unable to meet demand for health care services), or in a case of informed refusal of hospitalization, alternative settings1 for health care provision may need to be considered.
If such a reason exists, patients with mild symptoms2 and without underlying chronic conditions such as lung or heart disease, renal failure, or immunocompromising conditions that place him/her at increased risk of developing complications may be cared for in the home environment. The same principle of care in the home environment applies to symptomatic patients no longer requiring hospitalization. This decision requires careful clinical judgment and should be informed by assessing the safety of the patient’s home environment3.
A communication link with a health care provider should be established for the full duration of the home care period until the patient fully recovers. Health care personnel should be involved in reviewing the current health status for the progression of symptoms3of contacts by phone and, ideally and if feasible, by face-to-face visits on a regular (e.g. daily) basis, performing specific diagnostic tests as necessary.
In addition, the patients and the household members should be educated on personal hygiene, basic infection prevention and control measures, on how to care for the suspected infected member of the family as safely as possible, and to prevent spread of infection to household contacts. The patient and family should be provided with ongoing support, education and monitoring. They should adhere to the following recommendations.
• Place the patient in a well-ventilated single room.
• Limit the number of caretakers of the patient, ideally assign one person who is in a good health without risk conditions. No visitors.
• Household members should stay in a different room or, if that is not possible, maintain a distance of at least 1 m from the ill person (e.g. sleep in a separate bed)4.
• Limit the movement of the patient and minimize shared space. Ensure that shared spaces (e.g. kitchen, bathroom) are well ventilated (e.g. keep windows open).
• The caregiver should wear a medical mask fitted tightly to the face when in the same room with the ill person. Masks should not be touched or handled during use. If the mask gets wet or dirty with secretions, it must be changed immediately. Discard the mask after use and perform hand hygiene after removal of the mask.
• Perform hand hygiene (2) following all contact with ill persons or their immediate environment. Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet, and whenever hands look dirty. If hands are not visibly soiled, alcohol-based hand rub can be used. Perform hand hygiene using soap and water when hands are visibly soiled. Address safety concerns (e.g. accidental ingestion and fire hazards) before recommending alcohol-based hand rubs for household use.
• When using soap and water, disposable paper towels to dry hands is desirable. If not available, use dedicated cloth towels and replace them when they become wet.
• Respiratory hygiene should be practiced by all, especially ill persons, at all times. Respiratory hygiene refers to covering the mouth and nose during coughing or sneezing using medical masks, cloth masks, tissues or flexed elbow, followed by hand hygiene.
• Discard materials used to cover the mouth or nose or clean them appropriately after use (e.g. wash handkerchiefs using regular soap or detergent and water).
• Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves to provide oral or respiratory care and when handling stool, urine and waste. Perform hand hygiene before and after removing gloves.
• Gloves, tissues, masks and other waste generated by ill persons or in the care of ill persons should be placed in a lined container in the ill person’s room before disposal with other household waste.4
• Avoid other types of possible exposure to ill persons or contaminated items in their immediate environment (e.g. avoid sharing toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths or bed linen). Eating utensils and dishes should be cleaned with either soap or detergent and water after use and may be re-used instead of being discarded.
• Clean and disinfect frequently touched surfaces such as bedside tables, bedframes, and other bedroom furniture daily with regular household disinfectant containing a diluted bleach5 solution (1-part bleach to 99 parts water).
• Clean and disinfect bathroom and toilet surfaces at least once daily with regular household disinfectant containing a diluted bleach6 solution (1-part bleach to 99 parts water).
• Clean clothes, bedclothes, bath and hand towels, etc. of ill persons using regular laundry soap and water or machine wash at 60–90 °C with common household detergent, and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled laundry and
avoid direct contact of the skin and clothes with the contaminated materials.
• Use disposable gloves and protective clothing (e.g. plastic aprons) when cleaning or handling surfaces, clothing or linen soiled with body fluids. Perform hand hygiene before and after removing gloves.
• Persons with symptoms should remain at home until their symptoms are resolved based on either clinical and/or laboratory findings (two negative RT-PCR tests at least 24 hours apart).
• All household members should be considered contacts and their health should be monitored as described below.
• If a household member develops symptoms of acute respiratory infection, including fever, cough, sore throat and difficult breathing, follow public health recommendations below.
Healthcare workers providing home care should do risk assessment to select the appropriate PPE.
Management of contacts
In view of the limited evidence of human-to-human transmission of 2019-nCoV, persons (including health care workers) who may have been exposed to individuals with suspected 2019-nCoV infection should be advised to monitor their health for 14 days from the last day of possible contact and seek immediate medical attention if they develop any symptoms, particularly fever, respiratory symptoms such as coughing or shortness of breath, or diarrhoea.
A communication link with a health care provider should be established for the duration of the observation period. Health care personnel should be involved in reviewing the current health status of the contacts by phone and, ideally and if feasible, by face-to-face visits on a regular (e.g. daily) basis, performing specific diagnostic tests as necessary.
The healthcare provider should give advance instructions on where to seek care when a contact becomes ill, what should be the most appropriate mode of transportation, when and where to enter the designated health care facility, and what infection control precautions should be followed.
• Notify the receiving medical facility that a symptomatic contact will be coming to their facility.
• While traveling to seek care, the ill person should wear a medical mask.
• Avoid public transportation to the health care facility, if possible; call an ambulance or transport the ill person with a private vehicle and open the windows of the vehicle if possible.
• The ill contact should be advised to always perform respiratory hygiene and hand hygiene; stand or sit as far away from others as possible (at least 1 m), when in transit and when in the health care facility.
• Appropriate hand hygiene should be employed by the ill contact and caregivers.
• Any surfaces that become soiled with respiratory secretions or body fluids during transport should be cleaned and disinfected with regular household containing a diluted bleach solution6 (1-part bleach to 99 parts water).
This rapid guidance is based on the MERS-CoV document which was developed in consultation with the WHO Global Infection Prevention and Control Network and other international experts. WHO thanks those who were involved in the development and updates of IPC documents for MERS-CoV.