The Ministry of Health changed the criteria for hospitalization of those infected with coronavirus amid a sharp increase in the number of cases of Covid-19 in Ukraine.
In particular, on Tuesday, First Deputy Minister of Health Iryna Sadovyak said that by order of October 27, changes were made regarding primary medical and outpatient care.
You can also undergo treatment at home, and a significant part of patients do so. Treatment at home is called "outpatient", it is also prescribed by a doctor, prescribes the necessary medications and tests, and appoints the time of repeated admission.
According to the standards of medical care for those infected with coronavirus, home treatment is prescribed for a mild form and some indicators of a moderate form of the disease.
Mild form of the disease
Every day in the news we hear about "mild" and "difficult" forms of the disease. Probably, many people think that doctors determine this by eye, but in fact, there are a number of signs. According to the standards of care, the mild form is characterized by the following symptoms:
- low fever (up to 38° C);
- runny nose and/or nasal congestion;
- sore throat;
- muscle pain;
- cough without signs of respiratory failure (shortness of breath, increased respiratory rate, hemoptysis);
- lunar-intestinal manifestations (nausea, vomiting, diarrhea) without signs of dehydration;
- lack of changes in mental state (impaired consciousness, lethargy);
- distortion of smell, taste and/or loss of smell, taste.
Now about the disease of moderate severity, this condition is characterized by:
- pneumonia (fever, cough, shortness of breath, and rapid breathing);
- saturation (blood oxygen saturation level), when measured with a pulse oximeter, is not less than 92%.
Who is subjected to hospitalization?
A patient with a diagnosis or only suspected coronavirus can be hospitalized if there is at least one of the following:
- respiratory rate less than 10 per minute or more than 30;
- saturation (blood oxygen saturation) when measured with a pulse oximeter ≤92%;
- impaired consciousness (on the AVPU scale, everything except A);
- patients with the course of the disease of moderate severity who have severe concomitant pathology (severe course of arterial hypertension, decompensated diabetes mellitus, immunosuppressive conditions, severe chronic pathology of the respiratory and cardiovascular systems, renal failure) in the stage of decompensation.
It is also noted that inpatient treatment is indicated in cases of moderate severity and severe course of the disease.
The hospital is indicated if there are signs of pneumonia, respiratory failure (an increase in the frequency of respiratory movements above the physiological norm, hemoptysis).
They will definitely be sent to the hospital in the presence of radiologically confirmed pneumonia.
They are sent for treatment to a hospital if there is the presence of clinical and instrumental data of acute respiratory distress syndrome (HRDS). This is swelling and inflammation of the lungs.
Another indication is sepsis and / or septic shock (systemic inflammatory response syndrome).
Also one of the indicators is organ / systemic failure, except for respiratory failure.
How are the new criteria different from the old ones?
Previously, the list of criteria for hospital treatment was much broader. In the previous text of the standards of the Ministry of Health for the provision of care for infected with coronavirus, it was discussed about hospitalization, regardless of the severity form (now we are talking about the average form) of patients who are at risk of developing complications:
- severe course of arterial hypertension
- decompensated diabetes mellitus
- immunosuppressive conditions
- severe chronic pathology of the respiratory and cardiovascular systems
- renal failure
- autoimmune diseases
- severe allergic diseases
- cerebrovascular diseases in the stage of decompensation
- oncological diseases.
You’re hospitalized, what's next?
The patient, after being admitted to the hospital, undergoes triage.
Doctors recognize SARS (Severe Acute Respiratory Syndrome), assess the severity of the disease, and initiate medical care if necessary.
During triage, patients with SARS and ARDS (acute respiratory distress syndrome, i.e. edema and pneumonia) with hypoxemia or shock are immediately provided with supportive therapy and monitoring.
Patients with the severe course are provided with monitoring and correction of therapeutic measures, depending on the concomitant pathological conditions.
Pregnant women with suspected Covid-19 are hospitalized in a maternity hospital.
And the most important thing. When can you return to your usual life?
If the treatment took place at home, then the criteria for completing the treatment are:
- absence of clinical manifestations of acute respiratory disease within 3 days, counting from the 10th day from the date of onset of symptoms, without laboratory examination;
- absence of clinical manifestations of acute respiratory disease within 3 days, counting from the 10th day from the date of sampling (with a positive result for coronavirus by PCR), without laboratory examination;
- absence of clinical manifestations of acute respiratory disease provided that one negative test result is obtained by the PCR method.
If the treatment was in a hospital in a hospital, then the decision on discharge will be made only by the doctor on the basis of the absence of hospitalization criteria. If, despite the absence of clinical and laboratory signs of an active infectious process, the PCR method detects fragments of the pathogen RNA (positive or doubtful result) in a patient, the patient can be discharged home for self-isolation and continue treatment at home under the supervision of a family doctor.
Patients are considered non-infectious after ten days of treatment if the PCR method does not detect fragments of the pathogen RNA and in the absence of clinical manifestations of acute respiratory disease within 3 days, counting from the 10th day from the date of onset of symptoms.