Protect Yourself - Home Care Advice from the WHO and Chinese CDC
Due to the rapid increase in incidence of coronavirus (2019-nCoV) infections, the World Health Organization (WHO) has developed a rapid advice notice to give recommendations on safety measures for persons with suspected 2019-nCoV infection and asymptomatic contacts. What can you do if you or someone you know has a suspected coronavirus infection or has been in close contact with a suspected person? Read on as we have gathered the current advice from the WHO and Chinese Centers for Disease Control and Prevention.
This article is adapted from the WHO “Home care for patients with suspected novelcoronavirus (nCoV) infection presenting with mild symptoms and management of contacts - interim guidance (1) and translated from the Chinese CDC’s advice on how to avoid spreading the virus at home (2).
In view of the currently limited knowledge of the disease caused by the 2019-nCoV infection and its transmission patterns, the WHO recommends that suspected cases of 2019-nCoV infection be isolated and monitored in a hospital setting. However, WHO acknowledges that "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 settings (including home settings) for healthcare provision may need to be considered.”
WHO suggests that the following types of patients may be cared for at home
Patients with mild symptoms,* without existing chronic conditions such as lung or heart disease, renal failure, and immuno-compromising conditions that place him/her at increased risk of developing complications.
Asymptomatic patients no longer requiring hospitalization.
*Mild symptoms include low-grade fever, cough, malaise, rhinorrhoea (running nose), sore throat without any warning signs, shortness of breath or difficulty in breathing, sputum or coughing of blood, gastro-intestinal symptoms such as nausea, vomiting, and/or diarrhoea, and those without changes in their mental status (i.e. confusion, lethargy).
This decision to be cared for at home requires careful clinical judgment and should be informed by assessing the safety of the patient’s home environment. Open communication between the health care provider and the patient should be established for the full duration of the home care period until the patient fully recovers. 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 family member as safely as possible, and to prevent the spread of infection to household contacts [1].
For those who may be cared for at home, the WHO recommends the following:
Place the patient in a well ventilated room. Limit the movement of the patient and minimize shared space. Avoid visitors.
Ensure that shared spaces (e.g. kitchen, bathroom) are well ventilated.
Sleep in a separate room from the patient. If conditions are limited, maintain a distance of at least 1 meter from the ill person (sleep in a separate bed). A mother can continue to breastfeed.
The caregiver should wear a medical mask fitted tightly to the face when in the same room with the ill person. Properly dispose of it after use, and wash your hands. Don’t reuse the mask if it gets wet or dirty with secretions.
Hand hygiene should be performed before and after preparing food, before eating, after using the toilet, and whenever your hands look dirty. Use soap and running water, or an alcohol based hand rub (if hands are not visibly soiled). Avoid accidental ingestion and stay away from sources of fire when using alcohol-based hand rubs.
When using soap and water, use disposable paper towels to dry hands if possible. If not available, use a dedicated cloth towel and replace them when they become wet.
Discard materials used to cover the mouth or nose, or clean them properly after use.
Avoid sharing toothbrushes, cigarettes, utensils, dishes, drinks, towels, wash cloths, or bed linen. Utensils and dishes should be cleaned with either soap or detergent and water after use.
Clean and disinfect frequently touched surfaces, such as bedside tables, bed frames, and other bedroom furniture, and bathroom and toilet surfaces daily. To creat a diluted bleach solution, use one part bleach to 99 parts water.
Clean clothes, bedding, and bath and hand towels belonging to those who are ill, using regular laundry soap and water, or machine wash at 60-90 degrees with common household detergent, and dry thoroughly.
Wear protected clothing before cleaning or touching surfaces with a person's secretions, clothes, or bed linens. Use disposable gloves to provide oral and respiratory care. Wash hands before putting on and after taking off gloves.
The Chinese Centers for Disease Control (China CDC) suggests the following:
1) General standard precautions
Avoid going to public areas with high risks.
Avoid going to crowded public areas, esepcially where there is poor ventilation (such as public bathing areas, spas, cinemas, internet cafes, KTV, shopping malls, bus stations, train stations, etc.).
Avoid touching, buying, or eating wildlife animals or products; avoid going to markets where live poultry, seafood, or wildlife animals are still being sold; cook eggs, poultry, and meat thoroughly.
Keep household clean, open windows often, and ensure good ventilation.
Practice hand hygiene at all times. Avoid touching public objects in public areas. Wash hands after returning from public areas, after coughing, before eating, and after going to toilets. Use soap and running water, or an alcohol based hand rub when washing your hands. Avoid touching your mouth, nose, and eyes with your hands, especially when they have not been cleaned.
Cough or sneeze into your elbow, not your hands, or cough or sneeze into a tissue and dispose of the dirty tissues in a covered rubbish bin.
Wear a mask when going outdoors. Consider taking a surgical mask or N95 mask when you are going to public areas, going to a hospital, or taking public transport.
Practice good hygiene and a healthy lifestyle. Avoid sharing towels, keep your home and utensils clean. Avoid spitting. Eat a balanced diet and exercise indoors as much as you can.
Practice self monitoring at home, especially if you have fever. Pay more attention to children and more closely monitor their body temperatures.
Get a regular physical examination. Make sure you have access to a body thermometer, disposable masks, and household disinfectants.
2) Recommendations for when a family member shows mild symptoms
If a person is showing mild symptoms including a low-grade fever, cough, malaise, rhinorrhoea (running nose), sore throat, shortness of breath or difficulty breathing, sputum or coughing of blood, gastro-intestinal symptoms such as nausea, vomiting, and/or diarrhoea, and changes in mental status (i.e. confusion, lethargy), seek medical advice right away.
Avoid taking public transport, including subways, buses, coaches, and avoid crowded public areas.
When seeing a doctor, tell him/her about your close contact with someone who is confirmed to have, or being evaluated for, 2019-nCoV infection. This will help your doctor take the appropriate steps to keep other people from getting infected.
Family members of a person with confirmed or suspected 201-nCoV infection must wear a mask, maintain a reasonable distance from other asymptomatic family members, and avoid close contacts.
If a family member has confirmed 2019-nCoV infection and has been in close contact with other family members, all should be monitored closely for 14 days.
Disinfect surfaces and objects that the person with confirmed or suspected infection has touched.
When getting medical care, follow these recommendations:
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.
Always perform respiratory hygiene and hand hygiene. Stand or sit as far away from others as possible (at least 1 meter) when in transit and when in the healthcare facility.
Any surfaces that become soiled with respiratory secretions or body fluids during transport should be cleaned and disinfected with regular household cleaner containing a diluted bleach solution (1-part bleach to 99 parts water).
In the early morning of January 26th, the Beijing Municipal Commission of Health announced that only designated hospitals were allowed to diagnose and treat confirmed cases. The list of 20 hospitals, including the city-level designated hospitals of Beijing Ditan Hospital, Beijing You'an Hospital, and the Fifth Medical Center of the PLA, are responsible for the medical treatment of confirmed cases, and can be found below.
BJU’s online appointment channel will be temporarily closed
In order to further improve infection control and reduce the risk of spreading the novel coronavirus infection in the Hospital, Beijing United Family Hospital has temporarily suspended the WeChat and online appointment channels. During this period, if you have any medical needs, please call our 24hr Service Center at 4008-919191.
All patients are required to have their temperature taken at the entrance of either BJU Building 1, 2, or 3. Please pay attention to the appropriate signage regarding this step.
If a patient has a fever and has traveled to Wuhan, a BJU triage nurse will provide a mask and direct the patient to the fever screening clinic. If you have symptoms of fever and have recently traveled to Wuhan, please follow the sign for a pre-examination.
References:
1. Homecare for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts - Interim guidance 20 January2020
2.中国疾控中心提示：在家怎么做？（家庭预防篇）https://mp.weixin.qq.com/s/dfy7H9ZFig8Vxp9EP4m5GA
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