Skip to main content

Table 1 Options for health services for confirmed or suspect COVID-19, by level of the health system

From: Considerations for planning COVID-19 treatment services in humanitarian responses

Level of care

COVID-19 treatment services objectives

Interventions

Home / community

Promote safe and dignified home care

Reduce intra-household, community and nosocomial transmission

• Promote home (and, if possible, self-) care of non-severe COVID-19 symptoms through supportive treatment (e.g. antipyretics) [5], adequate hydration and nutrition. This can be supported through community messaging and training of healthcare workers;

• Undertake risk communication and behaviour change promotion to limit transmission within households and the wider community (through patient home isolation and household self-quarantine), and to make patients aware of when to seek higher levels of care (e.g. for worsening symptoms);

• Identify people with risk factors for severe COVID-19, advising them on care-seeking and promoting earlier supportive treatment if COVID-19 symptoms occur (e.g. antipyretics) [5];

• Involve community health workers (CHWs) in COVID-19 treatment service delivery, appropriate to their current workload and skillset, as a secondary priority after COVID-19 risk communication and behaviour change promotion [6]: CHW involvement may include advice on home care, treatment seeking and self-isolation; identification, monitoring and advice to people at high-risk of severe COVID-19; support for home based palliative care [7] and delivery of drugs and supplies to reduce patients’ need to visit health facilities;

• Follow up for high-risk patients discharged from inpatient care who could develop/ have developed complications (e.g. poor nutritional status, respiratory difficulties).

Outpatient care

Promote safe and dignified home care

Identify patients in need of hospitalisation

• Encourage home care of non-severe cases, as above;

• Identify suspect COVID-19 patients with signs and symptoms of severe illness and refer them onward if higher-level care is available;

• Treat co-morbidities and co-infections, e.g. malaria, that may be complicating the clinical picture;

• Identify people with risk factors for severe COVID-19 [3] and assess presence of complications including hypoxia or respiratory distress. Consider these patients for early hospital admission (if appropriate and where available) e.g. to facilitate monitoring and maintenance of oxygen levels. If they are well but at high risk, consider monitoring them in the community (if feasible and safe for CHWs) [6, 8];

• Follow up for high-risk patients discharged from inpatient care who could develop/ have developed complications.

Inpatient (district hospital, in a context where no respiratory support, e.g. oxygen, is available)

Manage some COVID-19 complications

Identify patients in need of more advanced care

If oxygen is not available, the risks of inpatient care are likely to outweigh the benefits. However, worthwhile interventions may include:

• Identify people with risk factors for severe COVID-19 [3] and assess presence of complications including hypoxia, respiratory distress, sepsis, dehydration, poor blood sugar control in diabetics, hypertension, and co-infections; and manage complications to the extent possible;

• Consider these patients for onward referral (if appropriate and where available) to facilitate monitoring and maintenance of oxygen levels and management of other complications;

• Offer palliative care if no further escalation of care is available or appropriate [7].

Inpatient (more advanced care including non-invasive respiratory support)

Supportive care to improve clinical outcomes

As above plus:

• Offer basic respiratory support (e.g. oxygen) as per COVID-19 clinical guidance [3];

• Offer other means of non-invasive ventilation, e.g. continuous positive airway pressure [9] if its effectiveness is confirmed, and with consideration for possible associated risk of nosocomial transmission [10];

• Offer palliative care (as above) if supportive therapy is unsuccessful.

Inpatient (advanced intensive care)

Intensive care to improve clinical outcomes

As above plus:

• Manage critical cases through supportive measures including invasive ventilation, cardiovascular support and renal supportive care.