Keywords
Covid-19; safe discharge; community reintegration criteria
Abstract
During the COVID-19 pandemic, discharge and community reintegration of patients are critical phases in order to guarantee public health.
A review of the international and Italian experience that represent the best evidence available was carried out, mainly focusing on the precise allocation of tasks and related responsabilities.
The report establishes a proposal for the systematic management pathway dedicated to Covid-19 patients.
The original result is a logigramme to guide health practitioners on discharge and community reintegration Covid-19 patients: standardize clinical attitudes helps in ensuring quality of care and patient safety that shuold be a core element even during a public health emergency.
References
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[30] Tong JY, Wong A, Zhu D, Fastenberg JH, Tham T. The Prevalence of Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2020 May 5:194599820926473. doi: 10.1177/0194599820926473.
[31] D. Wang. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia inWuhan, China. 7.02.2020. JAMA. 2020;323(11):1061-1069. doi:10.1001/jama.2020.1585
[32] Jianfeng Xie, Zhaohui Tong, Xiangdong Guan, Bin Du, Haibo Qiu, Arthur S Slutsky. Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Medicine 2020 May;46(5):837-840. doi: 10.1007/s00134-020-05979-7.
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https://www.sanita.puglia.it/documents/20182/99101921/Misure+prevenzioni+e+contrasto+Rsa+Anziani+25032020/e3035dc2-645b-4843-8acf-91cd4e38b61e
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http://www.regione.puglia.it/documents/10192/50708796/DPGR_172_2020.pdf/a84c5426-2f5e-4e98-bb98-fe7a79eb2e11;jsessionid=744054439BFACC8D8716E89B24C59ACF
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[6] W. Guan, Z. Ni, Yu Hu, W. Liang, C. Ou, J. He, L. Liu, H. Shan, C. Lei, D.S.C. Hui, B. Du, L. Li, G. Zeng, K.-Y. Yuen, R. Chen, C. Tang, T. Wang, P. Chen, J. Xiang, S. Li, Jin-lin Wang, Z. Liang, Y. Peng, L. Wei, Y. Liu, Ya-hua Hu, P. Peng, Jian-ming Wang, J. Liu, Z. Chen, G. Li, Z. Zheng, S. Qiu, J. Luo, C. Ye, S. Zhu, and N. Zhong, for the China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382:1708-20. DOI: 10.1056/NEJMoa2002032.
[7] Ministero della Salute, Parere del Consiglio Superiore di Sanità: definizione di Paziente guarito da Covid-19 e di paziente che ha eliminato il virus SARS-CoV-2. Available at: http://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2020&codLeg=73458&parte=1%20&serie=null
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[10] Lirong Zou, Feng Ruan, Mingxing Huang, Lijun Liang, Huitao Huang, Zhongsi Hong, Jianxiang Yu, Min Kang, Yingchao Song, Jinyu Xia, Qianfang Guo, Tie Song, Jianfeng He, Hui-Ling Yen, Malik Peiris, Jie Wu. SARS-CoV-2 Viral load in upper respiratory specimens of infected patients. N Engl J Med 2020 Mar 19;382(12):1177-1179. doi: 10.1056/NEJMc2001737.
[11] Roman Wölfel, Victor M Corman, Wolfgang Guggemos, Michael Seilmaier, Sabine Zange, Marcel A Müller, Daniela Niemeyer, Terry C Jones, Patrick Vollmar, Camilla Rothe, Michael Hoelscher, Tobias Bleicker, Sebastian Brünink, Julia Schneider, Rosina Ehmann, Katrin Zwirglmaier, Christian Drosten, Clemens Wendtner. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020. Published online April 1, 2020. doi:10.1038/s41586-020-2196-x.
[11]Jianghong An, Xuejiao Liao, Tongyang Xiao, Shen Qian, Jing Yuan, Haocheng Ye, Furong Qi, Chengguang Shen, Yang Liu, Lifei Wang, Xiaoya Cheng, Na Li, Qingxian Cai, Fang Wang, Jun Chen, Yingxia Liu, Yunfang Wang, Feng Zhang, Yang Fu, Xiaohua Tan, Lei Liu, Zheng Zhang, Clinical characteristics of the recovered COVID-19 patients with re-detectable positive RNA test; medRxiv preprint doi: https://doi.org/10.1101/2020.03.26.20044222.
[13] Lan Lan, Dan Xu, Guangming Ye, Chen Xia, Shaokang Wang, Yirong Li, Haibo Xu. Positive RT-PCR Test Results in Patients Recovered From COVID-19. JAMA. 2020;323(15):1502-1503. doi:10.1001/jama.2020.2783.
[14] Zhang JF, Yan K, Ye HH, Lin J, Zheng JJ, Cai T, SARS-CoV-2 turned positive in a discharged patient with COVID-19 arouses concern regarding the present standard for discharge. Int J Infect Dis. 2020 Mar 18. pii: S1201-9712(20)30126-0. doi: 10.1016/j.ijid.2020.03.007.
[15] World Health Organization (WHO). Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected. Interim guidance. Geneva: WHO; 28 Jan 2020. Available at:
https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
[16] Centers for Disease Control and Prevention (CDC). Interim guidance for discontinuation of transmission-based precautions and disposition of hospitalized patients with COVID-19. Atlanta: CDC. Available at:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html
[17] European Centre for Disease Prevention and Control (ECDC). Novel coronavirus (SARS-CoV-2). Technical Report. Discharge criteria for confirmed COVID-19 cases – When is it safe to discharge COVID-19 cases from the hospital or end home isolation? Stockholm: ECDC. Available at:
https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-Discharge-criteria.pdf
[18] European Centre for Disease Prevention and Control (ECDC). Coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK – seventh update 25 March 2020. Available at:
https://www.ecdc.europa.eu/sites/default/files/documents/RRA-seventh-update-Outbreak-of-coronavirus-disease-COVID-19.pdf
[19] BJM BEST EVIDENCE – Covid 2019, The right clinical information, right where it’s needed (last update: 12.03.2020; p. 32). Available at:
https://snlg.iss.it/wp-content/uploads/2020/03/BMJ-BEST-PRACTICE_COVID-19_BMJ-2020.pdf
[20] American Hospital Association - March 24, 2020, CDC Updates Guidance on Discharging Patients with COVID-19. Available at:
https://www.aha.org/system/files/media/file/2020/03/coronavirus-update-cdc-updates-guidance-on-discharging-patients-with-covid-19-3-24-2020.pdf
[21] Ministry of Health and Family Welfare, Government of India - Revised Discharge Policy for COVID-19. Available at:
https://www.mohfw.gov.in/pdf/ReviseddischargePolicyforCOVID19.pdf
[22] Regione Veneto, Procedura regionale - Nuovo coronavirus (SARS-CoV-2). Rev. 02 del 6.03.2020; p.46.
Available at:
https://ospedalevillasalus.it/wp-content/uploads/2020/03/Procedura-regionale-Covid-19-rev._2-6.3.2020.pdf
[23] Gestione clinica del paziente Covid19+ (versione 30.03.2020), ASL 4, Sistema Sanitario Regione Liguria.
Available at:
http://www.asl4.liguria.it/wp-content/uploads/2020/04/gestione-clinica-del-paziente-covid19.pdf
[24] Linee di indirizzo per la gestione del percorso COVID-19 in ambito ospedaliero e peri-ospedaliero - Regione Toscana.
Available at: http://www301.regione.toscana.it/bancadati/atti/Contenuto.xml?id=5247300&nomeFile=Ordinanza_del_Presidente_n.14_del_17-03-2020-Allegato-A
[25] Wenling Wang, Yanli Xu, Ruqin Gao, Roujian Lu, Kai Han, Guizhen Wu, Wenjie Tan. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA. 2020 Mar 11;323(18):1843-1844. doi: 10.1001/jama.2020.3786.
[26] Peter KC Cheng, Derek A Wong, Louis KL Tong, Sin-Ming Ip, Angus CT Lo, Chi-Shan Lau, Eugene YH Yeung, Wilina WL Lim.Viral shedding patterns of coronavirus in patients with probable severe acute respiratory syndrome. Lancet. 2004 May 22; 363(9422): 1699–1700. doi: 10.1016/S0140-6736(04)16255-7.
[27] Global Surveillance for human infection with novel coronavirus (2019-nCoV) – Interim guidance 21 January 2020; p.2.
Available at:
https://www.ephi.gov.et/images/20200121-global-surveillance-for-2019-ncov.pdf
[28] Ministero della Salute – Nuovo Coronavirus. FAQ – Covid-19, domande e risposte. Available at:
http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioFaqNuovoCoronavirus.jsp?lingua=italiano&id=228
[29] Lee Y, Min P, Lee S, Kim SW. Prevalence and Duration of Acute Loss of Smell or Taste in COVID-19 Patients. J Korean Med Sci. 2020 May 11;35(18):e174. doi: 10.3346/jkms.2020.35.e174.
[30] Tong JY, Wong A, Zhu D, Fastenberg JH, Tham T. The Prevalence of Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2020 May 5:194599820926473. doi: 10.1177/0194599820926473.
[31] D. Wang. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia inWuhan, China. 7.02.2020. JAMA. 2020;323(11):1061-1069. doi:10.1001/jama.2020.1585
[32] Jianfeng Xie, Zhaohui Tong, Xiangdong Guan, Bin Du, Haibo Qiu, Arthur S Slutsky. Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Medicine 2020 May;46(5):837-840. doi: 10.1007/s00134-020-05979-7.
[33] van Damme C, Berlingin E, Saussez S, Accaputo O. Acute urticaria with pyrexia as the first manifestations of a COVID-19 infection. J Eur Acad Dermatol Venereol. 2020 Apr 24. doi: 10.1111/jdv.16523.
[34] Apulia Region, “Prot. N. AOO/005/251 del 25/03/2020 – Urgente. Oggetto: misure per la prevenzione, il contrasto e il contenimento dell’emergenza epidemiologica da Covid-19 – Indicazioni operative per la gestione dell’emergenza nelle Rsa anziani”. Available at:
https://www.sanita.puglia.it/documents/20182/99101921/Misure+prevenzioni+e+contrasto+Rsa+Anziani+25032020/e3035dc2-645b-4843-8acf-91cd4e38b61e
[35] WHO, Laboratory biosafety guidance related to coronavirus disease 2019 (COVID-19) – Interim Guidance 12 February 2020. Available at:
https://apps.who.int/iris/bitstream/handle/10665/331138/WHO-WPE-GIH-2020.1-eng.pdf
[36] Direzione Generale della Prevenzione sanitaria, Ufficio 5 Prevenzione delle malattie trasmissibili e profilassi internazionale; 0011715-03/04/2020-DGPRE-DGPRE-P – Pandemia di COVID-19 – Aggiornamento delle indicazioni sui test diagnostici e sui criteri da adottare nella determinazione delle priorità. Aggiornamento delle indicazioni relative alla diagnosi di laboratorio; p.3.
Available at: http://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2020&codLeg=73799&parte=1%20&serie=null