Operational considerations for case management of COVID-19 in health facility and community

This document is intended for health ministers, health system administrators, and other decision-makers. It is meant to guide the care of COVID-19 patients as the response capacity of health systems is challenged; to ensure that COVID-19 patients can access life-saving treatment, without compromising public health objectives and safety of health workers. It promotes two key messages: (1). Key public health interventions regardless of transmission scenario; and (2). Key action steps to be taken by transmission scenario to enable timely surge of clinical operations.

The public health objectives at all stages of the preparedness and response plan are to:
• Prevent outbreaks, delay spread, slow and stop transmission.
• Provide optimized care for all patients, especially the seriously ill.
• Minimize the impact of the epidemic on health systems, social services, and economic activity.

Based on the largest cohort of COVID-19 patients, about 40% of patients with COVID-19 may have mild disease, where treatment is mostly symptomatic and does not require inpatient care; about 40% of patients have moderate disease that may require inpatient care; 15% of patients will have severe disease that requires oxygen therapy or other inpatient interventions; and about 5% have critical disease that requires mechanical ventilation. However, the evolution of the outbreak in some countries has shown a higher proportion of severe and critical cases and the need to rapidly increase surge capacity to prevent rapid exhaustion of biomedical supplies and staff. In some countries, doubling rates of cases every 3 days has been observed.

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