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Article Category: About COVID-19

Maseru – Myths and misinformation around COVID-19 vaccines are rife in Lesotho, where over 85% of nearly 500 health workers surveyed recently report widespread misconceptions.

A rapid survey, conducted in July by the World Health Organization (WHO) the United Nations Children’s Fund (UNICEF) and other partners covering five of Lesotho’s 10 districts showed conspiracy theories may be driving up fear, confusion and reluctance to get vaccinated in this highly religious society.

“My biggest fear was to be dragged into some cult and get the mark of the beast, so I watched and waited for others to get vaccinated to observe their health and behaviours,” says Mamookho Masamane, a church leader in the northern region of Leribe.

It is estimated that over 90% of people in Lesotho are Christian, and religious leaders are loved, respected and followed. The church provides over 40% of Lesotho’s health services through a network of hospitals, health centres and nursing colleges.

“We understand our calling is not just church-based, but it is also community-based. We are trusted by people and what we communicate can influence their decisions,” says Mapoloko Mabena, Secretary of the Christian Council of Lesotho in the northern city of Butha-Buthe.

With support from WHO and the Christian Council of Lesotho, the Ministry of Health is training religious leaders to spread life-saving facts on COVID-19 and COVID-19 vaccines.

“Prior to each training, participants are asked how much they know about COVID-19 vaccines. Most say they have very limited information, while some say they have no information at all, so we’re working to build up this knowledge,” says WHO Immunization Officer Selloane Maepe.

Six training sessions for 50 religious leaders have taken place in five of Lesotho’s 10 districts so far, starting with the northern districts of Berea, Leribe, and Butha-Buthe, as well as Mafeteng and in the capital, Maseru, which have all been hit hard by COVID-19.

“I never believed in this vaccine. I never wanted to take it myself or to encourage others to get it, but through this teaching I realized that a lack of information is actually a sin and getting vaccinated is important. I will share what I learned with everyone in my village, with friends and my church-mates.” says Mamookho Masamane at a training session in Leribe.

With a population of 2.1 million, Lesotho has recorded over 14 000 cases of COVID-19 and over 400 deaths. Nearly 10% of the population have received a first COVID-19 vaccine dose.

“The ability of religious leaders to effectively participate in responding to outbreaks depends on their understanding of them,” says Dr Richard Banda, WHO Representative in Lesotho.

“These workshops aim to impart knowledge to religious leaders as they play a crucial role in community mobilization, raising awareness, dispelling myths and misconceptions, boosting vaccine acceptance and bringing compromises where public health measures are considered to be discordant with religious values.”

The Ministry of Health, WHO and partners have five further workshops planned with religious and community leaders in five districts in the next month.


Brazzaville – Weekly COVID-19 cases in Africa fell by more than 20%—the sharpest seven-day decline in two months – as the third wave pandemic tapers off. However, the rate of deceleration is slower than the previous waves owing to the impact of more transmissible variants.

The continent recorded more than 165 000 cases in the week ending on 5 September—23% lower than the week before, yet still higher than the weekly cases recorded at the peak of the first wave.

The more contagious Delta variant that partly fuelled the third wave has been dominant in several countries that experienced COVID-19 surge. In southern Africa, for instance, where more than 4000 COVID-19 genome sequencing data was produced in August, the Delta variant was detected in over 70% of samples from Botswana, Malawi and South Africa, and in over 90% from Zimbabwe.

“While COVID-19 cases have declined appreciably, the downward trend is frustratingly slow due to the lingering effects of the more infectious Delta variant,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “We are spearheading critical work and supporting countries in scaling up pathogen surveillance through genome sequencing to detect and respond effectively to COVID-19 variants.”

In collaboration with the South African National Bioinformatics Institute, WHO is at the forefront of the efforts to set up the Regional Centre of Excellence for Genomic Surveillance and Bioinformatics in Cape Town. The centre will support 14 countries before being expanded to serve more countries. Last year, WHO and partners established a COVID-19 sequencing laboratory network in Africa which has to date produced nearly 40 000 sequencing data.

“The continent lags far behind the rest of the world when it comes to sequencing, with only 1% of over 3 million COVID-19 sequences conducted worldwide occurring in Africa,” said Dr Moeti. “The third wave has shown us how variants can hijack the efforts to tame the pandemic. Countries must step up surveillance because without genomic information, variants can spread undetected. You can’t fix what you don’t measure.”

WHO has also recently provided financial support to countries including Eswatini, Sao Tome and Principe and Senegal to reinforce genomic surveillance. To date, the dominant Delta variant has been detected in 31 African countries, while the Alpha and Beta variants have respectively been identified in 44 and 39 countries.

The C.1.2 variant initially identified in South Africa has so far been detected in 130 cases in 10 countries globally, including five in Africa. Although the variant has exhibited concerning mutations, there is no evidence that it is more transmissible or may affect vaccine efficacy, but more research is needed.

As Africa’s third COVID-19 pandemic wave eases off, vaccine shipments to the continent continue to grow, with around 5.5 million doses received through COVAX in the first week of September. However, only around 3% of the continent’s population is fully vaccinated.

“To ultimately tip the scales against this pandemic, our best efforts to reduce transmission through public health measures must be met by a significant step-up in vaccine supplies and vaccinations,” Dr Moeti said.

Dr Moeti spoke during a virtual press conference today facilitated by APO Group. She was joined by Professor Alan Christoffels, Director of the South African National Bioinformatics Institute, and Dr Christian Happi, Professor of Molecular Biology and Genomics and Director at the African Centre of Excellence for Genomics of Infectious Diseases at Redeemer’s University in Nigeria.

Also on hand to respond to questions were Dr Nicksy Gumede-Moeletsi, Regional Virologist, WHO Regional Office for Africa, Dr Richard Mihigo, Coordinator, Immunization and Vaccines Development Programme, WHO Regional Office for Africa, and Dr Thierno Balde, Regional COVID-19 Deputy Incident Manager, WHO Regional Office for Africa.

What can be done in eye and ear health emergencies during COVID-19?

Are people with preexisting eye or ear problems more likely to have COVID-19?

How can one prevent getting COVID-19 in an eye or ear health emergency?

Are people with preexisting eye or ear problems more likely to have COVID-19?

How effective is remote consultation for eye and ear problems to avoid visiting health facilities?

What do people need to know about COVID-19?

People of all ages can get COVID-19, but older people (60+) and those with pre-existing non-communicable diseases (NCDs) are at higher risk of getting severe symptoms of COVID-19 that can require admission to an intensive care unit (ICU).

These NCDs include cardiovascular diseases (e.g. hypertension, heart attack and stroke), diabetes, chronic respiratory disease (e.g. chronic obstructed pulmonary disease or COPD,) and cancer.

What are signs and symptoms ASTHMA, COPD and COVID?

ASTHMA: difficult expiration, but temporary and reversible. Present intermittent symptoms with asymptomatic periods in between, worse at night or early morning

COPD : Difficult expiration but permanent. Symptoms starts in middle age or later (usually after age 40), early morning cough at the beginning, persistent cough in the long run and sputum production; but symptoms don’t respond to bronchodilators (e.g salbutamol)

COVID-19: fever, fatigue, headache, cough and sore throat, body aches and difficulty in breathing and accelerated breathing requiring in severe forms admission to an intensive care unit (ICU)

How to differentiate ASTHMA, COPD and COVID-19?

ASTHMA: past history of chronic lung disease; history of seasonal allergy, eczema and/or allergies since childhood or early adulthood

COPD: past history of chronic lung disease; heavy smoking, with more than 20 cigarettes per day for more than 15 years or heavy and prolonged exposure to burning fossil fuels and to dust in an occupational setting

COVID-19: history of travel to a COVID-19 transmission zone or contact with a COVID-19 confirmed case. The COVID-19 test returns positive.

What to do to avoid complications during COVID-19?

– TAKE medications regularly as prescribed to keep ASTHMA/COPD under control

– TREAT all exacerbations to avoid confusion of the respiratory signs of COPD or ASTHMA with those of COVID-19

– EXERCISE regularly – briskly walk, or walk at least 30 minutes a day no matter the place

– QUIT smoking or any other form of tobacco use. Seek help from a health professional.

– AVOID other environmental exposures such as biomass fuel exposure and air pollution;

 

Are patient with ASTHMA, COPD more likely to get COVID-19?

People with Asthma or severe COPD are not at higher risk for contracting COVID-19 but they are more susceptible to severe complications if they do contract COVID-19 as COVID-19 most commonly affects the respiratory system

https://www.lung.org/blog/update-covid-19

Should patients still go to the doctor for scheduled visits even with the COVID-19 pandemic?

–  ASTHMA and COPD treatment is always initiated and monitored by a health care provider or at the health facility

–  TAKE medications regularly as prescribed. This will help to keep the respiratory symptoms under control and avoid acute exacerbations.

–  KEEP 3 months’ supply of prescribed medications

Does medications for ASTHMA or COPD increase the risk of getting sick of COVID-19?

 

What to do to lower the risk from COVID-19?

1.  Always WEAR a face mask whenever outside the house hold

2.  KEEP a safe distance of at least 1 meter from other persons and avoid touching surfaces with your hands.

3.  WASH hands often with soap and water or use alcohol-based hand rub.

4.  COVER the mouth when coughing (fold of the elbow or disposable handkerchief).

5.  Anyone that feels SICK, should stay at home and call a doctor or local emergency number

6.  Anyone with COVID like symptoms should:

In response to COVID-19 pandemic countries have been supplied with personal protective equipment (PPEs) for health workers as a barrier from getting infected by COVID-19. The high demand of PPE by countries has led to the local production and importation of sub-standards PPEs from different sources. During the use of these protective equipment, several countries have raised issues of their quality, the issue of recycling of PPE in some instances due to shortage. Insufficient knowledge deriving from inappropriate use of PPEs is another exacerbating factor leading to the infection of health workers. The use of PPE is based on prior risk assessment for the safety of the patient, of healthcare worker (including cleaners, ambulance drivers, etc.) and the community. The safety of the beneficiaries of these PPE depends on the quality of product and the accessibility to them in the facility and on the market. The PPE should be of the best affordable price. The IPC team should advise on appropriate procurement and use of PPE based on WHO recommended standards and international standard guidelines on PPE certification and quality check. These standards for certification and quality check may vary from a country to another. In general, products are certified by recognized and well-known institutions according to a set of quality standards. Therefore, companies will seek for certification before putting their manufactured products on the market. Once this is obtained, quality should be maintained to keep trust in the quality of the commercialised product. In the procurement chain, buyers or users should request for an updated product certificate. Many organisations and countries have management system, manufacturing process, service, and documentation procedure for standardisation and quality assurance.

The approach to certification should be rigorous as it upholds the integrity of accredited certification. As certification process is complex and laborious some organisations including accredited certification bodies and experts worldwide help medical device manufacturers achieve certification. They also offer a wide range of services to help organizations achieve and maintain compliance as well. The Emergency Global Supplies Catalogue (COVID-19) of 22.04.2020 gives an initial prioritized selection of items and is subject to constant review. This catalogue doesn’t offer or guarantee allocation of supplies and the costs on it are only estimates. As per principle of neutrality, WHO doesn’t give guarantee on certification of PPE to avoid promoting a product from a manufacturer in detriment of the one of another manufacturer. Therefore, WHO can only advise institutions or governments on the matter and not take decision on their behalf. During emergencies, donors and governments are advised to seek for useful information related to PPE certification and quality check.




The following documents are also needed for certification verification and others are useful for quality check:

  1. Name of the product and its intended use

  2. Supplier’s product code (catalogue number) & short description

  3. Manufacturer’s product code (catalogue number) & short description

  4. Supplier’s contact details, including link to web site with product catalogue

  5. Manufacturer’s contact details that may include the link to web site with product catalogue

  6. Contact details of the person appointed for post-market surveillance including vigilance, customer complaints and recalls

  7. Complete technical product specification

  8. List of all supporting items/devices required, but not supplied

  9. For sterile product: Sterilisation method and process (standard) followed for validation and routine control of sterilisation for medical devices; date of sterilisation; batch number (lot number); batch quantity

  10. Recommended temperature and humidity for shipping, storage and use/operating

  11. Instructions for use (IFU), brochure and training material

  12. Estimated weight and volume

  13. Photos of primary and secondary packaging with readable label information

  14. Packaging and manuals in appropriate language and translation as required by the buyer.

This interim guidance is based on what is currently known about coronavirus disease 2019 (COVID-19). It also provides recommendations for detecting and reporting deaths due to COVID19 in the community. This could be done through autopsy or a thorough epidemiological investigation using a verbal autopsy technique at the community level. As part of the Integrated Disease Surveillance and Response (IDSR); and the International Health Regulations 2005 (IHR 2005), member states are required to report to WHO all outbreaks in a timely manner including the number of cases and deaths occurring as a result of the disease in the health facilities and within the affected community. Under the leadership of the national / sub-national task force, the Rapid Response teams are required to investigate and report any death occurring in the community, where COVID-19 outbreak has been confirmed or suspected.

1. Scope

This document aims to support public health preparedness planning and response activities to identify and report deaths occurring at the community level.

2. Target audience

Public health responders and members of the community in member states.

3. Rationale

This guidance will assist member states to detect and report COVID-19 deaths occurring in the community. The mortality data will guide member states on decisions to be taken in adjusting or fine-tuning the response to the COVID-19 pandemic.

4. Levels and participants involved in detecting and reporting of COVID-19 community deaths

This guidance will assist member states to detect and report COVID-19 deaths occurring in the community. The mortality data will guide member states on decisions to be taken in adjusting or fine-tuning the response to the COVID-19 pandemic.

5. Roles and responsibilities

The role of the community

The role of the district

The role of the national

6. Step by step Surveillance guide: Death Detection, Verification and Reporting

Identification and detection

Notification

The following steps should be followed:

Investigation Team

7. Data collection and analysis

8.Protocol for conducting an autopsy and laboratory investigation

B. Laboratory protocol

1. Counselling of the Relatives and dead body handling

  • Before beginning the posthumous sample collection, the relatives of the deceased must be consulted, informed, and counselled on the rationale and planned procedures for sample collection.

  • The dead body must be handled with respect and dignity

  • There should be adequate security for personnel and equipment conducting the sample collection.

  • 2. Recommended Postmortem specimen for collection

    3. Recommended timeframe for testing
    Posthumous testing for suspected COVID-19 cases must be conducted within 3 days of the death of the patient.


    4. Recommended COVID-19 test to perform
    PCR is the recommended tests to be performed from samples collected from Nasopharyngeal Swab (NP swab) or Lung swab from each lung posthumously.

    5. Reporting of lab test Result
    Upon completion of laboratory testing of the sample, the test result must be relayed to both the relatives (with Counselling) and to the Surveillance team. In case of positive PCR test, all contacts must be identified followed or tested depending on the national testing strategy. Negative test should rule out death due to COVID-19 and reported accordingly.

    WHO/AFRO: RESPONSE TO COVID-19 OUTBREAK

    Background

    Patients with no symptoms or mild forms of COVID-19 infection are sometimes isolated and managed in their home after meeting criteria for home-based isolation and care (HBIC) (see guidance on home-based care for further details). Although there are no symptoms or the symptoms are mild in nature, these individuals need to be closely monitored. This is to identify danger signs and intervene quickly. One of such danger signs is the reduction in oxygen saturation level in the red blood cells called hypoxaemia.

    Target audience

    This guidance is to provide quick guide to clinicians and home monitoring teams (nurses, community health workers, voluntary health workers, etc.) involved in home-based isolation and care of patients (asymptomatic and mild).

    Pulse oximeter

    A pulse oximeter is a device that measures the oxygen saturation of haemoglobin in arterial blood described as SPO2. It consists of a monitor that has batteries and a display, and a probe that detects the pulse. It is usually used on the second finger of the patient. The monitor displays the oxygen saturation level. It is used to detect hypoxia, defined as abnormally low levels of oxygen in the body. Some pulse oximeter monitors display a pulse waveform which illustrates the pulse detected (Pulse rate in beats per minutes).

    Mechanism of measuring oxygen saturation

    It is based on the principle that oxyhemoglobin and deoxyhaemoglobin absorb red and near infra-red light at different wavelengths. Oxyhemoglobin absorbs more
    infra-red light than red light while deoxyhaemoglobin absorbs more red light. A light sensor containing two light sources (red and infra-red) transmits light through tissues, is absorbed by haemoglobin and detected by a photo sensor. The ratio of absorbance at the 2 wavelengths (red-660nm, infra-red-940nm) is calculated and calibrated against direct measurements of arterial oxygen saturation to derive SPO2 reading.

    Usefulness of pulse oximeter in HBIC

    A. Pulse oximeter use for home-based isolation care include:

     

     

     

    B. Practical use of the pulse oximeter – step-by-step guidance:

     

     

     

     

     

     

     

    C. Trouble shooting if no signal is detected by the pulse oximeter using:

     

     

     

    D. Interpretation of pulse oximeter readings

      1. SPO₂ ≥ 94% with no emergency signs (chest pain, dyspnoea, shortness of breath, altered mental status)- normal reading. Continue monitoring at home

     

     

     

     

     

     

    E. Causes of inaccurate pulse oximeter readings include:

      1. Nail polish, artificial nails cause falsely low oxygen saturation readings

     

      1. Poor perfusion due to hypotension, hypovolemia shock, or cold extremities.

     

      1. SP0₂ ≤ 90% is a medical emergency and requires referral to a health facility with an intensive care unit or high dependency unit.

     

      1. Excessive movement with motion artefacts.

     

      1. Abnormal haemoglobin.

     

    1. Carbon monoxide poisoning gives a falsely high reading.

    Conclusion

    Patients with asymptomatic and mild COVID-19 infection can be isolated and managed at home, after the criteria for HBIC are fulfilled. Close monitoring of vital signs including oxygen saturation level is crucial to monitor patients, detect deterioration and danger signs that require prompt intervention.

    Introduction and background

    The coronavirus disease 2019 (COVID-19) outbreak is rapidly evolving in Africa. The continent recorded its first case in Egypt on 13 February 2020. Three months into the outbreak in the continent, all countries have reported COVID-19. The initial confirmed cases were imported through international travel, however, now more than a half of the countries in the region are experiencing community transmission of COVID-19. There are also increasing incidents of cross-border transmission of COVID-19 between countries mainly through long-distance truck drivers and illicit movement through porous borders. The numbers of reported cases and deaths have been increasing exponentially in recent weeks, raising fears that Africa might be the next global epicenter of the pandemic, with severe public health consequences and devastating societal and economic disruptions. This latest trend calls for African governments and all stakeholders, using a whole of government and whole of society approach, to step up their readiness and response measures, focusing on decentralising interventions to subnational levels and to all communities. Recent analyses of the evolution of COVID-19 outbreak in the region show variable distribution of the disease within countries, with differing risk levels. In many countries, the outbreak has mainly affected the capital cities and large urban centres, with most rural communities either free of COVID-19 or reporting sporadic cases.

    This distribution pattern, therefore, calls for a differentiated approach in response to the outbreak within a country, with a focus on containing the disease in the rural, relatively unaffected communities, and mitigating the outbreak in the urban setting where transmission is high. This guidance document provides a differentiated approach in response to the COVID-19 outbreak in urban and rural settings. The interventions are customised in each setting based on the local COVID-19 transmission pattern, as defined by WHO

    The effectiveness of a differentiated approach is rooted in a robust evidence-based, timely analysis of the outbreak data in time, person and place (geographical context) to help design a risk-based response approach at local level. This should premise on the principles of Integrated Disease Surveillance and Response (IDSR) strategy and basic field epidemiology practices. It should also be noted that urban settings have diverse subpopulations with different sociocultural needs and vulnerabilities, which each require special attention. Some of the major issues are overcrowding and substandard housing, lack of access to safe water, sanitation and hygiene facilities, and economic distress (exacerbated by lockdowns), all affecting uptake of preventive and containment measures. There is also a differential access to medical care within the country, with many rural areas having limited access to healthcare services as opposed to most urban centres. Finally, this guidance should be used in conjunction with specific thematic-area guidelines, guidance documents and standard operating procedures elaborating the implementation of individual interventions.

    Instructions:

    The purpose of this document is to provide guidance on how to rapidly establish a triage area at a healthcare facility (HCF). The intended users of this document are healthcare officials/personnel who are responsible for case management (CM) and infection prevention and control (IPC) at the facility. Ideally, regardless of the type of facility, each entry point into the HCF should have a triage station, where patients will be screened for COVID-19. If triage stations are not capable of being placed at each point of entry at the healthcare facility level, then a single triage station where all entrants to the facility (including staff) can be screened should be established. This document will outline different options for setting up a triage station based on the resources and/or size of the healthcare facility. In this document, two triage options are being presented. Option A is a basic triage set-up, with the minimum requirements for a triage station, identified. Option B is a more advanced set-up, targeted toward larger, healthcare facilities that have the option of also conducting emergency treatment procedures.


    How to establish a triage station: Option A (primary and secondary facilities)

    1. This triage option is for small healthcare facilities, where resources may be limited. This triage options provides the minimum requirements for establishing a triage station.

    2. At each point of entry into the healthcare facility (emergency department, out-patient clinic, antenatal clinic, etc.), identify space where a triage station may be placed.

    3. If a structure (a building, tent) already exists at a healthcare facility point of entry, then this space may be utilised for a triage station.

    4. If a structure does not exist, one does not need to be constructed to set up a triage station. Do not wait to screen incoming
      patients into the HCF for COVID-19 due to infrastructural limitations. If no structure exists, then identify an area close to the health facilities POEs (which may be outside) that is well ventilated

    5. Patients who have COVID-19 symptoms should be placed in a separated seated area from patients who are not symptomatic. Their seats should be at least 1-meter apart.

    6. Minimally, one table and two chairs can be used as a triage station. One table and chair can be for the healthcare worker (HCW). One chair can be for the patient. These two tables should be 1-2 meters apart.

    7. In the triage area, screening forms, thermometers, hand hygiene and PPE should be available to HCWs. If a 1-2-meter distance is maintained by the HCW and the patient being triaged, the need for PPE is not required.

    8. An isolation space, close to triage, ideally attached to the triage area, should be established to separate suspected COVID-19cases from others. If it is not possible to establish an isolation space close to the triage area, then a ward at the HCF should be designated the isolation ward. Based on the healthcare facilities resources, suspect cases may be further separated based on symptoms (i.e. mild versus moderate).

    9. Two pathways (one for suspects who should be isolated and one for other patients who were screened and deemed not suspects) should be established. The isolation pathway should lead directly to the isolation area. The non-isolation pathway should lead to specific HCF departments based on patient’s needs.

    10. Ideally, the triage station will have one-way into the station and one-way out of the station. In short, uni-directional flow of patients and HCWs should be established.

    11. Hand hygiene stations should be established at each triage station and readily available throughout the waiting areas. Waste bins should also be placed at each triage station for hand hygiene and respiratory materials. These items can be placed in the same bin.
    12. Security (if needed) should be available at each point of entry to guide patients, their support systems, and HCWs to triage stations for screening.


    The triage process: Option A

    1. Except for patients in acute emergency (i.e. Severe respiratory distress),
      ALL patients entering a point of entry into the HCF MUST be screened at triage. Patients experiencing an emergency must be taken straight away to a healthcare facility that provides advanced care if those services are not available at the presenting healthcare facility.
    2. All HCWs before starting their shifts at the HCF MUST also be screened, wash they hands /clean hand using sanitiser before entering the HCF.

    3. As patients and their support systems (i.e. family members, friends, caregivers etc.) approach the triage station, they should be required to wash their hands at the hand hygiene station. Patients who have symptoms of COVID-19 should be provided a surgical mask while they wait to be screened.

    4. After washing their hands, they should be guided to take a seat if there is a queue at the triage station based on if they have COVID-19 symptoms or not. Patients presenting with COVID-19 symptoms should be seated in one area of the waiting area, while patients without COVID-19 should be seated in another area in the waiting room, maintaining at least a meter distance between spaces and patients.

    5. As patients and their support systems wait for the screening process, they should be reminded of the principles of respiratory hygiene (i.e. covering the mouth and nose during coughing or sneezing with a tissue or flexed elbow).

    6. If screening is occurring inside a built structure (an already existing building), patients and their support systems should be advised that the support individual(s) should wait outside the building/structure until the patient screening process is completed.

    7. During the screening process, a patient will be asked to come forward and sit in the triage chair. If a patient can stand, then standing while being screened is best. But, if the patient is too weak or very ill, the triage chair should be available for patients to sit. After this patient has been triaged, this chair should be disinfected. The patient will be asked some questions during the screening process. These questions include demographic information, COVID-19 symptoms, travel history, and contact history. After the questions on the screening for have been asked of the patient, the patient’s temperature should be assessed.

    8. Based on the case definition for COVID-19, if a patient is screened and deemed a potential suspect of COVID-19 and is having mild/moderate symptoms, then this patient should be escorted via the isolation pathway to the isolation area.

    9. If the patient is screened and deemed not to be a COVID-19 suspect, then the patient should be escorted down the routine healthcare services pathway into the HCF.

    10. Ideally, in the isolation area, a HCW will take specimen to test the patient. If a patient is diagnosed with COVID-19, they should be moved to a ward with other confirmed COVID-19 cases. The patient must stay on the confirmed ward until two RT-PRC tests are negative within a 24-
      hour period until they can return to the community.

    11. If a patient is screened and deemed to be a potential suspect COVID-19 and is having severe symptoms, then this patient should be admitted to the hospital urgently to a dedicated ICU room or ward for COVID-19 patients.

    12. HCWs should frequently wash their hands while working at the triage station. HCWs should be washing their hands at least once every 20 minutes.


    Basic Triage Station Set-up (minimum requirements):
    Option A

    How to establish a triage station: Option B (large, academic health facilities or tertiary facilities)

    1. This triage option (Option B) is intended for larger healthcare facilities or systems that have the resources and ability to set up a combined triage/emergency care center at a single point of entry at the healthcare facility.

    2. The benefits of a combined triage/emergency center are that patients who are in critical condition can gain access to healthcare facility services in an expediated manner.

    3. For this triage option, a basic infrastructure will need to be built, using tents, if an existing structure is not already available at the healthcare facility. An area for patient triage should be established as patients enter the healthcare facility, and the emergency care area should be established adjacent to the triage area. The triage structure of this triage/emergency care center should be open and well-ventilated.

    4. For the triage area, two separate triage stations should be established. A primary triage area should be established at the point of entry into the healthcare facility, where patients are rapidly screened for COVID19 symptoms. A second triage station should be placed after the first
      for further patient clinical assessment.

    5. After the second triage is established, an isolation space should be established. Inside the isolation area, there should be two areas: one for emergency, critical care for severe cases, one for suspected cases with mild or moderate symptoms. Inside the suspect isolation area, cases should be sub-dived based on patients with mild symptoms being placed together and patients with moderate symptoms being placed together.

    6. Outside the isolation area, a laboratory should be established to rapidly test those suspects with mild or moderate symptoms. If possible, for cases requiring emergency care, a test sample should be collected.

    7. Inside the isolation area, there should also be the emergency care area where patients with severe symptoms are rapidly placed for emergency care. Inside this emergency care area, supplies, medical equipment, and PPE should be available to care for a rapidly declining patient. Emergent medical services to stabilize the patient should be properly set-up in this space.

    8. An annex to this document (Annex A) outlines the required supplies and medical equipment needed to establish the triage/emergency care center. The supplies and medical equipment in this Annex are meant to serve 100 patients for 1-month.

    9. At the entry point of the healthcare facility, where the first triage station is established, hand hygiene stations should be set up. Waste bins should be placed by the hand hygiene stations to collect used
      tissues.

    10. Both triage stations should be well-equipped with PPE, screening forms, and thermometers.

    11. At both triage stations, a least 1-meter distance should be maintained between the healthcare worker and patient if possible.

    12. The triage/emergency care center should have one-way flow throw the
      center. There should be one-way in and one-way out.

    13. Of note, Option A would be the equivalent of “Triage 1” under Option B
      (see diagram)


    The triage process: Option B

    1. ALL patients and healthcare workers (HCWs) entering the healthcare facility MUST be screened. Where possible, separate screening points should be established for HCW and Patients to minimize risk of HCW exposure.

    2.  

    3. Upon entry into the healthcare facility, at the first triage station, HCWs and patients should be screened for COVID-19(Preferably at separate screening points where possible. If the HCW or the patient is not identified as a COVID-19 suspect, then these individuals may proceed to
      their clinical departments within the healthcare facility.

    4.  

    5. If the HCW or patient is identified as a COVID-19 suspect, then they should proceed immediately to the second triage station. At the second triage stations, patients’ clinical conditions will be further assessed and evaluated based on their symptoms (i.e. mild, moderate, or severe
      symptoms).

    6. If there is a queue at the second triage station, patients presenting with COVID-19 symptoms should be seated in one area of a waiting area, while patients without COVID-19 symptoms should be seated in another area in the waiting room, maintaining at least a meter distance spaces between patients.

    7. As patients and their support systems wait for the screening process, they should be reminded of the principles of respiratory hygiene (i.e. covering the mouth and nose during coughing or sneezing with a tissue or flexed elbow).

    8. At the second triage station, if the patient is having a medical emergency, they should be quickly placed into the emergency care area of the triage/emergency care center, which may function as an on-site ICU if needed. The emergency care area is an area considered under
      isolation. Emergency medical services to stabilize the patient should be available in the emergency medical area. Once the patient is stabilized and can be moved, they should be moved to the suspected isolation
      area, while test results are pending.

    9. At the second triage station, if the patient is not having a medical emergency, they will be called by a HCW to be further assessed.

    10. During the second screening process, a patient will be asked to come forward and sit in the triage chair. If a patient can stand, then standing while being screened is best. But, if the patient is too weak or too ill, the triage chair should be available for patients to sit. After this patient has been triaged, this chair should be disinfected. The HCW conducting the triage should be sitting in a chair (with or without a table in front of them) that is at least 1 meter away.

    11. After the second triage process, patients who are suspected COVID-19 suspects (that are not having a medical emergency) should be placed into a separate space from the emergency care area based on their symptoms (i.e. mild versus moderate). This separate area is also
      considered under isolation.

    12. As quickly as possible, COVID-19 suspects in the mild or moderate isolation area should be tested. If they are found to be positive, they should be moved to another ward at the healthcare facility where other positive COVID-19 cases are cohorted, if no single-patient rooms are available.

    Advanced Triage/Emergency Care Center Set-up:
    Option B