INTENSIFIED HOME-MANAGEMENT FOR WORRISOME COVID-19 ADULT PATIENTS

Abstract

In many countries facing the COronaVIrus Disease 2019 (COVID-19) outbreak, the healthcare system was progressively stretched to capacity, emergency departments were overwhelmed and a lack of hospitalbeds threatened to occur.[1, 2] Belgium was no exception and the hospital admissions due to COVID-19 peaked a first time in early April 2020, followed by a second even higher peak in early November 2020. During this second wave of the COVID-19 epidemic, the overstretched capacity of the Intensive Care Units (ICU) was a matter of concern. Patients from some overburdened hospitals had to be transferred to other hospitals within Belgium and even abroad. In order to relieve hospital overloading and save intensive care beds for the most severe cases, the option to treat highly selected patients at home with intensified monitoring and therapy emerged. A decision-aid tool for the home-based management of COVID-19 adult patients was elaborated by the Outbreak Support Team in Liège (OST-Liège) (see Figure 1, version as of 01/11/2020). It aims at helping the General Practitioners (GPs) with a number of crucial considerations to decide which patient with a (confirmed or highly suspected) COVID-19, is eligible for intensified home-based care (monitoring and treatment) in the context of hospital saturation. Such an approach is in line with the WHO interim guidance on home care[3] which recommends that: • COVID-19 care pathways be established at local, regional and national levels. COVID-19 care pathways are for persons with suspected or confirmed COVID-19. • Hospitals and health systems at local, regional, national and global level plan and be ready to surge clinical care capacity (staff, structure, supplies and systems) in order to be able to provide appropriate care of all COVID-19 patients and maintain essential health services. • Each institution should establish a plan for what to do in situations of resource scarcity to cover the allocation or access to critical medical interventions (such as oxygen, intensive care beds and/or ventilators). Such a plan should establish a clear overall aim. The OST-Liège decision-aid tool was inspired by other existing algorithms/tools and was discussed with emergency teams and hospital physicians in four hospitals in Liège. A first diffusion towards the French-speaking GPs was performed in November 2020 in a webinara. At the end of October 2020, the Collège de Médecine Générale (CMG) and the Cellule d’Appui Scientifique Universitaire (CASU) asked KCE to validate the various components of this decision-aid tool