Annex 2 Management of Pui and Confirmed Covid-19 Case 1. Admission Criteria

Annex 2
MANAGEMENT OF PUI AND CONFIRMED COVID-19 CASE
1. ADMISSION CRITERIA
a. All COVID-19 cases (Laboratory confirmed case) *

b. PUI COVID-19 who is clinically ill
c. PUI COVID-19 with uncontrolled medical conditions, immunocompromised
status, pregnant women, extremes of age (< 2 years or > 60 years old)
d. PUI COVID-19 who does not fulfil the above criteria but are not suitable for
home surveillance, to consider admission in quarantine station (Annex 32)
*COVID-19 positive from low risk group who are asymptomatic or mildly
symptomatic can be admitted directly to low risk COVID-19 quarantine and
treatment centres after discussion with relevant physician.
2. CHECKLIST FOR SUITABILITY OF PUI TO UNDERGO HOME

SURVEILLANCE:
(The checklist is provided as a guide, hence the assessment of patient

suitability for home surveillance is tailored from one patient to another).
a. Has a separate bedroom with en-suite bathroom (preferable); if not, common

bathroom with frequent disinfection
b. Has access to food and other necessities
c. Has access to face mask, glove and disinfectant at home
d. Able to seek medical care if necessary and return with own private transport
e. Able to adhere to instruction to follow home surveillance order
f. Able to stay away (at least 2 meter apart) from the high-risk household
members (e.g. individual > 60 years old, young children <2 years, pregnant
women, people who are immunocompromised or who have chronic lung,
kidney, heart disease)
3. CRITERIA FOR TRANSFER TO A STEP-DOWN FACILITY
Confirmed COVID-19 who fulfilled below criteria
a. At least seven days have passed since symptoms first appeared AND
b. At least three days (72 hours) have passed since recovery of symptoms
(defined as resolution of fever without antipyretics and improvement in
respiratory symptoms [e.g., cough, shortness of breath]) AND stable co-
morbids
• Patient can be transferred to identified Step Down Centers until discharge.
• Step Down Center can be from an identified ward in district hospital or an

area which is suitable within the acute hospital.
• The coordination and management of these centers is under the

responsibility of the hospital.
• Daily monitoring by medical personnel must be done in this center.
4. CRITERIA FOR DISCHARGE FROM INFECTIOUS DISEASE WARD FOR

CONFIRMED COVID-19 CASE
4.1 Patients with laboratory-confirmed COVID-19 can be discharged from

infectious disease ward or released from COVID-19 Care Pathway when fulfil
the following criteria:
a. Symptomatic patient
• At least 3 days (72 hours) have passed since recovery defined as resolution
of fever without the use of fever-reducing medications and improvement in
respiratory symptoms (e.g., cough, shortness of breath); AND
• At least 14 days have passed since symptoms first appeared
b. Asymptomatic patient
• 14 days have passed since the date of their first positive COVID-19
diagnostic test, assuming they have not subsequently developed symptoms
since their positive test.
Note: No COVID-19 test is required before patient is discharged from the

ward. If patients still require on-going medical care, they can be released from
COVID-19 Care Pathway, and transferred out to other wards.
For immunocompromised hosts such as those on chemotherapy, bone marrow

or organ transplantation, HIV with low CD4 cell count and prolonged use of
corticosteroids or other immunosuppressives, releasing from Covid-19 care
pathway has to be taken on a case to case basis.
4.2 Examples of Scenarios for the Discharged of COVID-19 Case
a. Scenario 1: Severe Illness

• Discharged from ICU at day 12 of illness on nasal prong Oxygen
• Off oxygen at day 14 of illness
• Recovered with minimal cough and no exertional dyspnoea on walking to
toilet, diabetes and hypertension well controlled at day 18 of illness
• Conclusion: Fit for discharge at day 21 of illness
b. Scenario 2: Mild Illness

• Mildly symptomatic on admission with no pneumonia (Day 5 of illness).
• Asymptomatic after day 3 of admission (Day 8 of illness)
• Conclusion: Fit for discharge at day 14 of illness (Day 9 of admission)
c. Scenario 3: Admission during pre-symptomatic period

• On admission patient is asymptomatic, however develops symptoms on day
2 of admission. Symptoms subside after 5 days.
• Conclusion: His onset of illness starts from day 2 of admission. Fit for
discharge at day 14 of illness (Day 15 of admission)
d. Scenario 4: Residual disease

• Admitted for CVA and found to be positive COVID-19
• Pneumonia but does not require oxygen
• Never have respiratory symptoms
• Conclusion: Discharged from COVID-19 ward and can be transferred to
stroke ward at day 14 since the date of COVID-19 diagnostic test positive.
5. POST DISCHARGE PLAN FOR CONFIRMED COVID-19 CASE
a. For patients with co-morbidities, to arrange appointment for the follow-up at the
nearest health facilities and to ensure adequate supply of medications until the
next appointment. Brief summary should be prepared upon discharge.
b. Upon discharge, all patients should be provided with the hospital’s contact number
and health education pamphlet (Guideline for COVID-19 Patient Discharged from
Hospital) as in Appendix 1.
c. If patients develop new COVID-19 symptoms within 30 days of initial illness, they
should call the hospital and seek advice. If indicated, swab for COVID-19 PCR,
culture and antibody test will be performed.
APPENDIX 1

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Annex 2

MANAGEMENT OF PUI AND CONFIRMED COVID-19 CASE

a. All COVID-19 cases (Laboratory confirmed case) *

2. CHECKLIST FOR SUITABILITY OF PUI TO UNDERGO HOME

(The checklist is provided as a guide, hence the assessment of patient

a. Has a separate bedroom with en-suite bathroom (preferable); if not, common

3. CRITERIA FOR TRANSFER TO A STEP-DOWN FACILITY

Confirmed COVID-19 who fulfilled below criteria

• Step Down Center can be from an identified ward in district hospital or an

• The coordination and management of these centers is under the

• Daily monitoring by medical personnel must be done in this center.

4. CRITERIA FOR DISCHARGE FROM INFECTIOUS DISEASE WARD FOR

4.1 Patients with laboratory-confirmed COVID-19 can be discharged from

Note: No COVID-19 test is required before patient is discharged from the

For immunocompromised hosts such as those on chemotherapy, bone marrow

4.2 Examples of Scenarios for the Discharged of COVID-19 Case

a. Scenario 1: Severe Illness

b. Scenario 2: Mild Illness

c. Scenario 3: Admission during pre-symptomatic period

d. Scenario 4: Residual disease

5. POST DISCHARGE PLAN FOR CONFIRMED COVID-19 CASE

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