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Statement on the management at home or in a care facility of suspected or confirmed Covid-19 patients (supplementing the statements dated 5 and

In the majority of cases, Covid-19 patients are managed by a general practitioner. The most common clinical signs reported in community medicine, along with atypical symptoms (loss of sense of smell or taste, specifics in the elderly, etc.), are clarified. The criteria possibly requiring hospital admission must be looked for immediately.

Of these criteria, peripheral capillary oxygen saturation (SpO2) < 95% in ambient air (with no history of hypoxemic disorders) is a key factor. Where severe symptoms are identified (SpO2 < 90%, rapid, shallow breathing or impaired consciousness), the medical emergency services (by dialling the French number 15 or European number 112) must be called.

The outpatient health response must be delivered by coordinating the stakeholders of the facilities managing the patient (GP practice part of a federation, multidisciplinary practice, health centre, primary care networks, care homes for dependent elderly people and home care).

The clinical situation can be assessed over the ‘phone or via a remote consultation. At the end of this assessment, simple advice can be issued and monitoring set up. That said, in some cases a clinical examination will be necessary, particularly to measure peripheral capillary oxygen saturation (SpO2) and respiratory rate. During any delivery of care in person (whether at home or in a care facility), compliance with the basic protective measures and protection of nursing staff remain essential.

Screening for SARS-CoV-2 by RT-PCR assay will be carried out in the situations listed as meeting the criteria for priority access to diagnostic testing.

No other biological testing is recommended on a systematic basis, with the exception of conducting an assay that can identify SARS-CoV-2 and differentiate it from other respiratory infections with similar symptoms. Conducting a chest scan in the community is not recommended and chest x-rays do not contribute significantly to Covid-19 diagnosis.

Medicinal treatments:

  • To date, the prescription of antiviral agents in outpatient settings is not recommended – outside of clinical trials.
  • In the absence of pneumonia, only symptomatic treatment is recommended – anti-inflammatory drugs should not be administered.
  • When pneumonia has been identified, antibiotic therapy should only be indicated on the recommendations of the French Infectious Diseases Society (SPILF) and French Society of Emergency Medicine (SFMU).

In some cases, supportive care (possibly including oxygen therapy) and palliative care can be organised at home.

The specifics for managing elderly patients are reiterated. The arrangements for monitoring patients (including during palliative care) are clarified.
Finally, the specifics regarding the management of palliative care or home care patients are described.

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