Home care for patients with suspected novel coronavirus (COVID-19) infection presenting with mild symptoms, and management of their contacts: interim guidance, 04 February 2020

1 Home care for patients with suspected novel coronavirus (COVID-19) infection presenting with mild symptoms, and management of their contacts Interim guidance 04 February 2020 Introduction WHO has developed this rapid advice to meet the need for recommendations on safe home care for patients with suspected novel coronavirus (COVID-19) infection who present with mild symptoms1 and on public health measures related to the management of contacts. This document was adapted from the interim guidance that addressed Middle East respiratory syndrome coronavirus (MERS-CoV) infection that was published in June 2018 (1) and is informed by evidence-based guidelines published by WHO, including Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care (2), and based on current information regarding COVID-19 infection. This rapid advice is intended to guide public health and infection prevention and control (IPC) professionals, healthcare managers and healthcare workers (HCWs) when addressing issues related to home care for patients with suspected COVID-19 infection who present with mild symptoms and when managing contacts. This guidance is based on evidence about COVID-19 infection and the feasibility of implementing IPC measures at home. For the purpose of this document, caregivers refer to parents, spouses, other family members or friends without formal healthcare training. For COVID-19 disease case definitions, please refer to https://www.who.int/publications-detail/global-surveillance- for-human-infection-with-novel-coronavirus-(2019-ncov). For guidance on IPC at the facility level, please refer to https://www.who.int/publications-detail/infection- prevention-and-control-during-health-care-when-novel- coronavirus-(ncov)-infection-is-suspected. Home care for patients with suspected COVID-19 infection who present with mild symptoms In view of the current data on the disease and its transmission, WHO recommends that all patients with suspected COVID-19 infection who have severe acute respiratory infection be triaged at the first point of contact with the healthcare system and that emergency treatment should be started based on disease severity. For those presenting with mild illness, hospitalization may not be required unless there is concern about rapid deterioration (3). If there is only mild 1 Mild symptoms include low-grade fever; cough; malaise; rhinorrhoea; or sore throat without any warning signs, such as shortness of breath or difficulty in breathing; increased respiratory difficulty, such as sputum or haemoptysis; gastrointestinal symptoms, such as nausea, vomiting, and/or diarrhoea; and without changes in mental status, such as confusion or lethargy. illness, providing care at home may be considered. Other patients who may be cared for at home include those who are symptomatic but no longer require hospitalization and cases in which an informed decision has been made to refuse hospitalization; home care may also be considered when inpatient care is unavailable or unsafe (e.g., capacity is limited, and resources are unable to meet the demand for healthcare services). In any of these situations, patients with mild symptoms1 and without underlying chronic conditions − such as lung or heart disease, renal failure or immunocompromising conditions that place the patient at increased risk of developing complications − may be cared for at home. This decision requires careful clinical judgment and should be informed by an assessment of the safety of the patient’s home environment.2 In cases in which care is to be provided at home, a trained HCW should conduct an assessment to verify whether the residential setting is suitable for providing care; the HCW must assess whether the patient and the family are capable of adhering to the precautions that will be recommended as part of home care isolation (e.g., hand hygiene, respiratory hygiene, environmental cleaning, limitations on movement around or from the house) and can address safety concerns (e.g., accidental ingestion of and fire hazards associated with using alcohol-based hand rubs). A communication link with a healthcare provider or public health personnel, or both, should be established for the duration of the home care period – that is, until the patient’s symptoms have completely resolved. More comprehensive information about the mode of COVID-19 infection and transmission is required to define the duration of home isolation precautions. Patients and household members should be educated about personal hygiene, basic IPC measures and how to care for the member of the family suspected of having COVID-19 disease as safely as possible to prevent the infection from spreading to household contacts. The patient and the family should be provided with ongoing support and education, and monitoring should continue for the duration of home care. Patients and families should adhere to the following recommendations. • Place the patient in a well-ventilated single room (i.e., with open windows and an open door). • Limit the movement of the patient in the house and minimize shared space. Ensure that shared spaces 2 A sample checklist for assessing environmental conditions in the home is available in the Annex C of reference 2. Home care for patients with novel coronavirus (COVID-19) infection presenting with mild symptoms and management of their contacts 2 (e.g., kitchen, bathroom) are well ventilated (e.g., keep windows open). • Household members should stay in a different room or, if that is not possible, maintain a distance of at least 1 m from the ill person (e.g., sleep in a separate bed).3 • Limit the number of caregivers. Ideally, assign one person who is in a good health and has no underlying chronic or immunocompromising conditions (3). Visitors should not be allowed until the patient has completely recovered and has no signs and symptoms. • Perform hand hygiene after any type of contact with patients or their immediate environment (4). Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet and whenever hands look dirty. If hands are not visibly dirty, an alcohol-based hand rub can be used. For visibly dirty hands, use soap and water. • When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them when they become wet. • To contain respiratory secretions, a medical mask4 should be provided to the patient and worn as much as possible. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene − that is, the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. Materials used to cover the mouth and nose should be discarded or cleaned appropriately after use (e.g., wash handkerchiefs using regular soap or detergent and water). • Caregivers should wear a tightly fitted medical mask that covers their mouth and nose when in the same room as the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty from secretions, it must be replaced immediately with a new clean, dry mask. Remove the mask using the appropriate technique – that is, do not touch the front, but instead untie it. Discard the mask immediately after use and perform hand hygiene. • Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves and a mask when providing oral or respiratory care and when handling stool, urine and other waste. Perform hand hygiene before and after removing gloves and the mask. • Do not reuse masks or gloves. • Use dedicated linen and eating utensils for the patient; these items should be cleaned with soap and water after use and may be re-used instead of being discarded. • Clean and disinfect daily surfaces that are frequently touched in the room where the patient is being cared for, such as bedside tables, bedframes and other bedroom furniture. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite (i.e., equivalent to 5000 pm or 1 part bleach5 to 9 parts water) should be applied. 3 An exception may be made for breastfeeding mothers. Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother could can continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby. She will also need to follow the other hygiene measures described in this document. 4 Medical masks are surgical or procedure masks that are flat or pleated (some are shaped like a cup); they are held in place by strings that tie around the back of the head. • Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite should be applied.5 • Clean the patient’s clothes, bed linen, and bath and hand towels using regular laundry soap and water or machine wash at 60–90 °C with common household detergent, and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid contaminated materials coming into contact with skin and clothes. • Gloves and protective clothing (e.g., plastic aprons) should be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Depending on the context, either utility or single-use gloves can be used. After use, utility gloves should be cleaned with soap and water and decontaminated with 0.5% sodium hypochlorite solution. Single-use gloves (e.g., nitrile or latex) should be discarded after each use. Perform hand hygiene before and after removing gloves. • Gloves, masks and other waste generated during at-home patient care should be placed into a waste bin with a lid in the patient’s room before being disposed of as infectious waste.6 • Avoid other types of exposure to contaminated items from the patient’s immediate environment (e.g., do not share toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths or bed linen). • When HCWs provide home care, they should perform a risk assessment to select the appropriate personal protective equipment and follow the recommendations for droplet and contact precautions. Management of contacts Persons (including caregivers and HCWs) who have been exposed to individuals with suspected COVID-19disease are considered contacts and should be advised to monitor their health for 14 days from the last possible day of contact. A contact is a person who has had any of the following exposures: • a healthcare-associated exposure, including providing direct care for patients with COVID-19 disease, working with HCWs infected with the virus that causes COVID-19 disease, visiting patients or staying in the same environment as a patient with COVID-19 disease; • an exposure through working together in close proximity to or sharing the same classroom with a patient with COVID-19 disease; • an exposure through traveling with a patient who has COVID-19 disease in any kind of vehicle; • an exposure through living in the same household as a patient with COVID-19 disease within 14 days after the onset of symptoms in the patient (5). 5 Most household bleach solutions contain 5% sodium hypochlorite. Recommendations on how to calculate the dilution from a given concentration of bleach can be found at https://www.cdc.gov/hai/pdfs/resource-limited/environmental-cleaning-508.pdf. 6 The local sanitary authority should adopt measures to ensure that the waste is disposed of at a sanitary landfill and not at an unmonitored open dump. Home care for patients with novel coronavirus (COVID-19) infection presenting with mild symptoms and management of their contacts 3 A way for caregivers to communicate with a healthcare provider should be established for the duration of the observation period. Also, healthcare personnel should review the health of contacts regularly by phone but, ideally and if feasible, through daily in-person visits, so specific diagnostic tests can be performed as necessary. The healthcare provider should give instructions to contacts in advance about when and where to seek care if they become ill, what is the most appropriate mode of transportation to use, when and where to enter the designated healthcare facility, and which IPC precautions should be followed. If a contact develops symptoms, the following steps should be taken. • Notify the receiving medical facility that a symptomatic contact will be arriving. • While traveling to seek care, the person who is ill should wear a medical mask. • The contact should avoid taking public transportation to the facility if possible; an ambulance can be called, or the ill contact can be transported in a private vehicle with all of the windows open, if possible. • The symptomatic contact should be advised to always perform respiratory hygiene and hand hygiene and to stand or sit as far away from others as possible (at least 1 m) when in transit and when in the healthcare facility. • Any surfaces that become soiled with respiratory secretions or other body fluids during transport should be cleaned with soap or detergent and then disinfected with a regular household product containing a 0.5% diluted bleach solution. Acknowledgements The original version of the MERS-CoV IPC guidance (1) that constituted the basis for this document was developed in consultation with WHO’s Global Infection Prevention and Control Network and other international experts. WHO thanks those who were involved in developing the IPC documents for MERS-CoV. WHO thanks the following individuals for providing review: Abdullah M Assiri, Director General, Infection Control, Ministry of Health, Saudi Arabia; Michael Bell, Deputy Director of the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Gail Carson, ISARIC Global Support Centre, Director of Network Development, Consultant in Infectious Diseases, and Honorary Consultant with Public Health England, United Kingdom; John M Conly, Department of Medicine, Microbiology, Immunology and Infectious Diseases, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Faculty of Medicine, University of Calgary, Calgary, Canada; Barry Cookson, Division of Infection and Immunity, University College London, United Kingdom; Babacar NDoye, Board Member, Infection Control Network, Dakar, Senegal; Kathleen Dunn, Manager, Healthcare-Associated Infections and Infection Prevention and Control Section, Centre for Communicable Disease Prevention and Control, Public Health Agency of Canada; Dale Fisher, Global Outbreak Alert and Response Network Steering Committee; Fernanda Lessa, Epidemiologist, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Moi Lin Ling, Director, Infection Control Department, Singapore General Hospital, Singapore, and President of Asia Pacific Society of Infection Control; Didier Pittet, Director, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, and Faculty of Medicine, Geneva, Switzerland; Fernando Otaiza O’Ryan, Head, National IPC Program, Ministry of Health, Santiago, Chile; Diamantis Plachouras, Unit of Surveillance and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden; Wing Hong Seto, Department of Community Medicine, School of Public Health, University of Hong Kong, China, Hong Kong Special Administrative Region; Nandini Shetty, Consultant Microbiologist, Reference Microbiology Services, Health Protection Agency, Colindale, United Kingdom; Rachel M. Smith, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. From WHO we also thank: Benedetta Allegranzi, Gertrude Avortri, April Baller, Ana Paula Coutinho, Nino Dal Dayanghirang, Christine Francis, Pierre Clave Kariyo, Maria Clara Padoveze, Joao Paulo Toledo, Nahoko Shindo, Valeska Stempliuk, and Maria Van Kerkhove. References 1. Home care for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection presenting with mild symptoms and management of contacts: interim guidance, June 2018. Geneva: World Health Organization; 2018 (WHO/MERS/IPC/18.1; https://apps.who.int/iris/handle/10665/272948, accessed 26 January 2020). 2. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. Geneva: World Health Organization; 2014 (https://apps.who.int/iris/bitstream/handle/10665/112656/9789 241507134_eng.pdf?sequence=1, accessed 26 January 2020). 3. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance, 28 January 2020. Geneva: World Health Organization; 2020 (https://www.who.int/publications- detail/clinical-management-of-severe-acute-respiratory- infection-when-novel-coronavirus-(ncov)-infection-is- suspected, accessed 4 February 2020). 4. WHO guidelines on hand hygiene in health care: first global patient safety challenge. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44102, accessed 20 January 2020). 5. Global surveillance for human infection with novel coronavirus (2019-nCoV): interim guidance v3, 31 January 2020. Geneva: World Health Organization (WHO/2019-nCoV/SurveillanceGuidance/2020.3; https://www.who.int/publications-detail/global-surveillance- for-human-infection-with-novel-coronavirus-(2019-ncov), accessed 4 February 2020). Home care for patients with novel coronavirus (COVID-19) infection presenting with mild symptoms and management of their contacts 4 Further References Management of asymptomatic persons who are RT-PCR positive for Middle East respiratory syndrome coronavirus (MERS-CoV): interim guidance, 3 January 2018. Geneva: World Health Organization; 2018 (WHO/MERS/IPC/15.2; https://apps.who.int/iris/bitstream/handle/10665/180973/WH O_MERS_IPC_15.2_eng.pdf;jsessionid=3E232F5051C5D3C 7F8D27207599D022E?sequence=1, accessed 20 January 2020). Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance, updated January 2019. Geneva: World Health Organization; 2019 (WHO/MERS/Clinical/15.1; https://apps.who.int/iris/bitstream/handle/10665/178529 /WHO_MERS_Clinical_15.1_eng.pdf?sequence=1&is Allowed=y&ua=1, accessed 20 January 2020). Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection: interim guidance. Geneva: World Health Organization; 2015 (WHO/MERS/IPC/15.1; http://apps.who.int/iris/handle/10665/174652, accessed 20 January 2020). Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto WH, editors. Natural ventilation for infection control in health-care settings: WHO guidelines 2009. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44167, accessed 20 January 2020). Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance, 17 January 2020. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/330676, accessed 20 January 2020). Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020. doi: 10.1016/S0140-6736(20)30154-9. Drosten C, Meyer B, Müller MA, Corman VM, Al-Masri M, Hossain R, et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828-35. doi:10.1056/NEJMoa1405858. Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team. Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill. 2013;18(11):20427. doi:10.2807/ese.18.11.20427-en. Hung C, Wang Y, Li X, Ren L, Yhao J, Hu Y, et al. Clinical features of patients infected with 2019 coronavirus in Wuhan, China. Lancet. 2020. doi:10.1016/S0140-6736(20)30183-5. Li Q, Guan X, Wu P, Zhou L, Tong Y, Ren R, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus−infected pneumonia. N Engl J Med. 2020. doi:10.1056/NEJMoa2001316. Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis. 2013;17(9):e668-72. doi:10.1016/j.ijid.2013.07.001. Ren LL, Wang YM, Wu YQ, Xiang YC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020. doi:10.1097/CM9.0000000000000722. © World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. WHO reference number: WHO/nCov/IPC/HomeCare/2020.2

1 Home care for patients with suspected novel coronavirus (COVID-19) infection presenting with mild symptoms, and management of their contacts Interim guidance 04 February 2020 Introduction WHO has developed this rapid advice to meet the need for recommendations on safe home care for patients with suspected novel coronavirus (COVID-19) infection who present with mild symptoms1 and on public health measures related to the management of contacts. This document was adapted from the interim guidance that addressed Middle East respiratory syndrome coronavirus (MERS-CoV) infection that was published in June 2018 (1) and is informed by evidence-based guidelines published by WHO, including Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care (2), and based on current information regarding COVID-19 infection. This rapid advice is intended to guide public health and infection prevention and control (IPC) professionals, healthcare managers and healthcare workers (HCWs) when addressing issues related to home care for patients with suspected COVID-19 infection who present with mild symptoms and when managing contacts. This guidance is based on evidence about COVID-19 infection and the feasibility of implementing IPC measures at home. For the purpose of this document, caregivers refer to parents, spouses, other family members or friends without formal healthcare training. For COVID-19 disease case definitions, please refer to https://www.who.int/publications-detail/global-surveillance- for-human-infection-with-novel-coronavirus-(2019-ncov). For guidance on IPC at the facility level, please refer to https://www.who.int/publications-detail/infection- prevention-and-control-during-health-care-when-novel- coronavirus-(ncov)-infection-is-suspected. Home care for patients with suspected COVID-19 infection who present with mild symptoms In view of the current data on the disease and its transmission, WHO recommends that all patients with suspected COVID-19 infection who have severe acute respiratory infection be triaged at the first point of contact with the healthcare system and that emergency treatment should be started based on disease severity. For those presenting with mild illness, hospitalization may not be required unless there is concern about rapid deterioration (3). If there is only mild 1 Mild symptoms include low-grade fever; cough; malaise; rhinorrhoea; or sore throat without any warning signs, such as shortness of breath or difficulty in breathing; increased respiratory difficulty, such as sputum or haemoptysis; gastrointestinal symptoms, such as nausea, vomiting, and/or diarrhoea; and without changes in mental status, such as confusion or lethargy. illness, providing care at home may be considered. Other patients who may be cared for at home include those who are symptomatic but no longer require hospitalization and cases in which an informed decision has been made to refuse hospitalization; home care may also be considered when inpatient care is unavailable or unsafe (e.g., capacity is limited, and resources are unable to meet the demand for healthcare services). In any of these situations, patients with mild symptoms1 and without underlying chronic conditions − such as lung or heart disease, renal failure or immunocompromising conditions that place the patient at increased risk of developing complications − may be cared for at home. This decision requires careful clinical judgment and should be informed by an assessment of the safety of the patient’s home environment.2 In cases in which care is to be provided at home, a trained HCW should conduct an assessment to verify whether the residential setting is suitable for providing care; the HCW must assess whether the patient and the family are capable of adhering to the precautions that will be recommended as part of home care isolation (e.g., hand hygiene, respiratory hygiene, environmental cleaning, limitations on movement around or from the house) and can address safety concerns (e.g., accidental ingestion of and fire hazards associated with using alcohol-based hand rubs). A communication link with a healthcare provider or public health personnel, or both, should be established for the duration of the home care period – that is, until the patient’s symptoms have completely resolved. More comprehensive information about the mode of COVID-19 infection and transmission is required to define the duration of home isolation precautions. Patients and household members should be educated about personal hygiene, basic IPC measures and how to care for the member of the family suspected of having COVID-19 disease as safely as possible to prevent the infection from spreading to household contacts. The patient and the family should be provided with ongoing support and education, and monitoring should continue for the duration of home care. Patients and families should adhere to the following recommendations. • Place the patient in a well-ventilated single room (i.e., with open windows and an open door). • Limit the movement of the patient in the house and minimize shared space. Ensure that shared spaces 2 A sample checklist for assessing environmental conditions in the home is available in the Annex C of reference 2. Home care for patients with novel coronavirus (COVID-19) infection presenting with mild symptoms and management of their contacts 2 (e.g., kitchen, bathroom) are well ventilated (e.g., keep windows open). • Household members should stay in a different room or, if that is not possible, maintain a distance of at least 1 m from the ill person (e.g., sleep in a separate bed).3 • Limit the number of caregivers. Ideally, assign one person who is in a good health and has no underlying chronic or immunocompromising conditions (3). Visitors should not be allowed until the patient has completely recovered and has no signs and symptoms. • Perform hand hygiene after any type of contact with patients or their immediate environment (4). Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet and whenever hands look dirty. If hands are not visibly dirty, an alcohol-based hand rub can be used. For visibly dirty hands, use soap and water. • When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them when they become wet. • To contain respiratory secretions, a medical mask4 should be provided to the patient and worn as much as possible. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene − that is, the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. Materials used to cover the mouth and nose should be discarded or cleaned appropriately after use (e.g., wash handkerchiefs using regular soap or detergent and water). • Caregivers should wear a tightly fitted medical mask that covers their mouth and nose when in the same room as the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty from secretions, it must be replaced immediately with a new clean, dry mask. Remove the mask using the appropriate technique – that is, do not touch the front, but instead untie it. Discard the mask immediately after use and perform hand hygiene. • Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves and a mask when providing oral or respiratory care and when handling stool, urine and other waste. Perform hand hygiene before and after removing gloves and the mask. • Do not reuse masks or gloves. • Use dedicated linen and eating utensils for the patient; these items should be cleaned with soap and water after use and may be re-used instead of being discarded. • Clean and disinfect daily surfaces that are frequently touched in the room where the patient is being cared for, such as bedside tables, bedframes and other bedroom furniture. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite (i.e., equivalent to 5000 pm or 1 part bleach5 to 9 parts water) should be applied. 3 An exception may be made for breastfeeding mothers. Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother could can continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby. She will also need to follow the other hygiene measures described in this document. 4 Medical masks are surgical or procedure masks that are flat or pleated (some are shaped like a cup); they are held in place by strings that tie around the back of the head. • Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite should be applied.5 • Clean the patient’s clothes, bed linen, and bath and hand towels using regular laundry soap and water or machine wash at 60–90 °C with common household detergent, and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid contaminated materials coming into contact with skin and clothes. • Gloves and protective clothing (e.g., plastic aprons) should be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Depending on the context, either utility or single-use gloves can be used. After use, utility gloves should be cleaned with soap and water and decontaminated with 0.5% sodium hypochlorite solution. Single-use gloves (e.g., nitrile or latex) should be discarded after each use. Perform hand hygiene before and after removing gloves. • Gloves, masks and other waste generated during at-home patient care should be placed into a waste bin with a lid in the patient’s room before being disposed of as infectious waste.6 • Avoid other types of exposure to contaminated items from the patient’s immediate environment (e.g., do not share toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths or bed linen). • When HCWs provide home care, they should perform a risk assessment to select the appropriate personal protective equipment and follow the recommendations for droplet and contact precautions. Management of contacts Persons (including caregivers and HCWs) who have been exposed to individuals with suspected COVID-19disease are considered contacts and should be advised to monitor their health for 14 days from the last possible day of contact. A contact is a person who has had any of the following exposures: • a healthcare-associated exposure, including providing direct care for patients with COVID-19 disease, working with HCWs infected with the virus that causes COVID-19 disease, visiting patients or staying in the same environment as a patient with COVID-19 disease; • an exposure through working together in close proximity to or sharing the same classroom with a patient with COVID-19 disease; • an exposure through traveling with a patient who has COVID-19 disease in any kind of vehicle; • an exposure through living in the same household as a patient with COVID-19 disease within 14 days after the onset of symptoms in the patient (5). 5 Most household bleach solutions contain 5% sodium hypochlorite. Recommendations on how to calculate the dilution from a given concentration of bleach can be found at https://www.cdc.gov/hai/pdfs/resource-limited/environmental-cleaning-508.pdf. 6 The local sanitary authority should adopt measures to ensure that the waste is disposed of at a sanitary landfill and not at an unmonitored open dump. Home care for patients with novel coronavirus (COVID-19) infection presenting with mild symptoms and management of their contacts 3 A way for caregivers to communicate with a healthcare provider should be established for the duration of the observation period. Also, healthcare personnel should review the health of contacts regularly by phone but, ideally and if feasible, through daily in-person visits, so specific diagnostic tests can be performed as necessary. The healthcare provider should give instructions to contacts in advance about when and where to seek care if they become ill, what is the most appropriate mode of transportation to use, when and where to enter the designated healthcare facility, and which IPC precautions should be followed. If a contact develops symptoms, the following steps should be taken. • Notify the receiving medical facility that a symptomatic contact will be arriving. • While traveling to seek care, the person who is ill should wear a medical mask. • The contact should avoid taking public transportation to the facility if possible; an ambulance can be called, or the ill contact can be transported in a private vehicle with all of the windows open, if possible. • The symptomatic contact should be advised to always perform respiratory hygiene and hand hygiene and to stand or sit as far away from others as possible (at least 1 m) when in transit and when in the healthcare facility. • Any surfaces that become soiled with respiratory secretions or other body fluids during transport should be cleaned with soap or detergent and then disinfected with a regular household product containing a 0.5% diluted bleach solution. Acknowledgements The original version of the MERS-CoV IPC guidance (1) that constituted the basis for this document was developed in consultation with WHO’s Global Infection Prevention and Control Network and other international experts. WHO thanks those who were involved in developing the IPC documents for MERS-CoV. WHO thanks the following individuals for providing review: Abdullah M Assiri, Director General, Infection Control, Ministry of Health, Saudi Arabia; Michael Bell, Deputy Director of the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Gail Carson, ISARIC Global Support Centre, Director of Network Development, Consultant in Infectious Diseases, and Honorary Consultant with Public Health England, United Kingdom; John M Conly, Department of Medicine, Microbiology, Immunology and Infectious Diseases, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Faculty of Medicine, University of Calgary, Calgary, Canada; Barry Cookson, Division of Infection and Immunity, University College London, United Kingdom; Babacar NDoye, Board Member, Infection Control Network, Dakar, Senegal; Kathleen Dunn, Manager, Healthcare-Associated Infections and Infection Prevention and Control Section, Centre for Communicable Disease Prevention and Control, Public Health Agency of Canada; Dale Fisher, Global Outbreak Alert and Response Network Steering Committee; Fernanda Lessa, Epidemiologist, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Moi Lin Ling, Director, Infection Control Department, Singapore General Hospital, Singapore, and President of Asia Pacific Society of Infection Control; Didier Pittet, Director, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, and Faculty of Medicine, Geneva, Switzerland; Fernando Otaiza O’Ryan, Head, National IPC Program, Ministry of Health, Santiago, Chile; Diamantis Plachouras, Unit of Surveillance and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden; Wing Hong Seto, Department of Community Medicine, School of Public Health, University of Hong Kong, China, Hong Kong Special Administrative Region; Nandini Shetty, Consultant Microbiologist, Reference Microbiology Services, Health Protection Agency, Colindale, United Kingdom; Rachel M. Smith, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. From WHO we also thank: Benedetta Allegranzi, Gertrude Avortri, April Baller, Ana Paula Coutinho, Nino Dal Dayanghirang, Christine Francis, Pierre Clave Kariyo, Maria Clara Padoveze, Joao Paulo Toledo, Nahoko Shindo, Valeska Stempliuk, and Maria Van Kerkhove. References 1. Home care for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection presenting with mild symptoms and management of contacts: interim guidance, June 2018. Geneva: World Health Organization; 2018 (WHO/MERS/IPC/18.1; https://apps.who.int/iris/handle/10665/272948, accessed 26 January 2020). 2. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. Geneva: World Health Organization; 2014 (https://apps.who.int/iris/bitstream/handle/10665/112656/9789 241507134_eng.pdf?sequence=1, accessed 26 January 2020). 3. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance, 28 January 2020. Geneva: World Health Organization; 2020 (https://www.who.int/publications- detail/clinical-management-of-severe-acute-respiratory- infection-when-novel-coronavirus-(ncov)-infection-is- suspected, accessed 4 February 2020). 4. WHO guidelines on hand hygiene in health care: first global patient safety challenge. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44102, accessed 20 January 2020). 5. Global surveillance for human infection with novel coronavirus (2019-nCoV): interim guidance v3, 31 January 2020. Geneva: World Health Organization (WHO/2019-nCoV/SurveillanceGuidance/2020.3; https://www.who.int/publications-detail/global-surveillance- for-human-infection-with-novel-coronavirus-(2019-ncov), accessed 4 February 2020). Home care for patients with novel coronavirus (COVID-19) infection presenting with mild symptoms and management of their contacts 4 Further References Management of asymptomatic persons who are RT-PCR positive for Middle East respiratory syndrome coronavirus (MERS-CoV): interim guidance, 3 January 2018. Geneva: World Health Organization; 2018 (WHO/MERS/IPC/15.2; https://apps.who.int/iris/bitstream/handle/10665/180973/WH O_MERS_IPC_15.2_eng.pdf;jsessionid=3E232F5051C5D3C 7F8D27207599D022E?sequence=1, accessed 20 January 2020). Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance, updated January 2019. Geneva: World Health Organization; 2019 (WHO/MERS/Clinical/15.1; https://apps.who.int/iris/bitstream/handle/10665/178529 /WHO_MERS_Clinical_15.1_eng.pdf?sequence=1&is Allowed=y&ua=1, accessed 20 January 2020). Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection: interim guidance. Geneva: World Health Organization; 2015 (WHO/MERS/IPC/15.1; http://apps.who.int/iris/handle/10665/174652, accessed 20 January 2020). Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto WH, editors. Natural ventilation for infection control in health-care settings: WHO guidelines 2009. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44167, accessed 20 January 2020). Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance, 17 January 2020. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/330676, accessed 20 January 2020). Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020. doi: 10.1016/S0140-6736(20)30154-9. Drosten C, Meyer B, Müller MA, Corman VM, Al-Masri M, Hossain R, et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828-35. doi:10.1056/NEJMoa1405858. Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team. Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill. 2013;18(11):20427. doi:10.2807/ese.18.11.20427-en. Hung C, Wang Y, Li X, Ren L, Yhao J, Hu Y, et al. Clinical features of patients infected with 2019 coronavirus in Wuhan, China. Lancet. 2020. doi:10.1016/S0140-6736(20)30183-5. Li Q, Guan X, Wu P, Zhou L, Tong Y, Ren R, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus−infected pneumonia. N Engl J Med. 2020. doi:10.1056/NEJMoa2001316. Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis. 2013;17(9):e668-72. doi:10.1016/j.ijid.2013.07.001. Ren LL, Wang YM, Wu YQ, Xiang YC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020. doi:10.1097/CM9.0000000000000722. © World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. WHO reference number: WHO/nCov/IPC/HomeCare/2020.2

1 Home care for patients with suspected novel coronavirus (COVID-19) infection presenting with mild symptoms, and management of their contacts Interim guidance 04 February 2020 Introduction WHO has developed this rapid advice to meet the need for recommendations on safe home care for patients with suspected novel coronavirus (COVID-19) infection who present with mild symptoms1 and on public health measures related to the management of contacts. This document was adapted from the interim guidance that addressed Middle East respiratory syndrome coronavirus (MERS-CoV) infection that was published in June 2018 (1) and is informed by evidence-based guidelines published by WHO, including Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care (2), and based on current information regarding COVID-19 infection. This rapid advice is intended to guide public health and infection prevention and control (IPC) professionals, healthcare managers and healthcare workers (HCWs) when addressing issues related to home care for patients with suspected COVID-19 infection who present with mild symptoms and when managing contacts. This guidance is based on evidence about COVID-19 infection and the feasibility of implementing IPC measures at home. For the purpose of this document, caregivers refer to parents, spouses, other family members or friends without formal healthcare training. For COVID-19 disease case definitions, please refer to https://apps.who.int/iris/bitstream/handle/10665/330857/WH O-2019-nCoV-SurveillanceGuidance-2020.3-eng.pdf. For guidance on IPC at the facility level, please refer to https://www.who.int/publications-detail/infection- prevention-and-control-during-health-care-when-novel- coronavirus-(ncov)-infection-is-suspected. Home care for patients with suspected COVID-19 infection who present with mild symptoms In view of the current data on the disease and its transmission, WHO recommends that all patients with suspected COVID-19 infection who have severe acute respiratory infection be triaged at the first point of contact with the healthcare system and that emergency treatment should be started based on disease severity. For those presenting with mild illness, hospitalization may not be required unless there is concern about rapid deterioration (3). If there is only mild 1 Mild symptoms include low-grade fever; cough; malaise; rhinorrhoea; or sore throat without any warning signs, such as shortness of breath or difficulty in breathing; increased respiratory difficulty, such as sputum or haemoptysis; gastrointestinal symptoms, such as nausea, vomiting, and/or diarrhoea; and without changes in mental status, such as confusion or lethargy. illness, providing care at home may be considered. Other patients who may be cared for at home include those who are symptomatic but no longer require hospitalization and cases in which an informed decision has been made to refuse hospitalization; home care may also be considered when inpatient care is unavailable or unsafe (e.g., capacity is limited, and resources are unable to meet the demand for healthcare services). In any of these situations, patients with mild symptoms1 and without underlying chronic conditions − such as lung or heart disease, renal failure or immunocompromising conditions that place the patient at increased risk of developing complications − may be cared for at home. This decision requires careful clinical judgment and should be informed by an assessment of the safety of the patient’s home environment.2 In cases in which care is to be provided at home, a trained HCW should conduct an assessment to verify whether the residential setting is suitable for providing care; the HCW must assess whether the patient and the family are capable of adhering to the precautions that will be recommended as part of home care isolation (e.g., hand hygiene, respiratory hygiene, environmental cleaning, limitations on movement around or from the house) and can address safety concerns (e.g., accidental ingestion of and fire hazards associated with using alcohol-based hand rubs). A communication link with a healthcare provider or public health personnel, or both, should be established for the duration of the home care period – that is, until the patient’s symptoms have completely resolved. More comprehensive information about the mode of COVID-19 infection and transmission is required to define the duration of home isolation precautions. Patients and household members should be educated about personal hygiene, basic IPC measures and how to care for the member of the family suspected of having COVID-19 disease as safely as possible to prevent the infection from spreading to household contacts. The patient and the family should be provided with ongoing support and education, and monitoring should continue for the duration of home care. Patients and families should adhere to the following recommendations. • Place the patient in a well-ventilated single room (i.e., with open windows and an open door). • Limit the movement of the patient in the house and minimize shared space. Ensure that shared spaces 2 A sample checklist for assessing environmental conditions in the home is available in the Annex C of reference 2. Home care for patients with novel coronavirus (COVID-19) infection presenting with mild symptoms and management of their contacts 2 (e.g., kitchen, bathroom) are well ventilated (e.g., keep windows open). • Household members should stay in a different room or, if that is not possible, maintain a distance of at least 1 m from the ill person (e.g., sleep in a separate bed).3 • Limit the number of caregivers. Ideally, assign one person who is in a good health and has no underlying chronic or immunocompromising conditions (3). Visitors should not be allowed until the patient has completely recovered and has no signs and symptoms. • Perform hand hygiene after any type of contact with patients or their immediate environment (4). Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet and whenever hands look dirty. If hands are not visibly dirty, an alcohol-based hand rub can be used. For visibly dirty hands, use soap and water. • When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them when they become wet. • To contain respiratory secretions, a medical mask4 should be provided to the patient and worn as much as possible. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene − that is, the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. Materials used to cover the mouth and nose should be discarded or cleaned appropriately after use (e.g., wash handkerchiefs using regular soap or detergent and water). • Caregivers should wear a tightly fitted medical mask that covers their mouth and nose when in the same room as the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty from secretions, it must be replaced immediately with a new clean, dry mask. Remove the mask using the appropriate technique – that is, do not touch the front, but instead untie it. Discard the mask immediately after use and perform hand hygiene. • Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves and a mask when providing oral or respiratory care and when handling stool, urine and other waste. Perform hand hygiene before and after removing gloves and the mask. • Do not reuse masks or gloves. • Use dedicated linen and eating utensils for the patient; these items should be cleaned with soap and water after use and may be re-used instead of being discarded. • Clean and disinfect daily surfaces that are frequently touched in the room where the patient is being cared for, such as bedside tables, bedframes and other bedroom furniture. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite (i.e., equivalent to 5000 pm or 1 part bleach5 to 9 parts water) should be applied. 3 An exception may be made for breastfeeding mothers. Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother could can continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby. She will also need to follow the other hygiene measures described in this document. 4 Medical masks are surgical or procedure masks that are flat or pleated (some are shaped like a cup); they are held in place by strings that tie around the back of the head. • Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite should be applied.5 • Clean the patient’s clothes, bed linen, and bath and hand towels using regular laundry soap and water or machine wash at 60–90 °C with common household detergent, and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid contaminated materials coming into contact with skin and clothes. • Gloves and protective clothing (e.g., plastic aprons) should be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Depending on the context, either utility or single-use gloves can be used. After use, utility gloves should be cleaned with soap and water and decontaminated with 0.5% sodium hypochlorite solution. Single-use gloves (e.g., nitrile or latex) should be discarded after each use. Perform hand hygiene before and after removing gloves. • Gloves, masks and other waste generated during at-home patient care should be placed into a waste bin with a lid in the patient’s room before being disposed of as infectious waste.6 • Avoid other types of exposure to contaminated items from the patient’s immediate environment (e.g., do not share toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths or bed linen). • When HCWs provide home care, they should perform a risk assessment to select the appropriate personal protective equipment and follow the recommendations for droplet and contact precautions. Management of contacts Persons (including caregivers and HCWs) who have been exposed to individuals with suspected COVID-19disease are considered contacts and should be advised to monitor their health for 14 days from the last possible day of contact. A contact is a person who has had any of the following exposures: • a healthcare-associated exposure, including providing direct care for patients with COVID-19 disease, working with HCWs infected with the virus that causes COVID-19 disease, visiting patients or staying in the same environment as a patient with COVID-19 disease; • an exposure through working together in close proximity to or sharing the same classroom with a patient with COVID-19 disease; • an exposure through traveling with a patient who has COVID-19 disease in any kind of vehicle; • an exposure through living in the same household as a patient with COVID-19 disease within 14 days after the onset of symptoms in the patient (5). 5 Most household bleach solutions contain 5% sodium hypochlorite. Recommendations on how to calculate the dilution from a given concentration of bleach can be found at https://www.cdc.gov/hai/pdfs/resource-limited/environmental-cleaning-508.pdf. 6 The local sanitary authority should adopt measures to ensure that the waste is disposed of at a sanitary landfill and not at an unmonitored open dump. Home care for patients with novel coronavirus (COVID-19) infection presenting with mild symptoms and management of their contacts 3 A way for caregivers to communicate with a healthcare provider should be established for the duration of the observation period. Also, healthcare personnel should review the health of contacts regularly by phone but, ideally and if feasible, through daily in-person visits, so specific diagnostic tests can be performed as necessary. The healthcare provider should give instructions to contacts in advance about when and where to seek care if they become ill, what is the most appropriate mode of transportation to use, when and where to enter the designated healthcare facility, and which IPC precautions should be followed. If a contact develops symptoms, the following steps should be taken. • Notify the receiving medical facility that a symptomatic contact will be arriving. • While traveling to seek care, the person who is ill should wear a medical mask. • The contact should avoid taking public transportation to the facility if possible; an ambulance can be called, or the ill contact can be transported in a private vehicle with all of the windows open, if possible. • The symptomatic contact should be advised to always perform respiratory hygiene and hand hygiene and to stand or sit as far away from others as possible (at least 1 m) when in transit and when in the healthcare facility. • Any surfaces that become soiled with respiratory secretions or other body fluids during transport should be cleaned with soap or detergent and then disinfected with a regular household product containing a 0.5% diluted bleach solution. Acknowledgements The original version of the MERS-CoV IPC guidance (1) that constituted the basis for this document was developed in consultation with WHO’s Global Infection Prevention and Control Network and other international experts. WHO thanks those who were involved in developing the IPC documents for MERS-CoV. WHO thanks the following individuals for providing review: Abdullah M Assiri, Director General, Infection Control, Ministry of Health, Saudi Arabia; Michael Bell, Deputy Director of the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Gail Carson, ISARIC Global Support Centre, Director of Network Development, Consultant in Infectious Diseases, and Honorary Consultant with Public Health England, United Kingdom; John M Conly, Department of Medicine, Microbiology, Immunology and Infectious Diseases, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Faculty of Medicine, University of Calgary, Calgary, Canada; Barry Cookson, Division of Infection and Immunity, University College London, United Kingdom; Babacar NDoye, Board Member, Infection Control Network, Dakar, Senegal; Kathleen Dunn, Manager, Healthcare-Associated Infections and Infection Prevention and Control Section, Centre for Communicable Disease Prevention and Control, Public Health Agency of Canada; Dale Fisher, Global Outbreak Alert and Response Network Steering Committee; Fernanda Lessa, Epidemiologist, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Moi Lin Ling, Director, Infection Control Department, Singapore General Hospital, Singapore, and President of Asia Pacific Society of Infection Control; Didier Pittet, Director, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, and Faculty of Medicine, Geneva, Switzerland; Fernando Otaiza O’Ryan, Head, National IPC Program, Ministry of Health, Santiago, Chile; Diamantis Plachouras, Unit of Surveillance and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden; Wing Hong Seto, Department of Community Medicine, School of Public Health, University of Hong Kong, China, Hong Kong Special Administrative Region; Nandini Shetty, Consultant Microbiologist, Reference Microbiology Services, Health Protection Agency, Colindale, United Kingdom; Rachel M. Smith, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. From WHO we also thank: Benedetta Allegranzi, Gertrude Avortri, April Baller, Ana Paula Coutinho, Nino Dal Dayanghirang, Christine Francis, Pierre Clave Kariyo, Maria Clara Padoveze, Joao Paulo Toledo, Nahoko Shindo, Valeska Stempliuk, and Maria Van Kerkhove. References 1. Home care for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection presenting with mild symptoms and management of contacts: interim guidance, June 2018. Geneva: World Health Organization; 2018 (WHO/MERS/IPC/18.1; https://apps.who.int/iris/handle/10665/272948, accessed 26 January 2020). 2. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. Geneva: World Health Organization; 2014 (https://apps.who.int/iris/bitstream/handle/10665/112656/9789 241507134_eng.pdf?sequence=1, accessed 26 January 2020). 3. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance, 28 January 2020. Geneva: World Health Organization; 2020 (https://www.who.int/publications- detail/clinical-management-of-severe-acute-respiratory- infection-when-novel-coronavirus-(ncov)-infection-is- suspected, accessed 4 February 2020). 4. WHO guidelines on hand hygiene in health care: first global patient safety challenge. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44102, accessed 20 January 2020). 5. Global surveillance for human infection with novel coronavirus (2019-nCoV): interim guidance v3, 31 January 2020. Geneva: World Health Organization (WHO/2019-nCoV/SurveillanceGuidance/2020.3; https://www.who.int/publications-detail/global-surveillance- for-human-infection-with-novel-coronavirus-(2019-ncov), accessed 4 February 2020). Home care for patients with novel coronavirus (COVID-19) infection presenting with mild symptoms and management of their contacts 4 Further References Management of asymptomatic persons who are RT-PCR positive for Middle East respiratory syndrome coronavirus (MERS-CoV): interim guidance, 3 January 2018. Geneva: World Health Organization; 2018 (WHO/MERS/IPC/15.2; https://apps.who.int/iris/bitstream/handle/10665/180973/WH O_MERS_IPC_15.2_eng.pdf;jsessionid=3E232F5051C5D3C 7F8D27207599D022E?sequence=1, accessed 20 January 2020). Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance, updated January 2019. Geneva: World Health Organization; 2019 (WHO/MERS/Clinical/15.1; https://apps.who.int/iris/bitstream/handle/10665/178529 /WHO_MERS_Clinical_15.1_eng.pdf?sequence=1&is Allowed=y&ua=1, accessed 20 January 2020). Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection: interim guidance. Geneva: World Health Organization; 2015 (WHO/MERS/IPC/15.1; http://apps.who.int/iris/handle/10665/174652, accessed 20 January 2020). Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto WH, editors. Natural ventilation for infection control in health-care settings: WHO guidelines 2009. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44167, accessed 20 January 2020). Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance, 17 January 2020. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/330676, accessed 20 January 2020). Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020. doi: 10.1016/S0140-6736(20)30154-9. Drosten C, Meyer B, Müller MA, Corman VM, Al-Masri M, Hossain R, et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828-35. doi:10.1056/NEJMoa1405858. Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team. Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill. 2013;18(11):20427. doi:10.2807/ese.18.11.20427-en. Hung C, Wang Y, Li X, Ren L, Yhao J, Hu Y, et al. Clinical features of patients infected with 2019 coronavirus in Wuhan, China. Lancet. 2020. doi:10.1016/S0140-6736(20)30183-5. Li Q, Guan X, Wu P, Zhou L, Tong Y, Ren R, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus−infected pneumonia. N Engl J Med. 2020. doi:10.1056/NEJMoa2001316. Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis. 2013;17(9):e668-72. doi:10.1016/j.ijid.2013.07.001. Ren LL, Wang YM, Wu YQ, Xiang YC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020. doi:10.1097/CM9.0000000000000722. © World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. WHO reference number: WHO/nCov/IPC/HomeCare/2020.2

1 Home care for patients with suspected novel coronavirus (COVID-19) infection presenting with mild symptoms, and management of their contacts Interim guidance 04 February 2020 Introduction WHO has developed this rapid advice to meet the need for recommendations on safe home care for patients with suspected novel coronavirus (COVID-19) infection who present with mild symptoms1 and on public health measures related to the management of contacts. This document was adapted from the interim guidance that addressed Middle East respiratory syndrome coronavirus (MERS-CoV) infection that was published in June 2018 (1) and is informed by evidence-based guidelines published by WHO, including Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care (2), and based on current information regarding COVID-19 infection. This rapid advice is intended to guide public health and infection prevention and control (IPC) professionals, healthcare managers and healthcare workers (HCWs) when addressing issues related to home care for patients with suspected COVID-19 infection who present with mild symptoms and when managing contacts. This guidance is based on evidence about COVID-19 infection and the feasibility of implementing IPC measures at home. For the purpose of this document, caregivers refer to parents, spouses, other family members or friends without formal healthcare training. For COVID-19 disease case definitions, please refer to https://apps.who.int/iris/bitstream/handle/10665/330857/WH O-2019-nCoV-SurveillanceGuidance-2020.3-eng.pdf. For guidance on IPC at the facility level, please refer to https://www.who.int/publications-detail/infection- prevention-and-control-during-health-care-when-novel- coronavirus-(ncov)-infection-is-suspected. Home care for patients with suspected COVID-19 infection who present with mild symptoms In view of the current data on the disease and its transmission, WHO recommends that all patients with suspected COVID-19 infection who have severe acute respiratory infection be triaged at the first point of contact with the healthcare system and that emergency treatment should be started based on disease severity. For those presenting with mild illness, hospitalization may not be required unless there is concern about rapid deterioration (3). If there is only mild 1 Mild symptoms include low-grade fever; cough; malaise; rhinorrhoea; or sore throat without any warning signs, such as shortness of breath or difficulty in breathing; increased respiratory difficulty, such as sputum or haemoptysis; gastrointestinal symptoms, such as nausea, vomiting, and/or diarrhoea; and without changes in mental status, such as confusion or lethargy. illness, providing care at home may be considered. Other patients who may be cared for at home include those who are symptomatic but no longer require hospitalization and cases in which an informed decision has been made to refuse hospitalization; home care may also be considered when inpatient care is unavailable or unsafe (e.g., capacity is limited, and resources are unable to meet the demand for healthcare services). In any of these situations, patients with mild symptoms1 and without underlying chronic conditions − such as lung or heart disease, renal failure or immunocompromising conditions that place the patient at increased risk of developing complications − may be cared for at home. This decision requires careful clinical judgment and should be informed by an assessment of the safety of the patient’s home environment.2 In cases in which care is to be provided at home, a trained HCW should conduct an assessment to verify whether the residential setting is suitable for providing care; the HCW must assess whether the patient and the family are capable of adhering to the precautions that will be recommended as part of home care isolation (e.g., hand hygiene, respiratory hygiene, environmental cleaning, limitations on movement around or from the house) and can address safety concerns (e.g., accidental ingestion of and fire hazards associated with using alcohol-based hand rubs). A communication link with a healthcare provider or public health personnel, or both, should be established for the duration of the home care period – that is, until the patient’s symptoms have completely resolved. More comprehensive information about the mode of COVID-19 infection and transmission is required to define the duration of home isolation precautions. Patients and household members should be educated about personal hygiene, basic IPC measures and how to care for the member of the family suspected of having COVID-19 disease as safely as possible to prevent the infection from spreading to household contacts. The patient and the family should be provided with ongoing support and education, and monitoring should continue for the duration of home care. Patients and families should adhere to the following recommendations. • Place the patient in a well-ventilated single room (i.e., with open windows and an open door). • Limit the movement of the patient in the house and minimize shared space. Ensure that shared spaces 2 A sample checklist for assessing environmental conditions in the home is available in the Annex C of reference 2. Home care for patients with novel coronavirus (COVID-19) infection presenting with mild symptoms and management of their contacts 2 (e.g., kitchen, bathroom) are well ventilated (e.g., keep windows open). • Household members should stay in a different room or, if that is not possible, maintain a distance of at least 1 m from the ill person (e.g., sleep in a separate bed).3 • Limit the number of caregivers. Ideally, assign one person who is in a good health and has no underlying chronic or immunocompromising conditions (3). Visitors should not be allowed until the patient has completely recovered and has no signs and symptoms. • Perform hand hygiene after any type of contact with patients or their immediate environment (4). Hand hygiene should also be performed before and after preparing food, before eating, after using the toilet and whenever hands look dirty. If hands are not visibly dirty, an alcohol-based hand rub can be used. For visibly dirty hands, use soap and water. • When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them when they become wet. • To contain respiratory secretions, a medical mask4 should be provided to the patient and worn as much as possible. Individuals who cannot tolerate a medical mask should use rigorous respiratory hygiene − that is, the mouth and nose should be covered with a disposable paper tissue when coughing or sneezing. Materials used to cover the mouth and nose should be discarded or cleaned appropriately after use (e.g., wash handkerchiefs using regular soap or detergent and water). • Caregivers should wear a tightly fitted medical mask that covers their mouth and nose when in the same room as the patient. Masks should not be touched or handled during use. If the mask gets wet or dirty from secretions, it must be replaced immediately with a new clean, dry mask. Remove the mask using the appropriate technique – that is, do not touch the front, but instead untie it. Discard the mask immediately after use and perform hand hygiene. • Avoid direct contact with body fluids, particularly oral or respiratory secretions, and stool. Use disposable gloves and a mask when providing oral or respiratory care and when handling stool, urine and other waste. Perform hand hygiene before and after removing gloves and the mask. • Do not reuse masks or gloves. • Use dedicated linen and eating utensils for the patient; these items should be cleaned with soap and water after use and may be re-used instead of being discarded. • Clean and disinfect daily surfaces that are frequently touched in the room where the patient is being cared for, such as bedside tables, bedframes and other bedroom furniture. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite (i.e., equivalent to 5000 pm or 1 part bleach5 to 9 parts water) should be applied. 3 An exception may be made for breastfeeding mothers. Considering the benefits of breastfeeding and the insignificant role of breast milk in the transmission of other respiratory viruses, a mother could can continue breastfeeding. The mother should wear a medical mask when she is near her baby and perform hand hygiene before and after having close contact with the baby. She will also need to follow the other hygiene measures described in this document. 4 Medical masks are surgical or procedure masks that are flat or pleated (some are shaped like a cup); they are held in place by strings that tie around the back of the head. • Clean and disinfect bathroom and toilet surfaces at least once daily. Regular household soap or detergent should be used first for cleaning, and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite should be applied.5 • Clean the patient’s clothes, bed linen, and bath and hand towels using regular laundry soap and water or machine wash at 60–90 °C with common household detergent, and dry thoroughly. Place contaminated linen into a laundry bag. Do not shake soiled laundry and avoid contaminated materials coming into contact with skin and clothes. • Gloves and protective clothing (e.g., plastic aprons) should be used when cleaning surfaces or handling clothing or linen soiled with body fluids. Depending on the context, either utility or single-use gloves can be used. After use, utility gloves should be cleaned with soap and water and decontaminated with 0.5% sodium hypochlorite solution. Single-use gloves (e.g., nitrile or latex) should be discarded after each use. Perform hand hygiene before and after removing gloves. • Gloves, masks and other waste generated during at-home patient care should be placed into a waste bin with a lid in the patient’s room before being disposed of as infectious waste.6 • Avoid other types of exposure to contaminated items from the patient’s immediate environment (e.g., do not share toothbrushes, cigarettes, eating utensils, dishes, drinks, towels, washcloths or bed linen). • When HCWs provide home care, they should perform a risk assessment to select the appropriate personal protective equipment and follow the recommendations for droplet and contact precautions. Management of contacts Persons (including caregivers and HCWs) who have been exposed to individuals with suspected COVID-19disease are considered contacts and should be advised to monitor their health for 14 days from the last possible day of contact. A contact is a person who has had any of the following exposures: • a healthcare-associated exposure, including providing direct care for patients with COVID-19 disease, working with HCWs infected with the virus that causes COVID-19 disease, visiting patients or staying in the same environment as a patient with COVID-19 disease; • an exposure through working together in close proximity to or sharing the same classroom with a patient with COVID-19 disease; • an exposure through traveling with a patient who has COVID-19 disease in any kind of vehicle; • an exposure through living in the same household as a patient with COVID-19 disease within 14 days after the onset of symptoms in the patient (5). 5 Most household bleach solutions contain 5% sodium hypochlorite. Recommendations on how to calculate the dilution from a given concentration of bleach can be found at https://www.cdc.gov/hai/pdfs/resource-limited/environmental-cleaning-508.pdf. 6 The local sanitary authority should adopt measures to ensure that the waste is disposed of at a sanitary landfill and not at an unmonitored open dump. Home care for patients with novel coronavirus (COVID-19) infection presenting with mild symptoms and management of their contacts 3 A way for caregivers to communicate with a healthcare provider should be established for the duration of the observation period. Also, healthcare personnel should review the health of contacts regularly by phone but, ideally and if feasible, through daily in-person visits, so specific diagnostic tests can be performed as necessary. The healthcare provider should give instructions to contacts in advance about when and where to seek care if they become ill, what is the most appropriate mode of transportation to use, when and where to enter the designated healthcare facility, and which IPC precautions should be followed. If a contact develops symptoms, the following steps should be taken. • Notify the receiving medical facility that a symptomatic contact will be arriving. • While traveling to seek care, the person who is ill should wear a medical mask. • The contact should avoid taking public transportation to the facility if possible; an ambulance can be called, or the ill contact can be transported in a private vehicle with all of the windows open, if possible. • The symptomatic contact should be advised to always perform respiratory hygiene and hand hygiene and to stand or sit as far away from others as possible (at least 1 m) when in transit and when in the healthcare facility. • Any surfaces that become soiled with respiratory secretions or other body fluids during transport should be cleaned with soap or detergent and then disinfected with a regular household product containing a 0.5% diluted bleach solution. Acknowledgements The original version of the MERS-CoV IPC guidance (1) that constituted the basis for this document was developed in consultation with WHO’s Global Infection Prevention and Control Network and other international experts. WHO thanks those who were involved in developing the IPC documents for MERS-CoV. WHO thanks the following individuals for providing review: Abdullah M Assiri, Director General, Infection Control, Ministry of Health, Saudi Arabia; Michael Bell, Deputy Director of the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Gail Carson, ISARIC Global Support Centre, Director of Network Development, Consultant in Infectious Diseases, and Honorary Consultant with Public Health England, United Kingdom; John M Conly, Department of Medicine, Microbiology, Immunology and Infectious Diseases, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Faculty of Medicine, University of Calgary, Calgary, Canada; Barry Cookson, Division of Infection and Immunity, University College London, United Kingdom; Babacar NDoye, Board Member, Infection Control Network, Dakar, Senegal; Kathleen Dunn, Manager, Healthcare-Associated Infections and Infection Prevention and Control Section, Centre for Communicable Disease Prevention and Control, Public Health Agency of Canada; Dale Fisher, Global Outbreak Alert and Response Network Steering Committee; Fernanda Lessa, Epidemiologist, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Moi Lin Ling, Director, Infection Control Department, Singapore General Hospital, Singapore, and President of Asia Pacific Society of Infection Control; Didier Pittet, Director, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, and Faculty of Medicine, Geneva, Switzerland; Fernando Otaiza O’Ryan, Head, National IPC Program, Ministry of Health, Santiago, Chile; Diamantis Plachouras, Unit of Surveillance and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden; Wing Hong Seto, Department of Community Medicine, School of Public Health, University of Hong Kong, China, Hong Kong Special Administrative Region; Nandini Shetty, Consultant Microbiologist, Reference Microbiology Services, Health Protection Agency, Colindale, United Kingdom; Rachel M. Smith, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. From WHO we also thank: Benedetta Allegranzi, Gertrude Avortri, April Baller, Ana Paula Coutinho, Nino Dal Dayanghirang, Christine Francis, Pierre Clave Kariyo, Maria Clara Padoveze, Joao Paulo Toledo, Nahoko Shindo, Valeska Stempliuk, and Maria Van Kerkhove. References 1. Home care for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection presenting with mild symptoms and management of contacts: interim guidance, June 2018. Geneva: World Health Organization; 2018 (WHO/MERS/IPC/18.1; https://apps.who.int/iris/handle/10665/272948, accessed 26 January 2020). 2. Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. Geneva: World Health Organization; 2014 (https://apps.who.int/iris/bitstream/handle/10665/112656/9789 241507134_eng.pdf?sequence=1, accessed 26 January 2020). 3. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance, 28 January 2020. Geneva: World Health Organization; 2020 (https://www.who.int/publications- detail/clinical-management-of-severe-acute-respiratory- infection-when-novel-coronavirus-(ncov)-infection-is- suspected, accessed 4 February 2020). 4. WHO guidelines on hand hygiene in health care: first global patient safety challenge. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44102, accessed 20 January 2020). 5. Global surveillance for human infection with novel coronavirus (2019-nCoV): interim guidance v3, 31 January 2020. Geneva: World Health Organization (WHO/2019-nCoV/SurveillanceGuidance/2020.3; https://www.who.int/publications-detail/global-surveillance- for-human-infection-with-novel-coronavirus-(2019-ncov), accessed 4 February 2020). Home care for patients with novel coronavirus (COVID-19) infection presenting with mild symptoms and management of their contacts 4 Further References Management of asymptomatic persons who are RT-PCR positive for Middle East respiratory syndrome coronavirus (MERS-CoV): interim guidance, 3 January 2018. Geneva: World Health Organization; 2018 (WHO/MERS/IPC/15.2; https://apps.who.int/iris/bitstream/handle/10665/180973/WH O_MERS_IPC_15.2_eng.pdf;jsessionid=3E232F5051C5D3C 7F8D27207599D022E?sequence=1, accessed 20 January 2020). Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance, updated January 2019. Geneva: World Health Organization; 2019 (WHO/MERS/Clinical/15.1; https://apps.who.int/iris/bitstream/handle/10665/178529 /WHO_MERS_Clinical_15.1_eng.pdf?sequence=1&is Allowed=y&ua=1, accessed 20 January 2020). Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection: interim guidance. Geneva: World Health Organization; 2015 (WHO/MERS/IPC/15.1; http://apps.who.int/iris/handle/10665/174652, accessed 20 January 2020). Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto WH, editors. Natural ventilation for infection control in health-care settings: WHO guidelines 2009. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44167, accessed 20 January 2020). Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance, 17 January 2020. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/330676, accessed 20 January 2020). Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020. doi: 10.1016/S0140-6736(20)30154-9. Drosten C, Meyer B, Müller MA, Corman VM, Al-Masri M, Hossain R, et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828-35. doi:10.1056/NEJMoa1405858. Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team. Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill. 2013;18(11):20427. doi:10.2807/ese.18.11.20427-en. Hung C, Wang Y, Li X, Ren L, Yhao J, Hu Y, et al. Clinical features of patients infected with 2019 coronavirus in Wuhan, China. Lancet. 2020. doi:10.1016/S0140-6736(20)30183-5. Li Q, Guan X, Wu P, Zhou L, Tong Y, Ren R, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus−infected pneumonia. N Engl J Med. 2020. doi:10.1056/NEJMoa2001316. Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis. 2013;17(9):e668-72. doi:10.1016/j.ijid.2013.07.001. Ren LL, Wang YM, Wu YQ, Xiang YC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020. doi:10.1097/CM9.0000000000000722. © World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. WHO reference number: WHO/nCov/IPC/HomeCare/2020.2

-1- Уход на дому за пациентами с легкой формой заболевания, предположительно вызванного новым коронавирусом (COVID-19), и тактика ведения контактных лиц Временное руководство 4 февраля 2020 г. Введение ВОЗ разработала эти краткие положения для восполнения потребности в рекомендациях по безопасному уходу на дому за пациентами с легкой формой1 заболевания, предположительно вызванного новым коронавирусом (COVID-19), а также по мерам общественного здравоохранения, касающимся тактики ведения контактных лиц. Этот документ представляет собой адаптированную версию временного руководства, посвященного вопросам инфицирования коронавирусом ближневосточного респираторного синдрома (БВРС-КоВ), которое было опубликовано в июне 2018 г. (1), и составлен на основе научно обоснованных руководящих положений, опубликованных ВОЗ, включая руководство «Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care» (Профилактика инфекций и борьба с острыми респираторными инфекциями, способными вызывать эпидемии и пандемии, при оказании медико-санитарной помощи) (2), а также с учетом имеющейся на сегодняшний день информации в отношении заболевания, вызванного коронавирусом 2019-nCoV. Настоящие краткие рекомендации предназначены для применения специалистами в области общественного здравоохранения, работниками службы профилактики инфекций и инфекционного контроля (ПИИК), руководителями системы здравоохранения, а также медицинскими работниками при решении вопросов, связанных с организацией ухода на дому за пациентами с легкой формой заболевания, предположительно вызванного новым коронавирусом (COVID-19), и при ведении контактных лиц. В основу данного руководства положены фактические данные о заболевании, вызванном новым коронавирусом (COVID-19), и о возможностях практической реализации мер ПИИК на дому. В настоящем документе понятие лиц, осуществляющих уход, относится к родителям, супругам и другим членам семьи, либо друзьям, не имеющим медицинского образования. Информация об определении случаев заболевания COVID-19 представлена по адресу https://apps.who.int/iris/bitstream/handle/10665/331133/WH O-nCov-IPC-HomeCare-2020.2-eng.pdf. 1 К симптомам легкого течения заболевания относятся: субфебрильная температура тела; кашель; недомогание; насморк или боль в горле без каких-либо тревожных симптомов, таких как одышка или затруднение дыхания; появление патологического отделяемого дыхательных путей, например, мокроты или крови; симптомы со стороны Руководство по ПИИК на уровне ЛПУ представлено по адресу https://apps.who.int/iris/bitstream/handle/10665/ 330893/WHO-nCoV-Clinical-2020.3-rus.pdf. Уход на дому за пациентами с легкой формой заболевания, предположительно вызванного новым коронавирусом (COVID-19) С учетом имеющихся данных об этом заболевании и особенностях передачи возбудителя ВОЗ рекомендует проводить сортировку всех пациентов с подозрением на заражение COVID-19 и симптомами тяжелого течения острой респираторной инфекции при первом обращении за медицинской помощью, а при соответствующей степени тяжести – приступать к экстренному лечению. Для людей с легким течением заболевания госпитализация может не требоваться, если нет риска быстрого ухудшения состояния (3). При слабо выраженных симптомах заболевания может быть рассмотрен вопрос об организации ухода в домашних условиях. Тот же самый принцип оказания помощи на дому может применяться к пациентам с наличием симптоматики, которые больше не нуждаются в стационарном лечении, или в случае сознательного отказа от госпитализации; кроме того, необходимость оказания медицинской помощи на дому может возникнуть в ситуациях, когда госпитализация невозможна или небезопасна (то есть при дефиците потенциала и ресурсов, не позволяющем удовлетворить спрос на медицинские услуги). В любой из этих ситуаций пациентам со слабо выраженными симптомами 1 и отсутствием сопутствующих хронических заболеваний, таких как болезни легких или сердца, почечная недостаточность или иммунодефицитные состояния, повышающих риск развития осложнений, может быть предложено лечение в домашних условиях. Такое решение следует принимать на основе тщательного анализа клинической ситуации и оценки домашних обстоятельств пациента с точки зрения безопасности его лечения в домашних условиях2. При планировании помощи на дому в первую очередь необходимо, чтобы подготовленный медицинский работник оценил жилищные условия на предмет их желудочно-кишечного тракта, например тошнота, рвота и (или) диарея; а также отсутствие изменений в психическом состоянии (таких как спутанность сознания, заторможенность). 2 Образец контрольного перечня для оценки домашних условий представлен в Приложении С документа 2 (см. список литературы). Уход на дому за пациентами с легкой формой заболевания, вызванного новым коронавирусом (COVID-19), и тактика ведения контактных лиц -2- пригодности для организации ухода; необходимо, чтобы медицинский работник оценил готовность пациента и членов семьи к соблюдению мер предосторожности, которые будут рекомендованы для обеспечения изоляции в домашних условиях (то есть гигиена рук, респираторная гигиена, уборка помещения, ограничения на перемещение внутри дома и за его пределами), а также к появлению возможных источников опасности (то есть спиртосодержащих средств для обработки рук, которые случайно могут быть приняты внутрь, и, кроме того, являются пожароопасными). В течение всего периода оказания помощи на дому, то есть до полного исчезновения симптомов заболевания, должно быть налажено взаимодействие пациента с поставщиком медицинских услуг или с работником органов общественного здравоохранения, либо с обеими этими службами одновременно. Для определения продолжительности мер предосторожности при изоляции пациента на дому необходима более полная информация об особенностях передачи возбудителя заболевания COVID-19. Необходимо разъяснять пациентам и членам домохозяйства различные аспекты личной гигиены, сущность основных мер ПИИК, а также порядок организации ухода за членом семьи, подозрительным на заражение COVID-19, с тем чтобы оказание помощи создавало как можно меньший риск заражения членов домохозяйства. Пациенту и его семье необходимо оказывать непрерывную поддержку, проводить с ними санитарно-просветительскую работу и постоянно наблюдать за их состоянием в течение всего периода ухода на дому. Пациенты и члены их семей должны строго придерживаться следующих рекомендаций.  Поместите пациента в отдельную, хорошо проветриваемую комнату (то есть с открытыми окнами и открытой дверью).  Ограничьте передвижения пациента по дому и постарайтесь свести к минимуму его пребывание в одном помещении с другими людьми. Следите за тем, чтобы общие помещения (например, кухня, ванная комната) хорошо проветривались (например, держите окна открытыми).  Члены домохозяйства должны оставаться в другой комнате или, при отсутствии такой возможности, находиться на расстоянии не менее одного метра от заболевшего (например, спать на отдельной кровати)3.  Ограничьте количество лиц, ухаживающих за пациентом. В идеале выберите одного человека с крепким здоровьем, без хронических заболеваний или иммунодефицитных состояний (3). Необходимо исключить визиты посетителей к больному до момента полного выздоровления и исчезновения любых признаков и симптомов заболевания.  Принимайте меры, обеспечивающие гигиену рук, после любого контакта с пациентом или с окружающими его предметами (4). Кроме того, необходимо мыть или обрабатывать руки до и после 3 Для кормящих матерей может быть сделано исключение. Учитывая преимущества грудного вскармливания и незначительную роль грудного молока в передаче других респираторных вирусов, мать может продолжать кормить ребенка грудью. При этом она должна носить медицинскую маску, когда находится рядом с ребенком, и тщательно соблюдать гигиену рук до и после тесного контакта с младенцем. Кроме того, она должна выполнять и другие правила гигиены, описанные в этом документе. приготовления пищи, перед едой, после посещения туалета, и всякий раз, когда они выглядят грязными. Если на руках нет видимых следов загрязнения, то их можно обрабатывать спиртосодержащими средствами для рук. Если руки заметно загрязнены, их следует мыть водой с мылом.  Для вытирания рук после мытья водой с мылом желательно использовать одноразовые бумажные полотенца. Если их нет в наличии, следует использовать чистые полотенца из ткани и заменять их, как только они становятся влажными.  Пациенту следует предоставить медицинскую маску4, которую он должен носить по возможности все время, что будет препятствовать распространению отделяемого из дыхательных путей. Если человек не переносит наличия на лице медицинской маски, он должен строго соблюдать правила респираторной гигиены: прикрывать рот и нос при кашле или чихании одноразовой бумажной салфеткой. Использованные для прикрывания рта или носа материалы после применения следует выбрасывать или очищать соответствующим образом (например, стирать носовые платки в воде с помощью обычного мыла или моющих средств).  Ухаживающий за больным должен носить медицинскую маску, плотно прилегающую к лицу, всякий раз, когда он находится в одной комнате с пациентом. Не следует прикасаться к маске или поправлять ее во время использования. Если маска промокла или загрязнилась выделениями, ее следует немедленно заменить новой сухой и чистой маской. Снимайте маску, используя надлежащую методику, то есть взявшись за резинки сзади, не прикасаясь к передней части маски. Использованную маску следует выбросить, после чего необходимо выполнить процедуры, обеспечивающие гигиену рук.  Избегайте прямого контакта с биологическими жидкостями больного, особенно с выделениями из ротовой полости или дыхательных путей, и с калом больного. При осуществлении ухода за полостью рта или дыхательными путями больного и при обращении с его калом, мочой и другими отходами используйте одноразовые перчатки и маску. До и после снятия перчаток и маски выполняйте процедуры, обеспечивающие гигиену рук.  Не допускайте повторного использования масок или перчаток.  Для пациента следует специально выделить постельное белье и столовые приборы; каждый раз после использования их следует мыть водой с мылом или моющим средством, и тогда их можно не выбрасывать, а использовать повторно.  Поверхности, к которым регулярно прикасается больной, такие как прикроватные тумбочки, спинки кровати и другие предметы мебели в комнате больного, необходимо ежедневно мыть и дезинфицировать. Для первичной обработки следует 4 Медицинские маски – это хирургические или процедурные маски, плоские или плиссированные (некоторые из них имеют чашкообразную форму), которые фиксируются к голове с помощью резинок. Уход на дому за пациентами с легкой формой заболевания, вызванного новым коронавирусом (COVID-19), и тактика ведения контактных лиц -3- воспользоваться бытовым мылом или моющим средством, а затем, после ополаскивания, бытовым дезинфицирующим средством, содержащим 0,5% гипохлорита натрия (то есть эквивалент 5000 миллионных долей или 1 части отбеливающего раствора5 на 9 частей воды).  Не реже одного раза в день следует мыть и дезинфицировать поверхности ванны и туалета. Для первичной обработки следует воспользоваться бытовым мылом или моющим средством, а затем, после ополаскивания, бытовым дезинфицирующим средством, содержащим 0,5% гипохлорита натрия5.  Одежду, постельные принадлежности, полотенца для душа и для рук и т.д., которыми пользуется больной, следует стирать вручную с обычным хозяйственным мылом или в стиральной машине с обычным стиральным гелем или порошком при температуре 60–90°C, а затем тщательно просушивать. Грязное белье больного следует складывать в мешок для стирки. Его не следует встряхивать, при этом необходимо избегать контакта кожи или одежды с контаминированными материалами.  Очистку и обработку поверхностей, одежды или постельного белья, загрязненных жидкими выделениями больного, следует производить только в одноразовых перчатках и с использованием защитной одежды (например, фартуков из полимерного материала). В зависимости от конкретных обстоятельств следует пользоваться хозяйственными или одноразовыми перчатками. После использования хозяйственные перчатки следует вымыть с мылом и деконтаминировать 0,5% раствором гипохлорита натрия. Использованные одноразовые перчатки (например, нитриловые или латексные) следует сразу же выбрасывать. До и после снятия перчаток принимайте меры по обеспечению гигиены рук.  Перчатки, маски и другие отходные материалы, которые образовались при уходе за пациентом на дому, до их утилизации вместе с другими бытовыми отходами следует помещать в закрывающийся контейнер в комнате больного6.  Следует также избегать других типов контакта с контаминированными предметами, которыми пользуется пациент (например, избегайте совместного пользования зубными щетками, сигаретами, столовыми приборами, посудой, чашками, полотенцами, мочалками или постельными принадлежностями).  Медицинские работники, оказывающие помощь на дому, должны провести оценку риска, чтобы выбрать надлежащие средства индивидуальной защиты, а также следовать рекомендациям в отношении мер предосторожности для защиты от воздушно- капельных и контактных инфекций. 5 Обычно бытовые отбеливающие растворы содержат 5% гипохлорита натрия. Рекомендации по расчету разведения отбеливателя определенной концентрации представлены по адресу https://www.cdc.gov/hai/pdfs/resource-limited/environmental- cleaning-508.pdf. Тактика ведения контактных лиц Всех лиц (включая людей, осуществлявших уход, и медицинских работников), которые могли контактировать с больными, подозрительными на заражение COVID-19, целесообразно считать контактными, и следует рекомендовать им контролировать состояние своего здоровья в течение 14 дней с момента последнего возможного контакта. Определению контактных соответствуют лица, которые:  оказывали медицинскую помощь, в том числе непосредственную помощь, пациентам, зараженным COVID-19, совместно работали с медицинским персоналом, инфицированным новым коронавирусом, посещали пациентов или находились в том же помещении, что и пациент, зараженный COVID-19;  работали в непосредственной близости от или в одном кабинете с пациентами, зараженными COVID-19;  совместно перемещались на одном транспортном средстве любого вида с пациентом, зараженным COVID-19;  проживали в одном домохозяйстве с пациентом, инфицированным COVID-19, в период 14 дней после возникновения симптомов у пациента (5). Необходимо определить способ поддержания связи между медицинскими работниками и лицами, осуществлявшими уход, в течение всего периода наблюдения. Кроме того, в задачу медицинского персонала должна входить регулярная оценка состояния здоровья контактных лиц посредством телефонных звонков и, в идеале и при возможности, посредством личных посещений врача ежедневно с назначением, по мере необходимости, специфических диагностических тестов. Медицинский работник должен заранее дать инструкции контактным лицам о том, когда и куда обратиться за помощью в случае заболевания, на каком виде транспорта необходимо прибыть в назначенное медицинское учреждение, а также какие меры ПИИК следует применять. При возникновении у контактного лица симптомов заболевания следует принять следующие меры.  Уведомить принимающее медицинское учреждение о том, что к ним должен прибыть человек, находившийся в контакте с больным и имеющий симптомы заболевания.  Во время поездки в медицинское учреждение на заболевшем должна быть медицинская маска.  При поездке в лечебное учреждение контактному лицу следует по возможности избегать пользования общественным транспортом; вызовите скорую помощь или перевезите больного на личном автомобиле, открыв окна автомобиля, если это возможно.  Контактному лицу, у которого появились признаки заболевания, следует рекомендовать всегда 6 Местным органам санитарно-эпидемиологического надзора следует принять меры для обеспечения доставки таких отходов на санитарные свалки, а не открытые свалки на неохраняемой территории. Уход на дому за пациентами с легкой формой заболевания, вызванного новым коронавирусом (COVID-19), и тактика ведения контактных лиц -4- соблюдать правила респираторной гигиены и гигиены рук; в том числе стоять или сидеть как можно дальше от других людей (не ближе, чем в одном метре), как в транспорте, так и в медицинском учреждении.  Все поверхности, на которые во время транспортировки могли попасть выделения из дыхательных путей или биологические жидкости пациента, следует вымыть с мылом или бытовым моющим средством, а затем обработать при помощи бытового дезинфицирующего средства, содержащего разведенный 0,5% раствор хлорной извести. Выражение признательности Первоначальная версия руководства по мерам ПИИК в отношении БВРС-КоВ (1) была подготовлена при участии Глобальной сети ВОЗ по профилактике инфекций и инфекционному контролю, а также других международных экспертов. ВОЗ выражает благодарность всем, кто принимал участие в разработке и обновлении документов по мерам ПИИК в отношении БВРС-КоВ. ВОЗ благодарит следующих лиц за выполненный ими обзор (в порядке английского алфавита): Абдулла М. Ассири, генеральный директор Службы инфекционного контроля Министерства здравоохранения Саудовской Аравии; Майкл Белл, заместитель директора Отдела повышения качества здравоохранения Центра по контролю и профилактике заболеваний г. Атланта, США; Гейл Карсон, директор по развитию сети Международного центра поддержки ISARIC, консультант по инфекционным заболеваниям и почетный консультант Службы общественного здравоохранения Англии, Соединенное Королевство; Джон М. Конли, Отдел медицины, микробиологии, иммунологии и инфекционных заболеваний, Институт хронических болезней им. Кальвина, Фебе и Джоан Синдер, Медицинский факультет Университета Калгари, Канада; Барри Куксон, Отделение инфекций и иммунитета, Университетский колледж, Лондон, Соединенное Королевство; Бабакар Н. Дуай, член правления Сети инфекционного контроля, Дакар, Сенегал; Катлин Данн, менеджер Секции инфекций, связанных сo здравоохранением, профилактики инфекций и инфекционного контроля Центра по профилактике инфекционных болезней и инфекционному контролю, Агентство здравоохранения Канады; Дейл Фишер, член руководящего комитета Глобальной сети оповещения о вспышках болезней и ответных мерах; Фернанда Лесса, эпидемиолог Отдела повышения качества здравоохранения Центра по контролю и профилактике заболеваний, г. Атланта, США; Мои Лин Линь, директор Отдела инфекционного контроля Сингапурской клинической больницы и президент Азиатско-Тихоокеанского общества инфекционного контроля; Дидье Пите, директор программы ПИИК и Сотрудничающего центра ВОЗ по безопасности пациентов, больницы при Женевском университете и медицинском факультете, Женева, Швейцария; Фернандо Отайза О’Раян, руководитель Национальной программы ПИИК Министерства здравоохранения, Сантьяго, Чили; Диамантис Плачурас, Отдел наблюдения и поддержки реагирования, Европейский центр профилактики и контроля заболеваний, Сольна, Швеция; Вин Хун Сето, Кафедра общественной медицины Факультета общественного здравоохранения Университета Гонконга, Гонконг, Китайская Народная Республика; Нандини Шетти, микробиолог-консультант Справочной службы микробиологии, г. Колиндейл, Агентство защиты здоровья, Соединенное Королевство; Рэйчел Смит, Отдел повышения качества здравоохранения Центра по контролю и профилактике заболеваний, г. Атланта, США. Благодарим следующих сотрудников ВОЗ: Бенедетта Аллегранци, Гертруда Авортри, Эйприл Баллер, Ана Паула Коутиньо,Нино Дал Даянгиранг, Кристина Фрэнсис, Пьер Клаве Карийо, Мария Клара Падовезе, Жуан Паула де Толедо, Нахоко Синдо, Валеска Стемплюк и Мария Ван Керхове. Литература 1. Home care for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection presenting with mild symptoms and management of contacts: interim guidance, June 2018. Geneva: World Health Organization; 2018. Имеется по адресу https://apps.who.int/iris/handle/10665/272948, по состоянию на 26 января 2020 г. 2. Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. Geneva: World Health Organization; 2014. Имеется по адресу https://apps.who.int/iris/bitstream/handle/10665/112656 /9789241507134_eng.pdf?sequence=1, по состоянию на 26 января 2020 г. 3. Клиническое ведение тяжелой острой респираторной инфекции при подозрении на новую коронавирусную (2019-nCoV) инфекцию. Временные рекомендации. 28 января 2020 г. Женева: Всемирная организация здравоохранения; 2020 г. Имеется по адресу https://apps.who.int/iris/ bitstream/handle/10665/330893/WHO-nCoV-Clinical- 2020.3-rus.pdf, по состоянию на 4 февраля 2020 г. 4. WHO guidelines on hand hygiene in health care: first global patient safety challenge. Geneva: World Health Organization; 2009. Имеется по адресу http://apps.who.int/iris/handle/10665/44102, по состоянию на 20 января 2020 г.). 5. Глобальный эпиднадзор за случаями инфекции человека, вызванной новым коронавирусом (2019-nCoV). Временные рекомендации. 31 января 2020 г. Женева: Всемирная организация здравоохранения. Имеется по адресу https://apps.who.int/iris/bitstream/handle/10665/330857 /WHO-2019-nCoV-SurveillanceGuidance-2020.3- rus.pdf, по состоянию на 4 февраля 2020 г. Уход на дому за пациентами с легкой формой заболевания, вызванного новым коронавирусом (COVID-19), и тактика ведения контактных лиц -5- Дополнительная литература Ведение бессимптомных пациентов с положительным результатом ОТ-ПЦР тестирования на коронавирус ближневосточного респираторного синдрома (БВРСКоВ). Временные рекомендации. Женева: Всемирная организация здравоохранения; 2018 г. Имеется по адресу http://www10.who.int/ csr/disease/coronavirus_infections/management_of_asy mptomatic_patients/ru/, по состоянию на 20 января 2020 г. Клиническое руководство по ведению пациентов с тяжелыми острыми респираторными инфекциями при подозрении на инфицирование коронавирусом ближневосточного респираторного синдрома (БВРС- КоВ), январь 2019 г., обновленное издание. Женева: Всемирная организация здравоохранения; 2019 г. Имеется по адресу https://www.who.int/ csr/disease/coronavirus_infections/case-management- ipc/ru/, по состоянию на 20 января 2020 г. Профилактика инфекций и борьба с ними во время оказания медицинской помощи при вероятных или подтвержденных случаях инфицирования коронавирусом ближневосточного респираторного синдрома (БВРС-КоВ). Временное руководство. Женева: Всемирная организация здравоохранения; 2015 г. Имеется по адресу https://apps.who.int/iris/ bitstream/handle/10665/174652/WHO_MERS_IPC_15. 1_rus.pdf?sequence=8&isAllowed=y, по состоянию на 20 января 2020 г. Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto WH, editors. Natural ventilation for infection control in health-care settings: WHO guidelines 2009. Geneva: World Health Organization; 2009. Имеется по адресу (http://apps.who.int/iris/handle/10665/44167, по состоянию на 20 января 2020 г.). Лабораторное тестирование при подозрении на заражение человека новым коронавирусом 2019 г. (2019-nCoV). Временные рекомендации, 17 января 2020 г. Женева: Всемирная организация здравоохранения; 2020 г. Имеется по адресу (https://apps.who.int/iris/bitstream/handle/10665/33067 6/9789240001053-rus.pdf?sequence=9&isAllowed=y, по состоянию на 20 января 2020 г.). Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020. doi: 10.1016/S0140-6736(20)30154-9. Drosten C, Meyer B, Müller MA, Corman VM, Al-Masri M, Hossain R, et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828-35. doi:10.1056/NEJMoa1405858. Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team. Evidence of person- to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill. 2013;18(11):20427. doi:10.2807/ese.18.11.20427-en. Hung C, Wang Y, Li X, Ren L, Yhao J, Hu Y, et al. Clinical features of patients infected with 2019 coronavirus in Wuhan, China. Lancet. 2020. doi:10.1016/S0140-6736(20)30183-5. Li Q, Guan X, Wu P, Zhou L, Tong Y, Ren R, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus−infected pneumonia. N Engl J Med. 2020. doi:10.1056/NEJMoa2001316. Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis. 2013;17(9):e668-72. doi:10.1016/j.ijid.2013.07.001. Ren LL, Wang YM, Wu YQ, Xiang YC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020. doi:10.1097/CM9.0000000000000722. © Всемирная организация здравоохранения 2020. Некоторые права защищены. Данная работа распространяется на условиях лицензии CC BY-NC-SA 3.0 IGO. WHO reference number: WHO/nCov/IPC/HomeCare/2020.2

-1- 症状轻微的疑似新型冠状病毒（COVID-19） 感染者的家庭护理及其接触者管理 临时指导文件 2020年 2月 4日 引言 这份快速建议由世卫组织编写，以满足对症状 轻微的1疑似新型冠状病毒（COVID-19）感染者的安 全家庭护理以及与接触者管理相关的公共卫生措施建 议的需求。 本文件改编自2018年6月发布的针对中东呼吸综合 征冠状病毒（MERS-CoV）感染的临时指导文件(1)，参 考了世卫组织发布的循证指南，包括《卫生保健中易 流行和大流行的急性呼吸道感染的感染预防和控制》 (2)，并以关于 COVID-19感染的现有信息为基础。 这项快速建议旨在指导公共卫生和感染预防与控 制专业人员、卫生保健管理者和卫生保健工作者解决 与症状轻微的疑似 COVID-19 感染者的家庭护理相关 的问题，并对接触者进行管理。本指导文件基于关于 COVID-19 感染的证据和在家中实施感染预防和控制 措施的可行性。就本文件而言，看护者是指未经正式 卫生保健培训的父母、配偶、其他家庭成员或朋友。 关 于 COVID-19 病 例 的 定 义 ， 请 参 阅 https://apps.who.int/iris/bitstream/handle/10665/331133/ WHO-nCov-IPC-HomeCare-2020.2-eng.pdf。 关于机构一级的感染预防和控制指导，请参阅 https://www.who.int/publications-detail/infection- prevention-and-control-during-health-care-when-novel- coronavirus-(ncov)-infection-is-suspected。 症状轻微的疑似 COVID-19 感染者的家 庭护理 鉴于目前关于该疾病及其传播的数据，世卫组织 建议，所有疑似感染 COVID-19 的严重急性呼吸道感 染患者应在与卫生保健系统接触的第一时间进行分 类，并根据疾病严重程度开始紧急治疗。就症状轻微 的患者而言，除非担心病情迅速恶化，否则可能不需 要住院治疗(3)。如果只是轻症，可以考虑在家提供护 1 轻微症状包括低烧、咳嗽、不适、鼻溢或喉咙痛，无任何危险信号，如呼吸急 促或呼吸困难、呼吸频率加快（咯痰或咯血)、胃肠症状（如恶心、呕吐和/或腹 泻），没有精神状态方面的变化（如意识模糊或昏睡）。 理。其他可以在家接受护理的患者包括有症状但不再 需要住院治疗的患者，以及作出拒绝住院治疗这一知 情决定的患者；当无法住院治疗或住院治疗不安全时 （例如，能力有限，资源无法满足对卫生保健服务的 需求），也可以考虑家庭护理。 在这些情况下，症状轻微 1 且没有肺或心脏疾 病、肾衰竭或免疫功能低下等会加大其罹患并发症风 险的基础性慢性疾病的患者可以在家接受护理。这一 决定需要审慎的临床判断，并应考虑患者的家庭环境 安全性评估2。 在需要提供家庭护理的情况下，受过培训的卫生 保健工作者应进行评估，以核实居住环境是否适合提 供护理；卫生保健工作者必须评估患者及其家人是否 能够遵守将作为家庭护理隔离措施的一部分推荐的预 防措施（例如，手卫生、呼吸卫生、环境清洁、限制 在室内或室外活动），是否能够解决安全问题（例 如，与使用含酒精成分的免洗洗手液有关的意外摄入 和火灾危险）。 在整个家庭护理期间——即直至患者的症状完全 得到解决——应与卫生保健提供者或公共卫生工作人 员或二者建立沟通联系。需要关于 COVID-19 感染和 传播模式的更全面信息来确定家庭隔离预防措施的持 续时间。 此外，患者及其家属应接受个人卫生、基本的感 染预防和控制措施、如何尽可能安全地护理疑似感染 COVID-19 疾病的家庭成员以防家庭接触者被感染方 面的教育。应向患者及其家庭提供持续的支持和教 育，并且在家庭护理期间持续进行监测。患者及其家 庭应遵循以下建议。  将患者置于通风良好的单间（将门窗打开）。  限制患者在室内的活动，尽量减少共享空间。确 保共享空间（如厨房、浴室）通风良好（如保持 窗户打开）。 2 参考文献2的附件C中提供了评估家庭环境条件的样本清单。 症状轻微的疑似新型冠状病毒（COVID-19）感染者的家庭护理及其接触者管理 -2-  家庭成员应待在另一房间，如果不可能，应与病人 保持至少 1米的距离（例如睡在另一张床上）3。  限制看护者的人数。最好是指定一个健康状况良 好且无基础性慢性疾病或免疫功能低下情况的人 看护患者(3)。应谢绝访客，直至患者完全康复并 且没有任何迹象和症状。  在与患者或其周围环境进行任何形式的接触后应 采取手卫生措施(4)。在准备食物之前和之后、吃 饭前、上厕所后以及手显得脏的时候也应采取手 卫生措施。如果手没有明显弄脏，可以使用含酒 精成分的免洗洗手液。在手明显弄脏时，使用肥 皂和水。  在使用肥皂和水洗手时，用一次性纸巾擦干手是 可取的。如果没有纸巾，可使用干净的毛巾，并 在毛巾变湿时更换。  为了控制呼吸道分泌物，应该向患者提供医用口 罩4，并尽可能佩戴。不能忍受医用口罩的人应 该采取严格的呼吸卫生做法，也就是说，在咳嗽 或打喷嚏时，应该用一次性纸巾遮住口鼻。用来 遮住口鼻的东西应在使用后丢弃或适当清洗（例 如，用普通肥皂或清洁剂和水清洗手帕）。  看护者在与患者同处一室时，应佩戴用来遮住口 鼻的紧贴面部的医用口罩。在使用过程中不应触 摸或摆弄口罩。如果口罩被分泌物弄湿或弄脏， 必须立即换上干净、干燥的新口罩。应采用适当 的方法取下口罩——也就是说，不要触摸口罩正 面，而是解开口罩。使用后应立即丢弃口罩，并 采取手卫生措施。  避免直接接触体液，尤其是口腔或呼吸道分泌物 以及粪便。在进行口腔或呼吸道护理以及处理粪 便、尿液和其它废物时，应使用一次性手套和口 罩。在取下手套和口罩之前和之后应采取手卫生 措施。  不要重复使用口罩或手套。  患者应有专用的床上用品和餐具；这些物品在使 用后应该用肥皂和水进行清洗，并且可以重复使 用而不是丢弃。  应对病人所在房间内日常接触的表面进行清洁和 消毒，如床头柜、床架和其它卧室家具。先用普 通家用肥皂或清洁剂进行清洁，然后，在冲洗 后，使用含有 0.5%次氯酸钠的普通家用消毒剂 3 进行母乳喂养的母亲可以例外。考虑到母乳喂养有好处并且母乳在其它呼吸道 病毒传播中的作用微不足道，母亲可以继续进行母乳喂养。母亲在靠近婴儿时 应佩戴医用口罩，并且在与婴儿密切接触之前和之后应采取手卫生措施。她还 需要遵循本文件中描述的其它卫生措施。 4 医用口罩是平坦的或打褶的外科或手术口罩（有些形状像杯子）。 它们通过绑 在脑后的绳子固定在适当的位置。 （即相当于 5000 pm或 1份消毒剂5兑 9份水）进 行消毒。  每天至少对浴室和卫生间的表面进行一次清洁和 消毒。先用普通家用肥皂或清洁剂进行清洁，然 后，在冲洗后，使用含有0.5%次氯酸钠的普通家 用消毒剂进行消毒 5。  使用普通洗衣皂和水清洗患者的衣服、床上用 品、浴巾和手巾等，或用普通家用洗涤剂在 60- 90℃的温度条件下进行机洗，并彻底烘干。将被 污染的床上用品放入洗衣袋中。不要摇晃要洗的 脏衣服，避免皮肤和衣服与污染物接触。  清洁表面或处理被体液弄脏的衣物或床上用品 时，应使用手套和防护服（如塑料围裙）。根据 具体情况，可以使用实用手套或一次性手套。使 用后，应使用肥皂和水清洗实用手套，并用0.5% 的次氯酸钠溶液进行消毒。一次性手套（如橡胶 或乳胶手套）应在每次使用后丢弃。在取下手套 之前和之后应采取手卫生措施。  手套、口罩和家庭护理过程中产生的其它废物在 作为传染性废物处理之前，应放入患者房间里带 盖的垃圾箱中6。  避免与患者周围环境中的被污染物品有任何其它 形式的接触（例如，不要共用牙刷、香烟、餐 具、盘子、饮料、毛巾、浴巾或床上用品）。  卫生保健工作者在提供家庭护理时应进行风险评 估，以选择合适的个人防护装备，并遵循飞沫和 接触预防措施方面的建议。 接触者管理 接触过疑似 COVID-19 疾病感染者的人（包括看 护者和卫生保健工作者）被视为接触者，应建议他们 从可能接触的最后一天起监测自身健康状况 14天。 接触者是指有过以下任何一种接触的人：  与卫生保健相关的接触，包括为 COVID-19 疾病 患者提供直接护理、与感染了导致 COVID-19 疾 病的病毒的卫生保健工作者一起工作、探访患者 或与 COVID-19疾病患者待在同一环境中。  与 COVID-19 疾病患者近距离地一起工作或共享 同一个教室导致的接触；  与 COVID-19 疾病患者在任何一种交通工具中一 起旅行导致的接触； 5 大多数家用消毒液含有 5%次氯酸钠。关于如何从给定的消毒液浓度计算稀释 度的建议，请参阅：https://www.cdc.gov/hai/pdfs/resource-limited/environmental- cleaning-508.pdf。 6 当地卫生主管部门应采取措施，确保废物在卫生垃圾填埋场处置，而不是在不 受监督的露天垃圾场处置。 症状轻微的疑似新型冠状病毒（COVID-19）感染者的家庭护理及其接触者管理 -3-  在COVID-19疾病患者出现症状后的 14天内，与 其生活在同一家庭导致的接触(5)。 应确定观察期内看护者与卫生保健提供者进行沟 通的方式。此外，卫生保健工作人员应通过电话定期 检查接触者的健康状况，但理想情况下，如果可行的 话，应每天亲自上门检查，以便根据需要进行特定的 诊断测试。 卫生保健提供者应提前告知接触者如果发病的话 应在什么时候去哪里就医，最合适的交通方式是什 么，什么时候从哪里进入指定的医疗机构，以及应遵 循什么感染预防和控制措施。 如果接触者出现症状，则应采取以下步骤。  通知定点医疗机构有症状的接触者将来到该机 构。  病人前去就医时应佩戴医用口罩。  可能的话接触者应避免搭乘公交前往医疗机构； 可以叫救护车，也可以用私家车运送患病的接触 者，可能的话应打开所有车窗。  应建议有症状的接触者始终采取呼吸卫生和手卫 生措施，在前往医疗机构的途中和在医疗机构 时，尽可能站在或坐在远离他人（至少 1 米）的 地方。  应用肥皂或清洁剂对运送病人过程中被呼吸道分 泌物或体液污染的表面进行清洁，然后用含有 0.5%稀释消毒液的普通家用产品进行消毒。 鸣谢 构成本文件基础的MERS-CoV感染预防和控制指 导文件(1)的最初版本是与世卫组织全球感染预防和控 制网络及其他国际专家协商制定的。世卫组织对参与 为 MERS-CoV 编写感染预防和控制文件的人表示感 谢。 世卫组织感谢下列人员提供的审查：Abdullah M Assiri，沙特阿拉伯卫生部感染控制司司长；Michael Bell，美国佐治亚州亚特兰大市疾病控制和预防中心 医疗质量提升部副主任；Gail Carson，ISARIC全球支 持中心，网络发展主任，传染病顾问，英国公共卫生 荣誉顾问；John M Conly，加拿大卡尔加里市卡尔加 里大学医学院卡尔文、菲比和琼·斯奈德慢性疾病研 究所医学、微生物学、免疫学和传染病系；Barry Cookson，英国伦敦大学学院感染和免疫系；Babacar NDoye，塞内加尔达喀尔感染控制网络董事会成员； Kathleen Dunn，加拿大公共卫生署传染病预防和控制 中心卫生保健相关感染和感染预防和控制科主管； Dale Fisher，全球疫情警报和应对网络指导委员会； Fernanda Lessa，美国佐治亚州亚特兰大市疾病控制和 预防中心医疗质量提升部流行病学家；Moi Lin Ling，新加坡总医院感染控制部主任，亚太感染控制 学会会长；Didier Pittet，瑞士日内瓦大学医院和医学 院感染控制规划和世卫组织患者安全合作中心主任； Fernando Otaiza O’Ryan，智利圣地亚哥卫生部国家感 染预防和控制规划负责人；Diamantis Plachouras，瑞 典索尔纳欧洲疾病预防和控制中心监测和反应支助 股，Wing Hong Seto，中国香港特别行政区香港大学 公共卫生学院社区医学系；Nandini Shetty，联合王国 科林代尔健康保护局参考微生物服务机构顾问微生物 学家；Rachel M. Smith，美国佐治亚州亚特兰大市疾 病控制和预防中心医疗质量提升部。 我们还感谢下述世卫组织工作人员：Benedetta Allegranzi、Gertrude Avortri、April Baller、Ana Paula Coutinho、Nino Dal Dayanghirang、Christine Francis、 Pierre Clave Kariyo、Maria Clara Padoveze、Joao Paulo Toledo、Nahoko Shindo、Valeska Stempliuk以及Maria Van Kerkhove。 参考文献 1. Home care for patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection presenting with mild symptoms and management of contacts: interim guidance, June 2018. Geneva: World Health Organization; 2018 (WHO/MERS/IPC/18.1; https://apps.who.int/iris/handle/10665/272948, accessed 26 January 2020). 2. Infection prevention and control of epidemic- and pandemic prone acute respiratory diseases in health care. Geneva: World Health Organization; 2014 (https://apps.who.int/iris/bitstream/handle/10665/112656/9789 241507134_eng.pdf?sequence=1, accessed 26 January 2020). 3. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance, 28 January 2020. Geneva: World Health Organization; 2020 (https://www.who.int/publications- detail/clinical-management-of-severe-acute-respiratory- infection-when-novel-coronavirus-(ncov)-infection-is- suspected, accessed 4 February 2020). 4. WHO guidelines on hand hygiene in health care: first global patient safety challenge. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44102, accessed 20 January 2020). 5. Global surveillance for human infection with novel coronavirus (2019-nCoV): interim guidance v3, 31 January 2020. Geneva: World Health Organization (WHO/2019-nCoV/SurveillanceGuidance/2020.3; https://www.who.int/publications-detail/global-surveillance- for-human-infection-with-novel-coronavirus-(2019-ncov), accessed 4 February 2020). 症状轻微的疑似新型冠状病毒（COVID-19）感染者的家庭护理及其接触者管理 -4- 其它参考文献 Management of asymptomatic persons who are RT PCR positive for Middle East respiratory syndrome coronavirus (MERS-CoV): interim guidance, 3 January 2018. Geneva: World Health Organization; 2018 (WHO/MERS/IPC/15.2; https://apps.who.int/iris/bitstream/handle/10665/180973/WH O_MERS_IPC_15.2_eng.pdf;jsessionid=3E232F5051C5D3C 7F8D27207599D022E?sequence=1, accessed 20 January 2020). Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS CoV) infection is suspected: interim guidance, updated January 2019. Geneva: World Health Organization; 2019 (WHO/MERS/Clinical/15.1; https://apps.who.int/iris/bitstream/handle/10665/178529 /WHO_MERS_Clinical_15.1_eng.pdf?sequence=1&is Allowed=y&ua=1, accessed 20 January 2020). Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection: interim guidance. Geneva: World Health Organization; 2015 (WHO/MERS/IPC/15.1; http://apps.who.int/iris/handle/10665/174652, accessed 20 January 2020) . Atkinson J, Chartier Y, Pessoa-Silva CL, Jensen P, Li Y, Seto WH, editors. Natural ventilation for infection control in health-care settings: WHO guidelines 2009. Geneva: World Health Organization; 2009 (http://apps.who.int/iris/handle/10665/44167, accessed 20 January 2020). Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance, 17 January 2020. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/330676, accessed 20 January 2020). Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020. doi: 10.1016/S0140-6736(20)30154-9. Drosten C, Meyer B, Müller MA, Corman VM, Al-Masri M, Hossain R, et al. Transmission of MERS-coronavirus in household contacts. N Engl J Med. 2014;371:828-35. doi:10.1056/NEJMoa1405858. Health Protection Agency (HPA) UK Novel Coronavirus Investigation Team. Evidence of person-to-person transmission within a family cluster of novel coronavirus infections, United Kingdom, February 2013. Euro Surveill. 2013;18(11):20427. doi:10.2807/ese.18.11.20427-en. Hung C, Wang Y, Li X, Ren L, Yhao J, Hu Y, et al. Clinical features of patients infected with 2019 coronavirus in Wuhan, China. Lancet. 2020. doi:10.1016/S0140-6736(20)30183-5. Li Q, Guan X, Wu P, Zhou L, Tong Y, Ren R, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus−infected pneumonia. N Engl J Med. 2020. doi:10.1056/NEJMoa2001316. Omrani AS, Matin MA, Haddad Q, Al-Nakhli D, Memish ZA, Albarrak AM. A family cluster of Middle East respiratory syndrome coronavirus infections related to a likely unrecognized asymptomatic or mild case. Int J Infect Dis. 2013;17(9):e668-72. doi:10.1016/j.ijid.2013.07.001. Ren LL, Wang YM, Wu YQ, Xiang YC, Guo L, Xu T, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020. doi:10.1097/CM9.0000000000000722. ©世界卫生组织 2020。 部分版权保留。作品署名-非商业性使用-相同方式共享的政府间组织 3.0版本适用于 该作品 (CC-BY-NC-SA 3.0 IGO) WHO reference number: WHO/nCov/IPC/HomeCare/2020.2

-1- الʛعاǽة الʺʻʜلʽة للʺʛضـ ــ ــ ـــ ــــ ــى الʺʸـــ ــــ ــ ــ ـــابʽʧ ǼعʙوȐ فʽʛوس ؗʨرونا ( الʺʷـ ــ ــ ــ ــ ــʱʰه فʽها والʺʸـ ــ ــ ــ ــ ــʴʨȃة Ǽأعʛاض 91-الʺʶـ ــ ــ ــ ــ ــʱʳʙ )كʨفʽʙ والʱʙبʽʛ العلاجي لʺʵالʢʽهʦ ،خفʽفة إرشادات مʰʙئʽة 0202فʰʛايʛ/ شʰاȋ 4 الʺقʙمة وضــعʗ مʻʤʺة الʸـʴة العالʺʽة هʚه الʻʸـائح الʶـʛȄعة تلʰʽًة للʴاجة إلى تʨصــ ـــ ʽــ ات Ǽʷـــ ــ ــأن الʛعاǽة الʺʻʜلʽة الʺأمʨنة للʺʛضــ ــ ـــى الʺʸـــ ــ ــابʽʧ ǼعʙوȐ Ȅعانʨن مʧ أعʛاض و ( الʺʷــʱـ ʰه فʽها 91-فʽʛوس ؗʨرونا الʺʶـ ــʱʳʙ )كʨفʽʙ وȃʷـ ــ ـــ ـــ ـــ ـــأن تʙابʽʛ الʸــ ـــ ــ ـــ ـــ ــʴة العʺʨمʽة الʺʱعلقة Ǽالʱʙبʽʛ العلاجي 1،خفʽفة لʺʵالʢʽهʦ. اقʱʰُʶʗ هʚه الʨثʽقة مʧ الإرشادات الʺʰʙئʽة الʵاصة ǼالعʙوȐ Ǽفʽʛوس وقʙ كʨرونا الʺʶـــ ــ ـــʰʖ لʺʱلازمة الʷـــ ـــ ــʛق الأوسـ ـــ ــــȌ الʱʻفʶـ ـــ ـــʽـ ة الʱي ُنʷــ ــ ــــʛت في وتʶـ ــ ـــ ـــ ــʱʛشـ ــ ـــ ـــ ــʙ Ǽالʺʰادȏ الʱʨجʽهʽة الʺʶـ ـــ ـــ ــ ــّʻʙة ،(1) 8102حʜȄʛان/ يʨنʽʨ الʨقاǽة مʧ الʨثʽقة الʺعʻʨنة Ǽالʰّʽʻات الʱي نʷـ ــ ـــ ـــ ــʛتها الʺʻʤʺة، Ǽʺا في ذلʥ العʙوȐ Ǽالأمʛاض الʱʻفʶʽة الʴادة الʱي قʙ ُت ʶʰʖ أوȃʯة وجʨائح ومȞافʴʱها ، وتʶــ ـــ ــʱʻʙ إلى الʺعلʨمات الʺʱاحة حالʽًا Ǽʷـ ـــ ـــأن (2) الʛعاǽة الʸــ ــ ـــʴʽةفي .91-ؗʨفʽʙ العʙوȐ Ǽʺʛض وȄʱʺʲل الغʛض مʧ هʚه الʻʸــــ ـــائح الʶــ ــ ـــʛȄعة في تʨجʽه الʺهʻʽʽʧ الʺعʻʽʽʧ والعاملʽʧ Ǽالʸـ ـــ ـــ ـــ ــ ـــʴة العʺʨمʽة والʨقاǽة مʧ العʙوȐ ومȞافʴʱها، والʺʙيʛȄʧ ʺʱعلقة Ǽالʛعاǽة الʸـ ـــʴʽة معالʳʱهʦ للʺʶـــ ــائل ال عʻʙ في الʛعاǽة الʸـــــʴʽة، Ȅعانʨن مʧ و الʺʷـــʱʰه فʽها 91-للʺʛضـــى الʺʸـ ــابʽʧ ǼعʙوȐ مʛض ؗʨفʽʙ لʱʙبʽʛ العلاجي لʺʵالʢʽهʦ. وتʶــ ــ ــــ ــ ـــʱʻʙ هʚه ا هʦأعʛاض خفʽفة، وعʻʙ تقʙǽʺ وȃإمȞانʽة تʻفʽʚ 91-الإرشادات إلى الʰّʽʻات الʵاصة ǼعʙوȐ مʛض ؗʨفʽʙ ولأغʛاض هʚه الʨثʽقة، تʙابʽʛ الʨقاǽة مʧ العʙوȐ ومȞافʴʱها في الʺʻʜل. الʛعاǽة إلى الʨالʙيʧ والأزواج وســ ــائʛ أفʛاد القائʺʽʧ علىǽʷـ ــʽـ ʛ مʸـ ـــʢلح الʚيʧ لʦ يʱلقʨا تʙرȄʰًا رسʺʽًا على الʛعاǽة الʸʴʽة. الأسʛة، أو الأصʙقاء ʛجى الʛجʨع إلى ، ي ُ91-للاʡلاع على تعــارȄʅ الʴــالات لʺʛض ؗʨفʽــʙ الʛاǼȌ الʱالي: HW/331133/56601/eldnah/maertstib/siri/tni.ohw.sppa//:sptth O-voCn-CPI-eraCemoH-2.0202-fdp.gne افʴʱها على صعʽʙ الʺʛافȘ، وللاʡلاع على تʙابʽʛ الʨقاǽة مʧ العʙوȐ ومȞ ُيʛجى الʛجʨع إلى الʛاǼȌ الʱالي: snoitacilbup/tni.ohw.www//:sptth-dnoitcefni/liate-noitneverp- dna-lortnoc-gnirud-htlaeh-erac-nehw-levon-surivanoroc- )vocn(-noitcefni-si-detcepsus الʛعاǽة الʺʻʜلʽة للʺʛضـــ ـــ ــــــ ــى الʺʸــــ ـــ ــ ــــ ــابʽʧ ǼعʙوȐ فʽʛوس ( الʺʷـــــʱʰه فʽها والʺ ʸـ ــ ــʴʨȃة 91-كʨرونا الʺʶـ ــ ــʱʳʙ )كʨفʽʙ Ǽأعʛاض خفʽفة Ǽʷأن الʺʛض وانʱʷاره، تʨصي الʺʻʤʺة Ǽفʛز وفقًا للʰʽانات الʺʱاحة حالʽًا الʺʷـ ـــʱـ ʰه فʽها الʚيʧ 91-جʺʽع الʺʛضـ ــــى الʺʸـ ــــابʽʧ ǼعʙوȐ مʛض ؗʨفʽʙ ǽعانʨن مʧ مʛض الʳهاز الʱʻفʶـــي الʴاد الʨخʽʦ، عʻʙ أول اتʸـــال بʻʤام تʷــ ــ ـــ ـــʺل الأعʛاض الʵفʽفة الʴʺى الʢفʽفة، والʶـــ ـــــ ــعال، والʱʨعʥ، وســـ ـــــــʽلان 1 الأنف، وألʦ الʴلȘ، مʧ دون علامات الإنʚار مʲل ضـــ ــ ــــــʽـ Ș الʻفʝ أو صــ ـــ ـــ ــ ــعʨȃة الʴالة العقلʽة تغّʽʛدون مʧ الʺعʨȄة مʲل الغʲʽان و/ أو القيء و/ أو الإســهال، و الʙم، والأعʛاض ال َʺ ِعʙǽة الʱʻفʝ، وزȄادة الʸعʨȃات الʱʻفʶʽة، مʲل الʰلغʦ أو نفʘ مʲل الʱʵلʽȌ أو الʻʨام. الʛعاǽة الʸــ ـــ ـــ ــ ـــ ــʴʽة، وȃʰʙء العلاج الʢارȏ Ǽالاســ ـــ ــ ـــ ـــ ــʱʻاد إلى مʙȐ وخامة في ǽعانʨن مʧ الʺʛض الʵفʽف،الʺʛضـ ـــ ــ ـــى الʚيʧ ولا يلʜم إيʙاع الʺʛض. تʙهʨر حʙوث الʺʶʱʷفʽات إلا إذا ؗان هʻاك ما يʙعʨ للقلȘ Ǽʷأن إمȞانʽة ʺʛض الʵفʽف، ǽʺȞʧ إصــ ــ ـــ ـــ ــ ــابʱهʦ Ǽال. وفي حال (3) حالʱهʦســـ ــ ــــ ــ ـــʛȄع في وȄʷـ ــ ــــ ــ ـــʺل الʺʛضـ ــــ ــ ــ ـــى الآخʛون الʚيʧ الʻʤʛ في تقʙǽʦ الʛعاǽة في الʺʻʜل. عانʨن مʧ الأعʛاض ǽʺȞʧ رعايʱهʦ في الʺʻʜل، الʺʛضــ ـــ ــ ــــ ـــى الʚيʧ مازالʨا ǽ الʰقاء في الʺʶـʱʷـفى، والʴالات الʱي حالاتهʦ أصـʰʴʗ لا تʶـʱʙعي ولؔʧ وȄʺȞʧ الʻʤʛ أǽʹـــًا في ؛ʙخʨل الʺʶـــʱ ʷـ ــفىرافʹـــًا لاتʵʚت قʛارًا مʶــʱـ ʻʽʛًا تʨافʛ الʛعاǽة داخل الʺʶــــ ــʱʷـــ ــفʽات أو في حال عʙم تقʙǽʦ الʛعاǽة الʺʻʜلʽة غʽʛ مʨاردهاة مʴʙودة، أو الاسʱـ ʽعابʽ قʙرتها)عʻʙما تؔʨن عʙم مأمʨنʽʱها ى خʙمات الʛعاǽة الʸʴʽة، مʲًلا(.كافʽة لʱلʰʽة الʢلʖ عل وفي أȑ مʧ هʚه الʴالات، ǽʺȞʧ تقʙǽʦ الʛعاǽة الʺʻʜلʽة إلى الʺʛضــ ـــ ــ ــــ ــ ــى مʧ حالات مʛضʽــ ة مʜمʻة أســاسـا ً ولا ǽعانʨن 1الʺʸــابʽʧ Ǽأعʛاض خفʽفة مʲل أمʛاض الʛئة أو القلʖ، أو الفʷل الؔلʨȑ أو حالات نقʟ الʺʻاعة - ض الʺʛȄʠ لʜȄادة مʵاʡʛ الإصاǼة Ǽالʺʹاعفات. وȄʱʢلʖ هʚا عʛ ّالʱي ت ُ القʛار الʴȞʦ الʶـــ ــــʛȄʛȑ الʺʱأني وȄʻʰغي أن ǽʶــ ــ ـــʱʛشــ ــــʙ بʱقʽʽʦ مʙȐ مأمʨنʽة 2الʰʽʯة الʺʻʜلʽة للʺʛȄʠ. ي ُتقــʙم فʽهــا الʛعــاǽــة في الʺʻʜل، يʻʰغي أن يʱʨلى أحــʙ وفي الʴــالات الʱ العاملʽʧ في الʛعاǽة الʸـ ــــʴʽة إجʛاء تقʽʽʦ للʱʴقȘ مʧ مʙȐ ملاءمة الʰʽʯة الʺʻʜلʽة لʱقʙǽʦ الʛعاǽة الʸــ ــ ـــʴʽة، وȄʳʖ على هʚا العامل تقʽʽʦ مʙȐ قʙرة الʺʛȄʠ وأســــʛته على الالʱʜام Ǽالاحʱʽاʡات الʱي ســ ــʽʨصــ ــي بها في إʡار أجل الʛعاǽة الʺʻʜلʽة )مʲل نʤافة الʽʙيʧ والʻʤافة الʱʻفʶــ ـــ ــ ـــ ـــʽـ ـة العʜل مʧ قʙرتهʦ و ،(الʵʛوج مʻهوالʻʤافة الʰʽʯʽة والʴʙ مʧ الʱʴʛك داخل الʺʻʜل أو معـال ʳـة مʸـــ ــ ــــ ــ ــ ـــادر القلȘ الʺʱعلقـة Ǽـالʺـأمʨنʽـة )م ʲـل مʵـاʡʛ ابʱلاع على الʺʴلʨل الؔʴʨلي لʱ ــʙلʽ ــʥ الʽ ــʙيʧ عʧ ʡʛȄȘ الʵʢــأ ومʵــاʡʛ نʷـ ـــ ــ ــــ ــ ـــʨب (.ʺة عʻهالʻاجالʴʛائȘ للاتʸــ ـــ ـــ ــ ـــال Ǽʺقʙم الʛعاǽة الʸــ ـــ ـــ ــ ــʴʽة أو العاملʽʧ تʴʙيʙ وســـ ــ ـــ ـــ ʽــ لةوȄʻʰغي Ǽالʛعاǽة الʸــ ـــ ـــ ــ ـــ ــʴʽة، أو ؗلʽهʺا، ʡʨال مʙة الʛعاǽة الʸــ ـــ ــ ـــ ــــʴʽة، أȑ حʱى . وȄلʜم الʴʸـ ــ ــــʨل على تʺاما ً تʻʱهي الأعʛاض الʱي ǽʷــ ــ ـــȞʨ مʻها الʺʛȄʠ لʱʴʙيʙ وانʱقالها 91-معلʨمات شــ ــ ـــ ـــ ـــاملة عʧ ʡʛȄقة العʙوȐ Ǽʺʛض ؗʨفʽʙ مʙة الاحʱʽاʡات الʵاصة Ǽالعʜل الʺʻʜلي. وȄʻʰغي تʨعʽة الʺʛضـى وأفʛاد الأسـʛة الʺعʽʷʽـ ة Ǽʷـأن الʻʤافة الʷـʵʸʽـ ة، والʱʙابʽʛ الأسـ ــــ ــ ــــاسـ ـــ ــ ـــ ــʽة للʨقاǽة مʧ العʙوȐ ومȞافʴʱها، ؗو ʽفʽة رعاǽة الفʛد أو الʺʷــʱʰه في إصــابʱه Ǽه Ǽأقʸــى قʙر مʧ 91-الʺʸــاب Ǽʺʛض ؗʨفʽʙ ل العʙوȐ إلى مʵالʢʽه مʧ أفʛاد الأســــ ــ ـــʛة الʺعʽʷـ ـــ ــ ـــʽة. الʺأمʨنʽة لʺʻع انʱقا الʛصʙ وȂجʛاءتقʙǽʦ الʙعʦ والʱʨعʽة إلى الʺʛȄʠ وأسʛته، مʨاصلة وȄʻʰغي يʻʰغي أن ǽʺʱʲل الʺʛضــ ـــ ــ ــــ ــ ــى ؗʺا ʡʨال مʙة الʛعاǽة الʺʻʜلʽة. الʺʶــ ـــ ــ ـــ ـــ ــʱʺʛ وأسʛهʦ للʱʨصʽات الʱالʽة: ʚ )أȑ بها نʨاف لʨحʙه ضـ ـــ ـــ ـــ ــع الʺʛȄʠ في غʛفة جʽʙة الʱهʨȄةو يʻʰغي  مفʱʨحة وȃاب مفʱʨح(. "ج" تʛد قـ ـــائʺــــة مʛجعʽــــة لʱقʽʽʦ الʤʛوف الʰʽʯʽ ــــة في الʺʻʜل، في الʺلʴȘ 2 .2للʺʛجع ( الʺʸʴʨȃة Ǽأعʛاض خفʽفة والʱʙبʽʛ العلاجي لʺʵالʢʽهʦ91-ؗʨرونا الʺʶʱʳʙ )كʨفʽʙالʛعاǽة الʺʻʜلʽة للʺʛضى الʺʸابʽʧ ǼعʙوȐ فʽʛوس -2- اتʴʙ مʧ الʺʶـ ـــ ـــ ـــ ــاحالʙ مʧ حʛؗ ة الʺʛȄʠ داخل الʺʻʜل و الʴيʻʰغي  أن الʺʶــ ـــاحات الʺʷــ ـــʱʛؗ ة ʱأكʙ مʧالو إلى أدنى قʙر. معه الʺʷـــ ــʱʛؗ ة اســـ ـــ ــ ـــʱʰقاء الʻʨافʚ مفʱʨحة، Ǽ)مʲل الʺʢʰخ ودورة الʺʽاه( جʽʙة الʱهʨȄة ) .مʲًلا( تعʚر غʛفة مʵʱلفة، أو إذايʻʰغي لأفʛاد الأسـʛة الʺعʽʷʽـ ة الإقامة في  ʧ الʷــ ـــ ـــ ــ ــــʵʟ عمʱʛ واحـ ــʙ على الأق ـــل الابʱعـــاديʻʰغي لهʦ ذل ـــʥ، 3، مʲًلا(.مʻفʸلالʺʛȄʠ )الʻʨم على فʛاش في الʴــالات الʺʲلى، و الʛعــاǽــة. القــائʺʽʧ علىمʧ عــʙد الʴــʙيʻʰغي  مʧ حالات أساسا ً شʵʟ واحʙ يʱʺʱع Ǽʸʴة جʽʙة ولا ǽعاني تعʽʽʧ Ȅʻʰغي عʙم الʶــ ـــ ــ ـــ ـــ ــʺاح و ( 3لʺʻاعة.)مʛضــ ـــ ـــ ــ ـــ ʽــ ة مʜمʻة أو مʧ نقʟ ا علامات الʺʛض وتʜولللʜوار Ǽعʽادة الʺʛȄʠ حʱى ǽȞʱʺل شـ ــ ـــ ــــ ــفاؤه وأعʛاضه. ل مع الʰʽʯة أو تعام ُ لʺʛȄʠلقʰل أȑ مʵالʢة تʻʤʽف الʽʙيʧيʻʰغي  تʻʤʽف الʽʙيʧ قʰل إعʙاد الʢعام أǽʹــ ـــ ـــ ــ ـــ ــًا (. وȄʻʰغي 4) الʺʴʽʢة Ǽه وȃعʙه، وقʰل تʻاول الʢعام، وȃعʙ اسʱʵʙام دورة الʺʽاه، ؗو لʺا اتʶʵʗ ، ǽʺȞʧ للعʽان مʱʶـʵʱʽʧ على نʴʨ واضـح الʽʙانالʽʙان. وȂذا لʦ تؔʧ ʱʽʧمʱʶــ ـــ ـــ ــ ـــ ــʵ اإذا ؗانʱوأما ،ا Ǽʺʴلʨل ؗʴʨلي لʱʙلʽʥ الʽʙيʧʺتʻʤʽفه يلʜم اسʱʵʙام الʺاء والʸابʨن. للعʽان على نʴʨ واضح ورقʽة مʻاشـففʹــل اسـʱʵʙام وعʻʙ غʶـل الʽʙيʧ Ǽالʺاء والʸـابʨن، ǽ ُ  م ا. وفي حال عʙم تʨافʛها، اســ ــ ـــʱʵʙهʺاتʳفʽففي تُʶ ـــ ــ ʱــ ʵʙم مʛة واحʙة .ؗلʺا ابʱلʗ لهاابʙوȂمʻاشف نʤʽفة مʸʻʨعة مʧ القʺاش 4ولاحʱʨاء الإفʛازات الʱʻفʶـ ــــ ــ ـــ ــ ـــʽــة، يʻʰغي تʜوȄــʙ الʺʛȄʠ Ǽقʻــاع ʡʰي  على أن يʙاوم على اسـ ـــ ـــ ـــʱـ ʵʙامه قʙر الإمȞان. وفي حال عʙم تʴʺل الʷـــ ــ ـــ ـــ ــʵʟ للقʻاع الʢʰي، يʻʰغي له اّتʰاع تʙابʽʛ الʻʤافة الʱʻفʶـــ ــ ـــ ـــ ــʽة أȑ تغʢʽة الفʦ والأنف Ǽʺʻاديل ورقʽة تُʶ ــʱʵʙم مʛة واحʙة -Ǽʸــʛامة عʻʙ الʶــعال أو العʢʝ. وȄʻʰغي الʱʵلʟ مʧ الʺʨاد الʺʶʱــ ʵʙمة في أو تʻʤʽفها جʽʙًا Ǽعʙ اســ ـــ ـــ ــ ـــ ʱــ ʵʙامها )أȑ غʶــ ـــ ـــ ــــ ـــل تغʢʽة الفʦ والأنف الʺʻاديل Ǽاسʱʵʙام الʺاء والʸابʨن أو الʺʻʤفات(. ʴȞʦ ǽغʢي الفʦ الʛعاǽة وضـ ـــ ـــ ــ ـــ ـــع قʻاع ʡʰي م ُ للقائʺʽʧ علىوȄʻʰغي  Ȅʻʰغي عʙم و والأنف عʻʙما ǽȞʨنʨن في الغʛفة نفʶــ ــــ ــ ــها مع الʺʛȄʠ. لʺʝ القʻاع أو تʴʛȄȞه أثʻاء الاســـʱʵʙام. وȂذا أصـــʰح القʻاع مʰʱًلا أو Ȅʻʰغي و مʱʶــ ـــ ـــ ــ ـــʵًا ǽʳʖ إبʙاله على الفʨر Ǽقʻاع جʙيʙ نʤʽف وجاف. نʜع القʻاع Ǽاســ ــ ـــ ـــʱـ ʵʙام الʢʛȄقة الʶــ ـــ ــ ـــلʽʺة، أȑ Ǽفʥ الʛȃاȋ دون لʺʝ ʱʵلʟ مʧ القʻــاع على الفʨر Ǽعــʙ اســ ـــ ـــ ـــ ــ ʱــ ʵــʙامــه الو الʳʜء الأمــامي. .ʽʙيʧوتʻʤʽف ال تʳʻʖ الʺلامʶـــة الʺʰاشـــʛة لʶـــʨائل الʳʶـ ــʦ، ولاســـʽʺا الإفʛازات يʻʰغي  م قفازȄʧ ǽُʶـʱـ ʵʙمان مʛة واحʙة ااسـʱـ ʵʙو ،الفʺʨȄة أو الʱʻفʶــʽة، والʰʛاز قʰل وتʻʤʽف الʽʙيʧعʻʙ ملامʶــ ـــ ـــ ـــة الʰʛاز والʰʨل وأȑ نفاǽات أخʛȐ. وȃعʙ خلع القفازȄʧ والقʻاع. اسʱʵʙام القʻاع أو القفازȄʧ. عʙم إعادةيʻʰغي  مʵʸـــ ــ ــــّ ʸـــ ـــ ـــة لʢعام لة وأدوات ʛ ّلأســ ـــ ــــِ لم مفʛوشــ ــ ـــ ــات ااســــ ــ ــʱـ ʵʙيʻʰغي  للʺʛȄʠ، وȄʻʰغي غʶـــ ـــ ـــ ــ ــــل هʚه الأشـ ـــ ــ ــــ ــ ـــʽاء Ǽالʺاء والʸـ ــ ـــ ــ ـــ ــــابʨن Ǽعʙ وȄʺȞʧ إعادة اسʱʵʙامها بʙًلا مʧ الʱʵلʟ مʻها. ،الاسʱʵʙام الأسʢح الʵاصة Ǽالاسʱʵʙامات الʽʨمʽة الʱي تʻʤʽف وتʢهʽʛيʻʰغي  يʱؔʛر لʺʶــ ــ ــــ ــ ــ ـــهـا في الغʛفـة الʱي يʱلقى فʽهـا الʺʛȄʠ الʛعـاǽــة، مʲـل لفʨائʙ الʱي تعʨد بها إلى اǽʺȞʧ اسʱʲʻاء الأمهات الʺʛضعات مʧ ذلʥ. نʤʛًا 3 الʛضــ ــاعة الʢʰʽعʽة وعʙم أهʺʽة دور لʰʧ الأم في انʱقال ســ ــائʛ الفʽʛوســـــات الʱي تʸـ ــʽʖ الʳهاز الʱʻفʶـــي، فإنه في إمȞان الأم أن تʶــʱـ ʺʛ في الإرضـ ــاع. وȄʻʰغي وأن تʻʤف يʙيها قʰل وȃعʙ للأم أن تʹــ ـــع قʻاعًا ʡʰʽًا عʻʙما تقʱʛب مʧ الʛضــــʽـ ع مʵالʢة الʛضʽع عʧ قʛب. ؗʺا سʽلʜم علʽها اّتʰاع سائʛ تʙابʽʛ الʻʤافة الʸʴʽة الʺʨضʴة في هʚه الʨثʽقة. الأقʻعة الʢʰʽة هي الأقʻعة الʺʶـــʢʴة أو ذات الʢʽات )يʱʵʚ Ǽعʹـــها شـ ــȞل 4 خʽʨȋ الؔʨب( الʱي ُتʶʱʵʙم في الʳʛاحة أو العʺلʽات، وتʲُʰʗ في مȞانها بʨاسʢة ُتʛȃȌ خلف الʛأس. غʛفة أثاثالʺʻاضـــʙ الʺʳاورة للفʛاش وأʡʛ الأســـʛة وسـ ــائʛ عʻاصـ ــʛ الʻʨم. وȄʻʰغي اسـ ــ ــʱـ ʵʙام الʸـ ــ ـــابʨن أو الʺʻʤف الʺʻʜلي العادȑ أوًلا، لʺʻʜلي العادȑ الʚȑ ثʦ Ǽعʙ الʷـ ـــ ـــ ـــ ــ ـــʢف Ǽالʺاء، اســ ـــ ـــ ـــ ــ ــʱʵʙام الʺʢهʛ ا )أȑ ما ǽعادل ٪5.0ǽʴʱʨȑ على هʽʰʨؗ لʨرȄʗ الʸـ ـــ ــ ـــ ــʨديʨم بʻʶـ ــ ـــ ـــ ــʰة 5أجʜاء مʧ الʺاء(. 9مʽȞʛومʱʛ أو جʜءًا واحʙًا لؔل 0005 مʛة واحʙة وتʢهʽʛهادورة الʺʽاه وأســ ـــ ــ ـــ ـــ ــʢح الʺʛحاض تʻʤʽف يʻʰغي  يʨمʽًا على الأقل. وȄʻʰغي اســ ـــ ــ ــʱʵʙام الʸــ ـــ ــــابʨن أو الʺʻʤف الʺʻʜلي ، ثʦ Ǽعʙ الʷـ ــــ ــ ـــ ـــ ــʢف Ǽالʺاء، اســ ـــ ــ ـــ ـــ ــʱʵʙام الʺʢهʛ الʺʻʜلي العادȑ أولا ً 5.٪5.0العادȑ الʚȑ ǽʴʱʨȑ على هʽʰʨؗلʨرȄʗ الʸʨديʨم بʻʶʰة ملاǼʝ الʺʛȄʠ ومفʛوشــات الʶــʛȄʛ ومʻاشــف الʴʺام تʻʤʽفيʻʰغي  غʶـ ــ ـــلها في صـــ ـــابʨن الغʶـ ــ ـــʽل العادȑ أو و والأيʙȑ Ǽاســ ـــʱـ ʵʙام الʺاء درجــة مʯʨȄــة 09و 06على درجــة تʱʛاوح بʽʧ غʶــ ــــ ــ ــــ ــ ـــالــة الʺلاǼʝ ضــــ ــــع وȄʻʰغي و جʽʙًا. وتʻʷـــ ــ ـــʽفهاǼاســ ـــ ــʱʵʙم الʺʻʤف الʺʻʜلي الʺعʱاد نفʠ الʺفʛوشـــ ــ ـــ ــات ، وعʙمالʺفʛوشـ ـــ ـــ ـــات الʺلʨثة في ؗʽʝ للغʶــ ـــ ــ ـــʽل .ʺلاǼʝالأو ʳلʙلوتʳʻʖ ملامʶة الأدوات الʺلʨثة ل ،الʺلʨثة الʰلاســ ـــ ــ ـــʱʽȞʽة( ةفازȄʧ وملاǼʝ واقʽة )مʲل الʺʽʙعيʻʰغي اسـ ـــ ــ ـــʱـ ʵʙام ق  عʻʙ تʻʤʽف الأســ ــ ــــ ــ ـــʢح أو مʻاولة الʺلاǼʝ أو الʺفʛوشــ ــــ ــ ــ ـــات الʺلʨثة Ǽʶʨائل الʳʶʦ. وȄʺȞʧ اسʱʵʙام قفازات الأعʺال الʺʻʜلʽة أو القفازات وȃعʙ الاســ ـــ ـــ ــʱʵʙام، يʻʰغي . لʤʛوفوفقًا ل، الʱي ُتʶـ ــــ ــ ـــʱعʺل مʛة واحʙة الأعʺال الʺʻʜلʽة Ǽالʺاء والʸــــ ـــ ــ ـــ ــــابʨن وȂزالة الʱلʨث غʶــ ــ ـــ ـــ ـــ ــل قفازȑ . وأمـا ٪5.0ʙام مʴلʨل هʽʰʨؗ لʨرȄـʗ الʸــ ـــ ــ ـــ ـــ ــʨديʨم بʱʛؗ ʽʜ Ǽـاســ ـــ ـــ ــ ـــ ــʱʵـ ʻʱʛȄل أو الʺ ʸــ ـــ ــ ـــʻـ ʨعان مʧ الالقفازان اللʚان ǽُ ʶــ ـــ ــ ــــʱعʺلان مʛة واحʙة ) وتʻʤʽف الʽʙيʧلاتؔʝ( فʽʻʰغي الʱʵلʟ مʻهʺا Ǽعʙ ؗل اســ ـــʱـ ʵʙام. ال قʰل وȃعʙ خلع القفازȄʧ. يʻʰغي وضــ ــ ــــ ــ ــع القفازات والأقʻعة وســ ـــ ـــ ــــائʛ الʻفاǽات الʱي تʱʛاكʦ أثʻاء  اǽة الʺʻʜلʽة للʺʛȄʠ في صʻʙوق قʺامة مʜود Ǽغʢاء يʨضع في الʛع 6غʛفة الʺʛȄʠ قʰل الʱʵلʟ مʻها بʨصفها نفاǽات معʙǽة. الʱي ǽʶـ ـــʱـ ʵʙمها أخʛȐ للأدوات الʺلʨثة Ǽʢʛق تʳʻʖ الʱعʛضيʻʰغي  في اسʱʵʙام فʛشاة الأسʻان مʷاؗر ʱه)عʙم الʺʛȄʠ اسʱʵʙامًا مʰاشʛا ً أو الʶـ ــ ـــ ـــ ــــʳائʛ أو أدوات الʢعام أو الʸـ ـــ ـــ ــ ــــʴʨن أو الʺʷــ ـــ ـــ ــ ـــʛوȃات أو ة(.ʛ ّالʺʻاشف أو أدوات تʻʤʽف الʳʶʦ والاسʱʴʺام أو مفʛوشات الأس ِ عʻʙما ǽقʙم العاملʨن في الʛعاǽة الʸʴʽة العʻاǽة الʺʻʜلʽة، يʻʰغي لهʦ  ئʺهʦ مʻها،لاخʱʽار ما يلاإجʛاء تقʽʽʦ لʺعʙات الʴʺاǽة الʷـــ ــ ـــʵʸـ ـــ ــ ــʽة واّتʰاع الʱʨصʽات Ǽʷأن الاحʱʽاʡات الʵاصة Ǽالُقʢʽʛات وȃالʺʵالʢة. ىالʱʙبʽʛ العلاجي لʺʵالʢي الʺʛض الʛعاǽة والعاملʨن في الʛعاǽة القائʺʨن على)Ǽʺا في ذلʥ ǽُعʙ الأشـــʵاص 91-الʸــʴʽة( الʚيʧ تعʛضــʨا للأشــʵاص الʺʸــابʽʧ ǼعʙوȐ مʛض ؗʨفʽʙ حالʱهʦ ال ʸـʴʽةالʺ ʷـʱʰه فʽها، مʵالʢʽʧ للʺʛȄʠ وȄʻʰغي نʸـʴهʦ بʛصـʙ يʨمــًا مʧ Ǽعــʙ الʽʨم الأخʽʛ الـʚȑ ǽʴʱʺــل أن ǽȞʨنʨا قــʙ خـالʢʨا 41لʺــʙة فʽه الʺʛȄʠ. ʱعʛض لأȑ مʺا يلي: ال له مʵالȌ الʺʛȄʠ هʨ شʵʟ سʰȘو مʵــالʢـة مʛتʰʢـة Ǽـالʛعـاǽـة الʸــ ـــ ـــ ــ ـــ ــʴʽــة، Ǽʺـا في ذلـʥ تقـʙǽʦ الʛعـاǽـة  ، أو العʺل مع 91-لʺʛȄʠ الʺʸــ ـــ ــاب Ǽʺʛض ؗʨفʽʙإلى االʺʰاشــ ـــ ــʛة ٪.5تʴʱʨȑ معʤʦ مʴالʽل الʱʰʽʽʠ على هʽʰʨؗ لʨرȄʗ الʸــــ ـــ ـــʨديʨم بʻʶـ ــــــــʰـ ة 5 وȄʺȞʧ الاʡلاع على الʱʨصʽات الʵاصة Ǽʢʛق حʶاب تʵفʽف مʴالʽل الʱʰʽʽʠ إلى تʛؗ ʽʜ معʽʧ على الʛاǼȌ الʱالي: ecruoser/sfdp/iah/vog.cdc.www//:sptth-latnemnorivne/detimil-gninaelc- fdp.805 يʻʰغي للʶـــــ ـــلʢات الʺʴلʽة الʺʶــ ـــ ـــʕولة عʧ الʻʤافة أن تʱʵʚ تʙابʽʛ لʹــ ـــ ـــʺان 6 الʱʵلʟ مʧ الʻفاǽات في مʙفʧ قʺامة صـــــ ـــ ــ ــʴـ ي ولʽʝ في مقلʖ نفاǽات مفʱʨح غʽʛ خاضع للʛصʙ. ( الʺʸʴʨȃة Ǽأعʛاض خفʽفة والʱʙبʽʛ العلاجي لʺʵالʢʽهʦ91-ؗʨرونا الʺʶʱʳʙ )كʨفʽʙالʛعاǽة الʺʻʜلʽة للʺʛضى الʺʸابʽʧ ǼعʙوȐ فʽʛوس -3- أحʙ العاملʽʧ في الʛعاǽة الʸـــʴʽة الʺʸـ ــابʽʧ Ǽالفʽʛوس الʚȑ ǽُʶـــʰʖ ، أو زȄارة الʺʛضـ ــ ـــ ـــى أو الʺȞʨث في الʰʽʯة نفʶـــــ ــ ــها 91-مʛض ؗʨفʽʙ ؛91-يʨجʙ بها أحʙ الʺʛضى الʺʸابʽʧ Ǽʺʛض ؗʨفʽʙالʱي الʱعʛض عʧ ʡʛȄȘ العʺل عʧ قʛب مع أحʙ الʺʛضــ ــ ــــى الʺʸـ ـــ ــــابʽʧ  أو الʱʨاجʙ في الف ʸــل الʙراســي نفʶــه الʚȑ يʨجʙ 91-Ǽʺʛض ؗʨفʽʙ فʽه الʺʛȄʠ؛ الʱعʛض عʧ ʡʛȄȘ الʶـــ ــ ــــفʛ مع أحʙ الʺʛضـــ ـــ ـــى الʺʸــ ـــ ــــابʽʧ Ǽʺʛض  أȑ نʨع مʧ الʺʛؗ ʰات؛ على مʱʧ 91-كʨفʽʙ أحـʙ عʧ ʡʛȄȘ الإقـامـة في الʺʻʜل نفʶــ ـــ ـــ ـــ ــ ـــه الـʚȑ أقـام فʽـه الʱعʛض  ، خلال الأǽام الأرȃعة عʷـــʛ 91-Ǽʺʛض ؗʨفʽʙ الʺʛضـــى الʺʸـــابʽʧ (5الʱي تلʗ ʣهʨر الأعʛاض علʽه.) الʛعـاǽـة تʴـʙيـʙ ʡʛȄقـة للʱʨاصـــ ــ ــــ ــ ـــ ــل مع أحـʙ مقـʙمي للقـائʺʽʧ علىوȄʻʰغي الʛعاǽة الʸـʴـ ʽة ʡʨال فʱʛة الʺʛاقʰة. ؗʺا يʻʰغي لʺʨʣف الʛعاǽة الʸــʴʽة اســʱعʛاض صــʴة مʵالʢي الʺʛȄʠ Ǽانʱʤام عʰʛ الهاتف، وȄُʶــʱʴʶــʧ إن له أمȞʧ، أن ǽȞʨن ذلʥ مʧ خلال زȄارات شــ ــʵـ ʸــ ـــʽة يʨمʽة حʱى يʱʶـــ ــʻى الاقʱʹاء. إجʛاء اخʱʰارات تʷʵʽʸʽة مʴʙدة حʶʖ وȄʻʰغي لʺقʙم الʛعاǽة الʸـ ـــʴʽة تʜوȄʙ مʵالʢي الʺʛȄʠ Ǽالʱعلʽʺات مقʙمًا لʽعʛفʨا مʱى وأيʧ يʻʰغي لهʦ الʱʺاس الʛعاǽة إذا ما أصـــ ــابهʦ الʺʛض، وما هي أفʹـــل وســʽـ لة ǽʺȞʧ اســـʱʵʙامها للانʱقال، ومʱى وأيʧ ǽʺȞʻهʦ الʙخʨل ت الʨقـاǽـة مʧ إلى مʛافȘ الʛعـاǽـة الʸــ ـــ ــ ـــ ـــ ــʴʽـة الʺʴـʙدة، ومـا هي احʱʽـاʡـا العʙوȐ ومȞافʴʱها الʱي يʻʰغي لهʦ اتʰاعها. وȂذا ʣهʛت الأعʛاض على أحــ ــ ـــʙ مʵـــ ــــالʢي الʺʛȄʠ، يʻʰغي اتʵــ ـــ ـــاذ الʵʢʨات الʱالʽة: ر الʺʛفȘ الʢʰي الʚȑ سـ ـــ ـــ ــʽʶــــ ــ ـــʱقʰل مʵالȌ الʺʛȄʠ الʚȑ بʙت اخʢإ  .سʽʛاجعهعلʽه الأعʛاض Ǽأنه له وعʻʙ انʱقال الʷــ ــ ــــ ــ ـــʵʟ الʺʛȄʠ للʴʸـــ ـــ ـــ ــــʨل على الʛعاǽة يʻʰغي  وضع قʻاع ʡʰي. وȄʻʰغي لʺʵالȌ الʺʛȄʠ أن يʱʳʻʖ ؗر ʨب وســـ ـــ ـــ ــائل الʻقل العامة إن  أمȞʧ عʻʙ ذهاǼه إلى الʺʛفȘ؛ وȄʺȞʧ الاتʸـ ـــال Ǽʶــ ــʽارة إســــعاف، أو نقل هʚا الʺʛȄʠ في مʛؗ ʰة خاصة مع فʱح جʺʽع نʨافʚها إن أمȞʧ. وȄʻʰغي نʸـــح مʵالȌ الʺʛȄʠ الʺʸـــاب Ǽالأعʛاض Ǽاّتʰاع إجʛاءات  الʻʤافة الʱʻفʶـ ـــ ـــ ـــʽـ ة وتʻʤʽف الʽʙيʧ على الʙوام وȃالʨقʨف أو الʳلʨس أǼعʙ ما ǽʺȞʧ عʧ الآخʛȄʧ )مʱʛ واحʙ على الأقل( عʻʙ مʛوره وعʻʙ مȞʨثه في مʛفȘ الʛعاǽة الʸʴʽة. و غʽʛها مʧ وȄʻʰغي تʻʤʽف أȑ أسـ ــ ــʢح تʱلʨث Ǽالإفʛازات الʱʻفʶـــ ʽــ ة أ  Ǽالʸابʨن أو الʺʻʤف الʺʻʜلي ثʦ تʢهʽʛها ،سʨائل الʳʶʦ أثʻاء الʻقل مʧ ٪5.0Ǽأحʙ الʺʻʱʳات الʺʻʜلʽة العادǽة الʱي تʴʨȑ على نʶــ ـــ ــ ـــ ـــ ــʰة مʴلʨل الʱʰʽʽʠ. شȞʛ وتقʙيʛ أُعʙت الʻʶــʵة الأصــلʽة للإرشــادات الʵاصــة Ǽالʨقاǽة مʧ العʙوȐ Ǽفʽʛوس والʱي ،(1الʷـʛق الأوسـȌ الʱʻفʶʽـ ة ومȞافʴʱها )كʨرونا الʺʶـʰʖ لʺʱلازمة شــلؔʗ أســاســًا ل ʸــʽاغة هʚه الʨثʽقة، Ǽالʱʷــاور مع خʰʛاء الʷـʰـ Ȟة العالʺʽة للʨقاǽة مʧ العʙوȐ ومȞافʴʱها الʱاǼعة لʺʻʤʺة الʸــ ـــ ـــ ــ ـــ ــʴة العالʺʽة وغʽʛهʦ مʧ الʵʰʛاء الʙولʽʽʧ. وتʷـ ـــ ـــ ــȞʛ الʺʻʤʺة ؗل مʧ شـــ ـــ ـــارك في إعʙاد الʨثʽقة العʙوȐ Ǽفʽʛوس ؗʨرونا الʺʶــ ـــʰـ ʖ لʺʱلازمة الʷــ ــــʛق الʵاصـــ ـــة Ǽالʨقاǽة مʧ الأوسȌ الʱʻفʶʽة ومȞافʴʱها. ،وتʱقʙم الʺʻʤʺة ǼالʷȞʛ إلى الأشʵاص القائʺʽʧ على عʺلʽة الاسʱعʛاض الʺʶــ ــــ ــ ـــʽʛȑ، الʺʙيʛ العام لʺȞافʴة العʙوȐ، .: عʰʙ الله مالʱالʽة أسـ ـــ ــ ـــ ــʺاؤهʦ مʙيʛ شــ ــعʰة وزارة ال ʸــ ــʴة Ǽالʺʺلؔة العʛȃʽة الʶــ ــعʨدǽة؛ وماǽȞل بل، نائʖ تعʜȄʜ جʨدة الʛعاǽة الʸـ ـــ ـــ ـــ ــ ـــʴʽة، مʛاكʜ مȞافʴة الأمʛاض والʨقاǽة مʻها، أتلانʱا، جʨرجʽا، الʨلاǽات الʺʱʴʙة الأمʛȄȞʽة؛ وغʽل ؗارسʨن، مʛؗ ʜ الʙعʦ العالʺي الʱاǼع للاتʴاد العالʺي الʺعʻي Ǽأمʛاض الʳهاز الʱʻفʶــ ـــ ــ ـــ ـــي الʴادة الʺعʻي Ǽالأمʛاض والʺʶـــ ــʱʷــ ـــار الʱʻʺʽة، مʙيʛ شـــ ــʰȞة والʺʶــ ــʱـ ʳʙةالʨخʽʺة الʺعʙǽة والʺʶــ ــ ــــʱʷــ ــ ــــار الفʵʛȑ لʨؗ الة الʸـــ ـــ ʴــ ة العامة الإنؔلʽʜȄة، الʺʺلؔة والʺʻـــاعʽـــات اؗʨنلي، قʶــ ـــ ــ ـــ ـــ ــʦ الʢـــʖ والʺʽȞʛوȃʽʨلʨجʽـــ .جʨن م الʺʱʴـــʙة؛ والأمʛاض الʺعʙǽة، معهʙ ؗالفʧ وفʽʰي وجʨان ســʻـ ايʙر للأمʛاض الʺʜمʻة، ʶــ ــ ـــ ــ ـــʨن، شـــ ـــ ــ ــــعʰة كلʽة الʢʖ Ǽʳامعة ؗالغارȑ، ؗالغارȑ، ؗʻʙا؛ وȃارȑ ؗʨؗ ʙوȑ، العʙوȐ والʺʻاعة ǼȞلʽة لʻʙن الʳامعʽة، الʺʺلؔة الʺʱʴʙة؛ وȃاǼاكار ن ْ شʰȞة مȞافʴة العʙوȐ، داكار، الʶʻغال؛ ؗو اثلʽʧ دن، مʙيʛة عʹʨ مʳلʝ فʛع العʙوȐ الʺʛتʰʢة Ǽالʛعاǽة الʸــ ــ ـــ ــ ـــʴʽة والʨقاǽة مʧ العʙوȐ ومȞافʴʱها، لʷـ ـــ ـــʰـ Ȟة للʱʨجʽهʽة ؗو الة الʸــ ــ ــــʴة العامة في ؗʻʙا؛ وديل فʽʷـ ـــ ــ ــʛ، اللʳʻة ا العالʺʽة للإنʚار Ǽʴʙوث الفاشـــ ــʽات ومʨاجهʱها؛ وفʛنانʙا لʽʶـ ــ ــا، أخʸــ ـــائʽة وȃائʽات، شـ ــ ــــعʰة تعʜȄʜ جʨدة الʛعاǽة الʸـ ــ ــــʴʽة، مʛاكʜ مȞافʴة الأمʛاض ومʨȑ لʽʧ والʨقــاǽــة مʻهــا، أتلانʱــا، جʨرجʽــا، الʨلاǽــات الʺʱʴــʙة الأمʛȄȞʽــة؛ ورئʽʶـ ـــ ـــ ـــ ــ ــة جʺعʽة مȞافʴة لʽʻغ، مʙيʛة إدارة مȞافʴة العʙوȐ، ســـ ـــ ـــ ــ ـــʻغافʨرة، ʗ، مʙيʛ بʛنامج مȞافʴة العʙوȐ في آسـ ـــ ــ ـــ ـــʽـ ا والʺʴʽȌ الهادȏ؛ وديʙيʽه ب ʱʽِ الʸـــ ـــ ــ ـــʴة العالʺʽة Ǽʷــ ـــ ـــ ــأن ســ ــ ــــ ـــلامة العʙوȐ والʺʛؗ ʜ الʺʱعاون مع مʻʤʺة الʺʛضـــ ــى، جامعة مʶـــ ــʱʷـــ ــفʽات جʻʽف، ؗو لʽة الʢʖ، جʻʽف، سـ ــ ــʨȄʶــــ ــʛا؛ العــــʙوȐ وفʛنــ ــانــ ــʙو أوتـ ـــايʜا أورايʧ، رئʽʝ الʰʛنـ ـــامج الʨʡʻي للʨقـ ـــاǽــ ــة مʧ ومȞافʴʱها، وزارة الʸــ ـــʴـ ة، ســ ــ ــانʱʽاغʨ، شــ ـــʽـ لي؛ ودǽامانʱʽʝ بلاشــ ــــʨراس، وحʙة دعʦ الʱʛصـــ ــ ـــʙ والاســ ـــ ـــʱـ ʳاǼة، الʺʛؗ ʜ الأوروȃي للʨقاǽة مʧ الأمʛاض ووȄʻغ هʨنغ سـ ـــʽـ ʱʨ، إدارة الʢʖ الʺʳʱʺعي، ومȞافʴʱها، ســ ـــʨلʻا، الʶــ ـــʨȄʙ؛ كلʽة الʸــ ـــʴة العʺʨمʽة، جامعة هʨنغ ؗʨنغ، الʸــ ـــʽʧ، مʻʢقة هʨنغ ؗʨنغ الإدارȄة الʵاصـــة؛ ونانʙيʻي شـــʽʱي، خʰʽʛ اســـʱʷـــارȑ في الʺʽȞʛوȃʽʨلʨجʽا، خʙمات الʺʽȞʛوȃʽʨلʨجʽا الʺʛجعʽة، وؗالة الʴʺاǽة الʸـ ـــ ـــ ـــ ــ ــʴـ ʽة، ؗʨلʽʻʙيل، سʺʽʘ، شعʰة تعʜȄʜ جʨدة الʛعاǽة الʸʴʽة، .الʺʺلؔة الʺʱʴʙة؛ وراشʽل م الʺʱʴʙة مʛاكʜ مȞافʴة الأمʛاض والʨقاǽة مʻها، أتلانʱا، جʨرجʽا، الʨلاǽات الأمʛȄȞʽة. ونʷــ ــȞʛ الʺʷــ ـــاؗر ʽʧ مʧ مʻʤʺة الʸـــــʴة العالʺʽة، الʱالʽة أسـ ـــʺاؤهʦ: بِʻʙِّ تا ألِّغʛانʜȑ، وجʛتʛود أفʨرتʛȑ، وȂيʰʛِل Ǽـاّلʽʛ، وآنــا Ǽـاولا ؗʨتʽʻهʨ، ونʽʻʨ دال داǽانغʽʛانغ، وؗʛȄʶــ ـــ ـــ ـــ ــ ــʱʽʧ فʛانʶـــ ــ ـــ ـــ ــــʽʝ، وȃʽʽʛ ؗلافي ؗارȄʽʨ، ومارȄا ؗلارا تʨلʽʙو، وناهʨؗʨ شــ ــ ـــ ــʽʻʙو، وفالʽʶـــ ــ ــــȞا ســ ــ ـــ ــʱʺʰلʽʨك، Ǽادوِفʜȑ، وجʨاو Ǽاولʨ ومارȄا فان ؗʽʛؗ هʨف. الʺʛاجع yrotaripser tsaE elddiM htiw stneitap rof erac emoH .1 gnitneserp noitcefni )VoC-SREM( surivanoroc emordnys miretni :stcatnoc fo tnemeganam dna smotpmys dlim htiw htlaeH dlroW :aveneG .8102 enuJ ,ecnadiug ;1.81/CPI/SREM/OHW( 8102 ;noitazinagrO dessecca ,849272/56601/eldnah/siri/tni.ohw.sppa//:sptth .)0202 yraunaJ 62 dna -cimedipe fo lortnoc dna noitneverp noitcefnI .2 htlaeh ni sesaesid yrotaripser etuca enorp cimednap 4102 ;noitazinagrO htlaeH dlroW :aveneG .erac /656211/56601/eldnah/maertstib/siri/tni.ohw.sppa//:sptth( dessecca ,1=ecneuqes?fdp.gne_4317051429879 .0202 yraunaJ 62 noitcefni yrotaripser etuca ereves fo tnemeganam lacinilC .3 si noitcefni )VoCn-9102( surivanoroc levon nehw :aveneG .0202 yraunaJ 82 ,ecnadiug miretni :detcepsus 0202 ;noitazinagrO htlaeH dlroW -lacinilc/liated-snoitacilbup/tni.ohw.www//:sptth( -nehw-noitcefni-yrotaripser-etuca-ereves-fo-tnemeganam ,detcepsus-si-noitcefni-)vocn(-surivanoroc-levon .)0202 yraurbeF 4 dessecca tsrif :erac htlaeh ni eneigyh dnah no senilediug OHW .4 htlaeH dlroW :aveneG .egnellahc ytefas tneitap labolg 9002 ;noitazinagrO dessecca ,20144/56601/eldnah/siri/tni.ohw.sppa//:ptth( .0202 yraunaJ 02 سوʛʽف ȐوʙعǼ ʧʽباʸʺلا ىضʛʺلل ةʽلʜʻʺلا ةǽاعʛلاʙʽفʨك) ʙʳʱʶʺلا انورʨؗ-19ʦهʽʢلاʵʺل يجلاعلا ʛʽبʙʱلاو ةفʽفخ ضاʛعأǼ ةȃʨʴʸʺلا ( -4- 5. 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