France – More contagious, the Omicron variant has exploded the contamination figures. Doctors, pharmacists, nurses are on the front line to support patients suspected of Covid-19 but not all of them come under the same care, depending on their degree of fragility, their risk of developing a serious form and their vaccination status. This is why the High Authority of Health (HAS) wrote 5 summary quick answer sheets to deal with 5 common situations. The main question, writes the HAS, being to refer patients with a positive Covid test and at risk of a severe form to their doctor (age ≥ 65 years and/or comorbidity) who are unvaccinated, incompletely vaccinated or immunocompromised due to their disease. and/or their processing.
Sheet no. 1: Conduct in front of a positive Covid-19 patient on an outpatient basis
How to deal with a patient with a positive Covid test (antigenic or RT-PCR) without medical consultation prior to diagnosis and at risk of severe form (age ≥ 65 years and/or comorbidity) unvaccinated, incompletely vaccinated or immunocompromised? If such a patient is referred to him, physicians should initiate management according to the following algorithm:
Sheet no. 2: What to do with a symptomatic patient (adolescent ≥ 12 years old and adult)
The HAS lists the different stages of the interview and consultation, recalling, for example, that the clinical examination carried out by the doctor includes in particular:
-
questioning the patient regarding his anti-Covid-19 vaccination status by having him specify the date of the last vaccine injection (more or less than 6 months) and of the booster;
-
measurement of O2 saturation which confirms or invalidates the decision for outpatient management (SpO2 ≥ 95%).
In the event of serious risk factors, the doctor may prescribe a pulse oximeter (or saturometer) for enhanced monitoring at home.
This monitoring will be carried out by self-monitoring or by an IDE, at a frequency of at least 3 times per 24 hours; until D14 following the onset of symptoms or following the date of the positive test.
> To find out more: Rapid responses in the context of COVID-19 – Follow-up of outpatient Covid-19 patients – Place of the pulse oximeter
Exceptionally, oxygen therapy to maintain an Sp02 > 92% may be implemented in the homes of patients with Covid-19 as part of a first-line multi-professional team in conjunction with a reference hospital team (pneumology, infectious diseases , critical care, etc.) and SAMU.
Oxygen therapy is reserved for 2 specific situations:
-
patients hospitalized for Covid-19, discharged on oxygen therapy;
-
non-hospitalized Covid-19 patients with oxygen requirements < 4 L/min.
> To find out more: Rapid responses in the context of Covid-19 – Home care for patients with Covid-19 and requiring oxygen therapy
Duration of isolation
In patients with a complete vaccination schedule, isolation should be for 7 days from the onset of symptoms with a possible lifting on D5 with an antigen test result (and in the absence of clinical signs of infection since 48h). If this test carried out on D5 is positive, isolation is for a total of 7 days (a new test on D7 is not necessary).
Unvaccinated patients or patients with an incomplete vaccination schedule must remain isolated for 10 days from the onset of symptoms. A lifting of isolation is possible on D7 with a negative antigen or RT-PCR test result (and in the absence of clinical signs of infection for 48 hours). If this test carried out on D7 is positive, isolation is for a total of 10 days (a new test on D10 is not necessary).
Sheet no. 3: What to do with a symptomatic child (under 12 years old)
When a child presenting or having presented symptoms suggestive of Covid-19 arrives for consultation (in the absence of signs of seriousness), a diagnostic test for SARS-Cov-2 must be prescribed (in the absence of a diagnostic test already carried out), in the event of fever without any other cause identified in children over 6 years of age or in the event of fever without any identified cause persisting on the third day in children under 6 years of age.
If the child is seen in consultation between D1 and D7 from the onset of symptoms, the RT-PCR test is carried out on a saliva sample. If the child consults between D1 and D4 from the onset of symptoms, it is possible to carry out an antigen detection test on a nasopharyngeal sample. If the antigen detection test is positive, the patient can be considered as a confirmed case.
For Covid-19 positive children, particular vigilance should be paid to post-infectious pediatric multi-system inflammatory syndrome (PIMS) within 4 to 6 weeks following the onset of symptoms, which requires emergency hospitalization. It is a serious disease with a risk of cardiac decompensation in the acute phase. If the child presents risks or signs of hemodynamic failure, it is advisable to contact the SAMU.
Duration of isolation
The child is isolated for 7 days from the onset of symptoms with a possible lifting on D5 with a negative antigen test result (and in the absence of clinical signs of infection for 48 hours). If this test carried out on D5 is positive, isolation is for a total of 7 days (a new test on D7 is not necessary).
> To find out more: Rapid response in the context of COVID-19: Identification and management of post-infectious pediatric multi-system inflammatory syndrome (PIMS)
Sheet n°4: What to do in front of an asymptomatic contact person
The action to be taken depends on the vaccination schedule.
Asymptomatic contact persons with a complete vaccination schedule (primary vaccination and booster) are not isolated pending the results of the test. On the other hand, for asymptomatic contact persons who are not vaccinated or who have an incomplete vaccination schedule, the isolation is 7 days, starting from the day of contact with a confirmed case.
Two detailed algorithms are proposed by the HAS: Rapid responses in the context of COVID-19 First-line care of patients with Covid-19
Sheet n°5: Treatment of immunocompromised patients
The Haute Autorité de Santé recommends encouraging immunocompromised patients, adults or children aged 12 and over, eligible for pre- or post-exposure preventive treatment for Covid-19, to benefit from it (see table below).
