Clinical Case Management and Facility Readiness Section

National COVID-19 Emergency Operation Center

Ethiopian Public Health Institute

Contents

Introduction

Objective

Scope

Governance ofNational COVID-19 Home Based Care and Isolation

Roles & Responsibilities of Stakeholders

Practical guidance on procedures of HBIC

Monitoring & Evaluation

Annexes:

3

4

5

6

7

10

17

18

Introduction

Corona virus disease (COYID-19) was first detected in Wuhan city, China in December 2019.

On30 January 2020, the WHO Director General declared that the current outbreak cons lituted a

Public Health Emergency of International Concern. Ethiopia notified the first confirmed case on

March 13, 2020. Since then and with increasing number of cases; Ethiopia has been responding

to the COVID-19 outbreak using the response pillars of the Incidence Management System

(IMS) in line with the World Health Organization (WHO) recommendation.

Whereas WHO recommends all laboratory confirmed COVID-19 cases to be ma aged in

healthcare facilities when and wherever. It also recognizes and emphases on the need for

countries to consider home based care in situations where management of all confirmed COVID-

19 cases in healthcare facilities is impossible. As at June 29, the country has reported more than

5000 lab confirmed cases and approximately 90% of these are asymptomatic (76%) or mild

symptoms (21%).

Given the current and projected trends and after careful consideration and review of the

outbreak/epidemiological situation; the Federal Ministry of Health of Ethiopia ha/ passed

decision to urgently develop, approve and implement national guide on home isolation and care

for asymptomatic and mild confirmed COVID-19 cases. This represents a strat / gic but

significant shift in our COVID-19 Case Management response strategy as well as the overall

pandemic response plan. FMoH recognizes the implications of this strategic shift and has

developed a clear implementation guidance for better management and effective ope ation of

home isolation and care across the country.

This "National Implementation Guide for COVID-19 Home Isolation and Care" is d veloped

with the hope to provide clear guidance, recommendation, procedures as well as ractical

considerations to enable all the concerned bodies and stakeholders to effectively and efficientlyI

implement the Home Isolation and Care. This document will be periodically reviewed based on

available evidence and the outbreak situation.

Objective

The objective of the National Implementation Guide for COVID-19 Home Isolation and Care

are:

•:• Outline the steps and procedures for better management and effective implementation of

home isolation and care

•:• Describe the roles and responsibilities of the different stakeholders during

implementation of national home isolation and care guide

•:• Provide detailed technical and administrative guidance on clinical monitoring,/ support

and referral links for asymptomatic and mild confirmed COVID-19 cases during home

isolation and care.

Scope

The document provides guidance and recommendations with regards to Lab confirmed fOVID-

19 patients who are asymptomatic or have mild symptoms. It should be applied in all racilities

(non-health care settings) or health care settings, and homes by all persons including health care

workers and home caregivers involved in providing care to COVID-19 patients kho are

asymptomatic and or have mild symptoms within Ethiopia.

Recommendations provided here do not provide for the management of moderate and severe

COVID-19 patients (Please see Guideline- for treatment of COVID-19 case -modJrate and

severe category). Home care settings for home isolation and care does not by any standard confer

the status of a "COVID-19 Treatment Center" to the applicable home setting.

The document does not provide for the treatment of non-COVID related morbidities anp disease

conditions that a patient may have. Such persons should and can access care at existiilig health

facilities in Ethiopia as already provided for and made available at Federal, Regional, and

Woreda health facilities.

Governance of National COVID-19 Home Based Care and lsolrtionResponsibilities for governance during the implementation of HBIC will be shared among the

relevant stakeholder including the Ministerial Committee, MoH /EPHI, Regional Health Fureau,and Zonal/Woreda Authorities, Ministry of Peace, Ministry of Foreign Affairs, Ministry of

Innovation &Technology and Ministry of Culture and Tourism.

•!• The Ministerial Committee is expected to lead/Chair the coordination of the Nationwide

Multisectoral Implementation Platform based on the advice forwarded by the coordinator,

MoH/EPHI, that will serve in the position of Technical Leadership.

•!• MoH/EPHI is expected to assign or establish a National COVID-19 Home based Care

Coordinating and Support Team/Unit in the EOC, and the Team/Unit should Je given

clear mandates with known roles and responsibilities for better manage, lent and

monitoring of national COVID-19 Home Based Care Performances

•!• RHB is expected to assign or establish a Regional COVID-19 Home basld Care

Coordinating and Support Team/Unit in the EOC, and the Team/Unit should be given

clear mandates with known roles and responsibilities for better management and

monitoring of national COVID-19 Home Based Care Performances

•!• Both are expected to establish clear guideline and procedures for reporting and

accountability

•!• Zone/Woreda will lead the coordination and implementation of the National Home-Based

Isolation & Care Guideline.

Roles & Responsibilities of StakeholdersThese stakeholders should be involved at all levels of the implementation of this ideline

ranging from Federal to Woreda Level.

1. Ministerial Committee

•:• The Ministerial Committee is expected to engage all regions and city administr tions in

the coordination of the Nationwide Implementation Platform led by MOH/EPHI

2. MoH/EPHI

•:• Distribute national implementation guideline for home based covid-19 Isolation and care.I

•:• Advocate and provide all the necessary technical and relevant supports to all regions and

administrative cities for effective implementation of national covid-19 home baked care

guide. I•:• Coordinate and monitor the overall management and performances on their follow ups

and monitoring of covid-19 home based care.

•:• Regular evaluation of the implementation ofprotocols and procedures.

•:• Outline the Roles & Responsibilities of each stakeholder.

•:• Provide guidance to use available technology to collaboration with relevant stakeholders

to enhance home based isolation and care.

•:• Periodically collect and analyze performance reports to enhance decision making,

planning and improvement of care.

•:• Create and strengthen community engagement awareness on COVID-19 honl e based

care using all relevant channels including but not limited to, electronic media such as

Federal TV, radios and social medias, and printed media such fliers, posters, and

billboards using local languages.

!.3. Regional Health Bureau

•!• Adapt and disseminate all documents in regards to Home Isolation & Care to a l Zones

and Woreda.

•!• Draft an action plan based on the implementation guideline that can be cascaded down to

the Zonal/Woreda level.

•!• Provide all the necessary technical, financial and material supports to zona and/or

Woreda. In addition, support the establishment of necessary units at the zonal, woreda

and facility level. (facilities should establish counseling unit for COVID positive patients

who are eligible for home isolation)

•!• Support zones in the facilitation of pre hospital care & patient referral with pro ision of

necessary materials/equipment such as ambulances.

•!• Periodically collect and analyze performance reports from city, zonal and/or Woreda

health offices, and provide feedback for timely action. RHB is expected to s rare the

weekly regional COVID-19 home based care activity performance report to Mo EPHI.

•!• Provide technical leadership for the regional level coordination of stake holders based on

the directive forwarded by MoH/EPHI and Ministerial Committee.

4. Zonal/Woreda

•!• Coordinate and engage all relevant health facilities such as Health Centers, He th Posts

and Private Institutions in the implementation.

•:• Identify, train and guide professionals such as HCW, HEW, RRT, Volunteers, etc ... to be

deployed at Woreda levels.

•!• Map all the Health facilities, Treatment Centers including Community Care Centers, and

Isolation/Quarantine Centers and facilitate pre hospital care, patient transfer and eferral.

•!• Collect data daily about Case Status Update for those on follow up at COVID- /9 Health

Care Settings; Home Care, Community Care Centers, Treatment Centers and Isolation

Centers (for those who will be transferred to Home Care or Treatment Centers).

•!• Provide regular update Regional Counterpart on Performance Report.

•!• Create and strengthen community engagement awareness on COVID-19 home ba ed care

using all relevant channels including but not limited to, electronic media sue~ as city

administration and/or regional TV, radios and social medias, and printed media such

fliers, posters, and billboards using local languages.

•!• Establish none home none health facilities with full basic necessities for those who do not

have the capacity for home isolation. Example: school, universities, etc.

•!• Ensure consents are signed and enforcement of the directive

5. Health facility

•!• Implement the home isolation protocol for example establish a counseling unit

•!• Approve patients for home-based care based on the protocol and link with responsible

team at woreda level assigned for this purpose /

•!• Receive referred patient who were on home-based isolation and become symptomatic

•!• Receive patients referred from Woreda task force based on protocol

6. Home Isolated Individual

•!• Properly isolate from other family members.

•!• Take full responsibility in prevention of transmission

•!• Strictly adhere to the National Directive on of Home-Based Isolation& Care.

•!• Provide reliable information during regular follow up either by phone or home visit.

•!• Report to nearest health facilities/established local referral system in case of any

emergency, appearance of new symptoms or worsening of existing symptoms.

Partner Stakeholders Role and Responsibility

1. Ministry of Peace

•!• Facilitate relevant legal, safety, security and other relevant support provrsions for

implementation of COVID-19 Home Based Care across the country.

2. Ministry of Foreign Affairs

•!• Support, and coordinate with relevant agencies to mobilize support for the effective

•:• Work with relevant agencies, stakeholders and members of diplomatic comm nity to

ensure compliance of foreign citizens with the National Home Isolation and care

guideline.

3. Ministry of Innovation & Technology & Ethiopian Telecommunication Corpora ion

•:• Facilitate the use of technology including electronic based system for Case follo up and

implementation of National Home Isolation and Care, based on the directive given by

MoH/EPHI

4. Ministry of Culture and Tourism

•:• Support Regions/ Zones in creating community awareness and engaging community

leaders & religious leaders to secure the active participation of the community in the

Ieffective implementation of the guideline.

•!• Coordinate the different associations and civil societies (Teachers, Volunteers& Private

Hospital) towards community engagement and community support during

implementation.

Practical Guidance on Procedures of HBICPractical considerations and steps for HBIC include the following

1. Result notification

2. Assessment for eligibility for HBIC (including household assessment)

3. Relevant basic care processes for HBIC

4. Follow +Up and Referral

5. Discharge

1. Result Notification

The process for the implementation of the HBIC starts when there is a L boratory

confirmed positive result of COVID-19 for a suspected patient who is asymptomatic of

have mild symptoms. The EPHI/RHB releases the result and informs focal perslon at the

Woreda/Facility of the Lab result for the patient.

2. Eligibility for Home-Based Isolation and Care

part of the assessment of

eligibility for HBIC. Criteria for HBIC include. Below are points to consider for the

eligibility of the patient;

2A: Patient Assessment.!.

o Laboratory confirmed COVID 19

o Patients with mild symptoms and asymptomatic for COVID 19

o Stable/well controlled or absence of co morbidities such as Hypertension,

Diabetes Mellitus, and Chronic obstructive airway disease.

2B: Home/Household Assessment:

.!.

o A rapid assessment of the home environment will be conducted by a trained

health care worker to ascertain that the home environment meets the rriinimum

criteria for HBIC using the HBIC eligibility assessment check 1 ·/st. Key

consideration will include the following:

o Presence of Community health volunteer/appropriate care giver at home who is

able to provide relevant information about the patients' condition.

o Proper setup preventing infection spread. Particularly, Separate room with toilet,

bathroom, kitchen.

o Access to adequate basic PPE (Personal Protective Equipment) for the patient,

caregiver and family members. E.g. (Face masks, Gloves(optional))

o Ability to adhere to the standard droplet precautions e.g. appropriate cough

etiquette

o Availability of food and other basic necessities.

o Special precautions should be in place for high risk family members. (Individuals

greater than 60 years old, Infants, Pregnant woman and individuals with co

morbidities)J.

3. Home Isolation and Care: Procedures and Practices

3A. Instructions for HCW on commencement of the HBIC: the HCW wil do the

following:

.I_

!.

Io Educate patients and household members on relevant aspects of personal hygiene,

and basic IPC measures. /

o Educate on basic care activities and precautions to safely care for confirmed case

to prevent the infection from spreading to household contacts. j

o Provide guidance to patient and household members with ongoing sup art and

education, and monitoring should continue for the duration of home care.

o Provide a Phone contact no for the family members to call for daily report or any

emergency

o Document all relevant patients' information in the HBIC Admission Register and

open a follow-up register.

3B. Recommendations for Household Members and Occupants:

o Place the patient in a well-ventilated area or room with adequate access to windows and

cross ventilation.

o Limit the movement of the patient in the house and minimize shared space. Ensure that

shared spaces (e.g. kitchen, bathroom) are well ventilated (keep windows oJen) and

social distancing is maintained amongst the individuals (keep windows open)

o Household members should stay in a different room or, if that is not possible, m intain a

distance of at least 2 meters from the ill person (e.g. sleep in a separate bed).

Limit the number of caregivers. Ideally, assign one person who is in good healt~ and has

no underlying chronic or immune compromising conditions. Visitors shoul not be

allowed in the household until the patient has completely recovered.

o Perform hand hygiene after any type of contact with patients or their it , mediate

0

environment. Hand hygiene should also be performed before and after preparing food,

before eating, after using the toilet, and whenever hands look dirty. If hand I are not

visibly dirty, an alcohol-based hand rub can be used. For visibly dirty hands, use soap and

water.

o 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 personal cloth towels and rep lice them

frequently.

o To contain respiratory secretions, a medical mask should b~~provided to the palient and

worn as much as possible, and changed daily. Materials t~~M~~Wan:;_ mouth and nosef'' " h. >11·1;-). *4;~ ,,~ \4:_\ ~~-

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should be discarded or cleaned appropriately after use (e.g. wash handkerchiefs using

regular soap or detergent and water).

o Caregivers must wear a medical mask that covers their mouth and nose when in t e 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, d, mask.

Remove the mask using the appropriate technique - that is, do not touch the

instead untie it. Discard the mask immediately after use and perform hand hygiene.

o Avoid direct contact with any and all body fluids, particularly oral or reJpiratory

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 them ask.

o Do not reuse medical masks or gloves. But cloth masks can be washed and reused

o 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.

o Daily clean and disinfect surfaces that are frequently touched in the room w ere the

patient is being cared for, such as bedside tables, bed frames, and other b .d room

furniture. Regular household soap or detergent should be used first for cleaning, dnd then,

after rinsing, regular household disinfectant containing 0.5% sodium hypochloritJ, bleach

(berekina i.e. equivalent to 5000 ppm) should be applied.

o 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. Close

toilet while flashing

o 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 (140-194 °F) with common household

detergent, and dry thoroughly. If there is not laundry machine, wash with soup & water

and then sock with 0.05% Sodium Hypochlorite, bleach (berekina) for 30 minutes; then

continuously rinse with water. Place contaminated linen into a laundry bag. Do jot shake

soiled laundry and avoid contaminated materials coming into contact with skin and

clothes.

o Gloves and protective clothing (e.g. plastic aprons) should be used when deaning

surfaces or handling clothing or linen soiled with body fluids. Depending on the bontext,

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 olution.

Single-use gloves (e.g. nitrite orlatex) should be discarded after each use. Perform hand

hygiene before putting on and after removing gloves.

o Gloves, masks, and other waste generated during homecare should be placed into a waste

bin with a lid in the patient's room before disposing of it as infectious waste. The onus of

disposal of infectious waste resides with the local municipal waste collection syst . m.

o A void other types of exposure to contaminated items from the patient's immediate

environment (e.g. do not share toothbrushes, cigarettes, eating utensils, dishesj drinks,

towels, washcloths, or bed linen)

3C. Recommendations for Precautions and Safety Measures to taken by the patient

o Avoid physical contact with household members

o Avoid sharing of space as much as possible and stay in a designated, well ventilated room

o Wear a facemask appropriately, change the medical facemask every day Jr when

indicated such as if it is soiled/tom/wet or compromised in any way.

o Clean hands accordingly as frequent as possible with alcohol-based hand sanitizers, dry

them with a towel designated for the patient.

o Use a dedicated eating and drinking utensils which will be cleaned accordingly.

3D. Recommendations for Precautions and Safety Measures to be taken by Care Giver

o Avoid close contact with the patient and keep a distance of at least 2 meters.

o Sanitize hands with alcohol-based solutions and wash hands frequently, especially after

contact with the patient and with any item that has been in contact with the patien

0

0

Wear a face mask appropriately when sharing a room or in close contact with the patient.

When the face mask is taken off, it should be removed by touching only the elas l.c bands

or strings; front and inside parts should never be touched. Hands sh uld be

washed/cleaned immediately (and thoroughly) after mask removal.

o Wear gloves when providing care to the patient or when coming in contact wit bodily

fluids. Gloves should be changed every time they are worn or when they become soiled,

or if their integrity is compromised. Hands should be washed/ cleaned immediately after

removing the gloves.

o Caretakers should quarantine for 14 days after the patient has recovered and self-l onitor

for COVID-19-like symptoms while following strict precautions.

• Physical distancing of 2 meters,

• wear a mask,

• hand hygiene,

• avoid nonessential movement

3E. Considerations for Waste management

o The patient waste bag should be placed in her/his room.

o Facemasks and gloves used by care taker should be immediately put in the waste bag

of the patient.

o Patient waste bag should be closed when they are removed from the patie, t room,

never be emptied in another bag.

o After handling waste bag, appropriate and strict hand hygiene should proceed

o Hold/keep the waste at home for 3 days to protect the exposure of waste collectors.

4. Follow -Up and Referral

4A: Follow-Up: On commencement of HBIC,

o The patient will be followed up by a health care team consisting of a member f house

hold who had volunteered for this assignment, an assigned HCW- who m y be a

Community Health Volunteer (HCW) or Health Extension Worker (HEW) and a facility

based HCW. The Household member conduct regular checks -like asking if there is fever

or any symptoms and provides such information to the CHY/HEW.

o The CHY/HEW conducts regular follow up by phone calls to the patient and or ssigned

family member. Daily follow up checks is documented in a Follow-up register for HBIC

which is provided to the CHY/HEW.

4B: Conditions for HCW Intervention and Referral

During the follow-up of the patient on HBIC, the patient and family will be info ed to

CALL the HCW (CHV/HEW) or facility based HCW if:

.L

I. The patient's symptoms worsen.

2. New symptoms develop

3. The home care giver or other family member(s) become sick or develop

symptoms

All the member of the Follow-Up team and family member will be informed on the

condition. The HCW will conduct an appropriate evaluation of the patient either in

person or by phone.

!.

Where necessary, arrange for referral.

For any event requiring Referral:

o If the care giver and family members develop symptom.

o The follow up team/HCW should be notified as soon as possible.

o The HCWs communicate the RRTs

o The RRTs will conduct protocol-based assessment and act accordingly.

o The facility of management of the care giver is again decided in the same fashion as the

other family member.

!

5. Discharge: When to end the Home Isolation& Care

o For asymptomatic patients - Isolation should be maintained until 14 days from t e date

the patient is assessed eligible for Home Isolation and Care from date of first positive test

for asymptomatic and mild cases and from the date of symptom improvement for

symptomatic patients

o Mild symptoms - Refer to the National Recovery Protocol

Monitoring & EvaluationProcess Indicators

SIN Indicator No ReportingFreq.

RemarksI

Number of New asymptomatic COVID-19 patients mHome-Based Care

Daily

2 Number of New mildly symptomatic COVID-19 patientsin Home- Based Care

Daily

3 Total No of COVID-19 patients in Home- Based Care Daily

5 Number of households assessed for eligibility for HBIC Daily

6 No of households that meets the criteria for HBIC Daily

7 Number of mildly symptomatic patient with worseningsymptoms and referred

Daily

!

8 No of Asymptomatic patient that develop symptoms whileon HBIC.

Daily

Daily9 Number of Mildly symptomatic patients in HBIC that aretransferred to treatment centers _

Outcome Indicator

S/ Indicator No Reporting R!emarksN Freq. II Number of symptomatic patients recovered and Daily

Idischarged from HBIC.2 % of Asymptomatic patients that developed symptoms Daily I3 No of symptomatic patients that recovered and Daily

Idischarged5 No of Home care givers (family) members that Daily

Ideveloped symptoms6 % of referrals to the Treatment or Community care Daily

Icenter

N.B From the commencement of the implementation of this guideline, the operations will be

!.

.!.

Flow Chart for Home Based Isolation and Care (HBIC).

Step 2: Assess: Does the patientmeet the criteria for HBIC: ConductRaoid House hold assessment

(CommunityI

<Care center

Persistent

MildSymptoms

orWorseningsymptoms

Stable Patient.

Isolate

Annexes:Annexes 1: Eligibility Checklist for Horne Isolation & Care

Name Age Sex Addres ~::rsments

IS.N Criterion Yes No Remark I

I Has NO co morbidities I2 Has a caregiver who is healthy and available to provide care 24/7

I3 There are NO individuals in the household with illness or co

morbidities (If No, the family can take special precautions forthe vulnerable individuals)

4 Has access to a private bedroom or the ability to designate a

Iprivate bedroom

5 Does the private bedroom have at least I window & I door?

I6 Is the patient resting area at least 2 meters away from the rest of

Ithe household members' resting area?

7 Has access to a private bathroom or the ability to designate aprivate bathroom

ORIf bathroom is shared, is the care giver willing to make sure thatit is cleaned after each use?

8 Has reliable access to potable water in the house?I

9 Has access to laundry services without leaving their home or has

Ia care giver that can facilitate

10 Has at least I dustbin with cover close to the patient?

I11 Ts able to dispose of garbage and refuse without leaving their

Ihome or has a care giver to dispose garbage

12 Has reliable access to food delivery without leaving their home

Ior has a care giver that can deliver

13 Has reliable access to needed medication without leaving theirIhome or has a care giver that can facilitate

14 Is able to isolate/quarantine without fear of abuse or domesticviolence in the home (this applies for underage individualswhere by the request for Home-Based Isolation comes from legalguardian)

15 Has reliable telephone access to report health status to theIfollow-up team

16 Has the ability to arrange for the care of dependents (childrenunder 12, elderly without co morbidities) ~\'"A°f<(,,1:~-

*'-,·\'"1') r/,J""IJ. ·,~~....

Plge j 19"'"" <;,. ·t ~@"•)<rr, ~ ,:. ...

=J. -:n ~·~'.J-.i ~~.It , i ."> I\,:,t41 ,;. ....-~~/ "!,.{0/~<:+.mocr-a'.;, x~ ~:\ "liop;a *

-~!~~-~~-

17 ls capable of adhering to recommended precautions, along withtheir household members, during the Isolation/quarantine period

18 Has access to basic health monitoring and infection preventionsuppliesJ.-Hand washing facility with Soap & Water within the householdor Hand sanitizer- Masks

-Gloves

-Disinfectant (Berekina)

Assessor'sComment _

Decision- Eligible I INot EligibleII

Name. _

Signature _

Page I 20

Annexes 2: HBIC COVID 19 Case Follow-up Sheet

1. IDENTIFICATIONDate of follow up L' _J L _J/[_\1_JL ,_JIU_JLO_J(_ · _JL _J

Patient ID: Region

Full Name Zone I City House NumberAge__ Sex Phone Number

Marital status I o Single / o Married I o Divorced Io WidowedPregnant o No o Yes Health care worker D No D Yes

2. DATE OF COVID-19 CONFIRMATION

Date of sample requested _ Date of sample result received _

3. DAILY CLINICAL FEATURES FOLLOW UP

SIGN DAY l DAY2 DAY3 DAY4 DAYS DAY6 DAY7 DAYS DAY9 DAY 10 DAY 11 DAY12 DAY13 DAY 14

AND YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/NSYMPTO 0 0 0 0 0 0 0 0 0 0 0 0 0 0M

Fever

Cough

Page I 21

,_ ,_

Sore throat

Chest pain

Myalgia

Dyspnea

1v~~

... ,'<' 0 :l\\Q" '"'';I ~J- -'.~ ~ \'CJ8j.);_'.:,, ..

i> ...0.......--·"",,. ~ ~*i§'~,· r ·~ ..,.,:.: ~ s: 0 ,> \; ,/ C,, ~' ~ " ' .......?3...,~ -j, -,,. "' iil -- .» ~

a "'· N' ,...-Js,I. 0 ._., I .: ';;·•I.\ I ~A'i*~.. ~~.,,,,-i<'. ,:, ·_., /,,V. ,.\)· -.: .

~~f('1r' .\'Ill '·,,~~-- ~"V·?l\,·J· ~-~~~·

Confusion

Seizure

Page I 22

4. COVID -19 RELATED QUESTIONS

Date of onset of symptoms------ Date of symptom subsided _

5. MEDICATIONIs the patient started on any medication for COVID-19 TREATMENT? D NoIfyes, please check all that apply:

D Yes DUnknown

SJGNAND DAYI DAY2 DAY3 DAY4 DAYS DAY6 DAY7 DAYS DAY9 DAY IO DAY II DAYI2 DAYI3 DAYI4

SYMPTOM YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N

0 0 0 0 0 0 0 0 0 0 0 0 0 0

Acyclovir

Dexamethason

e

Azithromycin

Antimalarial

agent~,.........,.,. ;_....... Etiti....

.: ·'>'r' . -"~/a . -': \O ::>!JG, ,.., ·{9.

----1---, . ··1kt1·fWP~---'-~-\--l·----1-----1---- 1-----1-----1---- 1----1----1----1----1·----1---­,.~ ,;s_~-~~_.....,.---.....;: • . 1t~-irtf~ ii,~~.~ _..~~ Page I 23

-~ ~ '" " . -~,"/ -~- .•"'J)i-711,.i,...,1A"-~~-;::_ ,:;,

Paracetamol

Tramadol

Augmentin

Chloroquine

phosphate

Other(s),

please specify:

6. PROGRESS OF THE PATIENT AND CARE GIVER RELATED QUESTIONS

How many people live in the house hold?----

n

{~-.,,

SIGN AND DAY l DAY2 DAY3 DAY4 DAYS DAY6 DAY7 DAYS DAY9 DAY 10 DAY 11 DAY 12 DAY 13 DAY 14

SYMPTOYES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N YES/N

M 0 0 0 0 0 0 0 0 0 0 0 0 0 0

/',~-;-:..,. bh~1g/.. ,:- >' ~·. -~ O!!Qri,;

/' ·: ..,-~~oC .:~ie.~~'/ ..,. 4,i.l' ~:, ..: (&~•sA ·;

-~,~p~rift~iA <st::@-~ ~:

~~Page I 24~"iJ ')..

·-~-~~ef

Does

anyone

among the

family

member has

started to

have

COVID-19

like

symptom?

Date of Recovery _Name of Physician/HO/Nurse who declares recovery _

Signature _

Page I 25

Annexes 3: HBIC COVID 19 Case Follow-up Sheet

23456789

101112

Page I 26