Author: Christopher Sampson, MD, FACEP, Program Director, Emergency Medicine Residency, Assistant Medical Director, MU Emergency Medical Services; Department of Emergency Medicine, Associate Clinical Professor, University of Missouri-Columbia
Note: Not all persons under investigation require hospital admission.
If COVID-19 testing is still pending, advise the patient that they need to voluntarily isolate until provided with results. Refer to the CDC guidelines for possible handouts for the patient. Verify contact information for the patient, active phone service, and appropriate language services, if needed.
Special needs populations include homeless patients, prisoners, and nursing-home patients. Refer to local health department guidelines on where these patients can be transported for self-isolation.
For long-term care or assisted-living facilities, the CDC recommends patients “...go to a facility with an ability to adhere to infection prevention and control recommendations for the care of COVID-19 patients. Preferably, the patient would be placed in a location designated to care for COVID-19 residents.”
The following clinical discharge criteria are based on anecdotal reports from Italy. This pathway is based on limited evidence from an interview with Italian emergency medicine physician Andrea Duca and should be used with good clinical judgment. Based on the capacity of the health care system, these criteria may or may not be possible.
If the following criteria are met with COVID-19 positive results, the patient may be considered safe for discharge. (Lab testing and imaging may not be indicated in mild cases; thus, clinicians must assess the severity of each case and use their own clinical judgment.)
If the above criteria are met, alternatives can be considered when there are limited hospital beds:
Based on lack of available evidence:
Authors: William Weber, MD, MPH; Kimberly A. Collins, MD, MPH, FACEP; Wendy L. Macias-Konstantopoulos, MD, MPH, FACEP; John Westhoff, MD, MPH, FACEP; reviewed by the ACEP Public Health and Injury Prevention Committee
You were evaluated in the emergency department with symptoms concerning for infection with coronavirus COVID-19. COVID-19 is a new strain of a common viral illness. While a diagnosis of coronavirus may feel scary, most cases of coronavirus are mild and resolve on their own without hospitalization. At this time, we feel that you are safe to go home.
Steps to take at home to care for yourself:
How to avoid spreading the virus to others:
If you or those around you are concerned about COVID-19, call your primary care doctor for advice about steps to take. Your health system may have specific locations to go for testing if you are not extremely sick. This lowers the risk that you could catch a virus or pass it on in the emergency department waiting room. If you are extremely sick and going to the emergency department, call ahead, so they can prepare for your visit.
Speak to your doctor or come back to the emergency department for new or worsening symptoms, such as severe headache, confusion, chest pain, difficulty breathing, or vomiting to the point that you cannot drink fluids. Review medication inserts for side effects, and call the emergency department if you have any questions about the medications or care you received.