COVID-19: outpatient care

The consultation request

Patients are therefore now invited, in the event of symptoms suggestive of COVID-19:

  • If there are no signs of seriousness: contact their doctor. Otherwise, the treatment centers or telemedicine solutions can be used. After medical contact, teleconsultation solutions should be favored, depending on the situation.
  • In the event of serious signs (malaise, breathing difficulties): call the SAMU-center 15
    Patients should always not be referred to emergency facilities to avoid contact with other patients.

Consultation

For physical consultations: general practitioners are invited to combine their consultations with COVID-19 suspect patients over the same time slot.
It is advisable to wear a mask during the consultation, and not to carry out an ENT examination.
During the examination, if the patient shows signs of seriousness: call the SAMU-center 15.

Place of tests

Patients with signs of COVID-19 are no longer systematically classified and confirmed by biological test (RT-PCR SARS-CoV-2).
The following situations should be systematically tested:

  1. people with signs of severity and symptoms suggestive of COVID-19
  2. healthcare professionals with symptoms suggestive of COVID-19
  3. people who are fragile or at risk with symptoms suggestive of COVID-19
  4. the first three people with symptoms suggestive of COVID-19 in collective structures housing fragile people, to take immediate measures to avoid transmission between residents
  5. hospitalized people with symptoms suggestive of COVID-19
  6. symptomatic pregnant women, whatever the term of the pregnancy
  7. organ, tissue or hematopoietic stem cell donors

For these populations, there are several testing possibilities:

  • For patients in hospital or with signs of severity, these tests will be performed in hospitals.
  • For other patients who meet the screening criteria, it is possible to be tested in laboratories in town, on medical prescription. The samples will be taken at home. In no case should patients go directly to the biological laboratories, but call them beforehand in order to know if the test is available there, and to know the methods of sampling.

The other patients are diagnosed if they have clinical signs compatible with COVID-19.

Home care and isolation

Patients and patients with COVID-19, in the absence of hospitalization criteria, are treated at home and are strictly isolated there. A work stoppage on free medical assessment is prescribed to them. However, in case of strong suspicion of COVID-19, the recommended duration is 14 days.
Treatment is symptomatic, accompanied by hygiene and monitoring advice. NSAIDs and corticosteroids are prohibited.
The monitoring methods are decided on medical assessment:

  • Simple self-monitoring of symptoms, without subsequent scheduling of consultation.
  • A medical follow-up (teleconsultation to be favored, if there is no physical) between D6 and D8 for surveillance.
  • Reinforced follow-up at home by IDE for subjects at risk who cannot assume self-monitoring.
  • A HAD for reinforced surveillance, in patients> 70 years with risk of complication or psychosocial complexity).

If symptoms worsen (difficulty breathing), patients should contact the SAMU Center 15.

The entire household living with a COVID-19 case must also be isolated strictly at home (except food supplies). Asymptomatic members must apply the recommendations for isolation with a patient, take their temperature twice a day and self-monitor their symptoms.

Symptomatic healthcare professionals are tested to biologically (or not) confirm their COVID-19 infection. If they are negative, they can continue their work. If they are positive, the management recommendations are identical to the general population: isolation, work stoppage and lifting of isolation after recovery criteria.

The following criteria allowing the lifting of strict isolation:

In general population:

  • General case: at least 8 days from the onset of symptoms + disappearance of the fever verified by a rectal temperature below 37.8 ° C (measured with a thermometer 2 times a day and in the absence of taking antipyretics in the previous 12 hours) AND at least 48 hours after the disappearance of any dyspnea (respiratory rate less than 22 / min at rest).
  • For immunocompromised people: at least 10 days from the start of symptoms and criteria identical to those of the general population. Wearing a type II surgical mask during the 14 days following the lifting of the confinement when resuming professional activities.

For health personnel:

  • Staff not subject to risk: at least 8 days from the onset of symptoms and criteria identical to those of the general population. Wearing a type II surgical mask for the 7 days following the lifting of the containment when resuming professional activities.
  • Staff subject to risk: at least 10 days from the onset of symptoms and criteria identical to those of the general population. Wearing a type II surgical mask for 7 days (14 days for immunocompromised patients) following the lifting of confinement when resuming professional activities.
  • Staff with severe form of COVID-19: on a case-by-case basis in connection with the doctor of the occupational health service.

Asymptomatic health professionals who are in contact with a COVID-19 case in the absence of appropriate protective measures must self-monitor their symptoms, apply barrier measures and wear a mask at the workplace and with patients for 14 days following the risky contact. In case of first symptoms, they immediately isolate themselves and contact a doctor.

Isolation Tips

In order not to contaminate other members of the household, it is advisable to stay in a specific room, avoiding contact with other occupants of the home, to ventilate regularly. If possible, a specific bathroom and toilet are preferred. Otherwise it is recommended to wash your hands frequently, not to touch common objects and to wash frequently touched surfaces daily (handles, mobile phones, etc.). It is not recommended to receive visits except essential, such as caregivers at home. Finally, home deliveries are possible, leaving the package on the landing.

Regarding masks

A strategy for the management and use of protective masks across the country has been put in place. It must primarily benefit health professionals and will adapt to the needs identified as well as to the evolution of the situation and the availability of protective masks.
Two national destocking operations (25 million) were carried out to meet the needs of reference health establishments, city health professionals, professionals in the medico-social sector and health transporters.
In order to preserve the mask resources, the Prime Minister requisitioned by decree of March 3, all the stocks and production of masks on the national territory.