A Rapid Guidance Summary from the
Penn Medicine Center for Evidence-based Practice
Last updated March 26, 2020 6:00 pm All links rechecked March 26 unless otherwise noted.
Criteria for discontinuing isolation precautions and COVID-19 related care are outside the scope of this report.
Guidelines for patients with mild disease who do not need to be hospitalized also apply to discharged patients.
Patients should remain in isolation at home until free of disease.
Provide patients with symptomatic treatment. Guidelines do not call for definitive treatment, and protocols from other hospitals call for symptomatic treatment only..
Patients should immediately contact the hospital if they develop symptoms of complicated disease
Key: A–consistently recommended in multiple guidelines, B–recommended in a single guideline, recommended only in hospital policy documents, or recommended weakly, C–guidelines or recommendations lacking or inconsistent.
Guideline: Guidance developed by a professional society or government agency, intended for use at multiple hospitals.
Policy: Guidance developed at a hospital for use at that hospital. It may be based on guidelines or on expert opinion.
Provide patient with mild COVID-19 with symptomatic treatment such as antipyretics for fever.
No relevant guidance.
Patients can be discharged from the healthcare facility whenever clinically indicated.
Acute and community hospitals must discharge all patients as soon as they are clinically safe to do so. 50% of discharged patients are expected to be cared for at home without support from a health or social care provider; 45% are expected to need health or social care support. 4% will need to be discharged to a rehabilitative care setting. 1% have had a life-changing event.
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 (e.g. kitchen, bathroom) are well ventilated (keep windows open). Limit the number of caregivers. Ideally, assign one person who is in good health and has no underlying chronic or immunocompromising conditions. Caregivers should wear a medical mask that covers their mouth and nose when in the same room as the patient.
Considerations for care at home include:
NHS guidance for isolation of patients and family members applies. Use of facemasks is not recommended. Please see linked document for details.
Please see Appendix A for detailed instructions.
Please see Appendix B for detailed instructions
No specific guidance for hospital patients discharged to home. We assume that outpatient treatment protocols apply.
Provide supportive care rather than definitive treatment to patients not requiring hospital care.
A Rapid Guidance Summary is a focused synopsis of recommendations from selected guideline issuers and health care systems, intended to provide guidance to Penn Medicine providers and administrators during times when latest guidance is urgently needed. It is not based on a complete systematic review of the evidence. Please see the CEP web site for further details on the methods for developing these reports.
Lead analyst: Matthew D. Mitchell, PhD (CEP)
Evidence team: Emilia J. Flores, PhD, RN (CEP), Kirstin A. Manges, PhD, RN (NCS); Shazia M. Siddique, MD (CEP)
Reviewer: Nikhil K. Mull, MD (CEP)
©2020 Trustees of the University of Pennsylvania
Medication after discharge
Generally, antiviral drugs are not necessary after discharge. Treatments for symptoms can be applied if patients have mild cough, poor appetite, thick tongue coating, etc. Antiviral drugs can be used after discharge for patients with multiple lung lesions in the first 3 days after their nucleic acid are tested negative.
A specialized doctor should be arranged for each discharged patient's follow-ups. The first follow-up call should be made within 48 hours after discharge. The outpatient follow-up will be carried out 1 week, 2 weeks, and 1 month after discharge. Examinations include liver and kidney functions, blood test, nucleic acid test of sputum and stool samples, and pulmonary function test or lung CT scan should be reviewed according to the patient's condition. Follow-up phone calls should be made 3 and 6 months after discharge.
Management of patients tested positive again after discharge
Strict discharge standards have been implemented in our hospital. There is no discharged case in our hospital whose sputum and stool samples are tested positive again in our follow-ups. However, there are some reported cases that patients are tested positive again, after being discharged based on the standards of national guidelines (negative results from at least 2 consecutive throat swabs collected at an interval of 24 hours; body temperature remaining normal for 3 days, symptoms significantly improved; obvious absorption of inflammation on lung images). It is mainly due to sample collection errors and false negative testing results. For these patients, the following strategies are recommended: