ACEP COVID-19 Field Guide

Author: Christopher Sampson, MD, FACEP, Vice Chair of Research, University of Missouri School of Medicine

Criteria

If COVID-19 testing is still pending, advise the patient that they need to voluntarily isolate until provided with results. Verify contact information for the patient, that they have active phone service, and that appropriate language services are available, if needed.

• Confirm the patient’s ability to manage activities of daily living;
• Confirm that the patient has enough support, home medications, and resources, including food and other necessary supplies, for up to 1 week while in self-isolation; and
• If available, provide a high-quality (N95) mask to the patient.

Consider discharging the patient home if they are well appearing and have no concerning imaging or laboratory findings (if these were obtained). Patients should not require oxygen to maintain oxygen saturations above 92%. Patients with preexisting pulmonary disease should be at or near their baseline oxygen saturation level.

Based on available evidence:

• If the patient is not hypoxic (oxygen saturation <92%) at rest or with exertion and the patient is in no respiratory distress, they can be given explicit discharge instructions with return precautions for concerning signs and symptoms, including worsening shortness of breath, altered mental status, and an inability to tolerate oral intake.

Refer to the American College of Emergency Physicians’ COVID-19 ED management tool for more information.

Smart Phrases

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

Suspected or confirmed COVID-19

Most cases of COVID-19 resolve on their own without hospitalization. Certain high-risk patients are treated with medications to reduce their risk of serious symptoms. Patients who are discharged home after being diagnosed with COVID-19 can take steps to manage their symptoms.

Steps to take at home for self-care

• Get lots of rest and stay hydrated by drinking plenty of fluids.
• Take acetaminophen or ibuprofen for fever and body aches if you do not have conditions that prevent you from taking them.
• If you have questions, call your primary care physician.
• If others are exposed to you while you are sick, they should test 5 days after exposure or immediately if symptoms have developed.
• Patients at high risk of severe COVID-19 may qualify for nirmatrelvir, a medication that can lower the risk of hospitalization. If your physician has prescribed this medication to you, take it as directed.

Isolation and return to normal activity after testing positive for COVID-19

• Isolate at home, except if seeking medical care. If you are around others at home, wear a high-quality mask (N95 or better). Do not share personal items like towels or utensils.
• Isolate until at least day 6 after developing symptoms or having a positive test. If you test negative twice, you likely have another viral illness, but you should still isolate until your symptoms are improving.
• If on day 6 you have improving or no symptoms and you have not had a fever for the past 24 hours (without the use of fever-reducing medications), you can end isolation and resume normal activities while wearing a mask until day 10.
• If your symptoms are not improving or you continue to have fever, isolate until day 10.

Vaccination against COVID-19 can reduce your risk of reinfection. Consider getting an updated vaccination if you qualify (you must wait at least 3 months after infection before getting vaccinated).

Speak to your doctor or go to the emergency department for new or worsening symptoms, such as a severe headache, confusion, chest pain, difficulty breathing, or vomiting to the point that you cannot drink fluids. Review medication inserts or speak to the pharmacist about medication interactions and side effects.