The COVID-19 pandemic has challenged the health care capacity and the ability to admit everyone to hospitals or Pusat Kuarantin dan Rawatan COVID-19 Berisiko Rendah (PKRC). Eighty percent of COVID-19 cases are asymptomatic and can therefore be monitored at home.
If the symptoms worsen/ having warning signs (Red Flags – see below) i.e CAT 2 Moderate and beyond, the patient will be referred to the PKRC or hospital for further management. CAT 2 Moderate, CAT 3, CAT 4 and CAT 5: Patient in these categories are to be admitted to the PKRC or hospital.
If you suspect you contracted Covid-19, you can perform a self-test or a professional Test, report it on MySejahtera or any Health District Offices (List of HDOs/ Pejabat Kesihatan Daerah).
COVID-19 Assessment Centres (CAC)
COVID-19 Assessment Centres (CAC) can be setup at health clinics/ klinik desa/ klinik komuniti/ PKRC or other suitable facilities identified by the district health office (DHO)/ state health department.
- Confirmed COVID-19 cases are assessed on their suitability for home
monitoring or need for admission to PKRC/ hospital
- DHO will do the initial triage and instruct patient to go to the CAC
- Assess and determine a care plan for COVID-19 cases to be monitored at home
- Provide patient with contact number (On Call number/ CAC Hotline/ CAC number/ any other number suggested by district health office)
- Monitor patient’s condition through telephone call/ virtual clinic/ Virtual Health
Advisory using Adult/ Paediatric COVID-19 Home Assessment Tool for Health
- Arrange home visit if necessary
- Carry out contact tracing
- Evaluate and discharge patients who have completed the home isolation period
and issue Release Order
Patients Qualified for Home Monitoring:
a. CAT 1 (No symptoms) and CAT 2 – Mild, irrespective of age;
b. Patient without or with stable / controlled morbidity (e.g. diabetes mellitus,
cardiovascular disease, chronic pulmonary disease including asthma, chronic renal disease, hypertension);
c. Patient without End Stage Renal Failure (ESRF);
d. Patient who is non- immunocompromised;
e. Patient with BMI<35 kg/m2;
f. Patient found to be stable after evaluation at CAC; and
g. Suitable obstetric patient (Refer to this document at Section 14 for pregnant mothers who are eligible for home monitoring)
h. Adhere to Standard Operating Procedure (SOP)
Fulfill These Conditions:
i. Have access to telephone and contactable all the time;
ii. Able to adhere to home isolation (separate bedroom, well ventilated
preferably with attached bathroom)
iii. Other occupants in the house do not have immunocompromised conditions;
iv. Suitable caregiver (who is not in the high risk group) available in the house;
v. Personal transport available to bring patient from their home to the clinic/
hospital (avoid using public transport); and
vi. Visitors should not be allowed in the home.
One of the warning sign is hypoxaemia, the reduction in oxygen saturation level in the red blood cells. A pulse oximeter measures the oxygen saturation of haemoglobin in the arterial blood (SpO2). Fingertip pulse oximeter can be provided for the following patients:
i. Those with comorbidities irrespective of age;
ii. 60 years old and above;
vi. BMI ≥30 kg/m2 to <35 kg/m2;
v. Category 2 Mild; and
vi. Patient who have not completed vaccination or within two weeks of completed
Standard Operating Procedures – SOPs For Patients Monitored at Home
- To stay home, maintain physical distance with other household members, limit movements in the house and avoid visitors
- To comply with basic preventive measures e.g. wear face mask, regular hand washing, and practice cough etiquettes
- To separate eating utensils, tableware (fork, knife, plate etc.), towels for their personal use.
- To report health status daily through MySejahtera/ attend phone calls from health care provider.
- Ministry of Health may SMS or call the patients using 03-2703 3000 to remind them to complete HAT, if they need to go to the nearest CAC for further evaluation if symptoms worsen, etc.
Report daily health status by answering the assessment questions on the Home Assessment Tool (H.A.T.)
Red Flag Warning signs include:
a. Shortness of breath
b. Coughing up blood
c. Blue dicolouration of lips, extrimities, and face
d. Prolonged fever >38oC for 3 days
e. Altered consciousness
f. Vomiting and diarrhoea
g. Reduced oral intake
h. Reduced or no urine output
i. Chest tightness
j. Cold and clammy skin
k. Per vaginal bleeding
l. Persistent abdominal pain
Completion and Discharge from Home Monitoring
- If patient remains asymptomatic for the number of quarantine days required after the date of their first positive test or since onset of illness
- Able to ambulate without assistance and self-administer medications
- Attend CAC to be assessed, obtain Release Order and remove the wristband if no Digital HSO was issued. If required, request for medical certificate and Discharge note
- Repeat Covid-19 swab test is not required for confirmed case before discharge from home monitoring
Quarantine Days for Confirmed COVID-19 Cases
- COVID-19 positive cases must quarantine for SEVEN (7) days regardless of vaccination status. However, they can be released earlier if tested negative by a supervised RTK-Antigen test on day 4 or later.
- Asymptomatic close contacts, regardless of vaccination status, are no longer required to quarantine.
- Symptomatic close contacts, regardless of vaccination status, are encouraged to self-quarantine and perform RTK-Antigen self-test on the day of onset of symptoms and on the third day. If tested negative and symptoms have improved, they may end the quarantine.
Test and release procedure
- COVID-19 positive cases have the option to end quarantine earlier if their supervised RTK-Ag test result on Day-4 is negative. This test can be done at the Nearest Health Facility for Professional Covid Test or virtually (Virtual Professional Covid Tests)
- This RTK-Ag test can also be done on Day-5 or 6 for the purpose of early release from quarantine.
- If tested positive, they must continue to quarantine until Day-7. No other test needed after completion of quarantine.
- For more detailed info: covid-19 moh my: garis panduan kkm – ANNEX 2: Management of Suspected, Probable and Confirmed COVID-19. CRITERIA FOR ENDING ISOLATION PRECAUTIONS – no testing required before discharge (except Severely immunocompromised)
- Guidelines on Home Monitoring and Clinical Protocol at Primary Care for Cat 1 and 2 Mild Confirmed COVID-19 Cases