The first point of contact is primary health providers and the dedicated hotline. Suspected cases are advised to stay at home until contacted by a health provider to receive further instructions. Primary care providers organize sampling and referral testing and if confirmed, a primary care doctor will contact the patient to explain further diagnosis and treatment protocols. If necessary, primary care doctors can arrange home visits to assess the severity of a patient’s condition and determine whether hospitalization is necessary.
Initially, all cases were treated in hospital setting and mild / asymptomatic cases were quarantined in observed in dedicated facilities, mainly repurposed hotels. On 19 May, the Minister of Health outlined a change in the strategy for COVID-19 treatment. Patients who have tested positive for COVID-19 but have no symptoms or very mild symptoms will no longer be quarantined in hospitals or hotels, and those currently in quarantine will be sent home. This is due to the increasing number of positive results on a daily and the desire to optimise resources and the use of hospital beds.
Hospitalization for COVID-19 is warranted under the following circumstances: 1) mild case of COVID-19 and aged over 60 years; 2) symptomatic pregnant women who have tested positive; 3) mild cases but with comorbidities (chronic cardiovascular disease, hypertension, diabetes, chronic obstructive pulmonary disease, immunodeficiency, cancer, obesity, chronic kidney disease); 4) moderate cases (pneumonia without hypoxia), with other symptoms: a. high fever, usually above 38 °C, b․ respiratory symptoms, c. pneumonia according to radiological data; 5) severe pneumonia, and aside from the signs of high fever and respiratory symptoms, or at least two of the following: a. respiratory rate: ≥30/min (adults), b. blood oxygen saturation SpO2 ≤93%, c. >50% of pulmonary infiltrate within 24-48 hours; 6) critical conditions (respiratory failure, septic shock and/or multi-organ failure). COVID-19 patients are hospitalized if the blood oxygen saturation is SpO2 ≤93% and/or the respiratory rate is >22/min. On 6 June, 200 people were awaiting hospitalization due to a shortage of beds; there were also shortages of ICU beds. The Ministry of Foreign Affairs is in intense negotiations with neighbouring Georgia to explore the possibility of sending Armenian patients across the border for care.
The National Institute of Health will organize large-scale online classes for medical workers on how to care for COVID-19 patients at home. A call center will be established at the St. Grigor Lusavorich Medical Center where health workers from across the country can be in touch with doctors with considerable experience in COVID-19 treatment to ask about treatments as well as individual cases. This should help improve communication between primary health care institutions and hospitals. On 17 July, the National Institute of Health introduced a new information portal on COVID-19: http://www.covidprotocols.am/ . The website provides the Armenian translation of the guidelines of Harvard’s Brigham and Women's hospital, containing information from clinical aspects of the COVID-19 to narrow professional fields such as cardiology, neurology, gastroenterology, surgery, etc. The website also contains other guidelines developed by Armenian medical unions.
The WHO Country Office is in the process of launching a project for updating guidelines and developing clear algorithms on 7 infectious conditions (including COVID-19) managed at primary healthcare level. The project aims to strengthen essential health services by improving the management of common infectious conditions at PHC level, avoid reported misuse of antibiotics and decrease burden of the diseases on hospitals. The project is supported through DG Near funded Solidarity for Health Initiative.