Policy responses for Ukraine - HSRM

Ukraine


Policy responses for Ukraine

3.2 Managing cases

The first point of contact is a primary healthcare physician or the emergency medical services (depending on the severity of the health condition). There is a list of designated national and regional hotlines, which are available for patients and healthcare professionals. In parallel, each citizen who is registered with a family doctor can reach out for consultation.

The triage approach is outlined in the national guidelines. A patient in case of suspicion should refer to primary care first, preferably through telecommunication (phone). The primary care responder should screen the patient’s symptoms and epidemiological history against the case definition for COVID-19 (also see Section 1.4 Monitoring and Surveillance). The mild cases are then advised to stay home. In case of suspicion with moderate or severe symptoms, the PHC should call an emergency medical team that hospitalizes the patient at a designated healthcare facility. Patients can be discharged from the hospital no earlier than on fifth day of the treatment when the clinical symptoms disappeared and laboratory parameters (hemograms, CRP, ALT, AST, urea, creatinine) stabilized (on the basis of double negative laboratory test results). If the patient, despite the absence of clinical and laboratory signs of active infectious process by PCR method identifies fragments of RNA of the pathogen (positive or doubtful result), the patient may be discharged home for self-isolation with the supervision of a primary care physician. 

There are dedicated national clinical protocols for COVID-19 management, approved by the national guidance as of 13 March 2020 and updated on 28 March ,09, 23 and 24 April, 17 September, 11 November which cover case definition, diagnostics, patient pathways, IPC, case management, etc. On 30 April MOH amended the guidance with the standard of rational use of PPE and on 20 May with standard on using ELISA tests. The protocols are being updated on a regular basis. https://moz.gov.ua/article/ministry-mandates/nakaz-moz-ukraini-vid-28032020--722-organizacija-nadannja-medichnoi-dopomogi-hvorim-na-koronavirusnu-hvorobu-covid-19.

The Ministry of Health has endorsed a treatment protocol for COVID-19 hospitalized patients, which includes the investigational therapeutic agents for COVID-19: Lopinavir/ritonavir, chloroquine, hydroxychloroquine, remdesivir, tociluzumab, favipiravin. At the same time the Ministry of health expressed readiness to join the SOLIDARITY Trial. On 21 July, the MOH amended treatment protocol by excluding Lopinavir/Ritonavir and recommending Remdesivir for children in severe conditions. On 17 September, additional amendments introdussed on: (i) the treatment protocol and supplemented list of medicines with dexamethasone; and (ii) medical care standard with the following provisions: a person (applies for adults and children) who has been self-isolated for 14 days and has no COVID-19 symptoms, should not pass PCR testing; patients who are scheduled for hospitalization should also not perform PCR tests unless they have signs of acute respiratory disease. Also updated algorithms envisage that patients with a mild symptoms who are not at risk of complications, as well as patients who are recovering and no longer need round-the-clock medical supervision, are recommended to be treated on an outpatient basis (at home). At the same time, doctors provide constant monitoring of the current condition of the patient and his/her contact persons by phone and / or can provide on-site consultations in compliance with the IPC. Outpatient (home) treatment is strictly prohibited if the patient is at risk for complications or has symptoms that are moderate to severe. An updated protocol as of 18 September contains an expanded scheme of glucocorticoid use, algorithms for anticoagulant therapy, supplemented approaches to antimicrobial therapy of secondary bacterial co-infection, and specified the indications for the use of the drug tocilizumab.

Among the changes are updated standards for diagnosing a suspicious and probable case of COVID-19, new criteria for non-contagiousness of patients that were diagnosed as a confirmed case of COVID-19, as well as the criteria for completion of outpatient treatment (termination of self-isolation) and an updated algorithm for testing for coronavirus SARS-CoV-2 infection. As of 11 November, the protocol was supplemented with the use of convalescent blood plasma of patients who have recovered from the disease for COVID-19 treatment.

An online platform containing information on the use of medicines for patients with COVID-19 has been created by the State Expert Center (SEC) of the Ministry of Health launched on 30 April. The resource is intended to inform citizens and doctors about the drugs used in the treatment of coronavirus disease.

On 18 April, the Ministry of Health received 1400 more packages of hydroxychloroquine, in addition to the 3000 packages previously purchased.

Additional credits: Dr Elina Dale; Dr Vitalii Stetsyk; Dr Liudmyla Slobodianyk;Mr Artem Skrypnyk;Ms Olga Demeshko; Ms Anastasiya Brylova; Ms Tetiana Dolhova

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*According to the national legislation (available at https://zakon.rada.gov.ua/laws/show/1645-14/print), the terms “quarantine” and “self-isolation” mean:

quarantine - administrative and health measures used to prevent the spread of highly dangerous infectious diseases;
 
self-isolation - the presence of a person in respect of whom there are reasonable grounds for the risk of infection or spread of an infectious disease, in the place (premises) determined by him in order to comply with anti-epidemic measures on the basis of the person's obligation.