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. 2020 Apr 22;44(3):275–281. doi: 10.1016/j.clinre.2020.04.001
Temporary cessation of employment Recommended for an initial period of 21 days if the employer cannot guarantee the possibility of teleworking (https://solidarites-sante.gouv.fr/IMG/pdf/arret-travail-covid-19_2.pdf).



Consultations Presence not required: Adaptation of non-urgent follow-up consultations initially planned face-to-face
=>Reorientation towards safe healthcare with respect to the risk of infection (Tele or video consultation) in order to avoid disruptions in follow-up.
+Home visits by a registered nurse on medical prescription if needed
+Automatic extension of prescriptions with pharmacists acting on medical advice in the case of polypharmacy (> 5 drugs) or renewal of treatment within 3 months.
Continuation of primary or secondary prophylaxis in patients with ascites, clinically significant portal hypertension and/or encephalopathy is essential to avoid hospitalisation.
Presence required (diagnosis and pre-treatment consultations for liver cancer, new patients with clinically significant signs: jaundice, increased serum ALAT level > 10 times the upper limit of normal values, recent hepatic decompensation)
Screening for signs of COVID-19 before coming to the hospital and at the reception desk (+body temperature taken at arrival), and if in doubt, screen for COVID-19 ideally before arriving in the department according to the facility's standard procedures.
Having patients wear a surgical mask (resources permitting) as soon as they arrive at the medical facility.
Implementation of barrier precautions: disinfect equipment (seats, handles, etc.) between each patient, avoid waiting in groups, reduce waiting times in waiting rooms, eliminate newspapers, maintain a minimal 1 metre distance between patients, frequently ventilate waiting rooms, enforce as strongly as possible the rules concerning hygiene and protection of nursing staff.



Scheduled day and short-stay admissions Reschedule stays and/or non-urgent procedures
=>In regions heavily impacted by the outbreak (peak or plateau phases), carried out in urban areas by mobilising available resources otherwise postpone with an approximate average delay of 1 to 2 months:
- periodic surveillance imaging of previous HCC or current HCC under treatment;
- biannual screening for HCC in high risk patients;
- non-urgent liver biopsies;
- measurements of liver stiffness and/or CAP.
It is cautious to defer pre-transplant check-ups when possible according to the risk/benefit balance, or to perform most tests outside the hospital depending on local resources.
- Maintenance of scheduled stays within non-COVID units by ensuring that before each admission patients do not present any signs of COVID-19 and by being extra careful to protect them (surgical mask as soon as they arrive in the facility, implement barrier precautions with avoidance of waiting in groups, especially at admissions and in waiting rooms, reduce waiting times, single rooms when possible, maintain a minimal 1 metre distance between patients, apply hygiene rules for the nursing staff and limit the number of health carers involved) for the following main indications:
-1/ curative treatments of primary liver cancer (surgery and interventional radiology) [3];
-2/ ascites paracentesis;
-3/ esophageal variceal ligation and gastric variceal sclerotherapy in secondary prevention;
-4/ urgent liver biopsies.



Clinical trials - Defer inclusions to the end of confinement if possible, except for COVID-19 trials and non COVID-19 observational trials (assessment of individual benefit/risk balances).
- On a case-by-case basis, evaluate with the promoter the possibility of carrying out remote consultations, blood sampling at home by registered nurses and home dispatching of the treatments under investigation.



Vaccinations In the absence of immunization against pneumococcus: carry out pneumococcal polysaccharide conjugate vaccine (13-valent, adsorbed) if this does not jeopardise confinement, otherwise defer it until the end of social isolation.