An effective screening and management process in the outpatient clinic for patients requiring hospitalization during the COVID‐19 pandemic

Dear editor,

By 4 April 2020, confirmed cases of coronavirus disease 2019 (COVID‐19) have been found in 206 countries and regions, with over one million diagnosed cases and 51 737 reported deaths. ¹ Despite the resource consumption of the COVID‐19 epidemic, it is important to circumvent the risk that this pandemic indirectly increases mortality and morbidity of commonly treatable diseases. Patients with life‐threating illness such as congestive heart failure, myocardial infarction, acute liver failure, and malignancy still require attention and care. ² , ³ To help countries navigate through these challenges, the World Health Organization has updated operational planning guidelines in balancing the demands of responding directly to COVID‐19 while maintaining essential health service delivery, and mitigating the risk of system collapse on 30 March 2020. ⁴ The suggestion from China has been to build dedicated COVID‐19 units and hospitals that allow other hospitals to function normally.

Therefore, there is an urgent need for a reasonable patient screening and disposal process in outpatient clinics that provide essential health services. This process aims to detect asymptomatic patients and suspected patients of COVID‐19, to minimize the incidence of nosocomial infections and to prevent hospitals from becoming epidemic foci in the long run.

At present, the biggest threat constitutes asymptomatic infections and patients in the incubation period. Studies show that about 30%‐60% of COVID‐19 patients have mild or no symptoms. Although these are covert coronavirus infections, these patients still have the ability to spread the virus. ⁵ China has scaled up the screening of asymptomatic patients in an effort to prevent a domestic recurrence of the outbreak.

There are several key points in the screening process (Figure 1). First, suspected patients must be transferred to a designated “Fever clinic,” launching an interdepartmental collaboration (early detection, early diagnosis, and early isolation). All close contacts must undergo a complete reverse transcriptase polymerase chain reaction (RT‐PCR) check‐up for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Second, all patients without symptoms or history of contact must undergo both, RT‐PCR testing and SARS‐CoV‐2 antibody testing. SARS‐CoV‐2 antibody detection is an effective supplement to RNA testing to identify patients with COVID‐19. ⁶ Third, it is suggested that patients with negative results of RT‐PCR and antibody testing should undergo chest computed tomography. This would be regarded as the basic clinical data in case of hospital admission, and it would also help to identify asymptomatic patients with only radiological abnormalities.

Figure 1.

Screening protocol in the outpatient clinic for patients requiring hospitalization during the COVID‐19 pandemic

Inpatients must be accommodated in single rooms considering the possibility of false negative results on examination. Family members of the inpatients must not allowed to accompany them, and inpatients would have restricted mobility around the ward to avoid cross‐infection. Our protocol is reviewed every 2 weeks by an internal board according to the latest insights on COVID‐19. This process has been admirably efficient in the screening and management of patients presenting to the outpatient clinics in China and provides a guideline for other countries around the world to emulate in this fight against the COVID‐19.

CONFLICT OF INTERESTS

The authors declare that there are no conflict of interests.

AUTHOR CONTRIBUTIONS

ZD and FZG drafted the manuscript. TBW critically read and revised the manuscript, and gave final approval for publication.