A home-assessment programme was developed collaboratively between Harborview Medical Center and Public Health – Seattle & King County in 2014 in readiness to test minimally symptomatic patients for Ebolavirus infection at home quarantine locations. When the number of people being monitored COVID-19 increased in King County, Washington, the Harborview Home Assessment Team (HAT) was revised to provide real-time clinical assessments of patients. Patients with symptoms and possible exposure to SARS-CoV-2 were identified and, if they meet CDC testing criteria, Public Health determines the appropriateness of a HAT visit. The HAT staff call the patient to confirm that they are safe (breathing comfortably, able to eat and drink, mobilising), discuss details of the visit, and determine the locations for donning/doffing PPE. Each HAT is made up of one physician, one nurse, one or more trained PPE observers, and a site-commander. The patient is evaluated by the physician and samples are taken (nasopharyngeal swab, oropharyngeal swab and sputum if appropriate) for SARS-CoV-2 testing. An additional nasopharyngeal swab is collected for viral respiratory pathogen testing. Patients are instructed to self-isolate pending the results of testing and to continue isolation if positive for SARS-CoV-2. By publication, the HAT has conducted 15 community-based assessment visits, including in single-family homes and commercial properties where patients were isolated. No patients required subsequent hospitalisation. Approximate time from dispatch to return is 3 hours on average; including 10 minutes for donning, 30 minutes for face-to-face patient care, and 30 minutes for doffing/waste procedures. Two patients tested positive for SARS-CoV-2. Other patients tested positive for human coronavirus, rhinovirus, parainfluenza or had negative results. No contamination of healthcare worker PPE has occurred and no members have developed symptoms. This programme is a scalable, cost-saving model that cuts-down on resources required to isolate and care for patients. The model may also be used for other novel outbreaks and potentially in unconventional settings such as ships, planes, and airports.
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