Clinical decision algorithm to guide care advice messages

• Ill or caring for someone ill?
• If “No,” provide education (Refer to Care Message A).
• If “Yes,” collect needed demographics including age and gender of the patient.
  • If younger than 2 years old, evaluate for life-threatening conditions:
    • Extremely fast or shallow breathing
    • Blue-colored lips or face
    • Not waking up or interacting when awake
    • So irritable that child doesn’t want to be held
    • Seizures
    • Other conditions as per your center’s protocol
  • If “Yes” to life-threatening conditions, call 911 (Refer to Care Message B).
  • If “No,” seek evaluation by outpatient medical provider as soon as possible. (Triage tool not intended for children < 2years) (Refer to Care Message C).
  • If 2 years or older, evaluate for life threatening conditions:
    • Extremely difficult breathing (can’t walk without gasping for air)
    • Blue-colored lips or face
    • Severe or persistent pain or pressure in the chest
    • Severe constant dizziness or lightheadedness
    • Acting confused or unable to wake up
    • Slurred speech (new or worsening)
    • New onset seizure or seizures that won’t stop
    • Other conditions as per your center’s protocol

• • If “Yes,” call 911.
  • If “No,” ask a series of questions.
    • Exposures: In the last 2 weeks before sick:
      • Have contact with someone with COVID-19?
      • Live in/visit a place where COVID-19 spreading?
    • Symptoms:
      • Fever (subjective or measured)
      • Shortness of breath
      • Severe shortness of breath (unable to speak full sentence)
      • Cough
      • Coughing up blood (hemoptysis)
      • Signs of low blood pressure (cold, pale, clammy skin, light-headed)
      • Runny or stuffy nose
      • Sore throat
      • Muscle, body aches, or headaches
      • Fatigue or malaise
      • Nausea, vomiting or diarrhea
      • For (age 2-4 years)
        • Ribs are pulling in with each breath (retractions)
        • Dehydration/decrease urine output
    •  High-risk Conditions:
      • Age ≥65 years
      • Chronic lung disease or moderate to severe asthma
      • Congestive heart failure
      • Diabetes with complications
      • Neurologic conditions that weaken ability to cough
      • People with weakened immune systems
      • Dialysis
      • Cirrhosis of the liver
      • Extreme obesity (Body Mass Index, or BMI greater than or equal to 40)
      • Pregnancy
    • Special Circumstances:
      • Living in nursing home or long-term care facility
      • Healthcare personne

Determine disposition

• • • Dispositions:
      • Provide education (Refer to Care Message A):
        • No symptoms/not sick
      • Urgent Medical attention is needed/Go to the ED (Refer to Care Message D):
        • Severe shortness of breath; or
        • Hemoptysis; or
        • Signs of low blood pressure; or
        • Dehydration (only ages 2-4); or
        • Retractions (only ages 2-4)
      • Call a provider within 24 hours (Refer to Care Message E):
        • • Any non-severe shortness of breath; or
          • Fever + ≥1 comorbidity; or
          • Cough + ≥1 comorbidity

        (Encourage tele-health options)

      • Contact facility occupational health provider immediately (Refer to Care Message F):
        • Healthcare personnel, and
        • Any non-severe shortness of breath; or
        • Fever; or
        • Any respiratory symptom
      • Contact LTC facility healthcare provider to be seen (Refer to Care Message G):
        • Live in a nursing home/LTC facility and
        • Any non-severe shortness of breath; or
        • Fever; or
        • Cough
      • Stay at home, call provider if you get worse (Refer to Care Message H):
        • Fever + no comorbidity; or
        • Cough + no comorbidity; or
        • Any other symptom, regardless of comorbidity
          (Encourage tele-health options)