|High Risk||Average Risk||Low Risk|
|Patients with any of the safety net flags||Otherwise healthy fully vaccinated (primary series plus booster) adults with non-concerning symptoms2,4; asymptomatic adults|
|Patients with symptom deterioration or symptoms of concern (dyspnea or significant diarrhea)2||Pregnant women||1-60 years old with no medical comorbidities|
|Any age with medical comorbidities who are not fully vaccinated (primary series plus booster)||Unvaccinated (excluding asymptomatic)*|
|Age > 60 not fully vaccinated||Patients > 60 or with comorbidities at any age who are fully vaccinated (primary series plus booster) and have milder symptoms (i.e., no dyspnea or significant diarrhea)|
Daily for 7 days then every few days, depending on progress until symptoms resolve
Every few days x 7 days; then could recommend self-monitor for additional 7 days depending on progress
Consider self-monitoring only; check-ins determined by individual patient. (Consider at 5-7 days for children and symptomatic adults especially in the 40-60 age group)3
NOTE 1: Adults and older children in High Risk category should have home pulse oximeter to assist monitoring if available. For Average Risk patients use clinical judgement. For example if comorbidities are of more concern e.g. significant COPD, or if there is prominent patient anxiety (remembering a goal of use is to reduce ED attendance and unnecessary healthcare use through reassurance). Pulse oximeters are not recommended for monitoring of younger children.
NOTE 2: Patients (adults and children) in the low risk category with increasing symptoms move to the high risk/daily monitoring (including pulse oximeter) category. With current restriction of access to PCR and therefore later presentation of patients to primary care, otherwise healthy adults with concerning symptoms at presentation (i.e., dyspnea, significant diarrea) should be monitored more closely – i.e., treated as “symptom deterioration”. Asymptomatic patients should have their risk category reassessed if they develop symptoms.
NOTE 3: Children with more prominent respiratory symptoms should be more closely monitored.
NOTE 4: in patients with significant fatigue in the low risk category, consider using pulse oximetry to determine this is not due to hypoxia.
NOTE 5: *Based on the latest data from 12 provinces and territories for the eligible population, 12 years or older: 0.08% of fully vaccinated people became infected, with the majority of recent cases and hospitalizations occurring in unvaccinated or partially vaccinated people.
- The average weekly rate of new COVID-19 cases in unvaccinated people was 11 times higher than in the fully vaccinated.
- The average weekly rate of hospitalized cases in unvaccinated people was 39 times higher compared to fully vaccinated people
*In patients who required hospitalization, the median time from symptom onset to dyspnea was 5 days.
In patient who developed ARDS the median time to onset was 3 days after development of dyspnea (around 8 days after symptom onset).
Safety Net Flags
- Socially isolated (Lives alone, unable to connect with others through technology, little to no social network)
- Lack of caregiver support if needed (including safe environment for care of children)
- Inability to maintain hydration (Diarrhea, vomiting, cognitive impairment, poor fluid intake)
- Food/financial insecurity
- Receive homecare support
- Challenges with health literacy or ability to understand treatment recommendations or isolation expectations
- Unable to self-manage