DECISION

On interim guidelines on medical specialty for implementation of Resolution No. 128/NQ-CP dated October 11, 2021 of the Government promulgating interim regulations on “Safety, flexibility and effective control of COVID-19”

THE MINISTER OF HEALTH

Pursuant to the Law on Prevention and Control of Infectious Diseases in 2007;

Pursuant to the Law on Medical Examination and Treatment in 2009;

Pursuant to Decree No. 75/2017/ND-CP dated June 20, 2017 of the Government on function, tasks, powers and organizational structures of the Ministry of Health;

Pursuant to Resolution No. 128/NQ-CP dated October 11, 2021 of the Government promulgating interim regulations on “Safety and flexibility and effective control of COVID-19”;

Implementing Official Telegram No. 1745/CD-TTg dated December 19, 2021 of the Prime Minister on enhancement of prevention and control of COVID-19, control of Omicron, a new variant of SARS-CoV-2;

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HEREBY DECIDES:

Article 1. Interim guidelines on medical specialty for implementation of Resolution No. 128/NQ-CP dated October 11, 2021 of the Government promulgating interim regulations on “Safety, flexibility and effective control of COVID-19” are promulgated together with this Decision.

Article 2. This Decision comes into force from the day on which it is signed and replaces Decision No. 4800/QD-BYT dated October 12, 2021 of the Ministry of Health.

Article 3. Chief of the Ministry Office, Chief Inspector of the Ministry; Director Generals of Departments and Agencies of the Ministry of Health; Directors of Preventive Medicine Institutes; Directors of hospitals affiliated to the Ministry of Health; Directors of the Departments of Health, Centers for Disease Control and Prevention of provinces and central-affiliated cities; medical Chief Officers of ministries, departments, Chief Officers of relevant units and agencies, organizations and individuals are responsible for implementation of this Decision./.

PP. MINISTER
DEPUTY MINISTER




Nguyen Truong Son

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(Issued together with Decision No. 218/QD-BYT dated January 27, 2022 of the Ministry of Health)

I. THE PRINCIPLES OF ASSESSMENT OF EPIDEMIC LEVELS AND RESPONSE

(1) Control of epidemic at source shall be an active and effective measure; application of blockage measures in large areas should be avoided.

(2) Domestic and international experience in epidemic prevention and control shall be inherited and absorbed in order to ensure relative stability in the process of adjusting indicators in the criteria for assessing epidemic levels and suitability for actual epidemic situation.

(3) General epidemic prevention and control measures shall include health, administration, social economy and treatment and prevention according to epidemic levels specified in Resolution No. 128/NQ-CP dated October 11, 2021 of the Government.

(4) Risks shall be controlled at the commune-level as early and orderly as possible in order to ensure flexibility and effectiveness; ensure early discovery of abnormalities for correct and effective handling. Local Government shall be proactive instead of leaving treatment of serious cases to health authorities.

II. CRITERIA FOR ASSESSING EPIDEMIC LEVELS

1. Criteria

a) Criterion 1: new local cases/population/time.

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c) Criterion 3: Capacity for admission and treatment of medical examination and treatment facilities at all levels.

2. Criteria determination

According to the World Health Organization, 02 groups for identifying epidemic levels include infection level indicators and Indicator response capacity indicators. On the basis of reference to international assessment methods and Vietnam's actual assessment, the Ministry of Health shall provide guidance on determination of the specific criteria as follows:

2.1. Criterion 1: Rate of new local cases/population/time

2.1.1. Indicator 1a: Weekly new cases in the commune/100.000 people (hereinafter referred to as "case rate", which Indicator is an infection level indicator).

There are 04 levels of case rates in ascending order (level 1: <90; level 2: from 90 to <450; level 3: from 450 to 600; level 4: >600).

2.1.2. Indicator 1b. Average cases on ventilators per 7 days in the commune/100.000 people (hereinafter referred to as "rate of cases on ventilators", which Indicator is an infection level indicator).

There are 04 levels of rate of cases on ventilators (level 1: <1; level 2: from 1 to <32; level 3: from 32 to 40; level 4: >40).

The rate of cases on ventilators shall be calculated by district-level health centers and distributed to each commune

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This indicator must not exceed 6/100.000 people in the commune.

This indicator is the combination of both infection level and response capacity and needs to be controlled; thus, this indicator shall be used to assess and adjust the epidemic levels in the commune.

2.2. Criterion 2: Vaccination coverage

2.2.1. Indicator 2a. Rate of full vaccination according to the recommendation at the time of assessment of the Ministry of Health in the commune, which involves the entire population in the area (hereinafter referred to as "Full vaccination coverage, which belongs to the group of infection levels).

The full vaccination coverage must reach at least 75% of the total population at the time of assessment.

Indicator 2a shall be used to adjust the infection levels in the commune.

2.2.2. Indicator 2b. Full vaccination coverage in the high-risk group (no contraindications to vaccination) in the commune (hereinafter referred to as “full vaccination coverage in the high-risk group", which is an infection level indicator).

The full vaccination coverage in the high-risk group must reach at least 90% at the time of assessment.

Indicator 2b shall be used to adjust the infection levels in the commune.

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2.3.1. Indicator 3a. Rate of managing and caring preparedness /10.000 people: ability to manage and care in the commune (hereinafter referred to as “Rate of management and care preparedness", which is a response capacity indicator).

This indicator has 3 levels (high: >500; medium: 200-500; low: <200).

2.3.2. Indicator 3b. Number of hospital beds available for COVID-19 patients in admission and treatment facilities in a district/100.000 people at the time of assessment (hereinafter referred to as “Rate of hospital beds available for COVID-19 patients, which is a response capacity indicator).

This indicator has 3 levels (high: >30; medium: 10-30; low: <10).

This indicator shall be determined by the Health Center of the district and then used for all communes of the district.

2.3.3. Indicator 3c. Number of fully staffed intensive care unit (ICU) beds /100.000 people (hereinafter referred to as "Rate of ICU beds", which is a response capacity indicator).

The rate of fully staffed ICU beds in a province must reach at least 4/100.000 people.

Indicator 3c shall be used to adjust the response levels in communes of the province. If this indicator does not reach at least (4/100.000), the response capacity levels of communes in the province must be decreased by one level (unless it is already the lowest level).

3. Determination of epidemic levels

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3.1. Stage 1: Determination of infection levels (4 levels)

Infection levels of a commune shall be the highest level of 02 indicators (1a, 1b) of Criterion 1 and adjusted according to indicator 2a and 2b of Criterion 2. To be specific:

Table 1: Determination of infection levels

Indicators for assessment of infectious risks

Level 1

Level 2

Level 3

Level 4

Indicator 1a. Case rate

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90-<450

450-600

>600

Indicator 1b. Rate of cases on ventilators

< 1

1 -<32

32 - 40

>40

Then, it will be combined with indicators 2a and 2b; if one of two indicators or both indicators 2a and 2b do not reach the minimum levels, the infection levels shall be increased by one level (unless it is already level 4) .

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Infection levels of an administrative division shall be the highest level of indicators 3a and 3b of Criterion 3 and adjusted according to indicator 3c of the Criterion 3. To be specific:

Table 2: Determination of response capacity of an administrative division

Indicators of assessment of response abilities of an administrative division

High capacity

Medium capacity

Low capacity

Indicator 3a. Rate of management and care preparedness

>500

200-500

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Indicator 3b. Rate of ICU beds available for COVID-19 patients

>30

10-30

<10

Then, it will be combined with indicator 3c; if indicator 3c does not reach the minimum levels, the infection level shall be decreased by one level (unless it is already low capacity).

3.3. Stage 3: Identification of epidemic levels

The epidemic levels shall be indentified according to the results of assessment of infection levels (4 levels of the stage 1) and the response abilities (3 abilities of the stage 2) and then adjusted by Indicator 1c of the Criterion 1 according to the following table 3:

Table 3: Calculation table of epidemic levels

Infection levels

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Response abilities

Level 1

Level 2

Level 3

Level 4

High

Level 1

Level 1

Level 2

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Medium

Level 1

Level 2

Level 3

Level 4

Low

Level 2

Level 3

Level 4

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After calculating the epidemic levels in the commune according to table 3, Indicator 1c of the criterion 1 shall be used to adjust and identify the epidemic levels. If Indicator 1c exceeds 6/100.000 people in the commune, the epidemic levels shall be upgraded a level (except for cases subject to the level 4).

III. PROFESSIONAL MEASURES

1. Preparation of capacity for response to the COVID-19 pandemic

To ensure safety, flexibility and effective control of COVID-19 pandemic, provinces and central-affiliated cities shall:

a) Formulate scenarios and plans for ensuring medical affairs serving COVID-19 pandemic prevention and control according to each epidemic level; implement them in case of local outbreaks.

b) Enhance the capacity for admission and treatment of COVID-19 cases:

- Assess capacity to manage and care for COVID-19 patients (F0 cases) at commune levels; ensure the availability of COVID-19 hospital beds at district-level admission and treatment facilities and fully staffed ICU beds at medical examination and treatment facilities in the provinces and cities (including private healthcare facilities) in order to be prepared for response to epidemic situation at the highest level. Update data and manage reporting software for F0 treatment and admission facilities.

- Carry out assessment and classification of patients at all levels, especially at commune level in order to manage and care for F0 cases at home or at suitable healthcare facilities; avoid invalid referral in order to avoid overloading upper-level facilities.

- Be prepared for outbreaks: examination and treatment facilities of districts and upper levels shall have the liquid or compressed oxygen supply system; medical stations of communes, wards and commune-level towns shall ensure supply of medical oxygen; have plans for organizing mobile medical stations, F0 caring teams in the community, F0 management organizations at home; areas with epidemic level 3 or higher must have plans for enhancing capacity for admission and treatment for COVID-19 patients to avoid overload in a large area.

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c) Enhance capacity for admission and treatment at all levels, especially grassroots levels. Provide training and carry out classification and treatment for COVID-19 patients according to the pyramid model of the Ministry of health in order to avoid overloading upper-level hospitals. Review and actively improve capacity for healthcare system; have definite plans with specific scenarios to avoid passivity. Make sure all people who test positive for Covid-19 have access to healthcare services, medicine support, management and health monitoring. Ensure adequate medical oxygen supply and referral for people at higher risk of severe Covid-19 illness, deaths and people who are undergoing home treatment and may have difficulty contacting medical workers. Develop a referral system to ensure accessibility for all people.

d) Enhance training to improve capacity for contact tracing, testing, medical quarantine/isolation and treatment in the area.

2. Testing

a) SARS-CoV-2 tests shall be carried out by one method or a combination of different methods; random and periodic screening tests shall be carried out by management authorities of units and areas in high-risk areas and for the high-risk group in accordance with the guidelines of the Ministry of Health.

b) Testing for elimination of Covid-19 clusters: local governments shall cooperate with Institute of Hygiene and Epidemiology, Pasteur Institute in deciding suitable subjects and areas for testing. Carry out genome sequencing testing samples of persons with unusual symptoms.

c) Do not require testing of people traveling within the country.

3. Medical quarantine

For persons who come in close contact with Covid-19 patients (F1 cases) and inbound passengers: implement guidelines of the Ministry of Health.

4. COVID-19 vaccination

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- Review and make lists of people at higher risk, organize administration of required doses and booster doses for people who have not been vaccinated or fully vaccinated.

5. F0 treatment: implement according to the guidelines of the Ministry of Health.

6. Current guidelines of the Ministry of Health, the Ministry of Education and Training, the Ministry of Transport and the Ministry of Industry and Trade shall apply to COVID-19 prevention and control assurance at healthcare facilities, manufacture and business establishments, shopping malls, supermarkets, markets, restaurants and at education and training institutions, vehicle operators.

For the organization of crowded indoor and outdoor activities in areas subject to epidemic level 2, 3 and 4: local governments will decide whether to increase the number of participants or the operating capacity in the case of 100% of the participants who have received full doses of vaccine or have recovered from COVID-19 or have tested negative for SARS-COV-2.

III. IMPLEMENTATION

1. The People’s Committees of provinces and central-affiliated cities

a) Direct the organization of the epidemic level assessment at least once per week according to this Guideline to effectively implement the Government's Resolution No. 128/NQ-CP dated October 11, 2021 and refuse to make regulations that are contrary to Resolution No. 128/NQ-CP of the Government; report the results of the epidemic level assessment in communes and adjust the thresholds of the indicators under the assessment criteria of the province and city to the Ministry of Health (the Department of Preventive Medicine).

b) Strengthen supervision and inspection down to grassroots level, prepare necessary conditions to be ready to respond quickly when the pandemic situation changes.

c) Direct the Department of Health to publish and update on the local portal of the Ministry of Health: capdodich.yte.gov.vn; direct local press agencies and the Department of Health to communicate to the people and the community about the epidemic levels, recommendations and messages on COVID-19 prevention and control.

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dd) Direct the Healthcare Centers of the districts to assess the rate of cases on ventilators and the rate of bed availability to assess the indicators under the criteria in the communes under their management area and cooperate with the Medical Stations of the communes in assessing the epidemic levels in the communes according to this guideline.

e) Direct the Medical Stations to cooperate with relevant units in implementing assessment of the indicators in order to determine the epidemic levels and implement epidemic prevention and control measures belonging to the epidemic levels under regulations.

2. Ministries and Central Authorities

a) Direct the relevant units and agencies to cooperate with local authorities in implementing this Guideline in order to implement effectively the Government's Resolution No. 128/NQ-CP dated October 11, 2021.

b) Cooperate with the Ministry of Health and local authorities in enhancing urge and inspection of implementation of this Guideline.

3. Units affiliated to the Ministry of Health

a) Actively implement this Guideline according to their assigned functions and tasks in the prevention and control of COVID-19.

b) The Department of Preventive Medicine shall act as the focal point to cooperate with relevant agencies and units in guiding, disseminating, directing and inspecting the implementation and reporting on the implementation results of this Guideline if necessary; deploying a nationwide vaccination campaign against COVID-19 to ensure safety, science and effectiveness and develop a route for children's vaccination and booster vaccination.

d) The Department of Examination and Treatment Administration shall provide guidance for the localities on formulating plans, training human resources and implementing assurance of capacity for admission and treatment at all levels; manage F0 individuals at home; update instructions on patient treatment and care even for health recovery after illness.

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e) The Information Technology Department shall cooperate with the Department of Preventive Medicine in updating and publishing capacity for admission and treatment, pandemic areas and epidemic levels of all the localities in Vietnam on the epidemic level portal at https://capdodich.yte.gov.vn. The Information Technology Department shall cooperate with The Department of Examination and Treatment Administration and the Department of Preventive Medicine in deploying Administration Software and consulting F0 individuals at home with the unity of all the localities in Vietnam.

g) The Department of Communication, Emulation and Commendation shall act as the focal point to cooperate with the Department of Preventive Medicine in formulating communication documents on the epidemic levels, recommendations and messages on COVID-19 prevention and control, updating them on the Electronic Data Warehouse (EDW), providing them to localities and units carrying out communication with the people; cooperating with press agencies in disseminating the Guidelines; organizing communication on social networking platforms.

h) "Sức khỏe và Đời sống" Newspaper, the Ministry of Health Portal shall strengthen communication on the Guidelines and implementation situation in the locality; update public information about capacity for admission and treatment, pandemic areas and epidemic levels of all the localities in Vietnam on the website of the Ministry of Health.

i) The Department of Planning and Finance shall act as the focal point to cooperate with relevant units in continually proposing and guiding the implementation of solutions and policies in order to strengthen investment capacity, improve the capacity of the healthcare system, especially preventive medicine and internal health organizations.

k) The Department of Cadre Organization shall act as the focal point to cooperate with the Ministry Office and relevant units of the Ministry of Defense, the Ministry of Public Security in readily preparing mobile forces to promptly assist local authorities in case epidemic situation is out of control of local authorities.

On the basis of the actual pandemic developments and actual characteristics in the provinces, the Ministry of Health and the Department of Health will continue to adjust the thresholds of the indicators under the appropriate assessment criteria for the epidemic levels.

Difficulties that arise during the period of implementation of this Circular should be reported promptly to the Ministry of Health (Department of Preventive Medicine) for handling. This Guideline will be continually updated and adjusted to suitable for the actual developments./.

APPENDIX:

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1. Definition of terms

(1) “In week” means 7 consecutive days from Monday to Sunday that is closest to the date of assessment.

(2) “new cases” means all the cases reported including imported cases undergoing isolation, management, care and treatment in the area.

(3) “The number of cases on ventilators” means all the cases that have to be put on ventilators using oxygen masks or nasal cannulas or in more serious condition

(4) “weekly deaths in a commune” means the total deaths recently recorded in the commune in that week. In which:

The number of deaths shall be counted from COVID-19 cases of units of the commune in the area to which they are referred or confirmed residence for the first time.

(5) "Full vaccination" means administration of the required doses and booster dose at the request of the Ministry of Health at the point of assessment for each entity group in the area.

Example: The Ministry of Health requires that until the end of January, 2022, children aged from 12 and over must be receive required doses and until March 31, 2022, persons aged 18 and over must receive booster doses. Thus, full vaccination for children aged from 12 to 18 is at least 2 doses of vaccines and for persons aged from 18 and over is at least 3 doses of vaccines. In case a person has received the required doses and is not yet qualified for the booster dose, he/she is still considered fully vaccinated if it is still within the vaccine protection period.

(6) “High-risk group” includes persons aged over 50, persons with co-morbidities, immunocompromised persons, pregnant women.

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(8) “COVID-19 treatment beds at district level” means the number of hospital beds available for COVID-19 patients at the admission and treatment facilities including extra beds mobilized by the district authority.

2. How to calculate indicators

(1) Indicator 1a: Case rate.

 Case rate = (Total new confirmed cases in the commune in the week/all population in the commune) x 100.000.

(2) Indicator 1b. Weekly rate of cases on ventilators in a commune/100.000 people.

Rate of cases on ventilators = (Total of weekly cases on ventilators in a commune/total of population in the commune) x100.000.

Total weekly cases on ventilators in the commune= Total of Total recorded daily cases on ventilators in the week/7.

(Example: Total of daily cases on ventilators in the week = Cases on ventilators recorded on Monday + Cases on ventilators recorded on Tuesday + …+ Cases on ventilators recorded on Sunday).

Total cases on ventilators in the commune = Total cases on ventilators (using oxygen masks or nasal cannulas or in more serious condition) who are monitored and treated in the commune + Total cases on ventilators (using oxygen masks or nasal cannulas or in more serious condition) who are residing in the commune but referred to district-level health facilities for treatment) (according to statistics provided by the Healthcare Centers of the district to its communes).

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Rate of deaths = (Total weekly deaths in the commune/ total population of the commune) x100.000

(4) Indicator 2a. Rate of full vaccination under regulations at the point of assessment of the Ministry of Health is calculated based on the total of population.

Full vaccination coverage = (Total of persons getting full vaccination according to the regulation at the point of assessment of the Ministry of Health in the commune/total population in the commune) x100.000.

(5) Indicator 2b. Full vaccination coverage in the high-risk group (without contraindication to vaccination)

Full vaccination coverage in the high-risk group = (Total of persons subject to the high-risk group who getting full vaccination according to the regulation at the point of assessment of the Ministry of Health in the commune/total entities subject to the high-risk group in the commune reviewed) x100.

(6) Indicator 3a. Rate of management and care preparedness/10.000 people: number of patients within the management and care capacity of a commune

Rate of management and care = (Total COVID-19 patients within the management and care capacity/total population if the commune) x10.000.

(7) Indicator 3b. Rate of hospital beds available for COVID-19 patients at the admission and treatment facilities in a district/100.000 persons at the point of assessing the rate of hospital beds available for COVID-19 patients at the admission and treatment facilities = [(Total hospital beds available for COVID-19 patients at the admission and treatment facilities –number of occupied hospital beds for COVID-19 patient)/total population of the district] x 100.000.

(8) Indicator 3c. Rate of fully staffed ICU beds/100.000 people

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