key: cord-0858802-nzy2iphz
authors: Matras, Przemyslaw; Klek, Stanislaw; Folwarski, Marcin; Zmarzly, Anna; Bartoszewska, Lidia; Cebulski, Wlodzimierz; Jakubczyk, Marlena; Kamocki, Zbigniew; Klepczyk, Katarzyna; Kunecki, Marek; Lawiński, Michal; Majewska, Krystyna; Matczuk, Maciej; Matysiak-Lusnia, Katarzyna; Sadowski, Maciej; Sobocki, Jacek; Sumlet, Magdalena; Szafranski, Waldemar; Szczepanek, Kinga; Urbanowicz, Krystyna; Zoubek-Wojcik, Agata
title: Home Medical Nutrition during SARS-CoV-2 pandemic – a position paper
date: 2020-05-11
journal: Clin Nutr ESPEN
DOI: 10.1016/j.clnesp.2020.05.002
sha: 65f6f18d2b361271d8ac0472cff12b37c71d5d83
doc_id: 858802
cord_uid: nzy2iphz

Summary Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a worldwide rapidly spreading illness, Coronavirus Disease 2019 (COVID-19). Patients fed enterally and parenterally at home are exposed to the same risk of infection as the general population, but more prone to complications than others. Therefore the guidance for care-givers and care-takers of these patients is needed. Methods The literature search identified no relevant systematic reviews or studies on the subject. Therefore a panel of 21 experts from 13 home medical nutrition (HMN) centres in Poland was formed. Twenty-three key issues relevant to the management of SARS-CoV-2 infection or COVID-19 in the HMN settings were identified and discussed. Some statements diverge from the available nutrition, surgical or ICU guidelines, some are based on the best available experience. Each topic was discussed and assessed during two Delphi rounds subsequently. Statements were graded strong or weak based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Results the panel issued 23 statements, all of them were graded strong. Two scored 85.71% agreement, eleven 95.23%, and ten 100%. The topics were: infection control, enrolment to HMN, logistics and patient information. Conclusions the position paper present pragmatic statements for HMN to be implemented in places without existing protocols for SARS-CoV-2 pandemic. They represent the state of knowledge available at the moment and may change should new evidence occurs.

A novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 76 resulted in an acute respiratory illness epidemic in Wuhan, China in the late 2019 [1] [2] [3] . The population, but much more exposed to the risk of severe complications of COVID-19 (due to 84 impaired immunity and co-morbidities). They require specialized care and increased attention. 85 Over last few weeks some organisations and societies have issued statements on the infection 86 control, screening and diagnosis in the general population, such as surgery or ICU, however, 87 no information on HMN patients has ever been published [5] [6] [7] [8] . 88 To improve this situation, a panel of Polish HMN experts decided to prepare and publish 89 statements that can be used during the everyday care of HMN patients, being fully aware that 90 most of these have not been validated. Nonetheless, the main aim was to pragmatically 91 implement nutritional care in HMN individuals to improve patient care in order to cope with 92 the current crisis. Twenty-three key issues relevant to the management of SARS-CoV-2 infection or COVID-19 123 in the HMN settings were identified and discussed.

Statements diverge from the available nutrition, surgical or ICU guidelines, some are based on 125 the best available experience. [5] [6] [7] [8] Each topic was discussed, and assessed during Delphi 126 rounds subsequently. Statements were graded strong or weak based on the balance between 127 benefit and harm, resource and cost implications, equity, and feasibility. 

The following statements were formulated in the process. It is recommend to form two teams working 7 day shifts. 

Treatment Expert Group for Clinical characteristics of Coronavirus Disease

European Centre for Disease Prevention and Control (ECDC)

Coronavirus disease (COVID-19) outbreak 2020 455

Espen expert statements and practical 458 guidance for nutritional management of individuals with sars-cov-2 infection

SAGES and EAES Statements Regarding Surgical Response to COVID-19 Crisis

Handbook of COVID-19 Prevention and treatment

Surviving Sepsis Campaign: Guidelines on the Management of 465

COVID-19)

Direct financial and industry-related COIs were not permitted and were considered 438 disqualifying. The development of this guideline did not include any industry input, funding,