Differences in triage criteria between low and high case fatality countries
| Triage criteria | Low CFR country | High CFR country |
| Duration of symptoms | Singapore and Japan recommend clinical assessment after day 4 of symptoms. | For both USA and the UK, duration of symptoms did not affect the triage advice in any case simulation completed. |
| Age | Singapore triages all patients over the age of 65 years with viral symptoms to clinical assessment. Japan recommend all ‘older adults’ to seek medical attention if viral symptoms persist more than 2 days. | Age (adults) did not appear to affect the recommendations in either the USA or UK triage systems. |
| Comorbidity | Singapore triaged all patients with any comorbidity directly to specialist clinic. Japan recommend patients with any comorbidity be assessed if symptoms are not improved after the second day. | The USA is more likely to triage patients with specific comorbidities to further care. The UK only considered patients with severe, high-risk comorbidities in their triage process. |
| Shortness of breath | Singapore and Japan all advise immediate clinical contact if a patient develops shortness of breath. | Both US and UK systems attempt to qualify the severity of shortness of breath. The USA and UK advise patients with ‘mild’ shortness of breath to remain at home. |
| Severity and safety-net advice | Singapore and Japan are explicit and repetitive about the need to make clinical contact if there are any worsening of symptoms. | The UK system’s advice to seek medical care if symptoms worsen is distant to the initial recommendation to remain at home. Guidance is provided on how to manage ‘breathlessness’ at home. Both the USA and UK focused on ‘stay home’. |
CFR, case fatality rate; GP, general practitioner.