Clinical Management Guidelines for Disease corona virus covid-19
Definitions :
•SARI (Severe Acute Respiratory Illness):
SARI with history of fever or measured temperature ≥38 C° and cough;
onset within the last about 10 days;
& requiring hospitalization.
However, the absence of fever does NOT exclude viral infection.
Surveillance case definitions for SARI (COVID-19)
Severe acute respiratory infection (SARI) in a person, with history of fever and cough requiring admission to hospital, with no other etiology that fully explains the clinical presentation AND any of the following:
A history of travel to corona affected countries in the 14 days prior to symptom onset; or
A healthcare worker who has been working in an environment where patients with severe ARI are being cared for; or
The person develops an unusual or unexpected clinical course, especially sudden deterioration despite appropriate treatment, without regard to place of residence or history of travel, even if another etiology has been identified that fully explains the clinical presentation
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A person with acute respiratory illness of any degree of severity who had any of the following exposures within 14 days before onset of illness:
close physical contact with a confirmed case of COVID-19 infection, while that patient was symptomatic; or
a healthcare facility in a country where hospital-associated COVID-19 infections have been reported
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Close Contact
Health care associated exposure, including providing direct care for COVID-19 patients, working with health care workers infected with COVID-19, visiting patients or staying in the same close environment of a COVID-19 patient
Working together in close proximity or sharing the same classroom environment with a with COVID-19 patient
Travelling together with COVID-19 patient in any kind of conveyance
Living in the same household as a COVID-19 patient
The epidemiological link may have occurred within a 14-day period before or after the onset of illness in the case under consideration
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Sign & Symptoms
COVID-19 can present as mild-moderate or severe illness
Mild
Uncomplicated illness with non-specific symptoms such as fever, cough, sore throat, congestion, headache, muscular pain or malaise
Moderate
Severe pneumonia with respiratory distress
Severe
Acute Respiratory Distress Syndrome (ARDS)
Sepsis
Septic sock with multi-organ failure
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Mild Illness
Uncomplicated Illness
Patients with uncomplicated URTI with non-specific symptoms such as fever, cough, sore throat, nasal congestion, malaise, headache
The elderly and immunosuppressed may present with atypical symptoms. These patients do not have any signs of dehydration, sepsis or shortness of breath
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Pneumonia
Patient with pneumonia and no signs of severe pneumonia
Child with non-severe pneumonia has cough or difficulty in breathing /fast breathing
Fast breathing (in breaths/min):
<2 months, ≥60; 2–11 months, ≥50; 1–5 years, ≥40 and
no signs of severe pneumonia
Moderate illness
Adolescent or adult: fever or suspected respiratory infection, plus one of the following:
Respiratory rate >30 breaths/min
Severe respiratory distress
SpO2 <90% on room air
Child with cough or difficulty in breathing, plus at least one of the following:
Central cyanosis or SpO2 <90%
Severe respiratory distress (e.g. grunting, very severe chest in-drawing)
Signs of pneumonia with a general danger sign
Inability to breastfeed or drink, lethargy or unconsciousness, or convulsions
Other signs of pneumonia may be present: chest in-drawing, fast breathing (in breaths/min): <2 months, ≥60; 2–11 months, ≥50; 1–5 years ≥40.
The diagnosis is clinical; chest imaging can exclude complications
Severe illness
Acute Respiratory Distress Syndrome
Onset: new or worsening respiratory symptoms within one week of known clinical insult
Chest imaging (radiograph, CT scan, or lung ultrasound): bilateral opacities, not fully explained by effusions, lobar or lung collapse, or nodules
Origin of oedema: respiratory failure not fully explained by cardiac failure or fluid overload. Need objective assessment (e.g.echocardiography) to exclude hydrostatic cause of oedema if no risk factor present.
Sepsis
Adults: life-threatening organ dysfunction caused by a dysregulated host response to suspected or proven infection, with organ dysfunction.
Signs of organ dysfunction include: altered mental status, difficult or fast breathing, low oxygen saturation, reduced urine output, fast heart rate, weak pulse, cold extremities or low blood pressure, skin mottling, or laboratory evidence of coagulopathy, thrombocytopenia, acidosis, high lactate or hyper-bilirubinemia.
Children: suspected or proven infection and ≥2 conditions of Systemic Inflammatory Response Syndrome (SIRS) criteria, of which one must be abnormal temperature or white blood cell count
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Septic Shock
Adults: persisting hypotension despite volume resuscitation, requiring vasopressors to maintain MAP ≥65 mmHg and serum lactate level >2 mmol/L
Children: any hypotension (SBP <5th centile or >2 SD below normal for age) or 2-3 of the following:
Altered mental state
Tachycardia or bradycardia (HR <90 bpm or >160 bpm in infants and HR <70 bpm or >150 bpm in children)
Prolonged capillary refill (>2 sec) or warm vasodilation with bounding pulses
Tachypnea
Mottled skin or petechial or purpuric rash
Increased lactate
Oliguria
Hyperthermia or hypothermia
Management
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