COVID 19 Diseases

exp date isn't null, but text field is

Coronavirus disease (COVID-19) results from infection with the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It is a novel virus in humans, knowledge of which and its pathogenesis still evolving. Additionally, the population-level immunity is uncertain. Complications of the severe infection can result in death.

Clinical features

  • Early symptoms are non-specific and may include:
  • fever, cough, myalgia, fatigue, shortness of breath, sore throat, headache, flu-like symptoms, diarrhea, nausea, respiratory distress, features of renal failure, pericarditis, and Disseminated Intravascular Coagulation (DIC).
  • It is important to know that many individuals with COVID-19 are asymptomatic. It is therefore paramount that all health workers observe strict infection prevention and control (IPC) measures at all times.

Classification of COVID 19 Disease

Disease Stage

Hallmark

Features

Mild Disease

No Respiratory Distress

Normal Vital Signs

Moderate Disease

Non-Severe Pneumonia

Crackles in chest but Normal SPO2, mild respiratory distress (Resp Rate <30)

Severe Disease

Oxygen

De saturation

Severe Respiratory distress (Resp Rate >30) & SPO2 <90%,

Critical

Organ Dysfunction

CNS: Altered Mental State

CVS: Hypotension & Shock

Kidney: Decreased Urine Output, Raised Creatinine

Liver: Elevated liver enzymes

Coagulation: Raised PT & INR, Thrombocytopenia

Endocrine: Hypoglycemia

 

 

 

Groups at High Risk of Developing Severe Disease or Complications

  • Age > 65 year
  • Obesity
  • Lung diseases (e.g. asthma, TB, COPD)
  • Hypertension
  • Heart conditions such as history of heart attack or stroke
  • Diabetes
  • Cancer patients whether or not on chemotherapy
  • Advanced liver disease
  • Person living with HIV
  • Kidney disease
  • Severe Acute Malnutrition
  • Sickle cell disease
  • COVID 19 unvaccinated
  • Pregnancy and recent pregnancy
  • Hypertension

Differential diagnoses

  • Malaria and other febrile illnesses.
  • Common respiratory, infectious, cardiovascular, oncological, and gastrointestinal diseases

Investigations

Management

  • Perform SARS-CoV-2 Rapid Diagnostic Test (RDT)
  • Carry out nasopharyngeal swabs for RT-RNA test
COVID-19 screening and triage process at health facilities
  • COVID-19 triage aims to flag suspected patients at first point of contact within the healthcare system in order to protect other patients and staff from potential exposure.
  • Identify and rapidly address severe symptoms, rule out other conditions with features similar to COVID-19, ascertain if suspect case definition is met.
  • All suspected patients should be directed to a designated area away from other patients and handled as per standard Covid protection guidelines
  • Refer to the Comprehensive COVID-19 Case Management Guidelines for details.

TREATMENT

LOC

Safety of health workers and caregivers: maximum level of infection control procedures

  • Strict isolation of suspect cases
  • Use of adequate protective gear
  • Minimize invasive intervention
  • Safe handling of linen
  • Appropriate use of chlorine mixtures
  • Proper disposal of health care waste
  • Educate the patient and care givers on appropriate infection control measures

HC2

No Hospitalization (mild to moderate diseases)

  • All patients with no risk of developing severe COVID-19 diseases.
    symptom management, supportive care, and monitoring (at home, or in the community).
  • Control fevers with paracetamol, multivitamins and advise on balanced diet

Adults and Children >40kg at increased risk of de- veloping severe COVID-19 diseases. Refer to current Covid-19 treatment guidelines.

  • nimatrelvir/ritonavir 300/100mg orally (PO) twice daily for 5 days (must be initiated within 5 days of symptom onset)
  • OR remdesivir IV infusion once daily for 3 days with a loading dose 200mg on Day 1 and 100mg on subsequent days. (initiated within 7 days of symptom onset)
  • OR molnupiravir 800mg orally (PO) twice daily for 5 days ONLY when ritonavir-boosted nirmatrelvir or remdesivir cannot be used; treatment should be initiated as soon as possible and within 5 days of symptom onset (contraindicated in pregnant or breastfeeding women and children)

HC2

If the patient requires hospitalization (Severe to Critical disease)

  • Oxygen therapy
  • And Corticosteroids
  • And Venous thromboembolism prophylaxis
  • And Interleukin-6 receptor blocker (tocilizumab or sarilumab)

or JAK Inhibitor (baricitinib)

For details refer to the Comprehensive COVID-19 case Management Guidelines

RR

 

 

 

 

 
Prevention
  • Vaccination (Refer to chapter 18: Immunization)
  • Epidemic preparedness i.e. prompt detection and treatment
  • Infection Prevention and control measures including mask wearing, social distancing, regular handwashing, avoid shaking hands etc.