Name | Description |
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ADMISSION CRITERIA |
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CARE OF A SUSPECTED CASE WITH MILD SYMPTOMS WHO IS BEING SENT HOME |
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CASE MANAGEMENT |
MANAGING THE CASE:
Ceftriaxone 2g iv st art fo llow ed by 1g bd i v x 1/52 & Azithromycin 500mg od po on day 1 and then 250mg daily x 4 days
o aim for maintenance fluids unless if there is evidence of septic shock or obvious dehydration. o Rapid IV fluid infusions may accelerate the respiratory decompensation in those with pneumonia and/or ARDS and
LABORATORY TESTING OF PATIENT
MANAGEMENT OF HYPOXEMIC RESPIRATORY FAILURE AND ARDS
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COVID-19 |
What is COVID-19?Corona viruses are responsible for the simple colds that we know about but COVID-19 is a viral infection due to the new/novel corona virus that was identified in China in December 2019. This new corona virus (SARS-CoV-2) is easily transmitted from person to person and those not exhibiting symptoms can transmit it too, unlike SARS/MERS where transmission appeared to be via those already exhibiting symptoms. We expect that 80% of those who get infected will be able to take care of themselves at home. However, 20% will need to be admitted as they will have moderate /severe symptoms of COVID-19. We also expect that 5% of the total that will be infected will need ventilation in an intensive care setting. Given our limited capacity to handle infected cases in our hospitals all over Zimbabwe, it is important that we avoid getting infected. Hence, we need to observe the current public health measures and practice infection prevention and control to the highest extent possible. What is the incubation period? The incubation period appears to be about 14 days in most cases but most symptoms will appear at about day 5 of infection. Hence, WHO recommends that contacts of patients with laboratory confirmed COVID-19 be quarantined for 14 days from the last time they were exposed to the patient. What is self-quarantine and self-isolation? Self-quarantine refers to when you distance yourself from others after exposure or potential exposure just in case you may develop symptoms of COVID-19. Self-isolation refers to those with symptoms suggestive of COVID-19 and therefore need to assume they are infected even if not yet tested so as to protect others around them. This will also apply to confirmed COVID-19 cases with mild symptoms and being managed at home i.e. not deemed sick enough to be admitted. What are the symptoms? The case definition is changing all the time but in general a new fever, dry cough, myalgia, shortness of breath and extreme fatigue warrant an exclusion of COVID-19. Thus, anyone presenting with flu like symptoms should be assumed to be a potential COVD-19 case until proved otherwise. Children may also have poor feeding, nausea and vomiting.
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DISCHARGE AND POST-DISCHARGE |
How DO WE DECIDE WHEN TO DISCHARGE A CASE?
POST-DISCHARGE: How should the patient behave or what should they do to prevent getting infected again?
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HANDLING A SUSPECTED CASE OF COVID-19 |
TRIAGE:
o Therefore, they need to be admitted o Check if they have a respiratoryrate > 24, tachycardia>120, 02 saturation <90% Where to refer to:You will need to know where to refer patients for admission from your site. Whom to contact:Keep the numbers of the local/focal person that you need to contact if you suspect COVID-19.
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HANDLING OF CONTACTS OF COVID-19 |
Self- Quarantine - for all persons with history of exposure to COVID-19 who had a close contact with an infected person or have had limited contact with an infected person for a short period of time including travel outside the country or exposure to a case of COVID-19. Those who feel sick should also stay home and self-quarantine even if symptoms seem mild. Self -isolation for all persons with symptoms suggestive of COVID-19 to prevent the spread of the virus, including those within your home. Those who are sick should be separated from others in their home to the greatest extent possible. |
INFECTION PREVENTION AND CONTROL (IPC) |
A COVID -19 IPC response plan should be embedded in the overall facility IPC policy and plan. In COVID-19, the hierarchy of control measures are:
The following measures should be strictly observed in order to prevent transmission of SARS-Cov2:
In summary:Wash hands with soap and water as often as possible for at least 20 seconds. If you have no access to water, use hand sanitizer ideally one with 60-80%% alcohol. Given that we will not know who is infected and who is not, healthcare workers (HCW) will need to use appropriate PPE in the hospital setting in particular at Emergency Rooms and when caring for a person with COVID-19. HCW must be trained in the donning and doffing of this PPE and its correct disposal. We need to identify dedicated isolation centers/hospitals for COVID -19 treatment. |
RECOMMENDED SPECIFIC ANTIVIRAL INTERVENTIONS FOR COVID-19 |
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SIGNS AND SYMPTOMS |
Presenting symptoms and signs:
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