Management

Triaging

1. Perform hand hygiene frequently with an alcohol based hand sanitizer (60-80% alcohol content) or wash hands with soap and running water.
2. Social distancing of at least 1 meter from each other (3 feet apart) so that if one coughs/sneezes, there is less likelihood of inhaling the droplets that may have the droplets
3. Early recognition of suspected COVID 19 cases, screen at arrival in hospital, isolate them in a separate room while awaiting testing. Refer appropriately
4. Patients with mild symptoms should be sent home for self-quarantine for at least 14-21days
5. The following patients should be considered at high risk of dying if they have COVID symptoms and should be considered for admission

• Patients with chronic diseases, for example Diabetes Mellitus, chronic lung disease, HIV Infection
• Patients older than 60
• Pregnant women

Management

6. Vital observations: Patient with the vital observations below should be admitted

                               Temperature >= 38 degrees Celsius

                                Respirations above 24bpm

                                Pulse-rate above 120bpm

                                Oxygen saturation of below 90%

*Make sure to exclude other causes of fever and respiratory distress e.g. malaria, pulmonary embolism and PCP*

7. Administer oxygen according to condition of patient, if in respiratory distress:  Give oxygen using non rebreather mask  (delivers 10 to 15litres/minute)  oxygen  administered per nasal prongs (delivers 5-6 L/m). If saturation remain low, use dual Oxygen therapy using both nasal prongs and non rebreather mask. If patient is not responding to dual therapy, give oxygen via high flow nasal cannula which delivers around 60-8-L/min.
8. Glucometer check stat and then 4 hourly. Give insulin per sliding scale if it goes above 11.1mmols/L(The cytokine storm response which happens in COVID patients or the steroid administration both warrants glucometer checks)
9. Avoid treatment with intravenous fluids unless there is obvious dehydration or septic shock (aggressive iv fluids worsen oxygenation)
10. Antibiotics to curb infection. Ceftriaxone 2g IV stat then 1g 12 hourly. Azithromycin 500mg per oral on day 1 then 250mg daily x4/7

     (For children give Ceftriaxone 50-80mg/kg plus Azithromycin 10mg/kg).

11. Paracetamol 1gram 8 hourly per oral as an antipyretic
12. For patients on oxygen, administer dexamethasone 6mg IV once daily x10/7 or until discharge (whichever comes first). Prednisolone 40mg per oral once daily.
13. Coagulation common in patients with COVID 19, administer an anti-coagulant, heparin 5000 IU subcutaneously 12houly (prophylaxis) or clexane 40mg subcutaneously once daily
14. Collect blood for FBC, U & E, LFT, CRP, IDH
15. CXR
16. Continuous monitoring of patient providing individualized care
17. Discharge patient based on clinical improvement