Clinical Management

Clinical Management

Usual COVID Symptoms: Fever, Cough, shortness of breath, head ache, body ache, loss of taste or smell

If symptoms are present, should be considered as a COVID case, and triaged as below, regardless of test result


Mild COVIDModerate COVIDSevere COVID
Definition
  • CAN TALK
  • CAN WALK
  • CAN TALK
  • CAN'T WALK
  • CAN'T TALK
  • CAN'T WALK
Management
  • Stay home, do not go out
  • Wear a mask
  • Fluids(Orals)
  • Paracetamol
  • Reassure

DEXAMETHASONE SHOULD NOT BE GIVEN, CAN BE HARMFUL AT THIS STAGE

Admit to hospital if bed available

  • Supplemental oxygen to keep comfortable or sats >92% if pulse oximeter available
  • Dexamethasone 6 mg day or other steroid equivalent for 5 days
  • Apixaban 2.5 mg twice a day oral for 5 days or until patient is walking if available
  • Alternatives to Apixaban

Admit to hospital

  • Supplemental oxygen to keep comfortable or sats >92% if pulse oximeter available
  • Dexamethasone 6 mg day or other steroid equivalent for 5 days
  • Apixaban 2.5 mg twice a day oral until patient is walking
  • Alternatives to Apixaban
  • If worsens despite above treatment
    • Noninvasive ventilation
    • Mechanical ventilation
    • ONLY in Age <60 yrs and no h/o diabetes increase Dexamethasone dose to 20 mg once a day for 5 days, followed by 10 mg a day for next 5 days
LabsNo blood testsCBC, Creatinine, CRP, d-dimer if possibleCBC, Creatinine, CRP, d-dimer if possible
RadiologyNo chest Xray, No CT scanNo routine chest Xray, No routine CT scanChest Xray or CT scan if available to evaluate for other lung pathology
NOT RECOMMENDEDIvermectin, Hydroxychloroquine, Azithromycin, Doxycyxline, Favipravir, Plasma, Vitamin C, Vitamin D, Remdesivir, Baricitinib, Itolizumab, Bevacizumab, Lopinavir/Ritonavir, Fluvoxamine, Interferon alpha 2b

WHO visual summary of recommended treatments

flow chart

* Alternatives to Apixaban

Rivaroxaban 10 mg orally once a day

OR

Enoxaparin 40 mg subcutaneous once daily

OR

Unfractionated heparin 5000 units subcutaneous three times daily

**Alternatives to Dexamethasone

Prednisolone/Prednisone 20 mg twice a day

OR

Hydrocortisone 40 mg given 4 times/day

OR

Methylprednisolone 16 mg twice a day


WHO visual summary of recommended treatments

Pediatric-acute-COVID

Last Updated on June 2, 2021

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