COVID-19 TREATMENT GUIDELINEIN TANZANIA, MARCH 2021
Posted by ULY CLINIC
24 Machi 2021 19:36:10
The guidance is based on proper case management aspects intended for clinicians involved in the care of patients with suspected or confirmed COVID-19. It is not meant to replace clinical judgment or specialist consultation but rather to strengthen frontline clinical management and the public health response.
NOTE. THIS GUIDELINE IS THE POPERTY OF MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN
10. ROLE OF NUTRITION
Adequate and appropriate nutrition is required for all cells to function optimally and this includes the cells in the immune system. The immune system’s demands for energy and nutrients that can be met from exogenous sources particularly the diet. If dietary sources are inadequate the body uses nutrients from endogenous sources that are body stores resulting into loss of proteins and some micronutrients.
The purpose of this guideline is to provide guidance on nutrition management to health care providers in managing COVID-19 cases. This document is based on the recent available evidence and elaborates the actions to be taken by health facilities and their staffs who are responsible for managing COVID-19 cases.
The beneficiaries of this guide are maternal, infant, young children, adolescents, adults and elderly suspected or confirmed with COVID-19. Other beneficiaries of this guide are people with chronic illnesses who are suspected or confirmed with COVID-19 for example people who are suffering from hypertension, Diabetes and Cancer.
a. Effects of COVID-19 on Nutrition
The COVID-19 like any other respiratory infections has greater influence in nutrition status of individuals.
• Infected person can present with different signs and symptoms including fever, cold and cough
• Infections and fever changes the functions of various body systems including digestive system. Fever increases metabolic rate, which tend to increase caloric needs of the body. Glycogen and fat stores are depleted since are burnt up to meet the increased caloric need. This also increases the breakdown of proteins and loss of micronutrients including zinc, iron, Folic Acid, vitamin A and vitamin E, which are vital in immunological functions.
• Increased excessive loss of body fluids due increase in excretion of body wastes through perspiration and evaporation, thus can lead to electrolytes imbalance
• Loss of appetite, poor food intake, and poor nutrients absorption thus person fails to meet daily nutritional requirements.
b. Nutritional recommendations for COVID-19
In order to improve immune function for reducing severity of COVID 19 effects, it is recommended to ensure that infected person meet daily nutrition requirement through taking adequate balanced meals from different food groups.
• Cereals, roots, tubers and plantains (green banana): Examples; Rice, maize, wheat, cassava, sweet potatoes, Yams etc.
• Foods of animal origin, legumes and nuts: Example; Beef, Chicken, milk, Yogurt, eggs, sardines and insects (senene and kumbikumbi), beans, cowpeas, peas, lentils, ground nuts, cashew nuts and edible seeds like sesame and sunflower
• Vegetables: Examples; Amaranth, sweet potato leaves, pepper, eggplant, carrots, cassava leaves, pumpkin leaves, okra, pumpkins, tomatoes, wild vegetables e.g mlenda, mchunga and figiri, sukumawiki and mchicha pori
• Fruits: Examples; Pawpaw, mangoes, oranges, pineapple and wild fruits such as baobab fruit, tamarind, mabungo, rubber vine and wild fruits. Fruits with yellow color are a good source of vitamin A and fruits like baobab, guava passion and lemons are good source of vitamin C
• Sugar, honey, fat and oils: Examples; Coconut oil, Cooking oil e.g. sunflower oil, palm oil, Butter, Margarine, sugar cane, sugar and honey.
b i. Dietary management for fever
• Drink plenty of safe drinking water at least 8 glasses to decrease body temperature and prevent dehydration
• Increase intake of citrus fruits juices
• Eat small frequent meals as tolerated high in energy and protein
b ii. Dietary management for Colds, flu and cough
• Eat vitamin C rich foods such as citrus fruits such as lemons, lime, oranges, tomatoes, tamarind (ukwaju),mabungo, baobabfruit, plums,mangoes,javaplums (zambarau),guavas and wild fruits
• Eat plenty of green vegetables
• Drink plenty of fluids
• Add ginger, cinnamon, lemon juice, garlic, turmeric and onions to drinks and foods
b iii. Dietary management for Sore throat
• Eat soft, mashed foods such as rice, carrots, scrambled eggs, potatoes, bananas, soups and porridge
• Eat warm temperature foods.
• Avoid spicy, salty or sticky foods.
• Avoid sugary foods that cause yeast to grow
• Drink plenty of fluids
• Avoid alcohol and cigarettes; these worsen the sore throat conditions
• Gargle saline water
b iv. Dietary management for Nausea and vomiting
• Eat small frequent meals
• Avoid an empty stomach; nausea is worse on an empty stomach.
• Do not lie down immediately after eating
• Eat soups, bland foods and dry foods such as crackers to calm the stomach
b v. Dietary management for Loss of taste
• Eat small frequent meals
• Include spices to enhance flavor of food
• Eat dry foods such as cracker and bread
• Chew food well and move it around the mouth to stimulate receptors
b vi. Dietary management for Loss of taste
• Eat Iron, Vitamin B12 and Folic acid rich foods such as animal products (eggs, fish, meat, liver), green leafy vegetables (amaranth, sweet potato leaves), legumes (beans), nuts, and fortified cereals
• Eat meals rich in vitamin C such as fresh tomatoes, baobab fruit oranges, beetroot guavas; Vitamin C helps the body absorb iron from plant-based foods
• Avoid drinking tea or coffee within 2 hours before or after meals because they interfere with iron absorption
c. Fluid retention
• Patients with fluid retention require sodium and fluid restriction.
• Depending on the diuretics, prescribed, increased dietary intake of potassium may be required.
• The use of parenteral lipids or calorically dense enteral feedings may help the meet energy needs.
• Other Co-morbidities
• Patients with other disease such as cardiovascular or renal disease, cancer, or diabetes mellitus should be nutritionally managed with their specific nutrient requirement.
d. Nutrition consideration for critically ill patients with COVID 19
• Consider medical nutrition therapy for all patients staying in the ICU, mainly for more than 48 hours
• General clinical assessment could include report of unintentional weight loss or decrease in physical performance before ICU admission, body composition, muscle mass and strength,
• Oral diet shall be preferred over Enteral Nutrition or Parenteral Nutrition in critically ill patients who are able to eat, and if not possible, initiate early enteral nutrition and if possible within 48 hours.
• In case of contraindications to oral and Enteral Nutrition, Parenteral Nutrition should be initiated within three to seven days
• To avoid overfeeding, early full Enteral Nutrition and Parenteral Nutrition shall not be used in critically ill patients but shall be prescribed within three to seven days.
• Hypocaloric nutrition (not exceeding 70% of Estimated Energy) should be administered in the early phase of acute illness and increased from day 3 to day 7 to 80-100% based on stability and tolerance of the patient.
• Antioxidants as high dose monotherapy should not be administered without proven deficiency.
• To enable substrate metabolism, micronutrients (i.e. trace elements and vitamins) should be provided daily with Parenteral Nutrition.
• Enteral Nutrition should be delayed if there is uncontrolled shock, hypoxemia, hypercapnia or acidosis upper GI bleeding, high-output intestinal fistula or gastric residual volume is above 500 ml.
Updated,
24 Machi 2021 20:17:37
References
1. THE UNITED REPUBLIC OF TANZANIA. MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDRENCORONAVIRUS DISEASE 2019 (COVID-19) TREATMENT GUIDELINES. MARCH 2021
2. Del Rio, C. and P.N. Malani, (2020). 2019 Novel Coronavirus—Important Information for Clinicians. JAMA, 2020. 323(11): p. 1039-1040.
3. World Health Organization, (2020). Coronavirus disease 2019 (COVID-19) Situation Report 46, 2020.
4. World Confederation of Physical Therapists (WCPT) (2020). Physiotherapy management for COVID 19 version 1.0 23 March 2020
5. Sohrabi, C., Z. Alsafi, N. O'Neill, M. Khan, A. Kerwan, A. Al-Jabir, C. Iosifidis, and R. Agha, (2020). World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg, 2020. 76: p. 71-76.
6. Guan, W.-j., … Ye, C.-j. Zhu, S.-y. and Zhong N.-s., (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. NewEngland Journal of Medicine, 2020.
7. van Doremalen, N., … Lloyd-Smith, J.O., de Wit, E., and Munster, V.J., (2020). Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. New England Journal of Medicine, 2020.
8. Yoon, S.H., K.H. Lee, J.Y. Kim, Y.K. Lee, H. Ko, K.H. Kim, C.M. Park, and Y.H. Kim, Chest Radiographic and CT Findings of the 2019 Novel Coronavirus Disease (COVID-19): Analysis of Nine Patients Treated in Korea. Korean J Radiol, 2020. 21(4): p. 494-500.
9. Zhao, D., F. Yao, L. Wang, L. Zheng, Y. Gao, J. Ye, F. Guo, H. Zhao, and R. Gao, A comparative study on the clinical features of COVID-19 pneumonia to other pneumonias. Clin Infect Dis, 2020.
10. Peng, Q.Y., X.T. Wang, L.N. Zhang, and G. Chinese Critical Care Ultrasound Study, Findings of lung ultrasonography of novel corona virus pneumonia during the 2019-2020 epidemic. Intensive Care Med, 2020.
11. Chen, N., M. Zhou, X. Dong, J. Qu, F. Gong, Y. Han, Y. Qiu, J. Wang, Y. Liu, Y. Wei, J. Xia,
T. Yu, X. Zhang, and L. Zhang, Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet, 2020. 395(10223): p. 507-51s3.
12. Zhou, F., T. Yu, R. Du, G. Fan, Y. Liu, Z. Liu, J. Xiang, Y. Wang, B. Song, X. Gu, L. Guan, Y. Wei, H. Li, X. Wu, J. Xu, S. Tu, Y. Zhang, H. Chen, and B. Cao, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 2020.
13. Xie, J., Z. Tong, X. Guan, B. Du, H. Qiu, and A.S. Slutsky, Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Medicine, 2020.
14. Australian and New Zealand Intensive Care Society, ANZICS COVID-19 Guidelines, 202, ANZICS: Melbourne.
15. Kress, J.P. and J.B. Hall, (2014). ICU-acquired weakness and recovery from critical illness.
N Engl J Med, 2014. 370(17): p. 1626-35.
16. Herridge, M.S., C.M. Tansey, A. Matte, G. Tomlinson, N. Diaz-Granados, A. Cooper, C.B. Guest, C.D. Mazer, S. Mehta, T.E. Stewart, P. Kudlow, D. Cook, A.S. Slutsky, and A.M. Cheung, (2011). Functional disability 5 years after acute respiratory distress syndrome. N Engl JMed, 2011. 364(14): p. 1293-304.
17. Brouwers, M.C., M.E. Kho, G.P. Browman, J.S. Burgers, F. Cluzeau, G. Feder, B. Fervers,
I.D. Graham, S.E. Hanna, and J. Makarski, (2010). Development of the AGREE II, part 1: performance, usefulness and areas for improvement. Cmaj, 2010. 182(10): p. 1045-52.
18. Schunemann, H.J., …Cuello, R. Waziry,and Akl, E.A., (2017). GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT. J Clin Epidemiol, 81: p. 101-110.
19. Moberg, J., A.D., …Morelli, G. Rada, and P. Alonso-Coello, (2018). The GRADE Evidence to Decision (EtD) framework for health system and public health decisions. Health Res Policy Syst, 16(1): p. 45.
20. Clinical Skills Development Service, Q.H. Physiotherapy and Critical Care Management eLearning Course. Accessed 21/3/20]; Available at https://central.csds.qld.edu.au/central/courses/108].
21. World Health Organisation, (2020). Infection prevention and control during health care when COVID-19 is suspected: Interim Guidance, M. 2020, Editor 2020.
22. Queensland Health,(2020). Clinical Excellence Division COVID-19 Action Plan: Statewide General Medicine Clinical Network,
23. The Faculty of Intensive Care Medicine. (2019). Guidelines for the provision of the intensive care services.; Available from: https://www.ficm.ac.uk/news-eventseducation/ news/guidelines-provision-intensive-care-services-gpics-%E2%80%93-secondedition.
24. Alhazzani, W., … Hayden, F., Evans, L., and Rhodes, A., (2019). Surviving sepsis campaign: Guidelines of the Management of Critically Ill Adults with Coronavirus Disease (COVID- 19). Critical Care Medicine, 2020. EPub Ahead of Print.
25. World Health Organization, (2020). Clinical Management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected Interim Guidance, 2020. p. WHO Reference number WHO/2019-nCoV/clinical/4.
26. Metro North, (2020). Interim infection prevention and control guidelines for the management of COVID-19 in healthcare settings,: https://www.health.qld.gov.au/ data/assets/pdf_file/0038/939656/qh-covid-19- Infectioncontrol- guidelines.pdf.
27. Stiller, K., (2013). Physiotherapy in intensive care: an updated systematic review. Chest,
144(3): p. 825-847.
28. Green, M., V. Marzano, I.A. Leditschke, I. Mitchell, and B. Bissett, (2016). Mobilization of intensive care patients: a multidisciplinary practical guide for clinicians. J Multidiscipline Health, 9: p. 247-56.
29. Hodgson, C.L. Zanni, L. Denehy, and S.A. (2014). Webb, Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical Care, 2014. 18(6): p. 658.
30. Australian and New Zealand Intensive Care seeliery, ANCS COVID 19 Guidelines 202 ANZICS Melhsore.
31. Zanni, M.J., denehy,L.(2014). Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical care. 18 (6): p 658.