COVID-19 TREATMENT GUIDELINEIN TANZANIA, MARCH 2021
Posted by ULY CLINIC
24 Machi 2021 12:02:43
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
2. SCREENING AND TRIAGING
The primary goal of the COVID-19 response is to slow and stop transmission by case Identification, sort and test every suspect case, and provide timely appropriate care to prevent adverse complications and death.
The recommended location of care will depend on disease severity and be either at a designated health facility or at home. Screening should be done at the entry point of the health facility.
Health care worker should be on appropriate PPE and any patient being attended should have a mask on and offset face-to-face position or maintain at least a one (1) meters between HCW and a patient.
During screening, adhere to respective and compassionate care, ensure privacy, ask open-ended questions, use language understood by client, communicate with contact tracing team and collect collateral information from family members.
Triage should be done quickly to identify patients who need emergency treatments based on disease severity to optimize patient outcomes (see table 1 below), and standardized triage tools should be used. See Annex 1, 2 &3
2.1. Symptoms associated with COVID-19
Presenting signs and symptoms of COVID-19 vary widely among patients.
In general, majority of patients will present with fever (83–99%), cough (59–82%), fatigue (44–70%), anorexia (40–84%), shortness of breath (31–40%) and myalgias (11– 35%).
In other cases, patients will have non-specific clinical signs such sore throat, nasal congestion, headache, diarrhoea, nausea and vomiting, and in several cases loss of smell (anosmia) or loss of taste (ageusia) preceding the onset of respiratory symptoms is a well-documented clinical presentation.
In some special population (example elderly and immunosuppressed), they may present with atypical symptoms such as fatigue, reduced alertness, reduced mobility, diarrhoea, loss of appetite, delirium, and absence of fever.
Children might not have reported fever or cough as frequently as adults.
Triaging according to severity of COVID 19 Patient
Disease severity
• Mild covid-19 disease
• Moderate covid-19 disease(pneumonia)
• Severe covid-19 disease (severe pneumonia)
• Critical disease-Acute respiratory distress syndrome (ARDS)
• Critical disease (sepsis)
• Critical disease (septic shock)
Mild covid-19 disease
Triaging parameters
Symptomatic patients meeting the Standard Case Definition (for COVID-19) without evidence of pneumonia or hypoxia. See section 2.1, for symptoms associated with COVID-19. Patient will have clear lungs, negative chest X-ray (if available).
Moderate covid-19 disease(pneumonia)
Adolescent or adult with clinical signs of pneumonia (fever, cough, dyspnea, fast breathing) but no signs of severe pneumonia, including SpO2≥ 90% on room air.
Child with clinical signs of non-severe pneumonia (cough or difficulty breathing PLUS fast breathing and/or chest in drawing) and no signs of severe pneumonia. Fast breathing (in breaths/min): In child < 2 months: respiratory rate ≥ 60; child aged 2–11 months: ≥ respiratory rate ≥ 50; child 1–5 years: ≥ 40.
NB: While the diagnosis can be made on clinical grounds; chest imaging (radiograph, CT scan, ultrasound) may assist in diagnosis and identify or exclude pulmonary complications, example: typically bilateral ground glass opacities found in CXR.
Severe covid-19 disease (severe pneumonia)
Adolescent or adult with clinical signs of pneumonia (fever, cough, dyspnea, fast breathing) PLUS one of the following: respiratory rate > 30 breaths/min; severe respiratory distress; or SpO2 < 90% on room air.
Child with clinical signs of pneumonia (cough or difficulty in breathing) PLUS at least one of the following:
• Central cyanosis or SpO2 < 90%; severe respiratory distress (e.g. fast breathing, grunting, very severe chest wall in drawing); general danger sign: inability to breastfeed or drink, lethargy, unconsciousness, or convulsions.
• Fast breathing (in breaths/min): < 2 months: ≥ 60; 2–11 months: ≥ 50; 1–5 years: ≥ 40.
NB: While the diagnosis can be made on clinical grounds; chest imaging (radiograph, CT scan, ultrasound) may assist in diagnosis and identify or exclude pulmonary complications, example: typically bilateral ground glass opacities found in CXR
Critical disease-Acute respiratory distress syndrome (ARDS)
Onset: within 1 week of a known clinical insult (i.e. pneumonia) or new or worsening respiratory symptoms.
Chest imaging: (radiograph, CT scan, or lung ultrasound): bilateral opacities, not fully explained by volume overload, lobar or lung collapse, or nodules.
Origin of pulmonary infiltrates: respiratory failure not fully explained by cardiac failure or fluid overload.
Need objective assessment (e.g. echocardiography) to exclude hydrostatic cause of infiltrates/edema if no risk factor present.
Oxygenation impairment in adults
SpO2<80% on room air or SpO2<90% on ≥10L/min oxygen via facemask (equivalent of SpO2/FiO2 <
180 or PaO2/FiO2 <120 (note with or without CPAP/PEEP).
Mild ARDS: 200 mmHg < PaO2/FiO2a ≤ 300 mmHg (with PEEP or CPAP ≥ 5 cmH2O).
Moderate ARDS: 100 mmHg < PaO2/FiO2 ≤ 200 mmHg (with PEEP≥ 5 cmH2O).
Severe ARDS: PaO2/FiO2 ≤ 100 mmHg (with PEEP ≥ 5 cmH2O).
Oxygenation impairment in children:
Note Oxygenation index (OI) and Oxygen Saturation Index (OSI). Use OI when available. If PaO2 not available, wean FiO2 to maintain SpO2
≤ 97% to calculate OSI or SpO2/FiO2 ratio:
Bi-level (NIV or CPAP) ≥ 5 cmH2O via full-face mask: PaO2/FiO2 ≤ 300 mmHg or SpO2/FiO2 ≤ 264.
Mild ARDS (invasively ventilated): 4 ≤ OI < 8 or 5 ≤ OSI < 7.5.
Moderate ARDS (invasively ventilated): 8 ≤ OI < 16 or 7.5
≤ OSI < 12.3.
Severe ARDS (invasively ventilated): OI ≥ 16 or OSI ≥ 12.3.
Critical disease (sepsis)
Adults: acute life-threatening organ dysfunction caused by a dis-regulated host response to suspected or proven infection. Signs of organ dysfunction include: altered mental status (delirium), difficult or fast breathing, low oxygensaturation, reduced urine output (92), fast heart rate, weak pulse, cold extremities or low blood pressure, skin mottling, laboratory evidence of coagulopathy, thrombocytopenia, acidosis, high lactate, or hyperbilirubinemia.
Children: suspected or proven infection and ≥ 2 age-based systemic inflammatory response syndrome (SIRS) criteria of which one must be abnormal temperature or white blood cell count.
Critical disease (septic shock)
Adults: persistent hypotension despite volume resuscitation, requiring vasopressors to maintain MAP ≥ 65 mmHg and serum lactate level > 2mmol/L.
Children: any hypotension (SBP < 5th centile or > 2 SD below normal for age) or two or three of the following: altered mental status; bradycardia or tachycardia (HR < 90 bpm or > 160 bpm in infants and heart rate < 70 bpm or > 150 bpm in children); prolonged capillary refill (> 2 sec) or weak pulse
NB: The severity triage system above, doesn’t replace the confirmatory test for COVID-19 (RT PCR) Prognostic signs/dangers signs- monitoring part
Note
NB: The severity triage system above, doesn’t replace the confirmatory test for COVID-19 (RT PCR) Prognostic signs/dangers signs- monitoring part
Updated,
25 Machi 2021 06:56:15
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