Clinical Guide to Managing an Adult COVID19 Patient (By WHO & ICMR)

In this blog post, we will cover what you need to know about an adult COVID19 patient. Then, we will go over the symptoms of the virus and how it is transmitted. Finally, we’ll discuss some tips for managing a patient with COVID19!

*Disclaimer: This is a medical document for clinical operations. Please refer and follow your physician/doctor’s advice and do not self-diagnose, self-medicate, or administer treatment to other patients based on the contents of this article.

Here is the WHO-approved Clinical Guide to Managing an Adult COVID19 Patient.

Let us get going!

About the Guides (WHO & ICMR)

World Health Organization’s guide to clinical management of adult COVID19 patients contains the Organization’s latest recommendations for the clinical management of people infected with COVID-19.

This documented guideline is meant to provide patient management guidance that is comprehensive and holistic for them. This is why WHO publishes and updates this document to include patients through their entire illness process.

Similarly, the Indian Council of Medical Research releases medical documents in India to set standards for managing treatment and other medical operations.

Here is what these guides have for you to know COVID better.

What is the Incubation Period of the COVID19 Virus?

The incubation period is the time between the person’s first exposure to the virus and the onset of the first symptoms of the associated disease.

The incubation period for COVID-19 is thought to be between 4 and 14 days, with a median time of five days. However, some studies have reported people experiencing symptoms up to 11.5 days after exposure to SARS-CoV-2.

This is the reason why world governments have imposed the rule of isolation for 14-days for a suspect COVID patient.

What are the signs and symptoms listed in WHO’s official guide?

As per WHO’s guide, the signs and symptoms differ across COVID-19 levels. However, the following list is representative of what a patient with moderate to severe categories

• Cough
• Congestion or runny nose
• Fever or chills
• Shortness of breath or difficulty breathing
• New loss of taste or smell
• Sore throat
• Fatigue
• Muscle or body aches
• Headache
• Diarrhea
• Nausea or vomiting

Patients with more severe cases of COVID19 symptoms usually report shortness of breath. However, patients who are not hospitalized often do not experience as much difficulty breathing.

Older adults or those with medical comorbidities may experience fever and respiratory symptoms later in illness than someone who is younger or doesn’t have comorbidities.

What are the hospital admission protocols?

Here, we will look at the directives of the Indian Council of Medical Research (ICMR). Since ICMR has jurisdiction in India, we will see the standard procedures set by this body to admit patients of varying COVID-infection severity.

Patients with Mild COVID19

ICMR categorizes patients with mild symptoms as having upper respiratory tract symptoms (&/or fever) without shortness of breath or hypoxia.

ICMR’s Patient Management Checklist (Mild Cases)

• Physical distancing, indoor mask use, strict hand hygiene.
• Symptomatic management (hydration, antipyretics, antitussive, multivitamins).
• Stay in contact with the treating physician.
• Monitor temperature and oxygen saturation (by applying a SpO2 probe to fingers)

When to seek medical attention for Mild cases?

The patient must seek immediate medical assistance if the following symptoms develop;

Difficulty in breathing

High-grade fever/severe cough, particularly if it lasts for more than 5 days

A low threshold to be kept for those with any of the high-risk features*

Patients with Severe Covid-19

ICMR categorizes patients with severe symptoms as having a Respiratory rate greater than 24/min with breathlessness. Severe cases of Covid-19 show the SpO2 level between 90% to < 93% on room air. ICMR's Patient Management Checklist (Severe Cases) Respiratory support

• Consider the use of NIV (Helmet or face mask interface depending on availability) in patients with increasing oxygen requirement if work of breathing is LOW.
• Consider the use of HFNC in patients with increasing oxygen requirements.
• Intubation should be prioritized in patients with high work of breathing /if NIV is not tolerated.
• Use conventional ARDSnet protocol for ventilatory management.

Anti-inflammatory or immunomodulatory therapy

li>Inj Methylprednisolone 1 to 2mg/kg IV in 2 divided doses (or an equivalent dose of dexamethasone), usually for 5 to 10 days.

Anticoagulation

• Weight-based intermediate-dose prophylactic unfractionated heparin or Low Molecular Weight Heparin (e.g., Enoxaparin 0.5mg/kg per dose SC BD). There should be no contraindication or high risk of bleeding.

Supportive measures

• Maintain euvolemia (if available, use dynamic measures for assessing fluid responsiveness).
• If sepsis/septic shock: manage as per existing protocol and local antibiogram.
• Monitoring
• Serial CXR; HRCT chest to be done ONLY if there is worsening.
• Lab monitoring: CRP and D-dimer 24-48 hourly; CBC, KFT, LFT daily; IL-6 to be done if deteriorating.

Closing Note

We hope that the treatment guidelines and SOPs recommended by WHO and ICMR would bring more awareness to the general public for managing Covid patients.

In case of any emergency, you can always contact ASIAN, the center of medical excellence in Faridabad, India.

We wish you all safe living and health!