p Criteria Investigatio ns Isolation ward/ Hospital ised Treatment Remarks F Septic Shock due to COVID 19 Baseline Hemogram , ECG, LFT, RFT, BSL profile, X-ray Chest, Sr. Amylase, 2 D Echo, CPKMB, PTINR ABG Daily SE , Magnesium if QTc prolongatio n ICU Oseltamivir 150 mg BD for 10 days (Double dose) + T Azithromycin 500mg OD x 10 days + T

1. DIAGNOSIS AND MANAGEMENT
CORONA VIRUS(COVID-19)
Dr Ayush Jain (RMO –
Medicine)

3. TESTING STRATEGY FOR COVID -
19

4. COLLECTION OF SPECIMEN FOR
LABORATORY DIAGNOSIS
• COLLECT BLOOD CULTURES, IDEALLY BEFORE
ANTIMICROBIAL THERAPY.
• COLLECT SPECIMENS FROM BOTH UPPER AND LOWER
RESPIRATORY TRACT FOR TESTING BY RT-PCR.
• BLOOD CULTURES-PNEUMONIA AND SEPSIS
• NASOPHARYNGEAL AND OROPHARYGEAL SECRETIONS
• SPUTUM,ENDOTRACHEAL
ASPIRATE,BRONCHEOALVEOLAR LAVAGE
• SPUTUM INDUCTION SHOULD BE AVOIDED-INCREASE
AEROSOL TRANSMISSION

5. ROUTING OF SAMPLES
• THE TEST IS FREE AND INVOLVES SAMPLING OF VARIOUS BODILY
FLUIDS. THERE ARE 136 GOVERNMENT-DESIGNATED
LABORATORIES ALL OVER INDIA, ACCORDING TO INDIAN COUNCIL
OF MEDICAL RESEARCH (ICMR).
• MADHYA PRADESH
1. ALL INDIA INSTITUTE MEDICAL SCIENCES, BHOPAL
2. NATIONAL INSTITUTE OF RESEARCH IN TRIBAL HEALTH (NIRTH),
JABALPUR
3. MGMMC , INDORE
4. GMC , BHOPAL
5. BHOPAL MEMORIAL HOSPITAL AND RESEARCH CENTRE,

6. DIAGNOSIS
Patients With Laboratory-confirmed 2019-
ncov Infection:
• By Real-time RT-PCR.
• Next-generation Sequencing
• Rapid antibody based blood test.

11. DROPLET PRECAUTIONS
• MEDICAL MASK
• SINGLE ROOMS OR GROUP TOGETHER
• WHEN PROVIDING CARE USE EYE PROTECTION
• LIMIT PT MOVEMENT WITHIN HOSPITAL AND
ENSURE THAT PTS WEAR MASK WHEN OUTSIDE
ROOMS

12. CONTACT PRECAUTIONS
• MASK, GOGGLES, GLOVES, GOWN
• USE PPE WHEN ENTERING AND REMOVE PPE WHILE LEAVING
• EQUIPMENTS –CLEAN AND DISINFECT BETWEEN EACH PT USE
• HCW-REFRAIN FROM TOUCHING THEIR EYES, NOSE, MOUTH
WITH GLOVED OR UNGLOVED HANDS
• AVOID CONTAMINATING ENVIRONMENTAL SURFACES
• PERFORM HAND HYGEINE

16. WHAT IS BEING DONE TO
CONTROL THE OUTBREAK?
WHAT ARE AFFECTED COUNTRIES DOING?
• REMAINING VIGILANT FOR NEW CASES AND PROVIDING CARE
FOR EXISTING CASES
• IMPLEMENTING SCREENING OF TRAVELERS
• SHARING INFORMATION WITH WHO AND OTHER COUNTRIES
WHAT IS WHO DOING?
• SUPPORTING AFFECTED COUNTRIES AND PROVIDING
GUIDANCE ON HOW TO MANAGE THE OUTBREAK
• WORKING WITH GLOBAL NETWORKS OF RESEARCHERS AND
EXPERTS TO DELIVER ACCURATE, UPDATED INFORMATION
• DELIVERING ACCURATE, TIMELY INFORMATION TO THE WORLD

17. SCORING
Sl. No. History Score
1 Travel History 3
2 Contact with COVID -19 3
3 Fever &/or Myalgia 1
4 Dry Cough 1
5 Shortness of breath 1
6 History of similar Symptoms in family /friends 1
7 Health care worker 1
SCORE
≤3……. HOME QUARANTINE FOR 14 DAYS
4-8…….HOSPITAL QUARANTINE AND TEST
≥9……..SHIFT TO ISOLATION WARD
ICMR Scoring

18. MuLBSTA scoring
S.No. Parameters Score
1. Multilobular Infiltration 5
2. Lymphopenia (lymphocytes <0.8*109) 4
3. Bacterial co-infection 4
4.
Smoking history
Acute Smoker 3
Quit Smoker 2
5. Hypertension 2
6. Age >60 years 2
• MuLBSTA scoring is early warning model for predicting
mortality in viral pneumonia.
• Score >12 is a predictor of mortality.
• Used to prioritise pts requiring intensive care and
aggressive management.
Ref- JAPI

19. INDICATIONS FOR HOSPITAL
ADMISSION
• 1. RESPIRATORY RATE > 30 /MIN
• 2. SPO2 < 92%
• 3. CONFUSION/DROWSINESS
• 4. SYSTOLIC BP < 90 MMHG OR DIASTOLIC BP < 60 MMHG
• 5. ANY TWO OF THE FOLLOWING
• A. AGE > 65 YEARS
• B. COMORBIDITIES (DIABETES MELLITUS, HYPERTENSION, HEART
DISEASE, CHRONIC LUNG DISEASE, PREGNANCY,
IMMUNOCOMPROMISED)
• C. RADIOLOGICAL FEATURES SUGGESTIVE OF PNEUMONIA

20. CRITERIA FOR ICU ADMISSION
• REQUIRING MECHANICAL VENTILATION
• HYPOTENSION REQUIRING VASOPRESSOR
SUPPORT
• WORSENING MENTAL STATUS

21. WHEN TO INTUBATE
• PAO2/FIO2 < 200
• PAO2/FIO2 < 300 WITH HYPOTENSION REQUIRING
VASOPRESSOR SUPPORT
• GCS < 8 WITH THREATENED AIRWAY

23. TREATMENT
• People Infected With 2019-ncov Should Receive Supportive Care To
Help Relieve Symptoms.
• For Severe Cases, Treatment Should Include Care To Support Vital
Organ Functions.
• People Who Think They May Have Been Exposed To 2019-ncov
Should Contact Your Healthcare Provider Immediately.

24. • Use A Room Humidifier Or Take A Hot Shower To
Help Ease A Sore Throat And Cough.
• If You Are Mildly Sick, You Should Drink Plenty Of
Liquids Stay Home And Rest

25. Early Supportive Therapy And Monitoring
 Give supplemental oxygen therapy immediately to patients with SARI and
respiratory distress, hypoxaemia, or shock
 Use conservative fluid management in patients with SARI when there is no
evidence of shock
 Give empiric antimicrobials to treat all likely pathogens causing SARI
 Give antimicrobials within one hour of initial patient assessment for patients
with sepsis

26.  DO NOT ROUTINELY GIVE SYSTEMIC CORTICOSTEROIDS FOR TREATMENT OF
VIRAL PNEUMONIA OR ARDS OUTSIDE OF CLINICAL TRIALS UNLESS THEY ARE
INDICATED FOR ANOTHER REASON
 CLOSELY MONITOR PATIENTS WITH SARI FOR SIGNS OF CLINICAL
DETERIORATION, SUCH AS RAPIDLY PROGRESSIVE RESPIRATORY FAILURE AND
SEPSIS, AND APPLY SUPPORTIVE CARE INTERVENTIONS IMMEDIATELY
 UNDERSTAND THE PATIENT’S CO-MORBID CONDITION(S) TO TAILOR THE
MANAGEMENT OF CRITICAL ILLNESS AND APPRECIATE THE PROGNOSIS.
COMMUNICATE EARLY WITH PATIENT AND FAMILY

27. HYDROXYCHOLOROQUINE
• HCQ HAS ANTIVIRAL EFFECTS.
• IT INCREASES LATE ENDOSOMAL AND LYSOSOMAL PH,
→IMPAIRED RELEASE OF THE VIRUS FROM THE ENDOSOME
OR LYSOSOME – RELEASE OF THE VIRUS REQUIRES A LOW
PH.
• THE VIRUS IS THEREFORE UNABLE TO RELEASE ITS GENETIC
MATERIAL INTO THE CELL AND REPLICATE.
• HCQ ALSO SEEMS TO ACT AS A ZINC IONOPHORE, THAT
ALLOWS EXTRACELLULAR ZINC TO ENTER THE CELL AND
INHIBIT VIRAL RNA-DEPENDENT RNA POLYMERASE.

28. CONTRAINDICATION OF HCQ
PROPHYLAXIS
•CHILDREN < 15 YEARS
•RETINOPATHY PATIENTS
•HYPERSENSITIVITY TO
DRUGS

29. HCQ PROPHYLAXIS IN COVID-19
FOR PROPHYLAXIS IN
ASYMPTOMATIC PATIENT
INVOLVED IN CARE OF COVID – 19 CASES CONTACT WITH LAB
CONFIRMED COVID-19 CASES
DOSE: DAY 1 : 400MG TWICE A DAY DAY 1 : 400MG TWICE A
DAY WITH
WITH MEALS MEALS
ONCE A WEEK :400MG ONCE A WEEK :400MG

30. • HCQ TREATMENT IS SIGNIFICANTLY ASSOCIATED
WITH VIRAL LOAD REDUCTION/DISAPPEARENCE IN
COVID-19 PATIENTS AND ITS EFFECT IS
REINFORCED BY AZITHROMYCIN.
• FRENCH STUDY ON HCQ AND AZITHROMYCIN
COMBINATION RESULTS SHOWED THAT ALL
PATIENTS TAKING THE COMBINATION WERE
VIROLOGICALLY CURED WITHIN 6 DAYS OF
TREATMENT.

31. OSELTAMIVIR
• OSELTAMIVIR IS A COMPETETIVE NEURAMINIDASE INHIBITOR OF
INFLUENZA NEURAMINIDASE ENZYME.
• THE ENZYME CLEAVES THE SIALIC ACID WHICH IS FOUND ON
GLYCOPROTEINS ON THE SURFACE OF HUMAN CELLS THAT
HELPS NEW VIRIONS TO EXIT THE CELL.
• THUS OSELTAMIVIR PREVENTS NEW VIRAL PARTICLES FROM
BEING RELEASED.
• CORONAVIRUS DOES NOT MANUFACTURE NEURAMINIDASE.
THEREFORE, NO ROLE IN COVID-19.
• MANY PATIENTS WITH SIMILAR PRESENTATION OF COVID 19
MIGHT BE INFLUENZA
• HENCE BETTER TO GIVE THE DRUG TO AVOID PATIENT
WORSENING DUE TO INFLUENZA
• • DOSE: 150MG BD X 5 DAYS

32. IVERMECTIN
• IVERMECTIN IS AN FDA-APPROVED BROAD SPECTRUM
ANTI-PARASITIC AGENT .
• IVERMECTIN HAS SHOWN TO INHIBIT REPLICATION OF
COVID-19 CAUSATIVE VIRUS (SARS-COV-2) BY NUCLEAR
TRANSPORT INHIBITORY ACTIVITY IN VITRO.
• A SINGLE TREATMENT ABLE TO EFFECT ∼5000-FOLD
REDUCTION IN VIRUS AT 48H IN CELL CULTURE.
• MORE TESTING IS NEEDED TO KNOW IF IT WORKS
WELL IN PEOPLE AND IF IT’S SAFE TO USE.

33. OTHER TREATMENT MODALITIES
• MRNA-1273/MODERNA A NOVEL CORONAVIRUS
VACCINE IS IN A PHASE 1 STUDY.
• REMDESIVIR ANTIVIRAL DRUG IS IN CLINICAL
TRIALS IN CHINA AND THE UNITED STATES.
• THE LOPINAVIR/RITONAVIR CO-MBINATION-
SUGGESTED DOSE-(200/50) 2 TAB BD FOR MAX 14
DAYS

34. • FAVILAVIR , formerly known as fapilavir, an antiviral
has shown efficacy in the treatment of the novel
coronavirus (covid-19), has been approved to be sold
in the market in China.
• CONVALESCENT PLASMA TO BE USED IN PATIENTS WITH
SERIOUS OR IMMEDIATELY LIFE-THREATENING COVID-19
INFECTIONS

35. PROTOCOL FOR TREATMENT OF
CONFIRMED COVID 19
Grou
p
Criteria Investigatio
ns
Isolation
ward/
Hospitalise
d
Treatment Remarks
A Asymptomatic but
positive for COVID
19
Hemogram Isolation ward Oseltamivir 75 mg BD*5
days
+
Tab. Azithromycin
500mg OD * 5 days
Baseline ECG for
QTc
B Symptomatic/URT
I without
comorbidity
3 out of 4
• Fever
• Dry cough
• Shortness of
breath
• Myalgia
Baseline
Hemogram
Isolation ward Oseltamivir 75 mg BD*5
days
+
Tab. Azithromycin
500mg OD * 5 days
+
Tab. HCQ 400mg BD on
day 1 then 200 mg BD
for 4days
Baseline ECG for
QTc
QTc prolongation –
Omit Azithromycin
and replace by
Cefixime 200 mg
BD for 5 days
If pt is symptomatic
at day 5 also
continue therapy for
next 5 days

36. Grou
p
Criteria Investigatio
ns
Isolation
ward/
Hospitalise
d
Treatment Remarks
C Symptomatic
/URTI with
comorbidity
• >60 yrs
• DM
• HTN/IHD
• COPD/Chro
nic lung
disease
• Immunocom
promised
state
• Immunosupp
ressive
drugs
• CKD
Baseline
Hemogram,
LFT,RFT,BS
L profile, X-
ray Chest,
Sr. Amylase,
ECG, 2D
Echo,
CPKMB ,
PT/INR,
ABG
Daily SE,
Magnesium
if QTc
prolongation
Isolation
Ward
Oseltamivir 75 mg
BD*5 days
+
T. Azithromycin
500mg OD * 5 days
+
T. HCQ 400mg BD
on day 1 then 200
mg BD for 4days
+
Lopinavir/ Ritonavir
200 mg + 50 mg 2
tab BD * 5 days
Baseline ECG for
QTc
QTc prolongation
–Omit
Azithromycin &
replace by
Cefixime 200 mg
BD for 5 days.
If QTc
prolongation
persists or
increases replace
Lopinavir-
Ritonavir by
Atazanavir (200
mg) – Ritonavir
(100 mg)
If pt is
symptomatic at
day 5 also

37. Grou
p
Criteria Investigatio
ns
Isolation
ward/
Hospitalise
d
Treatment Remarks
D Pneumonia
(LRTI)
without
respiratory
failure
Baseline
Hemogram ,
ECG, LFT,
RFT, BSL
profile, X-ray
Chest, Sr.
Amylase,
2 D Echo,
CPKMB,
PTINR
ABG
Daily SE ,
Magnesium
if QTc
prolongation
Isolation
ward/SOS
ICU
Oseltamivir 150 mg
BD for 10 days
(Double dose)
+
T. Azithromycin
500mg OD x 10 days
+
T. HCQ 400 mg BD
on day 1 then 200
mg BD for 9 days
+
Lopinavir /
Ritonavir
200 mg + 50 mg 2
tab BD x 10 days
ECG- Baseline &
daily to look for
QTc
prolongation -- If
present Omit
Azithromycine &
replace by
Cefixime 200 mg
BD for 5 days
.Continue ECG
monitoring daily
and if QTc
prolongation
persists or
increases replace
Lopinavir -
Ritonavir by at
Atazanavir (200
mg) -
Ritonavir(100
mg)

38. Grou
p
Criteria Investigatio
ns
Isolation
ward/
Hospital
ised
Treatment Remarks
E Pneumonia
(LRTI) with
respiratory
failure
Baseline
Hemogram
, ECG,
LFT, RFT,
BSL profile,
X-ray
Chest, Sr.
Amylase,
2 D Echo,
CPKMB,
PTINR
ABG
Daily SE ,
Magnesium
if QTc
prolongatio
n
Isolation
ward/SO
S ICU
Oseltamivir 150
mg BD for 10
days (Double
dose)
+
T Azithromycin
500mg OD x 10
days
+
T. HCQ 400 mg
BD on day 1 then
200 mg BD for 9
days
+
Lopinavir
/Ritonavir 200
mg + 50 mg 2 tab
BD x 10 days
ECG- Baseline &
daily to look for QTc
prolongation -- If
present Omit
Azithromycine &
replace by Cefixime
200 mg BD for 5
days .Continue
ECG monitoring
daily and if QTc
prolongation
persists or
increases replace
Lopinavir -
Ritonavir by at
Atazanavir (200
mg) - Ritonavir(100
mg). Management
of respiratory
failure is as per
ARDS guidelines

39. Grou
p
Criteria Investigatio
ns
Isolation
ward/
Hospitalise
d
Treatment Remarks
F Pneumonia
(LRTI) with
respiratory
failure multi
organ
dysfunction
syndrome
Baseline
Hemogram
, ECG, LFT,
RFT, BSL
profile, X-
ray Chest,
Sr.
Amylase,
2 D Echo,
CPKMB,
PTINR
ABG
BLOOD
CULTURE
HRCT
THORAX
PROCALCI
TONIN
Daily SE ,
Magnesium
if QTc
Isolation -
ICU
Oseltamivir
150 mg BD for
10 days
(Double dose)
+
T.
Azithromycin
500mg OD x 10
days
+
T. HCQ 400 mg
BD on day 1
then 200 mg BD
for 9 days
+
Lopinavir /
Ritonavir
200 mg + 50 mg
2 tab BD x 10
days
ECG- Baseline &
daily to look for QTc
prolongation -- If
present Omit
Azithromycine &
replace by Cefixime
200 mg BD for 5
days .Continue
ECG monitoring
daily and if QTc
prolongation
persists or
increases replace
Lopinavir - Ritonavir
by at Atazanavir
(200 mg) -
Ritonavir(100 mg)
Management of
respiratory failure
is as per ARDS
guidelines&