RECENT GUIDELINES ON COVID-19

1. PRESENT STATUS AND MANAGEMENT
CORONAVIRUS (COVID-19)
DR. MUDRA KHARE
(PG IInd year)
GUIDE :- DR. ABHIJEET KHANDELWAL
ASSOCIATE PROFESSOR - IMCHRC INDORE MP

2. Introduction
• Dec 2019: a novel coronavirus
identified as cause of a cluster
of pneumonia cases in Wuhan,
Hubei, China.
• Epidemic throughout China,
with sporadic cases reported
globally.
• Feb 2020: the WHO
designated the disease COVID-
19 or coronavirus disease
2019.
• Virus : severe acute respiratory
syndrome coronavirus 2
(SARS-CoV-2); previously,
2019-nCoV.
https://www.who.int/dg/speeches/detail/who-director-general-s-remarks-
at-the-media-briefing-on-2019-ncov-on-11-february-2020

3. Epidemiology
• Pandemic
• World wide - >1 lakh26 thousand infected
-4632 died
• Newyork times –china 80929 infected
-3172 died
• India -74 cases
- 1 died

5. Transmission
• Epidemiologic
investigation in Wuhan
identified an initial
association with a
seafood market where
most patients had
worked or visited.
• The seafood market
also sold live rabbits,
snakes, and other
animals.
World Health Organization. Novel coronavirus situation report -2. January 22, 2020

8. Published on February 28, 2020

9. Published on February 28, 2020

13. Chest Radiographs.
Shown are chest radiographs from Patient 2 on days 8 and 11 after the onset of illness.
The trachea was intubated and mechanical ventilation instituted in the period
between the acquisition of the two images. Bilateral fluffy opacities are present in both
images but are increased in density, profusion, and confluence in the second image; these
changes are most marked in the lower lung fields. Changes consistent with the
accumulation of pleural liquid are also visible in the second image.

14. LancetInfectDis2020February24

16. Collection of specimens for laboratory
diagnosis
• Upper respiratory tract: nasopharyngeal &
oropharyngeal
• Lower respiratory tract: sputum, endotracheal
aspirate, BAL, mini-BAL
• Serology for diagnostic purposes is
recommended only when RT-PCR is not
available.
• Collect blood cultures for bacteria that cause
pneumonia and sepsis
www.who.int/csr/disease/coronavirus_infections/merslaboratory-testing/en

17. Management: Home care
• Appropriate for patients with mild infection
who can be adequately isolated in OPD
setting.
• Should focus on prevention of transmission to
others & monitoring for clinical deterioration,
which should prompt hospitalization.
www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronaviru
s-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts

18. Management: Hospital Care
• Isolation: Negative pressure rooms.
• Conservative fluid management
• Empiric antimicrobials to treat all likely pathogens
• Avoid glucocorticoids
• Closely monitor patients for signs of clinical
deterioration
• Management of co-morbid condition(s)
• Management of hypoxemic respiratory failure,
shock, AKI
• Prevention of complications: DVT, VAP, bed sore,
GIT bleed
www.who.int/emergencies/diseases/novel-coronavirus-2019/
technical-guidance/patient-management
Containment plan: Novel Coronavirus disease, MoH&FW, GOI

20. Management
WHO

21. Triage

24. 3. 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
• Give empiric antimicrobials
• Closely monitor patients with SARI for signs of
clinical deterioration.
• Understand the patient’s co-morbid condition(s)

25. 4. Collection of specimens for laboratory
diagnosis
• Collect blood cultures for bacteria that cause
pneumonia and sepsis
• Collect specimens from BOTH the upper
respiratory tract (URT; nasopharyngeal and
oropharyngeal) AND lower respiratory tract
(LRT; expectorated sputum, endotracheal
aspirate, or bronchoalveolar lavage) for 2019-
nCoV testing by RT-PCR.

26. . Management of hypoxemic
respiratory failure and ARDS
• NIV AND HFNC
• Implement mechanical ventilation using lower
tidal volumes (4–8 ml/kg predicted body weight)
and lower inspiratory pressures plateau pressure
< 30cm H2O
• In patients with severe ARDS, prone ventilation
for >12 hours per day is recommended.

27. • moderate or severe ARDS, higher PEEP instead
of lower PEEP is suggested
• In patients with moderate-severe ARDS
(PaO2/FiO2 <150 neuromuscular by continous
infusion may not use
• ECLS
• Management of septic shock
• Nutritional support

29. Pneumonia associated with the 2019 novel coronavirus (2019-nCoV) is continuously and rapidly
circulating at present. No effective antiviral treatment has been verified thus far. We report here the
clinical characteristics and therapeutic procedure for four patients with mild or severe 2019-nCoV
pneumonia admitted to Shanghai Public Health Clinical Center. All the patients were given antiviral
treatment including lopinavir/ritonavir, Umefenovir, and Shufeng Jiedu Capsule (SFJDC, a
traditional Chinese medicine) and other necessary support care. After treatment, three patients
gained significant improvement in pneumonia associated symptoms, two of whom were confirmed
2019-nCoV negative and discharged, and one of whom was virus negative at the first test. The
remaining patient with severe pneumonia had shown signs of improvement by the cutoff date for
data collection. Results obtained in the current study may provide clues for treatment of 2019-nCoV
pneumonia. The efficacy of antiviral treatment including lopinavir/ritonavir, arbidol, and SFJDC
warrants further verification in future study.

30. Remdesivir has been recently recognized as a promising antiviral drug against a wide array
of RNA viruses (including SARS/MERS-CoV5) infection in cultured cells, mice and
nonhuman primate (NHP) models. It is currently under clinical development for the
treatment of Ebola virus infection.6 Remdesivir is an adenosine analogue, which
incorporates into nascent viral RNA chains and results in pre-mature termination.7 Our
time-ofaddition assay showed remdesivir functioned at a stage post virus entry (Fig. 1c, d),
which is in agreement with its putative antiviral mechanism as a nucleotide analogue.
Warren et al. Showed that in NHP model, intravenous administration of 10 mg/kg dose of
remdesivir resulted in concomitant persistent levels of its active form in the blood (10 μM)
and conferred 100% protection against Ebola virus infection.
Chloroquine, a widely-used anti-malarial and autoimmune disease drug, has recently been
reported as a potential broadspectrum antiviral drug.8,9 Chloroquine is known to block
virus infection by increasing endosomal pH required for virus/ cell fusion, as well as
interfering with the glycosylation of cellular receptors of SARS-CoV.10 Our time-of-addition
assay demonstrated that chloroquine functioned at both entry, and at postentry stages of
the 2019-nCoV infection in Vero E6 cells (Fig. 1c, d).

31. Other Experimental Drugs
1. Existing broad spectrum antiviral drugs:
Interferon I (IFN- alpha, beta, kappa ..), interferon
II (interferon gamma)
2. Screening existing compounds with important
physiological/ immunological effects, eg. kinase
signal transduction, protein processing and DNA
synthesis and repair …
3. Other drugs: fusion peptide (EK 1), RNA synthesis
inhibitor (TDF, 2TC), Chinese medicines
(ShungFengJieDu, Lianhuaquingwen)
Lu H. Bioscience Trends. Advance publication. 28 Jan 2020; www.biosciencetrends.com

32. Poor prognostic marker
• Older age
• High SOFA
• D-dimer >1 microgram /litress

33. Person-to-person spread
Spread from contact with infected surfaces or objects
Avoid crowding
Hand hygiene
Cough manner
Prevention: How COVID-19 Spreads
https://www.cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.html

35. CORONA V/S SWINE FLU
CORONA
• IP-5-6 days
• Serial interval=4.4 -7.5 days
• Infectious time is more
• No vaccines
• No effective medicines
• Doubling time is 4-5 days
SWINE FLU
• IP-1-2 days
• Serial interval=3 days
• Infectious time is less
• Vaccine available
• Medicines also available

37. “PREVENTION IS BEST TREATMENT”
REF-WHO GUIDLINE
PUBMED ARTICLE
NATIONAL CENTRE OF DISEASE CONTROL ,GOI
PRESENTED BY ;- DR. MUDRA KHARE
(PG IInd year)
GUIDED BY ;- DR ABHIJEET KHANDELWAL
ASSO.PROF.IMCHRC INDORE
MP

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