Clinical Management of Covid-19 is described here.

1. Made by
Dr. Sananda Halder
& Engr. Muhammad
Ridwanul Hoque

2. What is Covid-19 Crisis?
● Covid-19 is an ongoing Pandemic disease affecting most of the world.
● Potentially Severe Acute respiratory infection caused by previously
unknown beta-coronavirus.
● It was first identified in Wuhan city, Hubai Province, China, in
December, 2019.
● Globally 214 countries have been reported to be affected.
● It has been declared as Pandemic by WHO on the 11 th March, 2020.

3. ● Full Name: Severe Acute Respiratory Syndrome
Coronavirus-2 (SARS- CoV-2)
● It is a positive sense single stranded RNA virus belonging to
the Sarbecovirus subgroup of the Coronaviridae family
● Route of Transmission:
-Primary: via respiratory droplets from coughs and sneezes within
a range of about 1.8 m (6 ft)
Additional: Studies suggest-
- via speaking
- indirect contact via contaminated surface
● The Virus mainly targets the respiratory system but might
also affect:
-gastrointential organs
-cardiovascular system
-kidney etc
The Virus

4. Alarming Picture in Bangladesh
● So far, we have had 824,486 of diagnosed cases of
Covid-19 and 13,071 deaths by it.
● Though the country is under strict lockdown since
April, 2020; DGHS is reporting COVID-19 infections
on a daily basis.
● A vaccination programme has been initiated by our
Government this year including frontline workers and
citizens aged over 40 years.
● Recently the Delta variant which caused a massive
outbreak in India has also been found in about 31
Bangladeshis mostly living in southern border district
of Jessore which is an alarming fact.

6. Probable Covid 19 Case
A. A patient who meets clinical criteria above and is
a contact of a probable or confirmed case, or
epidemiologically linked to a cluster of cases
which has had at least one confirmed case
identified within that cluster.
A. A suspected case with chest imaging showing
findings suggestive of Covid-19
A. A person with recent onset anosmia or agensia
A. Death, not otherwise explained
Typical chest imaging findings
suggestive of COVID-19 include the
following (Manna 2020):
• chest radiography: hazy opacities,
often rounded in morphology, with
peripheral
and lower lung distribution
• chest CT: multiple bilateral ground
glass opacities, often rounded in
morphology,
with peripheral and lower lung
distribution
• lung ultrasound: thickened pleural
lines, B lines (multifocal, discrete, or
confluent),
consolidative patterns with or without
air bronchograms.

7. Confirmed case
A person with laboratory confirmation of COVID-19 infection, irrespective of
clinical signs and symptoms
A contact is a person who has experienced any one of the following exposures during the 2 days before
and the 14 days after the onset of symptoms of a probable or confirmed case:
1. face-to-face contact with a probable or confirmed case within 1 metre and for at least 15 minutes
2. direct physical contact with a probable or confirmed case
3. direct care for a patient with probable or confirmed COVID-19 disease without using recommended
personal protective equipment
N.B. for confirmed asymptomatic cases, the period of contact is measured as the 2 days before through
the 14 days after the date on which the sample that led to confirmation was taken
Definition of Contact

8. Definition of COVID-19 Death
A death resulting from a clinically compatible
illness in a probable or confirmed COVID-19 case.
All deaths should be documented.

10. Testing for Covid-19
Detection of Virus Radiology and Imaging
A. Specimen:
1. Upper Airway Specimen:
● Oropharyngeal Swab
● Nasal Swab
● Naropharyngeal Swab
1. Lower Airway Specimen:
● Spectrum
● Bronchoalevealar
B. Detection of viral Nucleic Acid:
By RT- PCR. It is the preferred method
● CT-chest: A high resolution CT is
highly preferable
● Chest X-ray: less sensitive than
HRCT
● USG of chest

15. Treatment Protocol
for COVID-19
Laboratory Investigations:
● CBC with CRP
● Chest x-ray
● ECG (>50 yrs)
● D-dimer
● LFT, RFT
● CT chest
● S. Electrolytes
● ABG
● LDH
● Ferritin
● Blood culture
● Procalcitonin
● Lactate
● Echocardiogram
● Troponine I & Pro-BNP
Critical Cases:
All investigations for severe
cases with additional ICU
investigations as necessary
Mild class
Moderate Class
Severe cases

16. Management
General Management :
● Bed rest
● Sufficient calorie intake
● Monitoring vital signs and oxygen saturation
● Timely initiating oxygen therapy
● Isolation:- Asymptomatic and mild cases at home
- moderate, severe, critical cases at hospital
Pharmacological Management :
1. Asymptomatic cases
2. Mild cases
3. Moderate cases
4. Severe cases
5. Critical cases
Home Isolation Protocol:
● bed rest at home in self
isolation
● physical distancing
● no visitor
● hand sanitizer
● face mask

18. Confirmed and Suspected Cases of Covid-19

19. Asymptomatic Patients
General management + Isolation protocol is enough. No
pharmacological approach
● Tab. Paracetamol (500 mg) if temp.>101℉
● Antihistamine
● Antitussive
● Thromboprophylaxis: Enoxaparin(40mg), S/C once
daily
● Unfractionated heparin

20. Moderate Case
● Oxygen through nasal canula (Maximum 5 L/min)
● Prone Position at least (4-6) hrs/day
● Thromboprophylaxis:
○ -LMW heparin: Enoxaparin (1 mg/kg SC BD)
○ -Inj. Unfractionated heparin
Given till symptoms resolved
● Antiviral: Inj. Remdesivir has been advocated
○ Dose:200 mg IV infusiin (Day 1)
Then,
100 mg IV infusiin (Day 2-5)

21. Severe Cases
Management of moderate protocol
+
● Steroid: Inj. Dexamethasone 6 mg daily for 10 days
Or,
Inj. Methylprednisolone(250 mg daily for 5 days)
● Early Norephinephrine for hypertension
● Broad spectrum antibodies- IV drug
● Consideration for:
a. Tocilizumab:
■ Abnormal chest imaging
■ Absence of systemic co-infection
b. Convalescent plasma therapy:
■ Age:>18 years
■ Severe life threatening disease
■ Symptoms> 8-10 days

22. Critical Cases
● Previously mentioned all steps
● Escalation of respiratory support:
○ Prone positioning( more than 12 hrs/day)
○ Low flow oxygen delivery devices
i. Nasal canula
ii. Simple mask
iii. Venturi mask
iv. Partial re-breather mask
v. Non re-breather mask
○ High flow delivery devices:
i. High flow nasal canula
○ Non-invasive positive pressure ventilation
○ Mechanical ventilation

26. Thank You