Therapeutic and triage strategies for 2019 novel coronavirus
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A recently published article in The Lancet, has described about a clinical algorithm which was developed by researchers in Wuhan during the early outbreak period. The SARS epidemic in 2003 was controlled through numerous measures in China. One effective strategy was the establishment of fever clinics for triaging patients. Based on researchers first-hand experience in dealing with the present outbreak in Wuhan, they have established the following clinical strategies in adult fever clinics.

1. Patients can be afebrile in the early stages of infection, with only chills and respiratory symptoms. High temperature is not a general presentation. Elevated C-reactive protein (CRP) is an important factor of 2019 novel coronavirus disease and impaired immunity, characterised by lymphopenia, is an essential characteristic.

2. In afebrile patients (temperature less than 37·3°C) without dyspnoea, researchers recommend measurements of complete blood count and CRP. Subsequently, if the lymphocyte concentration is more than 1100/μL, home care with self-isolation is advised. Oral azithromycin or amoxicillin can be prescribed.

3. Chest CT is helpful and is more sensitive than x-ray in identifying viral pneumonia. Imaging of patients with COVID-19 initially revealed characteristic patchy infiltration, progressing to large ground-glass opacities that often present bilaterally.

4. Febrile patients (temperature more than 37·3°C) should have both chest CT and respiratory viral tests. If the consensus is bacterial community-acquired pneumonia (CAP), then standard clinical protocols are followed.

5. Patients diagnosed with viral pneumonia require isolation and SARS-CoV-2 tests.

6. Empirical therapy consists of oral moxifloxacin or levofloxacin (consider tolerance) and arbidol.

7. If presenting with dyspnoea and hypoxia (oxygen saturation [SpO2] less than 93%), prescribe supplemental oxygen, admit to an isolation ward, and assess transfer risk.

8. If patients are deteriorating, the core treatment principle researchers recommend is antiviral plus antipneumococcus plus anti-Staphylococcus aureus.

9. High-dose nemonoxacin (750 mg once daily) and linezolid is effective against S pneumoniae and Staphylococcus aureus (including methicillin-resistant Staphylococcus aureus [MRSA]).

10. In emergency cases, such as SpO2 less than 90%, dexamethasone 5–10 mg or methylprednisolone 40–80 mg is given intravenously before transfer.

11. High-throughput oxygen therapy or continuous positive airway pressure (CPAP) ventilation are both effective supportive therapies and target blood SpO2 should be 88–90%.

12. Older patients (more than 65 years) and immunocompromised patients should be treated as moderate or severe cases in the initial assessment.

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S●●●●q A●●●d N●●●●i General Medicine
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Dr. N●●●●a G●●●a Obstetrics and Gynaecology
There are guidlines for telemedicine and those need to be followed, even repeat consultation and checking the reports will decrease a burden on overburdened health systwm.
Apr 16, 2020Like