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Truth Watch👁

National Guidelines for Clinical Management and Treatment of COVID-19

National committee for Management of COVID-19 Cases (Dubai Health Authority)

Objectives

The objectives of this document are:

  • To provide guidance on clinical management of the COVID-19 infection
  • To provide a protocol on the practical steps to deal with COVID-19 cases
  • To detail the measures necessary to protect hospital staff, patients and visitors
  • This guideline is not intended to override the clinical decisions that will be made by clinicians providing individualized patient care.

• This guideline will be updated as more information becomes available.

Introduction to Coronaviruses (CoV)

  • Corona virus is a large family of viruses that cause illness in humans and animals
  • In people, CoV can cause illness ranging in severity from the common cold to SARS.
  • SARS COV2 is one of seven types of known human coronaviruses. SARS COV2 like the MERS and SARS coronaviruses, likely evolved from a virus previously found in animals

• The estimated incubation period is unknown and currently considered to be up to 14 days

Case Definition:

Suspected COVID-19 case is defined as:

  1. Please refer to the local health authority websites for updated information on local case definition.

MOHAP, DoH, SEHA and DHA

Confirmed COVID-19 is defined as:

A person with confirmed positive COVID-19 test by a reference laboratory.

Clinical Findings and Complications

Stages of illness: There seem to be different stages of illness that patients may move through.

  1. Replicative stage – Viral replication occurs over a period of several days. An innate immune response occurs, but this response fails to contain the virus. Relatively mild symptoms may occur due to direct viral cytopathic effect and innate immune responses.
  2. Adaptive immunity stage – An adaptive immune response eventually kicks into gear. This leads to falling titres of virus. However, it may also increase levels of inflammatory cytokines and lead to tissue damage – causing clinical deterioration.
  • This progression may explain patient phenomena wherein they are relatively OK for several days, but then suddenly deteriorate when they enter the adaptive immunity stage

• This has potentially important clinical implications: Initial clinical symptoms aren’t necessarily predictive of future deterioration.

Clinical Symptoms: Signs and symptoms include:

  • Fever
  • Cough
  • Myalgia or fatigue
  • Shortness of breath
  • Sore throat
  • Runny nose
  • Diarrhoea and nausea
  • Muscle ache
  • Headache
  • Pneumonia and ARDS.
  • Renal failure, pericarditis and Disseminated Intravascular Coagulation

Complications:

  • Severe Pneumonia
  • Acute Respiratory Failure and ARDS
  • Acute Renal failure
  • Disseminated intravascular coagulation
  • Sepsis or septic shock

High risk group

  • Age above 60 years old
  • Smoker
  • Cardiovascular disease
  • Diabetes
  • Hypertension  
  • Other chronic disease such as chronic kidney disease, Chronic Respiratory disease, Sickle cell…etc.
  • Immune deficiency
  • Pre-existing pulmonary disease

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