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All we need to know about COVID-19 10
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What are the differences between the first wave and second wave in India?Lecture1.1
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How to assess risk Factors for Severe DiseaseLecture1.2
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How to manage on Day 1 of symptoms with COVID-19?Lecture1.3
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How to Interpret the Lab Findings in Mild/Moderate/Severe cases:Lecture1.4
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How to manage patients with information from the lab tests?Lecture1.5
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When to access need for critical care intervention?Lecture1.6
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What Investigations may be needed for inpatients?Lecture1.7
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HRCT in Covid – Indications and importance of HRCT Thorax:Lecture1.8
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Summary Points in COVID-19 Management.Lecture1.9
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Do’s and Don’ts in Covid 19:Lecture1.10
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CONCLUSION: 0
The COVID-19 infection has two phases, the first is the viraemic phase and the second one is the immunologic phase. These two have to be promptly identified and managed appropriately as mentioned above. The critical treatments are oxygen therapy when hypoxic and steroids during severe immunologic phase of the disease. Non Invasive Ventilation and other supportive care including appropriate anticoagulation when needed are crucial and may help to avoid ventilation as prognosis by then can be grim with almost 30-50% mortality.
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Summary Points in COVID-19 Management.
- Time: Timely SARS‐CoV‐2 testing is a crucial step in managing the patient.
- High Risk: Older age, male sex, and comorbidities increase the risk for severe disease.
- ARDS: For people hospitalized with Covid-19, a quarter may go on to develop covid-19 associated acute respiratory distress syndrome (CARDS).
- Oxygen: When used appropriately, high flow nasal cannula (HFNC) may allow CARDS patients to avoid intubation.
- Steroid/Dexamethasone treatment improves mortality for the treatment of severe and critical covid-19.
- Anticoagulation: Low molecular weight heparin, Aspirin, NOACs, (novel oral anticoagulants: dabigatran, rivaroxaban, apixaban, and edoxaban) to be used as it was earlier. Anticoagulants may need to be given for 3 weeks or more (2-4 weeks).
- Remdesivir may have modest benefit in time to recovery in patients with severe disease but shows no statistically significant benefit in mortality or other clinical outcomes.
- Mild to moderate cases: Symptomatic support remains the key treatment with maintaining hydration, nutrition, and controlling fever and cough. Steroids have no demonstrated benefit and may cause harm.
- Severe covid-19 (hypoxemic needing low flow supplemental oxygen) would need hospitalization. Corticosteroids (dexamethasone 6 mg/day × 10 days or until discharge or an equivalent dose of hydrocortisone or methylprednisolone) and may consider Remdesivir. May benefit little from use of tocilizumab. Other monoclonal antibodies that are available (in the USA) are Bamlanivimab 700mg, Etesevimab 1400mg or Casirivimab 1200mg and Imdevimab 1200mg which work when used ASAP within 10 days of symptom onset.
- Critical covid-19: Hospitalized for covid-19 and critically ill (needing HFNC, NIV, IMV, or ECMO): Supportive care with Corticosteroids (dexamethasone 6 mg/day × 10 days or until discharge or an equivalent dose of hydrocortisone or methylprednisolone) and may consider Remdesivir and may benefit from use of tocilizumab. Finally, there is no evidence to support convalescent plasma for COVID treatment.