Coronavirus aka COVID-19 is now storming many countries including Bangladesh. The testing facility is increased many folds. So there are a lot of new cases are detected daily. Still, the case detection rate is lowest in the world considering millions of people. Recently Govt was pressurized to open garments factory to fight ongoing severe economic loss by BGMEA. Bangladesh is the second-largest garment exporting country after China. Lockdown on the garments factory has a tremendous effect on GDP. Healthcare workers including doctors, nurses are working round the clock to ensure proper care of COVID-19 affected patients. Other frontline workers including Polices, journalists are also getting affected daily. I am also posted now in a Coronavirus dedicated hospital in Jashore. Today I am sharing a post written by Professor Dr. Robed Amin. This guideline is effective and easy to remember.
Treatment Guideline by Prof Dr. Robed Amin
Now we all need to diagnose the COVID-19 case with clinical case definition:
A) ANY FEVER & DRY COUGH: if present both- they will be COVID-19 unless otherwise proved.
B) If ANY of those two (FEVER/DRY COUGH) presents AND there are ANY ONE of MINOR symptoms (Sore Throat, Myalgia, and Fatigue) it is also highly likely to be COVID-19.
C) If ANY SINGLE MINOR complaints are present, it is LESS LIKELY to be COVID 19 (but you need to exclude actively).
Always ask for
- ABDOMINAL PAIN
- ANOSMIA and
- DYSGUESIA (taste difficulty).
If ANY of these is present in the above 3 categories you are dealing with a COVID-19 case.
Remember the big RED symptom-Shortness of breath or DYSPNOEA. You need to admit the patient immediately to the hospital.
Now categorize the patient in below 4 division
1) MILD: Any influenza-like illness (ILI) with the above symptoms.
2) MODERATE: PNEUMONIA WITHOUT DYSPNOEA but patient have fever, cough, pleurisy, etc AND CT chest or Chest Xray is diagnostic.
3) SEVERE: PNEUMONIA WITH respiratory rate more than 25, shortness of breath, saturation less than 92%, etc
4) CRITICAL: Very severe states, ARDS, Sepsis, or shock.
Plan of Treatment
Any Critical Case: Admit immediately in RED ZONE ( in HDU, ICU, makeshift HDU or ICU) and treat immediately with high flow oxygen and inhalers (with spacer) and keep in the prone position. Use a surgical mask for the patient. Give broad-spectrum antibiotics, IV Famotidine.
Any severe case: Must admit in YELLOW ZONE and start treatment with HFNC oxygen (2-6 liter)/min, inhaler with a spacer and prone position. Use a surgical mask for the patient. Give broad-spectrum antibiotics, IV Famotidine.
Any moderate case: Admit in GREEN ZONE and start oxygen 1-2 liter/min, inhaler with a spacer and prone position. Give broad-spectrum antibiotics ( maybe oral), IV famotidine.
Any mild case: Decide whether the patient can remain home isolation or not. If possible, then give prescription with paracetamol,
antihistamine, cough suppressant, etc (accordingly) and home isolation protocol. If not possible the same protocol in hospital in an isolation ward.
Check temperature and saturation frequently.
Other pharmaceutical Treatment
Any asymptomatic RTPCR confirmed case: HCQ only
Any symptomatic mild case: HCQ+ Azithromycin (If patient have Cardiac issue, ask cardiologist before prescribing both. Doxycycline is alternative choice)
Mild case: Start ANTICOAGULANT (oral or LMWH) Or unfractionated heparin Preferably oral.
Moderate case: All of mild + Favipiravir.
*If the moderate case has no response at all within 24 hrs, start methylprednisolone 60-80 mg/day single or divided dose for 7 days.
Severe case: All moderate + Inj Methyprednisolne 500 mg for 5 days (if previously oral-switch to IV)
*Early norepinephrine for hypotension.
*If no response- TOCILIZUMAB and CONVALESCENT PLASMA,
Critical case: All severe + High flow oxygen (50-60 lit/min) through NRBmask, Venturi.
*Prolonged prone position.
*CPAP, BIPAP (especially if cardiac fails or COPD) and
*at last if all fails go for ventilation.
IN ALL STEPS: Encourage Vit C, Vit-D, Zinc, Mask, Breathing exercise (unless critical), Hot bath, etc.
Don’t run through high-quality evidence always- Follow the frontliner of the world now as they are the evidence now.
hope you all got some benefit. Stay safe with distance.
Chamber: Labaid Limited, House # 1, Road # 4, Dhanmondi, Dhaka 1205.
Thanks to all. There could be an argument regarding the treatment protocol. As nothing is still fixed.