WHO releases technical guidance on management of Coronavirus patient

Delhi: World Health Organisation (WHO) has released technical guidance on the management of Coronavirus PatientClinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. This document is intended for clinicians taking care of hospitalized adult and pediatric patients with a severe acute respiratory infection (SARI) when a nCoV infection is suspected. It is not meant to replace clinical judgment or specialist consultation but rather to strengthen clinical management of these patients and provide up-to-date guidance. Best practices for SARI including IPC and optimized supportive care for severely ill patients are essential.

Early supportive therapy and monitoring

• Give supplemental oxygen therapy immediately to patients with SARI and respiratory distress, hypoxaemia, or shock.

Remarks: Initiate oxygen therapy at 5 L/min and titrate flow rates to reach target SpO2 ≥90% in non-pregnant adults and SpO2

≥92-95 % in pregnant patients.1,2 Children with emergency signs (obstructed or absent breathing, severe respiratory distress,

central cyanosis, shock, coma or convulsions) should receive oxygen therapy during resuscitation to target SpO2 ≥94%; otherwise,

the target SpO2 is ≥90%.

4 All areas where patients with SARI are cared for should be equipped with pulse oximeters, functioning

oxygen systems and disposable, single-use, oxygen-delivering interfaces (nasal cannula, simple face mask, and mask with

reservoir bag). Use contact precautions when handling contaminated oxygen interfaces of patients with nCoV infection.

Use conservative fluid management in patients with SARI when there is no evidence of shock.

Remarks: Patients with SARI should be treated cautiously with intravenous fluids, because aggressive fluid resuscitation may

worsen oxygenation, especially in settings where there is limited availability of mechanical ventilation.16

Give empiric antimicrobials to treat all likely pathogens causing SARI. Give antimicrobials within one hour of initial patient

assessment for patients with sepsis.

Remarks: Although the patient may be suspected to have nCoV, administer appropriate empiric antimicrobials within ONE hour

of identification of sepsis.17 Empiric antibiotic treatment should be based on the clinical diagnosis (community-acquired

pneumonia, healthcare-associated pneumonia [if the infection was acquired in a healthcare setting], or sepsis), local epidemiology and

susceptibility data, and treatment guidelines. Empiric therapy includes a neuraminidase inhibitor for the treatment of influenza when

there is local circulation or other risk factors, including travel history or exposure to animal influenza viruses.18 Empiric therapy

should be de-escalated on the basis of microbiology results and clinical judgment.

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Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts

WHO has developed this rapid advice note to meet the need for recommendations on the safe home care for patients with suspected novel coronavirus (2019-nCoV) infection presenting with mild symptoms and public health measures.

Closely monitor patients with SARI for signs of clinical deterioration, such as rapidly progressive respiratory failure and sepsis,

and apply supportive care interventions immediately.

Remarks: Application of timely, effective, and safe supportive therapies is the cornerstone of therapy for patients that develop

severe manifestations of 2019-nCoV.

Understand the patient's co-morbid condition(s) to tailor the management of critical illness and appreciate the prognosis.

Communicate early with patient and family.

Remarks: During intensive care management of SARI, determine which chronic therapies should be continued and which

therapies should be stopped temporarily. Communicate proactively with patients and families and provide support and prognostic

information. Understand the patient's values and preferences regarding life-sustaining interventions.

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Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected