CLINICAL MANAGEMENT OF SUSPECTED OR CONFIRMED COVID-19 DISEASE
Version 4 (18th May 2020)
Suspected COVID-19 cases
- A suspected COVID-19 case includes any person presenting with an acute (≤14 days) respiratory tract infection or other clinical illness compatible with COVID-19, or an asymptomatic person who is a close contact to a confirmed case
- Any suspected case should be identified as soon as possible (ideally prior to entering the facility). Such cases should immediately be given a surgical mask and be isolated. Good hand hygiene and cough etiquette should be taught, and appropriate samples obtained.
- A broad differential diagnosis should be entertained for suspected COVID-19 cases. Appropriate testing must be undertaken and empiric management prescribed as required for likely alternative diagnoses.
- Suspected COVID-19 cases who are medically well, or have mild disease, may be managed at home while awaiting test results if they are able to safely self-isolate.
- PCR-based testing is required for the diagnosis of acute COVID-19 cases. Only one upper respiratory tract swab needs to be taken – currently, a nasopharyngeal sample is recommended, but saliva maybe a viable alternative. Lower respiratory tract samples (e.g. sputum or endotracheal aspirate) should also be sent if available (do not perform sputum induction however).
- Antibody-based (serological) tests are not currently recommended for the diagnosis of acute COVID-19.
Confirmed COVID-19 cases
- Patients with mild disease may be considered for management at home, provided they are able to safely self-isolate (see criteria in table 2).
- We do not recommend that patients on ACE-inhibitors, angiotensin-receptor blockers, or nonsteroidal anti-inflammatory discontinue these agents due to COVID-19 related concerns. Paracetamol remains the recommended first-line medication for the treatment of fever and pain.
- Oxygen therapy is the cornerstone of management for most patients requiring admission – target oxygen saturations of ≥90% for most patients, using nasal prong oxygen, a simple face mask, or a face mask with a reservoir bag.
- For intubated patients with ARDS and low lung compliance, use lung-protective ventilation strategies.
- There is currently insufficient evidence to support the use of any specific therapy for COVID-19. Any investigational drugs or therapeutics should be reserved for hospitalized patients. They should ideally be administered as part of a clinical trial, but at a minimum they should be administered under the Monitored Emergency Use of Unregistered Interventions (MEURI) framework.
- Patients may be de-isolated without the need for repeat PCR tests. Provided the patient’s fever has resolved and their symptoms have improved, those with mild disease may be de-isolated 14 days after symptom onset, while those with severe disease may be de-isolated 14 days after achieving clinical stability (e.g. once supplemental oxygen is discontinued).
Healthcare worker personal protective equipment (PPE)
- For the majority of direct COVID-19 patient interactions, appropriate healthcare worker personal protective equipment consists of gloves, a gown or apron, a surgical mask and a face shield/visor/goggles.
- When performing aerosol-generating procedures (e.g. taking nasopharyngeal swabs, performing CPR, or intubating a patient), an N95 respirator should be used instead of a surgical mask.
- Meticulous compliance with donning and doffing procedures is critical to avoid contamination and infection.
Version 4: What’s New?
- Updated case definition for a suspected COVID-19 case (section 3.1)
- New guidance on SARS-CoV-2 sampling and on repeat testing (section 3.2)
- Recommendation against the use of rapid antibody-based tests for the routine diagnosis of acute COVID-19 (section 3.2)
- Removal of the requirement that mild disease in high-risk individuals requires hospitalization (section 4.1)
- Guidance on patients requiring nebulized medications or inhaled or systemic steroid use for management of their comorbidities (section 4.2)
- Updates to critical care section (section 4.5)
- Specific guidance on children, HIV patients, and pregnant/breastfeeding women (section 5)
- Updated guidance on the forms required when testing and managing COVID-19 patients (section 7)
IN THIS GUIDELINE
The interim guidelines are based on what is currently known about the Coronavirus Disease 2019 (COVID-19). The National Institute for Communicable Diseases will update these interim guidelines as needed and as additional information becomes available.