COVID-19 Management (Updated @ 21.09.2020)

 Disease Severity

	Clinical Stage
MILD	1	Asymptomatic	No antiviral treatment required
	2	Symptomatic, No Pneumonia	ü No antiviral treatment required in the absence of warning signs ü Close observation of vital signs and oxygen saturation ü Look for warning signs at each review. Treat as category 4 if any warning signs present
	3	Symptomatic, Pneumonia	ü Antiviral treatment required in the absence of risk factors / warning signs ü Close observation of vital signs and oxygen saturation ü Look for warning signs at each review. Treat as category 4 if any warning signs present ü Treat as category 4 if patient has any of the following risk factors: Age ≥ 50 years or ESRF
SEVERE	4	Symptomatic, Pneumonia, Requiring supplemental oxygen
	5	Critically ill with multiorgan involvement

 

 

Updated COVID-19 Drugs and Dosing (Used by ID , HQE)

	Drug	Dose Recommended	Remark(s)
1	Favipravir 200 mg Tab*	1800 mg bd for 1 day then 800 mg bd (5 – 10 days)	·        Teratogenic effect; Contraindicated for women of childbearing potential and men whose partner is of childbearing potential. ·        Avoid if GFR < 30 mL/min
2	Interferon Beta-1b 250 mcg Inj* (NO LONGER RECOMMENDED SINCE OCT 2020)	250 mcg stat then EOD for 3-5 doses	·        Use in the first week of illness as viral activity may predominate. ·        It may not be useful if started in the second week of illness.
3	Tocilizumab*	4-8 mg/kg single dose (MAX: 800 mg/dose)	·        Given that we will be giving dexamethasone more routinely, the need for Tocilizumab will drop. ·        But it still has a role in the following situations: o   Coming in late with evidence of advanced CRS disease – Grade 3/4 o   Rapidly progressive disease Ø Fold increases, net increases, or rate of change in cytokine levels may provide better correlates of CRS severity than absolute cytokine levels.* Ø CRP levels serve as a reliable surrogate for IL-6 bioactivity.*
4	Dexamethasone	6 mg OD (5-7 days)	·       Recommended in all patients needing supplemental oxygen > 7 day of illness ·       Benefits of use in patients < 7 day of illness is still uncertain
5	Methylprednisolone	0.5-1 mg/kg (5-7 days)

 

*May refer to Askdis Blogspot for details of administration

*Dosing suggested is for normal patient. Dose may need to be renally / hepatically adjusted PRN. Please double check.

 

As per agreed with ID HQE, Hydroxychloroquine, Kaletra and Ribavirin are no longer part of COVID-19 management.

 

References:

1)       Slides: COVID-19 Clinical Updates (by Dr Suresh, ID Physician, Hospital Sg Buloh)

2)       Slides: Mesyuarat Pengurusan Pesakit COVID-19 bersama TKPK(P) [28 Ogos 2020]