Directorate General of Primary Health Care

Patient flow at PHC institution during COVID-19

All PHC must have screening point at the entrance

before the medical record section.

Flu- like symptoms

No Yes

1. Give surgical mask to

To be directed to
patients.
non-infective zone
2. To be directed to
at PHC
infectious zone at
PHC

Continue Routine
services
Triage: COVID-19 case
definition

No Yes

1-To be managed as
in algorithm of case
To be managed as ARI definition document.
non-COVID-19
2-Perform clinical
assessment by GP
 Directorate General of Primary Health Care

Clinical assessment of flu-like symptoms at PHC

COVID-19 case definition confirmed by GP

NO Yes

Provide usual ARI

management

High risk: one of. Low risk

• Age ≥ 60
• CVD
• Hypertension
• DM
• Chronic respiratory
diseases
• Immunosuppressed
patient ( cancer, on drugs/
biological agents, bone
marrow transplant)
• Renal dialysis

Mild pneumonia Severe ARDS

symptoms pneumonia

Low High
Home Refer to Hospital
Risk Risk
isolation
 Clinical Assessment of patients with COVID-19 at PHC.
Category Description Clinical gaudiness
Mild illness with Patient with uncomplicated upper • Symptomatic treatment
low risk* respiratory tract infection symptoms
such as fever, cough, sore throat,
• Home/ institutional
isolation
fatigue, nasal congestion and rarely GI • No need for antibiotic/
symptoms. Antiviral
No clinical signs of pneumonia, • Return if worsen
RR≤ 20/min, PO2 ≥ 94 symptoms

Mild illness with Patient with uncomplicated upper • Give Tamiflu for 5 days
high risk * respiratory tract infection symptoms
such as fever, cough, sore throat,
• Home/ institutional
isolation
fatigue, nasal congestion and rarely GI • Return if worsen
symptoms. symptoms
No clinical signs of pneumonia,
RR≤ 20/min, PO2 ≥ 94

Pneumonia in low Adult or child with pneumonia (clinical • Give amoxicillin and
risk patient * or radiological ) but still maintain PO ≥
94 at room air, and Respiratory rate≤
clarithromycin for 5
days.
20 /min • Home/ institutional
isolation
• Return if worsen
symptoms
Pneumonia in High patient pneumonia ( clinical or
risk patient radiological ) but still maintain PO
≥94 at room air , and Respiratory Rate
≤ 20 ( adult) ,
Severe pneumonia Fever or suspected respiratory tract
infection( clinical or radiological ),
pulse one of:
• PO ≤ 93
• Respiratory Rate ≥ 30(adult),
• Respiratory Rate ≥40 (
children≤ 5y)
• Severe respiratory distress Refer to Hospital

Acute Respiratory Developed severe respiratory distress

Distress Syndrome with low PO2 within one week of upper
respiratory tract symptoms or
pneumonia.

Sepsis/sceptic shock Life threatening condition with sign of

organ dysfunction like alter mental
states, difficulty or fast breathing, heart
failure, low PO2, reduced urine output.
* For all home/institutional isolation Please do the following:

1. Clinical follow up:

- Daily call / visit from PHC staff to enquire about (worsening
cough, shortness of breath, difficulty in breathing, fast breathing,
unable to speak).
- Inform about test result once available.
- Ask the patient to come to health institute if having worsening in
symptoms as described above while wearing surgical mask on the
way.
- Upon arrival to health institute, assess the patient clinically and
refer to hospital as per Clinical Assessment of patients with COVID-
19 at PHC.

2. Contact tracing:
- Please refer to National contact tracing guideline ( attached ).