Instructions for the management

of coronavirus cases

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 CORONAVIRUS CASE MANAGEMENT INSTRUCTIONS SUMMARY
The purpose of the coronavirus case management instructions is to establish several specific
guidelines to be followed and complied with at each of the Heart Institute's sites in the city of
Bucaramanga, for each diagnosis and treatment of all patients suspected or diagnosed with
coronavirus.

For the management and care of such patient, in first stay, for the admission:
1. to a hospital unit from an IPS with respiratory symptoms, there each patient should be
questioned about possible or trips made in the last 14 days.
The staff in charge, a care coordinator or surveillance nurse is informed in order to immediately
perform an isolation by drops.
2. To a scheduled outpatient or priority consultation, where the respective isolation will be
performed and the staff in charge will be informed in the same way.

Such movements for these patients must be extremely careful, adopting all control measures,
ventilation, reinforcing hygiene measures and protocols during any procedure. Each initial
management will depend on the clinical severity of the patient, whether he/she presents any
respiratory distress, presence of pneumonia, sepsis, gastrointestinal or neurological symptoms,
and follow the recommended indications for such cases.

There are operative case definitions for coronavirus cases

There is definition 1, the probable case, which is based on events with unusually severe acute
respiratory failure, where it belongs to persons with fever greater than or equal to 38° and with
presence of cough, and who meet conditions such as, travel, hospitalizations or nations in the last
14 days before the onset of symptoms, health workers or hospital staff who work and people with
high mobility who have had close contact with a patient or person confirmed or probable by Covid-
19.

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The definition 2 of probable case is based on an event with mild or moderate acute respiratory
infection by a new virus with home management, where any person with symptoms of fever
greater than or equal to 38°, cough, respiratory distress, odynophagia or fatigue, and who meets
conditions such as travel in the last 14 days prior to the onset of symptoms, health worker, person
with high mobility or who has had close contact with a confirmed case of severe acute respiratory
infection associated with Covid-19.

In definition 3, there are suspected cases, this is based on the definition for an event with severe
acute respiratory infection, there compete any person with fever greater than or equal to 38 ° and
cough of no more than 10 days of evolution, requiring any in-hospital management in emergency
services, observation, hospitalization or ICU.

Each IPS must ensure the reporting of cases treated in ICU, hospitalization or emergency services.
In addition to cases in adults over 60 years of age, or people with cardiovascular diseases,
autoimmune diseases, diabetes, renal failure, HIV, cancer, among others. Special attention should
be paid to personnel such as health workers, military, employees of social protection services for
children, ethnic groups, street people, internal Colombian migrants, persons deprived of liberty,
and others.

In the following definition of suspected case, based on the definition of mild acute respiratory
infection equivalent to an influenza-like illness. It corresponds to each person with fever greater
than or equal to 38° and presence of cough of no more than 7 days of evolution that does not
require in-hospital management in emergency or observation services.

Definition 4, probable death due to COVID-19, includes all deaths due to acute respiratory
infection with a clinical picture of unknown etiology, during a consultation, observation,
hospitalization or at home.

In the 5th definition, asymptomatic case: any person with close contact with a confirmed case of
COVID-19 who does not show any symptoms in the first 7 days after contact.
In the definition of confirmed case for COVID 19, there belongs any person who meets the
definition of probable case and has a positive result for new coronavirus by RT-PCR.

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There are several cases, in case 1, it is an unusual severe respiratory infection with laboratory
confirmed case in patients with less than 14 days from the date of symptom onset. In cases where
this test is negative, a positive serological antibody test is performed 11 days or more from the
date of symptom onset, or clinical criteria such as radiological findings or increased levels of D-
dimer, ferritin or LDH.
Case 2 is a mild or moderate acute respiratory infection by a new virus with home management.
Case 3 is a patient with severe acute respiratory infection.
In case 4, it is the death by COVID19, which is a laboratory confirmed case, with positive RT.PCR
test for SARS-CoV2 in the last 14 days from the date of symptom onset, radiological findings and
increased levels of D-dimer and LDH.
Case 5 is the asymptomatic case, which is laboratory confirmed with positive RT-PCR test less
than 14 days from the date of last exposure with a confirmed case.

For the clinical management of symptomatic cases, the patient should be fully assessed, applying
all precautionary measures, using protective elements, applying all isolation measures to the
patient, immediately notifying the case in the epidemiological record according to the guidelines
of the national health institute. Ensure that the transfer maintains isolation, take the appropriate
samples for the etiological diagnosis considered by the treating physician, apply the appropriate
treatment according to the case, among others.
And generate an epidemiological follow-up from the territorial health entity.

In asymptomatic person, such person can be treated by outpatient, workplace or contact centers,
in which should be maintained, a social distancing for 14 days, follow up the case, report and have
an active communication with the respective territorial health entity.