Ministry of Health and Population

Coronavirus Disease 2019 (COVID-19),

SARS COV2
Management Guide
COVID-19 MOHP Management Guide Version 1 28 March 2020

Revised by the Scientific Committee for Management and Follow up of COVID-19

Cases

Affiliation
Name

Dr. Hossam Hosny Professor of Chest Diseases. Head of Pulmonary Hypertension Unit,
Masoud Faculty of Medicine, Cairo University

Dr. Gehan Elassal Professor of Pulmonary Medicine, Ain Shams University

Professor of Hepatogastroenterology and Infectious Diseases, Al

Dr. Samy Zaky
Azhar University

Consultant of Hepatoogy, Gastroenterology and Infectious

Dr. Amin Abdel
Diseases. National Hepatology and Tropical Medicine Research
Baky
Institute (NHTMRI), Cairo, Egypt

Dr. Hamdy
General Director of Directorate of Fever Hospitals, MOHP
Ibrahim

Dr. Wagdy Amin Director General for Chest diseases, MOHP

Dr. Akram Professor of critical care medicine, Cairo University. Chairman elect
Abdelbary of ELSO SWAAC chapter

Dr. Ahmad Said Lecturer of critical care medicine, Faculty of Medicine, Cairo
Abdel Mohsen University

Dr. Mohamed Fellow of Infectious Diseases and Endemic Hepatogastroentrology,

Hassany National Hepatology and Tropical Medicine Research Institute

Dr. Alaa Eid Head of Preventive Medical Sector, MOHP

Minister’s Advisor for Research and Health Development.

Dr. Noha Asem
Chairman of Research Ethics Committee MOHP. Lecturer of Public
Mohamed
Health, Cairo University.

Consultant Tropical Medicine Researcher of Tropical Medicine.

Dr. Ehab Kamal
Medical Division National Research Center.

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List of Contents
Introduction 4
Case Definitions 5
Algorithm for Healthcare Providers 6
Step One: Triage 7
Clinical Classification 8
Management 9
Antiviral therapy 9
Antibiotics 11
ICU Management Protocol 11
Extracorporeal membrane oxygenation (ECMO): 14
Management of Common complications 15
HScore 16
Discharge Standards and Follow-up Plan 17
List of Abbreviations 18
References 20

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Coronavirus Disease 2019 (COVID-19),

SARS COV2
Introduction
Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly
emergent coronavirus, that was first recognized in Wuhan, China, in December 2019.
While most people with COVID-19 develop only mild or uncomplicated illness,
approximately 14% develop severe disease that requires hospitalization and oxygen
support, and 5% require admission to an intensive care unit. In severe cases, COVID-
19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and
septic shock, multiorgan failure, including acute kidney injury and cardiac injury. Older
patients and those with comorbidities, such as cardiovascular disease and diabetes
mellitus, have increased risk of severe disease and mortality.

Routes of transmission
1. Respiratory droplets and close contact are the main routes of transmission.
2. There is the possibility of aerosol transmission in a relatively closed environment
for a long-time exposure to high concentrations of aerosol.
3. As the novel coronavirus can be isolated in feces and urine, attention should be
paid to feces or urine contaminated environment that leads to aerosol or contact
transmission.

The incubation period

The incubation period is 1-14 days, mostly 3-7 days.

Clinical Features
Fever, dry cough, fatigue. In severe cases, dyspnea or hypoxemia usually occur one
week after the onset of the disease.
The severe or critical case may have low fever, or even no fever.

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Case Definitions
Suspected cases
1. Any one of the epidemiological history with any of the clinical features.
OR
2. All three clinical features. OR
3. Severe Acute Respiratory Infection (SARI) with no other obvious cause.

Epidemiological history:
1. History of travel to or residence in communities where cases
reported within 14 days prior to the onset of the disease
2. In contact with viral RNA positive people within 14 days prior to
disease onset
3. In contact with patients who have fever or respiratory symptoms
from communities confirmed cases reported within 14 days
before disease onset
Clinical features:
1. fever and/or respiratory symptoms
2. imaging characteristics
3. The white blood cells count was normal or decreased, with
lymphocyte decreased.

Confirmed cases:
Suspected cases with one of the following virological or serological evidences:

1. RT-PCR indicates positive for novel coronavirus RNA

2. Viral specific IgM and IgG are detectable in serum
3. Viral specific IgG is detectable from negative to positive, or
4. Viral specific IgG antibody reaches a titration of at least 4-fold higher in the
recovery stage than in the acute stage.

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Algorithm for Healthcare Providers

*High Risk Conditions:

• Any Healthcare facility of the following:

o Fever Hospital
o Chest diseases Hospital
o Healthcare facility with confirmed case of Covid-19 (public – HCW) during last 14 days
• Diabetic
• Hypertensive
• Age above 50 years

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Triage
Step One: Triage (phone or clinic)
 Assessment
Apply case definition
 Gauge how sick they are: fever? Shortness of breath, lab. Imaging. …..
Associated chronic illness, such as diabetes, cardiovascular disease, or a lung
condition, that increases risk for infection and complications?
 to outpatient or inpatient assignment
 Patients with mild disease do not require hospital interventions, but isolation is
necessary to contain virus transmission
 Provide patients with mild COVID-19 with symptomatic treatment such as antipyretics for
fever.
 Counsel patients with mild COVID-19 about signs and symptoms of complicated disease.
If they develop any of these symptoms, they should seek urgent care through national
referral systems.
 Older patients and those with co-morbidities, such as cardiovascular disease and diabetes
mellitus, have increased risk of severe disease and mortality. They may present with mild
symptoms but have high risk of deterioration and should be admitted to a designated unit for
close monitoring.

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Clinical Classification
Mild Cases
The clinical symptoms are mild and no pneumonia manifestations can be found in
imaging.
Moderate Cases
Patients have symptoms such as fever and respiratory tract symptoms, etc. and
pneumonia manifestations can be seen in imaging.
Severe Cases
Adults who meet any of the following criteria:
Respiratory rate; 30 breaths/min;
Oxygen saturations< 93% at a rest state;
Arterial partial pressure of oxygen (PaO2)/ Fraction of inspired oxygen
(FiO2)<300 mm Hg.
Patients with more than 50% lesions progression within 24 to 48 hours in lung
imaging should be treated as severe cases.
Critical Cases
Meeting any of the following criteria:
Occurrence of respiratory failure requiring mechanical ventilation;
Presence of shock; other organ failure that requires monitoring and treatment in
the ICU.

Critical cases are further divided into early, middle and late stages according to
the degree of hypoxemia as categorized by the P/F ratio (PaO2/FiO2 *100) or S/F
ratio:
• Early stage: PO2/FiO2 (P/F ratio) 200-300, or Oxygen saturation by pulse
oximetry/ Fraction of inspired oxygen (S/F ratio) 181-235; without organ failure
other than the lungs. The patient has a great chance of recovery through active
antiviral, anti-cytokine storm, and supportive treatment.
• Middle stage: P/F ratio 100-200, or S/F ratio 118-181; may be complicated by
other mild or moderate dysfunction of other organs.
• Late stage: P/F ratio less than 100, or S\F ratio less than 118; diffuse
consolidation of both lungs that requires the use of ECMO; or failure of other vital
organs. The mortality risk is significantly increased.

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Management:
General measure
1. Isolation precautions are required
2. Personal protective equipment by caregivers is required.
3. Rest, fluid and symptomatic support therapy
4. Closely monitoring vital signs and oxygen saturation.
5. Monitoring lab test: blood routine result, urine routine result, c-reactive protein
(CRP), biochemical indicators (liver enzyme, myocardial enzyme, renal function
etc.), coagulation function, arterial blood gas analysis, chest imaging and
cytokines detection if necessary.
6. Maintaining fluid status and nutrition and supporting physiological functions
7. Treating complications and organ support
8. Early oxygen therapy and airway drainage (providing supplementary oxygen all
the way to ventilator support, or just waiting it out)
9. Should be alerted to "the big three" signs of secondary infection ― fever,
elevated white blood cell count, and lactic acidosis.
10. Immunosuppressed patients are at elevated risk for secondary infection.
11. Antibiotics are reserved for patients suspected of having concomitant bacterial or
fungal infections.

Antiviral therapy:
According to the World Health Organization (WHO), the Centers for Disease Control
and Prevention (CDC), and the U.S. Food and Drug Administration (FDA), there are
currently no medications or vaccines proven to be effective for the treatment or
prevention of the 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-
2).

Some drugs that are can be tried to treat COVID-19 and the efficacy of the drugs need
to be evaluated in clinical application.

Chloroquine phosphate:
• 500 mg PO BID 5 days
• Check for drug-drug interaction (consult clinical pharmacist for
recommendations)
• Druginteraction;checkathttp://www.covid19druginteractions.org.
• Check contraindications carefully.

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• Contra-indications: QTc > 500 msec , Myasthenia gravis , Porphyria ,Retinal

pathology , Epilepsy, G6PD deficiency, Allergy to 4-aminoquinolone,
Chronic Heart, Kidney or Liver disease, and Arrythmias.

Hydroxy Chloroquine:
• 400 every 12 hours for one day followed by 200 mg every 12 hours for 5
days.Check for drug-drug interaction (consult clinical pharmacist for
recommendations).
• Check contraindications carefully.
• Drug interactions and contraindications of hydroxychloroquine are likely
the same as chloroquine (see above).

Remdesivir:
• An investigational antiviral drug: It's a nucleotide analogue, and like other drugs
of that class, it disrupts nucleic acid production. it needs to be administered as
early as possible in the infection cycle.
• 200 mg IV on day 1, followed by 100 mg IV daily.
• Key Exclusion criteria: Evidence of Multi-organ failure, Pressor requirement to
maintain blood pressure, ALT levels > 5 X ULN, Cr Clearance <30 mL/min or
dialysis or Continuous Veno-Venous Hemofiltration.

Favipiravir:
• 1600 mg PO BID on day 1, followed by 600 mg PO TID from day 2.
• Rule of out Pregnancy in women of childbearing age before starting Favipiravir. It
is absolutely contraindicated in pregnancy. Favipiravir is distributed in Sperms.
Male patients must avoid unprotected intercourse for 4 weeks after stopping
Favipiravir.
• Lactating women, instruct to stop lactating.

Lopinavir-Ritonavir:
• 200/ 50 mg 2 tablets PO BID.
• Check for drug-drug interaction (consult clinical pharmacist for
recommendations).

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Antibiotics
The Rational Use of Antibiotics to Prevent Secondary Infection.
COVID-19 is a disease of viral infection, therefore antibiotics are not recommended to
prevent bacterial infection in mild or ordinary patients; it should be used carefully in
severe patients based on their conditions. Antibiotics can be used with discretion in
patients who have the following conditions: extensive lung lesions; excess bronchial
secretions; chronic airway diseases with a history of pathogen colonization in the
lower respiratory tract; taking glucocorticoids. The options of antibiotics include
quinolones (with caution if the patient is receiving chloroquine or
hydroxychloroquine), the second or third generation cephalosporins, etc. The
antibiotics should be used for the prevention of bacterial infection in critically severe
patients, especially those with invasive mechanical ventilation.
The antibiotics such as carbapenems, Beta-lactamase inhibitor compounds, linezolid
and vancomycin can be used in critically ill patients according to the individual risk
factors.
The patient's symptoms, signs and indicators such as blood routine, C - reactive protein,
and procalcitonin, need to be closely monitored during the treatment.

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ICU Management Protocol

Investigations:
Laboratory:

1. PCR for COVID 19 every 72 hours.

2. CBC with differential, ESR, Ferritin, creatinine, AST, fibrinogen, triglycerides daily. Other labs
according to standard care.
3. Cultures on admission and whenever needed (restrict cultures to decrease exposure).

Imaging:

1. Chest x-ray daily.

2. Echocardiography with starting hemodynamically stable.
3. Abdominal ultrasound if needed.

Fluid Management and Anticoagulation:

• Fluid balance with fluid restriction policy to keep balance either net or slightly negative with
consideration to hemodynamics and renal performance.
• Crystalloids. Avoid dextrose and synthetic colloids. Use albumin only if level very low (< 2g/dl).
• Prophylactic low molecular weight heparin (enoxaparine) 40 mg/24 hours as part of the ventilator
bundle in mechanically ventilated patients. To be upgraded to therapeutic dose of 1 mg/kd twice
daily if D-dimer >2 in view of previous autopsy data showing pulmonary thromboembolic disease
(weak recommendation and shall be largely judged by the ICU consultant). Dose shall be
modified according to creatinine clearance, shift to heparin of 5000 IU sq every 8 hours in case of
acute renal failure.

Mechanical Ventilation:
• Assessment for Mechanical ventilation:
A. Non-invasive ventilation (not recommended) (high flow nasal cannula if
available would be better):
• Conscious patients with minimal secretions.
• Hypoxia defined as SpO2<93% on non-rebreathing oxygen mask.
• Or hypercapnia >40 cmH2O provided pH 7.3 and above.
• NIV trial shall be short with ABG 30 minutes apart.
• Any deterioration in blood gases from baseline or oxygen saturation or consciousness
level shall prompt invasive mechanical ventilation immediately, prolonged NIV is
discouraged.
• PEEP gradually increased from 5-10 cmH2O.
• Pressure support from 10-15 cm H2O.
B. Invasive Mechanical ventilation: Precautions:
• Use PPE specially goggles during intubation.

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• Avoid bagging.
• (Laryngo-videoscopy use is encouraged).
• Indications:
• Failed NIV or not available or not practical.
• PO2 < 60 mmhg despite oxygen supplementation.
• Progressive Hypercapnia.
• Respiratory acidosis (PH < 7.30).
• Progressive or refractory septic shock.
• Disturbed consciousness level (GCS ≤ 8) or deterioration in consciousness level from
baseline.
• Mechanical ventilation settings for ARDS:
• Volume control ventilation mode (VCV)
• Start with:
#FiO2: 1
#Tidal volume 4-8 ml/kg PBW according to compliance.
#PEEP ≥ 10 cm H2O.
#Respiratory rate < 30 BPM.
• Target Plateau Pressure < 30 cm H2o.Switch to pressure controlled ventilation
(PCV) with PIP of 30 if plateau pressure is high on VCV.
• Target driving Pressure < 15 cm H2o.
• Target PH > 7.3.
• Sedation (Midazolam or Propofol or dexmeditomedine) plus fentanyl if needed.
• Muscle paralysis (Atracurium).
• Consider Prone Positioning.
• Medications:
I. Antibiotics:
A. Hemodynamically stable direct ICU admission:
• Third generation cephalosporine (ceftriaxone 2g q 24 hours or
cefoperazone 1g q 12 hours or cefotaxime 2g q 8 hours) plus
Azithromycin 500 mg OD for 10 days.
• Change to regimen B after 48 hours if no improvement or cultures
available.
B. Hemodynamically stable referred from hospital
• Piperacillin /tazobactam (4.5 g q 6 h), or Meropenem (1g q 8 hours) or
imipenem 500 mg q 6 hours plus Azithromycin 500 mg q 24 hours 10
days
C. Hemodynamically unstable:
• Piperacillin /tazobactam (4.5 g q 6 h), or Meropenem (2g q 8 hours
extended infusion) plus linezolid 600 mg q12 hours or Teicoplanin
(loading 12 mg/kg for 4 doses followed by maintenance dose 12 mg/kg
daily if creatinine clearance > 80 ،12 mg/kg every 48 h if creatinine
clearance 30-80, 12mg/kg every 72 hour if creatinine clearance < 30 ) for
14 days, Consider de escalation with culture results or improvement. In
case of deterioration send another culture and consider regimen D with
caution.
D. Multidrug resistant Gram negative organisms:

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• Piperacillin /tazobactam (4.5 g q 6 h )or Meropenem (2g q 8 hours
extended infusion) plus Amikacin 500 mg q 12 hours or gentamycin 160-
400 mg q 24 hours or levofloxacin 750 mg q 24 hours or moxifloxacin
400mg q 24 hours (in cases with nephrotoxicity , better avoided with
hydroxy chloroquine) or Polymyxin E (Colomycin or Colistin) (loading 9 g
and maintenance of 4.5g q 8 hours)
• Ceftazidime /Avibactam (Zavicefta) 2.5g q 8 hours for 14 days.
• Add antifungal in immunocompromised patients and if candida score is
high. Fluconazole 400 mg loading then 200 mg q 12 hours or
Caspofungin 70 mg loading then 50 mg once daily or Anidulafungin 200
mg loading then 100 mg once daily.
II. Antivirals only if not received before:
A. Oseltamivir (Tamiflu or Taminil) 150 mg q 12 hours for 5 days. Plus,
B. Hydroxychloroquine (Plaquinil) 400 q 12 hours for one day followed by 200 mg q
12 hours for 5 days. To be crushed and slowly dissolved over 5 minutes before
nasogastric tube administration. Or chloroquine 600 mg first dose followed by
300 mg after 12 hours then 300 mg daily till day 5.

Or,

C. Lopinavir/ritonavir combination two tablets q 12 hours for five days if

hydroxychloroquine or chloroquine are contraindicated.

Plus,

D. Azithromycin (500 mg OD for 5 days if not included before).

III. Hydrocortisone 50 mg q 6 hours if hemodynamically unstable.
IV. If evidence of cytokine storm [HScore> 169]:
A. Tocilizumab (Actimera) 4-8 mg /Kg (400 mg dose is recommended) second dose
after 12 hours if no improvement * second dose is not used in all countries.
B. Methylprednisolone 2 mg/kg/day for 3-5 days (only if Tocilizumab not available).
N.B : HScore ( Hyperinflammation) for Secondary
haemophagocyticlymphohistiocytosis (sHLH)
N.B : Consider Dose and Drug Modification in pediatric population and in
patients with Renal or Liver impairement

Extracorporeal membrane oxygenation (ECMO):

• Consider V-V ECMO if :
• Oxygen saturation SpO2 < 93% on mechanical ventilation according to above mentioned
protocol.
• P/F ratio 100-150 mmhg on FiO2 > 80% for more than 4 hours.
• P/F ratio < 100 mmhg on FiO2 > 80% for more than 2 hours.
• PCO2 > 80 or PH < 7.25 for more than 4 hours.
Medications:
 Antibiotics: Piperacillin Tazobactam, Or Meropenem 2g q 6 hours, plus Vancomycin or
linezolid, plus azithromycin, plus antifungal if high candida score.
 Methylprednisolone 1 mg/Kg/day for 5 days only.
• Eligibility Criteria for VV ECMO:

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• Age > 8 and < 55 years.
• GCS: 10T without sedation.
• No contraindication for anticoagulation.
• Duration of Mechanical ventilation < 7 days
• RESP score ≥ Zero (respscore.com).

• Consider V-A ECMO if:

• Fulminant myocarditis with the following criteria:
• CARDIOgenic shock
Cold extremities.
Anuric or best oliguric.
Refractory hypotension (SBP<90 mmHg) with poor echo not explained by sepsis
hypovolemia or bleeding.
Drowsy yet conscious.
Inotropes > 2 at 10ug/kg/min.
Onset within 4 hours.
 ST-T abnormalities detected by electrocardiography.
 Acute LV failure (LVEF< 25%) or acute reduction in LV function .
• Eligibility Criteria for VA ECMO:
• Age > 8 and < 55 years.
• GCS : 10T without sedation.
• No contraindication for anticoagulation.
• Duration of shock < 6 hours.
• SAVE score ≥ Zero (www.save-score.com).

Management of Common complications:

I- Myocarditis:
1. ECG changes
2. Inappropriate tachycardia
3. Heart failure
4. Impaired LVEF on echo with or without pericardial effusion.

Management:

1. Limit IV fluids.
2. Monitor fluid balance keep balanced or negative balance
3. Start antifailuremedications or inotropes as needed (nitroglycerine if hemodynamically
stable or Dobutamine or Milrinone if mild heart failure and add norepinephrine if
hypotensive or hypoperfused.)
4. Intubation and mechanical ventilation if not already ventilated.
5. Mechanical circulatory support:
a. Intra-aortic balloon counterpulsation if non responsive shock to two or more
inotropes with moderate impairment of LVEF (30 -45) transfemoral implantation
1:1 automatic set up.
b. VA ECMO (see above)

II- Acute kidney injury:

1. Fluid management to optimize fluid status.

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2. Start furosemide 10 mg bolus and escalate to infusion range from 5-40 mg per hour to
maintain diuresis above 0.5 ml/kg /hr
3. Hemodialysis if no response to furosemide infusion for 4 hours or if pulmonary edema
developed.
4. CVVHDF using CRRT machine and filters if the patient is hemodynamically unstable to
withstand hemodialysis Or SLEDD hemodialysis over 6 hours if CRRT not available or
Peritoneal dialysis (better avoided).

H Score
Number of points
Temperature
<38·4°C 0
38·4–39·4°C 33
>39·4°C 49
Organomegaly
None 0
Hepatomegaly or splenomegaly 23
Hepatomegaly and splenomegaly 38
Number of cytopenias*
One lineage 0
Two lineages 24
Three lineages 34
Triglycerides (mmol/L)
<1·5 mmol/L 0
1·5–4·0 mmol/L 44
>4·0 mmol/L 64
Fibrinogen (g/L)
>2·5 g/L 0
≤2·5 g/L 30
Ferritinng/ml
<2000 ng/ml 0
2000–6000 ng/ml 35
>6000 ng/ml 50
Serum aspartateaminotransferase
<30 IU/L 0
≥30 IU/L 19
Haemophagocytosis on bone marrow aspirate
No 0
Yes 35
Known immunosuppression†
No 0
Yes 18
The Hscore11 generates a probability for the presence of secondary HLH. HScores greater than

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169are93% sensitive and 86% specific for HLH. Note that bone marrow haemophagocytosis is not
mandatory for adiagnosis of HLH. HScores can be calculated using an online HScorecalculator.11
HLH=haemophagocyticlymphohistiocytosis. *Defined as either haemoglobinconcentration of 9·2 g/dL
or less (≤5·71 mmol/L), a whiteblood cell count of 5000 white blood cells per mm³ or less, or platelet
count of 110000 platelets per mm³ or less,or all of these criteria combined. †HIV positive or receiving
long-term immunosuppressive therapy(ie,glucocorticoids, cyclosporine, azathioprine).
Table: HScore for secondary HLH, by clinical parameter

Discharge Standards and Follow-up Plan for COVID-19

Patients
Discharge standards
(1) Body temperature remains normal for at least 3 days (ear temperature is lower
than 37.5 °C);
(2) Respiratory symptoms are significantly improved;
(3) The nucleic acid is tested negative for respiratory tract pathogen twice
consecutively (sampling interval more than 24 hours); the nucleic acid test of stool
samples can be performed at the same time
if possible;
(4) Lung imaging shows obvious improvement in lesions;
(5) There is no comorbidities or complications which require hospitalization;
(6) SpO2> 93% without assisted oxygen inhalation;
(7) Discharge approved by multi-disciplinary medical team.

Medication after discharge

Generally, antiviral drugs are not necessary after discharge. Treatments for
symptomscanbe applied if patients have mild cough, poor appetite, thick tongue
coating, etc.
Antiviral drugs can be used after discharge for patients with multiple lung lesions in
the first 3 days after their nucleic acid are tested negative.
Home isolation
Patients must continue two weeks of isolation after discharge. Recommended home
isolation conditions are:
Independent living area with frequent ventilation and disinfection;
Avoid contacting with infants, the elderly and people with weak immune functions at
home;
Patients and their family members must wear masks and wash hands frequently;
Body temperature are taken twice a day (in the morning and evening) and pay close
attention to any changes in the patient's condition.

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Follow-up
A specialized doctor should be arranged for each discharged patient's follow-ups.
The first follow-up call should be made within 48 hours after discharge.
The outpatient follow-up will be carried out 1 week, 2 weeks, and 1 month after
discharge.
Examinations include liver and kidney functions, blood test, nucleic acid test of
sputum and stool samples, and pulmonary function test or lung CT scan should be
reviewed according to the patient's condition.
Follow-up phone calls should be made 3 and 6 months after discharge.

List of Abbreviations:

ABG: Arterial Blood Gases

ALT: Alanine Aminotransferase
aPPT: activated Partial Thromboplastin Time
ARDS: Acute Respiratory Distress Syndrome
AST: Aspartate Aminotransferase
ATIII: Activity of Plasma Antithrombin Ill
CDC: Centers for Disease Control and Prevention
COVID-19: Coronavirus Disease 2019
Cr: Creatinine
CRP: C Reactive Protein
CRRT: Continuous Renal Replacement Therapy
CVVHDF: Continuous veno-venous hemodiafilteration
ECG: Electrocardiography
ECMO: Extracorporeal Membrane Oxygenation
FDA: Food and Drug Administration
FiO2: fraction of inspired oxygen
G6PD: Glucose-6-Phosphate Dehydrogenase Deficiency
GCS: Glasgow Coma Scale
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HIT: Heparin induced Thrombocytopenia

ICU: Intensive Care Unit
IV: Intravenous
LVEF: Left Ventricular Ejection Fraction
NIV: Non invasive ventilation
PaO2: Partial Pressure of Arterial Oxygen
PBW: Predicted Body Weight
PCR: Polymerase Chain Reaction
PCV: Pressure Controlled Ventilation
PEEP: Positive end-expiratory pressure
PIU: Person Under Investigation
PO: Per Oral
PPE: Personal protective equipment
RDT: Rapid Diagnostic Test
RESP: Respiratory Extracorporeal Membrane Oxygenation Survival Prediction
SARI : Severe Acute Respiratory Infection

SARS: Severe Acute Respiratory Syndrome

SAVE: Survival after Veno-Arterial ECMO

sHLH: Secondary HaemophagocyticLymphohistiocytosis
SLEDD: Sustained low-efficiency daily dialysis
SPO2: Oxygen saturation by pulse oximeter
ULN: Upper Limit of Normal
VV ECMO: venovenous extracorporeal membrane oxygenation
VA ECMO: venoarterial extracorporeal membrane oxygenation
WHO: World Health Organization

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References:

1. Interim Clinical Guidance for Patients Suspected of/Confirmed with COVID-19 In

Belgium ,19 March 2020; Version 4
2. World Health Organization. Clinical management of severe acute respiratory
infection when novel coronavirus (nCoV) infection is suspected
https://www.who.int/publicationsdetail/clinical-management-of-severe-acute-
respiratory-infection-when-novelcoronavirus-(ncov)-infection-is-suspected (13
March 2020)
3. CDCWebsite: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-
guidancemanagement-patients.html
4. FDA Website: https://www.fda.gov/emergency-preparedness-and-
response/mcmissues/coronavirus-disease-2019-covid-19
5. Report of the WHO-China Joint Mission onCoronavirus Disease 2019 (COVID-
19), 16-24 February 2020https://www.who.int/blueprint/priority-diseases/key-
action/Table_of_therapeutics_Appendix_17022020.pdf?ua=1
6. World health organization, Clinical management of severe acute respiratory
infection (SARI) when COVID-19 disease is suspected, Interim guidance, 13
March 2020
7. Imaging Profile of the COVID-19 Infection: Radiologic Findings and Literature
ReviewNG Ming-Yen, LEE1 Elaine YP, YANG Jin, YANG4 Fangfang, LI Xia,
WANG4 Hongxia, LUI Macy Mei-sze, LO Christine Shing-Yen, LEUNG Barry,
KHONG Pek-Lan, HUI Christopher Kim-Ming, YUEN Kwok-yung, KUO Michael
David
8. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected
PneumoniaQun Li, M.Med., Xuhua Guan, Ph.D., Peng Wu, Ph.D., Xiaoye Wang,
M.P.H., et al.
9. A familial cluster of pneumonia associated with the 2019 novel coronavirus
indicating person-to-person transmission: a study of a family cluster Jasper Fuk-
Woo Chan, MD * Shuofeng Yuan, PhD * Kin-Hang Kok, PhD * Kelvin Kai-Wang
To, MD * Hin Chu, PhD * Jin Yang, MD et al.
10. Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging
Findings in 919 Patients Read More:
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