THERAPEUTIC ALGORITHM FOR COVID-19

SEVERITY
HOST IMMUNE RESPONSE

VIRAL PHASE

TIME

ARDS, SIRS, Shock, MOF, cardiac failure,

Asymptomatic, fever <37.5°C,
SIGNS & diarrhoea, headache, asthenia,
SYMPTOMS
anosmia and ageusia, conjunctivitis
Dry cough, fever >37,5°C, arthro-myalgia Shortness of breathe, Hypoxia, arrythmia
MAS /HLH (Enlarged liver/spleen/lymph
nodes), skin rash, Easy bruising and/or
abnormal bleeding, fever >38.5°C.

progressive increase of d-dimer and

ferritin, increase transaminases and Elevation of inflammatory markers and
Increasing lymphopenia, mild increase of
Normal routine lab tests, mild triglycerides, abnormal blood gas (hypoxia ferritin, progressive cytopenias, increase
LAB lymphopenia, normal blood gas
PT and/or ferritin and/or D-Dimer and/or
<92-hypocapnia etc.), mild increase NT- in NT-proBNT, troponin and renal function
LDH, mild hypoxia >92
proBNP and troponin, IL6, CRP, reduction markers
of platelet count

Diffuse B-lines – pleural line thickening – Diffuse B-lines – pleural line thickening –
LUNG US Normal Localized B-lines Diffuse B-lines – pleural line thickening Subpleural consolidation, localized pleural Subpleural and alveolar consolidation – air
effusion bronchograms

Localized
CT SCAN Normal supleural Crazy paving
Ground glass
ground glass

paracetamol

Hyperimmune serum transfusions (convalescent patients)

Pharmacological therapeutic options

azithromycin

Remdesivir - lopinavir/ritonavir

hydroxychloroquine

LMWH

Tocilizumab (Anakinra - Jak inhibitors?)

Pulse steroids

Rescue: plasma exchange – IVIG (etoposide - IL2- Stem cells?)

HOME OR COMMUNITY HOSPITAL BASED COVID CLINICS INTENSIVE CARE UNITS

(NON INVASIVE VENTILATION)
Dr Felice Galluccio – Dr Mario Fajardo