WHO Update on Case Management

Presented on Case Management workshop

25 Sept to 2 October 2020

Indonesia Country Office

 Current Situation-23 September 2020
5000 300000
 Total confirmed cases:
4500
4000
250000 257 388 (↑ 4 465 from
previous day)

Cumulative Confirmed Cases

3500
200000
Daily Confirmed Cases

3000
2500
2000
150000
 Total death cases: 9 977
100000
1500
1000
50000
 Specimens tested:
500
0 0
3 032 250 (39 590 test/day
6-Apr
2-Mar
9-Mar
16-Mar
23-Mar

20-Apr
27-Apr
30-Mar

13-Apr

11-May
18-May

3-Aug
4-May

25-May

8-Jun

22-Jun
29-Jun

10-Aug
17-Aug
24-Aug
31-Aug
7-Sep
1-Jun

15-Jun

14-Sep
21-Sep
6-Jul
13-Jul
20-Jul
27-Jul
on average in the last 7
Konfirmasi Harian Konfirmasi Total
days)
Linear (Konfirmasi Total)

Indonesia Country Office

 Case definitions (suspected)

Suspected COVID-19 case (two suspected case definitions A or B):

A person who meets the clinical AND epidemiological criteria:

Clinical criteria:

1. Acute onset of fever AND cough;

OR

2. Acute onset of ANY THREE OR MORE of the following signs or symptoms: fever, cough, general weakness/fatigue,
headache, myalgia, sore throat, coryza, dyspnoea, anorexia/nausea/vomiting, diarrhoea, altered mental status.

Indonesia Country Office

 Case definitions (suspected)

Epidemiological criteria:
1. Residing or working in an area with high risk of transmission of the virus: for example, closed residential settings
and humanitarian settings, such as camp and camp-like settings for displaced persons, any time within the 14
days prior to symptom onset;

OR

2. Residing in or travel to an area with community transmission anytime within the 14 days prior to symptom onset;

OR

3. Working in health setting, including within health facilities and within households, anytime within the 14 days prior
to symptom onset.

B. A patient with severe acute respiratory illness (SARI: acute respiratory infection with history of fever
or measured fever of ≥ 38 C°; and cough; with onset within the last 10 days; and who requires
hospitalization).

Indonesia Country Office

 Case definitions (probable case)
A. A patient who meets clinical criteria above AND is a contact of a probable or confirmed case, or epidemiologically linked to a
cluster of cases which has had at least one confirmed case identified within that cluster.

B. A suspected case (described above) with chest imaging showing findings suggestive of COVID-19 disease*
– Typical chest imaging findings suggestive of COVID-19 include the following (Manna 2020):
• Chest radiography: hazy opacities, often rounded in morphology, with peripheral and lower lung distribution
• Chest CT: multiple bilateral ground glass opacities, often rounded in morphology, with peripheral and lower lung
distribution
• Lung ultrasound: thickened pleural lines, B lines (multifocal, discrete, or confluent), consolidative patterns with or
without air bronchograms.

C. A person with recent onset of anosmia (loss of smell) or ageusia (loss of taste) in the absence of any other identified cause.

D. Death, not otherwise explained, in an adult with respiratory distress preceding death AND who was a contact of a probable or
confirmed case or epidemiologically linked to a cluster which has had at least one confirmed case identified within that cluster.

Indonesia Country Office

 Case definitions

Confirmed COVID-19 case:

– A person with laboratory confirmation of COVID-19 infection, irrespective of clinical
signs and symptoms.

Definition of a contact:
– A contact is a person who has experienced any one of the following exposures during the 2
days before and the 14 days after the onset of symptoms of a probable or confirmed case:
• face-to-face contact with a probable or confirmed case within 1 metre and for at least 15 minutes
• direct physical contact with a probable or confirmed case
• direct care for a patient with probable or confirmed COVID-19 disease without using recommended personal
protective equipment
• OR
• other situations as indicated by local risk assessments.

Indonesia Country Office

Indonesia Country Office
 WHO main recommendations on case
management

Indonesia Country Office

 WHO clinical management guidelines (30 May
guidelines)
Key Recommendation
Treatment of acute co-infections:
For suspected or confirmed mild COVID-19, against the use of antibiotic therapy or prophylaxis.
For suspected or confirmed moderate COVID-19, that antibiotics should not be prescribed unless
there is clinical suspicion of a bacterial infection.

Prevention of complications:
In patients (adults and adolescents) hospitalized with COVID-19, use pharmacological prophylaxis,
such as low molecular weight heparin (e.g. enoxaparin), according to local and international
standards, to prevent venous thromboembolism, when not contraindicated.
For those with contraindications, use mechanical prophylaxis (intermittent pneumatic compression
devices).

Indonesia Country Office

 WHO clinical management guidelines (30 May guidelines)

 WHO recommend that the following drugs not be administered as treatment or prophylaxis for
COVID-19, outside of the context of clinical trials:
 Chloroquine and hydroxychloroquine (+/- azithromycin)
 Antivirals, including but not limited to:
 Lopinavir/ritonavir
 Remdesivir
 Umifenovir
 Favipiravir
 Immunomodulators, including but not limited to:
 Tocilizumab
 Interferon-β-1a
 Plasma therapy

Indonesia Country Office

 WHO clinical guidelines (30 May guidelines)

 We recommend patients with mild COVID-19 be given symptomatic treatment such as

antipyretics for fever and pain, adequate nutrition and appropriate rehydration.
 We recommend that patients with suspected or confirmed moderate COVID-19
(pneumonia) be isolated to contain virus transmission.
 Patients with moderate illness may not require emergency interventions or hospitalization;
however, isolation is necessary for all suspect or confirmed cases.
• • The location of isolation will depend on the established COVID-19 care pathway and can be done at a
health facility, community facility or at home.
• • The decision of location should be made on a case-by-case basis and will depend on the clinical
presentation, requirement for supportive care, potential risk factors for severe disease, and conditions
at home, including the presence of vulnerable persons in the household.
• • For patients at high risk for deterioration, isolation in hospital is preferred.

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Prevention of complications in hospitalized and
critically ill patients with COVID-19

Indonesia Country Office

 Prevention of complications in hospitalized and
critically ill patients with COVID-19
Adverse effects of medications

Careful consideration should be given to the numerous, clinically significant

side-effects of medications that may be used in the context of COVID-19,
as well as drug-drug interactions between medications, both of which may
affect COVID-19 symptomatology (including effects on respiratory, cardiac,
immune and mental and neurological function). Both pharmacokinetic and
pharmacodynamic effects should be considered.

Indonesia Country Office

 Corticosteroids
Strong recommendation
for systemic (i.e. intravenous or oral)
corticosteroid therapy (e.g. 6 mg of
dexamethasone orally or
Intravenously daily or 50 mg of
hydrocortisone intravenously every 8
hours) for 7 to 10 days in patients
with severe and critical COVID-19,
and a conditional recommendation
not to use corticosteroid therapy in
patients with non-severe COVID-19.

Indonesia Country Office

 WHO Global COVID-19 Clinical
Platform

What? System that enables rapid, standardized, and systematic collection of anonymized
clinical data on hospitalized cases with suspected or confirmed COVID19

Why? Facilitate real time aggregation, analysis, interpretation of clinical data from different settings
and sub-populations across the globe

Where?
IndonesiaSecure,
Country Office
limited-access, password-protected web based platform hosted on OpenClinica
Global WHO plan for clinical characterization and management of
hospitalized cases
WHO COVID19 Clinical
Rapid analysis
Platform Data curation,
aggregation,
analysis,
WHO GLOBAL
interpretation REPORT on
COVID19 clinical
characterization
(1) Summarize demographic and clinical features
De-identified patient and intervention globally, in regions and
clinical data from subgroups;
different settings and (2) Characterize the variability in the clinical
subpopulations features; (3) Explore the risk factors associated
with mortality and ICU admission

Rapid Response

Inform WHO
Guidelines on
COVID19 clinical
Indonesia Country Office management and
public heath
 CASE RECORD FORM

MODULE 1 MODULE 2 MODULE 3

Admission Inpatient stay Discharge or death
• Clinical inclusion criteria
• Demographics • Vital signs • Diagnostic/pathogen testing
• Date of onset and admission • Daily clinical features • Complications
vital signs • Lab results • Medication
• Co-morbidities • Medication • Supportive care received
• Medication • Supportive care received • Outcome
• Signs and symptoms on
admission
• Supportive care received
• Lab results

Indonesia Country Office

CORE CRF includes information on co-morbidities, co-
infections

Indonesia Country Office

 2 options for contribution data to WHO Platform
Pool Data
1) WHO CRF used to collect
data
(paper based or electronic)

Web-based System

2) Data entered in local system Variables aligned

and transferred to
WHO
WHO work with data
contributors to transfer relevant
variables from local databases
to the WHO COVID-19 Clinical
Indonesia Country Office
Data Platform
 New Recommendation on : Antigen-RDTs

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 Thank You

Indonesia Country Office