UPDATED COVID-19

PROTOCOLS
BASED ON THE LATEST GUIDELINES FROM DOH,
PSMID, CDC AND WHO
• Triage
• Testing
• Isolation
• Treatment
TRIAGE
• Fever • Diarrhea
• Respiratory symptoms (new onset • Anorexia
cough, dyspnea) • Anosmia
• Fatigue • Aguesia
• Myalgia
• Sore throat
OTHER FACTORS

• Co-morbidity
• Age >60 years old
• Recent close contact with a known positive case
• Interaction of more than 15 mins, < 1 meter distance
• Direct physical interaction
• Interaction with a known case without proper PPE
TESTING

• Nasopharyngeal RT-PCR remains to be the diagnostic test of choice to

confirm the diagnosis of COVID-19

• Posterior oropharyngeal swab and saliva swab can be used as alternative

specimen

Philippine COVID-19 Living Recommendations, June 2021

RAPID ANTIGEN TESTS

• Specificity of >80% (depending on brands) and very high specificity >97%

• Symptomatic, early phase (</= 7 days from onset)
• FDA Approved: Panbio (Abbott); Labnovation self test kits
• FDA Special Certification: SOFIA2 (Quidel Corp); STANDARD Q (SD
Biosensor); NowCheck (Bionote); Wondfo (Wondfo Biotech)

Philippine COVID-19 Living Recommendations, June 2021

SUMMARY OF DIFFERENCES BETWEEN RT-
PCR AND RAPID ANTIGEN TESTS

RT- PCR RAT

• Detects CURRENT infection • Detects CURRENT Infection
• Nasal, Nasopharyngeal, • Nasal, Nasopharyngeal
Oropharyngeal, Sputum, Saliva • Sensitivity varries depending on the
course of infection, generally moderate
• Sensitivity varies but generally high
to high at time of peak viral load

Center for Disecese Control and Prevention, COVID 19 Antigen Testing Guidelines
SUMMARY OF DIFFERENCES BETWEEN RT-
PCR AND RAPID ANTIGEN TESTS

RT- PCR RAT

• Specificity is high • Specificity is high
• Laboratory set up • Relatively easy to use, POC
• Turnaround time: 24-72 hours, • Results within 15 to 30 minutes
some could be within a few hours • Cost: 200 and up
• Cost: 2500 and up
Center for Disecese Control and Prevention, COVID 19 Antigen Testing Guidelines
SUMMARY OF DIFFERENCES BETWEEN RT-
PCR AND RAPID ANTIGEN TESTS

RT- PCR ADVANTAGES RAT ADVANTAGES

• Most sensitive method • Short turnaround time
• Confirmatory • Relatively cheaper
• Rapid identification leads to prevention of
transmission in workplace, community
• Comparable to RT PCR in symptomatic
patients
Center for Disecese Control and Prevention, COVID 19 Antigen Testing Guidelines
SUMMARY OF DIFFERENCES BETWEEN RT-
PCR AND RAPID ANTIGEN TESTS

RT- PCR DISADVANTAGES RAT DISADVANTAGES

• Longer turn-around time • May need confirmatory testing
• Higher cost • Less sensitive especially among
• Should not be repeated within 90 days asymptomatic people
of confirmed positive test since people
may continue to have detectable RNA
after risk of transmission has passed
Center for Disecese Control and Prevention, COVID 19 Antigen Testing Guidelines
CDC ANTIGEN TEST ALGORITHM
Antigen negative may need confirmatory testing if the patient has a high likelihood of SARS-COV2 intection

For Close Contacts or Suspected Exposure: Follow current guidelines for quarantine

Center for Disecese Control and Prevention, COVID 19 Antigen Testing Guidelines
SERIAL TESTING WITH ANTIGEN TESTS

• Outbreak control depends largely on frequency of testing, speed of reporting

an applications of interventions and is only marginally improved by
sensitivity of the test
• Serial antigen testing every 3 days or twice per week will almost always
identify SARS-COV-2 during early stages of infection and thus reduce
disease transmission

Center for Disecese Control and Prevention, COVID 19 Antigen Testing Guidelines
REPEAT TESTING WITH RT-PCR

• When initial RT PCR is negative among symptomatic patients highly

suspected to have COVID-19 infection

Philippine COVID-19 Living Recommendations, June 2021

OTHER TESTS

• Chest X-ray : Clinical management of symptomatic patients (mild features at

risk for progression, mod to sev COVID-19, symptomatic for at least 5 days)
• Chest CT Scan: if RT-PCR is not available, for patients with mild disease at
risk for progressing, mod to sev infection
• Lung ultrasound: not recommended
• LDH, CRP, Ferritin, D-Dimer: Conditional
QUARANTINE
GUIDELINES
PSN GUIDELINES FOR HD
PATIENTS/HD FACILITIES
PLACEMENT OF COVID-19 CLOSE CONTACT,
SUSPECT OR CONFIRMED HD PATIENTS USING
TRANSMISSION BASED PRECAUTIONS
• Close contact, suspect or confirmed COVID-19 patients with moderate to
severe symptoms should be admitted in a hospital and should undergo HD
treatment either of the ff area:
• Patient’s own room using portable RO machine
• Single isolation room at the dialysis complex
PLACEMENT OF COVID-19 CLOSE CONTACT,
SUSPECT OR CONFIRMED HD PATIENTS USING
TRANSMISSION BASED PRECAUTIONS
• Only patients with confirmed COVID19 infection can be cohorted together
at the COVID floor or ward using portable RO machine or in the last shift in
the dialysis complex. They should maintain at least 2 meters of separation
from other patients at all times.
PLACEMENT OF COVID-19 CLOSE CONTACT,
SUSPECT OR CONFIRMED HD PATIENTS USING
TRANSMISSION BASED PRECAUTIONS
• COVID19 suspect or confirmed patients who are asymptomatic or with
mild symptoms should undergo home or facility quarantine and undergo
hemodialysis treatment on an outpatient basis in dedicated COVID19 area or
shift of the hemodialysis facility.
PLACEMENT OF COVID-19 CLOSE CONTACT,
SUSPECT OR CONFIRMED HD PATIENTS USING
TRANSMISSION BASED PRECAUTIONS
• Patient with different etiology of respiratory symptoms (non-COVID) should
not be cohorted together with COVID19 suspect or confirmed patients.
PLACEMENT OF COVID-19 CLOSE CONTACT,
SUSPECT OR CONFIRMED HD PATIENTS USING
TRANSMISSION BASED PRECAUTIONS
• COVID19 suspect or confirmed patients being transferred to the
hemodialysis facility for dialysis treatment should be transported via
designated vehicle provided by the local RESU, an ambulance, or in a private
vehicle and monitored for symptoms.
QUARANTINE GUIDELINES

FULLY UN/PARTIALLY FULLY UN/PARTIALLY

VACCINATED VACCINATED VACCINATED VACCINATED
PATIENT PATIENT HCW HCW
PROBABLE 14 DAYS 14 DAYS 7 DAYS 10 DAYS
CONFIRMED 14 DAYS 14 DAYS 7 DAYS 10 DAYS
ASYMPTOMATIC
CONFIRMED 14 DAYS 14 DAYS 10 DAYS 10 DAYS
MILD TO
MODERATED
CONFIRMED 14 DAYS 14 DAYS 21 DAYS 21 DAYS
SEVERE TO
CRITICAL
UNVACCINATED CKD V DIALYSIS PATIENTS

• Allocated isolation room at a corner or end of row station of the dialysis unit,
away from the main flow or traffic and separated by at least 2 meters from
the nearest fully vaccinated patient in all directions
REGULAR LECTURES OR LAY FORA

• COVID-19 infection control practices at home and at the dialysis unit and
benefits of vaccination dialysis an patients with CKD
• may consider performing regular targeted SARS-COV-2 or Rapid Antigen
testing of all dialysis patients (example every two weeks) in their units in
close coordination and consultation with the dialysis center or hospital
infection control unit coordinators or head respectively, subject to availability
of testing kits in the area.
ANTIVIRAL DRUGS THAT ARE
APPROVED OR UNDER
EVALUATION FOR COVID19
TREATMENT
REMDESIVIR

• Recommend against the use of Remdesivir in patients with O2 saturation

>94% and do not require O2 supplementation
• Suggest the use of remdesivir in addition to dexamethasone in patients with
O2 Sat <94%
• Suggest against the use in patients on invasive mechanical ventilation
• IV Remdesivir is approved by FDA for the treatment of hospitalized patients
aged >12 yrs old and weighing >40kgs
REMDESIVIR

• Monitoring and adverse effects:

• GI symptoms like nausea
• Elevated transaminase levels
• Increase prothrombin time
• Hypersensitivity reactions
*** Discontinued if with ALT >10x the upper limit of normal, or if with signs of liver inflammation
REMDESIVIR

• Considerations in Patients with Renal Insufficiency

• Observational data suggests that Remdesivir can be used in patients with
EGFR <30mL/min if the potential benefits outweigh the risks
• FDA product label does not recommend the use of Remdesivir in patients
with EGFR <30mL/min due to lack of data
TOCILIZUMAB

• Recommend the addition of Tocilizumab to systemic steroids in patients

with rapid respiratory deterioration and/or requiring high doses of oxygen
• Recommend against the use in patients not requiring O2 supplementation
CHLOROQUINE/HYDROXYCHLOROQUINE
AND/OR AZITHROMYCIN

• Panel recommends against the use in hospitalized and non-hospitalized

patients
• No differences noted in end points during clinical trials
IBUPROFEN

• Recommend against the use

VIRGIN COCONUT OIL

• No evidence to recommend the use of VCO

LIANHUA

• Insufficient evidence
IVERMECTIN

• Recommend against the use of Ivermectin

COLCHICINE

• Suggest against the use of Colchicine

BARICITINIB

• Suggest the addition to dexamethasone and remdesivir in hospitalized

patients requiring low-flow O2, high flow O2 and Non-invasive ventilation
• Insufficient evidence to recommend as alternative to Tocilizumab
INHALED CORTICOSTEROIDS

• Insufficient evidence to recommend the use in non-hospitalized patients

LOPINAVIR/RITONAVIR AND OTHER HIV
PROTEASE INHIBITORS

• Recommends against the use of HIV protease inhibitors in the treatment of

hospitalized and non-hospitalized patients
INTERFERONS

• The COVID-19 Treatment Guidelines Panel (the Panel) recommends against the use
of systemic interferon beta for the treatment of hospitalized patients with COVID-19
(AI).
• The Panel recommends against the use of interferon alfa or lambda for the treatment
of hospitalized patients with COVID-19, except in a clinical trial (AIIa).
• The Panel recommends against the use of interferons for the treatment of
nonhospitalized patients with mild or moderate COVID-19, except in a clinical trial
(AIIa)
ANTI-SARS-COV2 MONOCLONAL
ANTIBODIES

Casirivimab plus imdevimab (Regeneron)

• Recommendation for the use of Regeneron in ambulatory patients with mild
to moderate sympmtoms at risk for progression
• Dose: 600mg Casirivimab + 600mg Imdevimab single IV infusion
• Adverse reactions: Hypersensitivity, rash, diarrhea, nausea, dizziness,
pruritus; in subcutaneous administration: ecchymosis, erythema
ANTI-SARS-COV2 MONOCLONAL
ANTIBODIES

• Bamlanivimab plus etesevimab

• Suggest the use as treatment for mild to moderate non hospitalized patients
with at least 1 risk factor for progression to severe disease (age >65, BMI
>35, Chronic Lung Dse, Chronic Metabolic Dse, CKD, Chronic liver disease,
Immunocompromised)
• Single dose via IV
LERONLIMAB

• Suggest against the use in treatment

STEAM INHALATION

• Recommend against
OSELTAMIVIR

• Recommend against
MOLNUPIRAVIR

• Suggest the use within 5 days of symptom onset among non-hospitalized

adult patients with mild to moderate infection with at least one risk factor for
progression
CONVALESCENT PLASMA

• Recommends against the use in hospitalized patients without impaired

humoral immunity
• Insufficient evidence to recommend for or against in patients with impaired
humoral immunity
NON-PHARMACOLOGIC INTERVENTIONS
MASK

• Well-fitted, with at least 2 layers

• For Omicron: Recommendation to use medical masks, in healthcare settings:
KN95, N95 masks
IONIZING AIR FILTERS

• Recommend against the use

FOOT BATHS

• Recommend against
MISTING TENTS

• Recommend against
UV LAMPS

• Used only in hospital/clinic set ups and not for public use
HIGH EFFICIENCY PARTICULATE AIR (HEPA)
FILTERS

• Recommend for the use of HEPA filters in indoor spaces with inadequate
ventilation