PGI Sarip - Covid 19
PGI Sarip - Covid 19
PGI Sarip - Covid 19
JUNAYYAH A. SARIP
Post Graduate Intern
DJNRMHS
Coronavirus disease 2019 (COVID-19)
Defined as illness caused by the
severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2), a newly
emergent coronavirus, that was first
recognized in Wuhan, Hubei province,
China, in December 2019.
SARS-CoV-2
• March 20, 2020 – DOH designates the Lung Center of the Philippines,
Dr. Jose N. Rodriguez Memorial Hospital, and UP-PGH as
COVID-exclusive centers
COVID-19 in the Philippines
• May 2020 – Cases plateaued which led to the relaxation of quarantine
measures.
• June 2020 – there has been a resurgence of cases within the National Capital
Region and in Cebu
• July 2020 – more than 60,000 reported cases with more than 1,000 deaths
PATHOPHYSIOLOGY
Critical COVID-19
with pneumonia and impending respiratory failure requiring
high flow oxygen, non-invasive or invasive ventilation, acute
respiratory distress syndrome, sepsis or shock, deteriorating
sensorium, multi-organ failure
MANAGEMENT
Classification of Covid-19
Severe COVID-19
with pneumonia and signs of respiratory distress, O2 sat<94%.
RR >30 cpm, requiring oxygen supplementation
Critical COVID-19
with pneumonia and impending respiratory failure requiring
high flow oxygen, non-invasive or invasive ventilation, acute
respiratory distress syndrome, sepsis or shock, deteriorating
sensorium, multi-organ failure
Triage & Evaluation Asymptomatic Covid-19
Triage & Evaluation Asymptomatic Covid-19
Triage & Evaluation Mild Covid-19
Triage & Evaluation Mild Covid-19
Triage & Evaluation Mild Covid-19
Triage & Evaluation Moderate Covid-19
Triage & Evaluation Moderate Covid-19
Triage & Evaluation Moderate Covid-19
Triage & Evaluation Severe Covid-19
Triage & Evaluation Severe Covid-19
Triage & Evaluation Severe Covid-19
Triage & Evaluation Critical Covid-19
Triage & Evaluation Critical Covid-19
Triage & Evaluation Critical Covid-19
Management Asymptomatic Covid-19
Management Mild Covid-19
Management Mild Covid-19
Management Moderate Covid-19
Management Moderate Covid-19
Management Moderate Covid-19
Management Severe Covid-19
Management Critical Covid-19
Management Critical Covid-19
Discharge & Reintegration Asymptomatic Covid-19
Discharge & Reintegration Mild Covid-19
Discharge & Reintegration Moderate Covid-19
Discharge & Reintegration Severe Covid-19
Discharge & Reintegration Critical Covid-19
Management Severe Covid-19
Investigational Drugs
HYDROXYCHLOROQUINE/CHLOROQUINE
The US-NIH recommends against the use of HCQ/CQ with or
without azithromycin in the treatment of COVID-19 in hospitalized
and non-hospitalized patients.
AZITHROMYCIN
Azithromycin is currently not recommended for the treatment of
COVID-19 outside of randomized trials.
Investigational Drugs
FAVIPIRAVIR
Major guidelines on COVID-19 have not issued a recommendation
for the use of favipiravir in their set of management options as there
is still insufficient and uncertain evidence for its use.
REMDISIVIR
IDSA suggested against remdesivir for routine treatment of patients
with oxygen saturation >94% and no supplemental oxygen and
strongly urges for continued study.
Addition of remdesivir to dexamethasone in patients with COVID-19
infection who have O2 sat < 94% and/or requiring oxygen supplementation
Investigational Drugs
TOCILIZUMAB
IDSA suggest the use of tocilizumab in adult hospitalized patients
with progressive severe or critical COVID-19 who have elevated
markers in addition to standard of care (i.e. steroids).
BARICITINIB
Both the US-NIH and IDSA recommend giving baricitinib in
combination with remdesivir only in cases where corticosteroids
cannot be given.
The US-NIH recommends the use of this treatment for hospitalized, non-
intubated COVID-19 patients who require oxygen supplementation and
cannot be given corticosteroids.
Investigational Drugs
LERONLIMAB
No recommendations on leronlimab have been released by the US
NIH, WHO, Australian Living CPG, and PSMID.
Currently, it has been granted emergency Interventional New Drug
(eIND) status by FDA, targeted to treat patients with respiratory
complications associated with COVID-19
CRITICAL CARE & RESPIRATORY MANAGEMENT
• Hemoperfusion
• An extracorporeal blood purification method that may have the
potential to mitigate excessive inflammation in patients with
Covid-19 by removing inflammatory cytokines from the blood
Philippine Society for Microbiology and Infectious Diseases. Unified COVID-19 Algorithms.
https://www.psmid.org/unified-covid-19-algorithms-5/
Philippine Society for Microbiology and Infectious Diseases. Philippine COVID-19living recommendations.
https://www.psmid.org/Philippine-covid-19-living-recommendations/
Philippine Society for Microbiology and Infectious Diseases,Philippine College of Chest Physicians,Philippine
College of Physicians,Philippine Rheumatology Association,Philippine College of Hematology and
Transfusion Medicine, 2020, July 20, ; INTERIM GUIDANCE ON THE CLINICAL MANAGEMENT OF ADULT
PATIENTS WITH SUSPECTED OR CONFIRMED COVID-19 INFECTION
WHO: 2021, January 25, ; INTERIM GUIDANCE ON THE CLINICAL MANAGEMENT OF ADULT PATIENTS
WITH SUSPECTED OR CONFIRMED COVID-19 INFECTION