From Our Bureau    

28th MAY 2020

The Corona Virus (CPVID-19) pandemic situation remained grim globally, with the confirmed cases across the world soaring to 55,93,631 and the death toll reaching 3,53,334 in the 216 affected countries and territories, according to the latest update from the World Health Organization (WHO).

Globally, European region continued to be the worst-hit in terms of fatalities with 20,79,924 confirmed cases and 1,77,331 deaths. American region came next with 25,56,479 confirmed cases and 1,48,412 deaths. Eastern Mediterranean region reported 4,61,824 confirmed cases and 11,621 deaths.

Western Pacific region’s tally stood at 1,77,460 confirmed cases and 6,957 deaths. South-East Asia region recorded 2,27,611 confirmed cases and 6,630 deaths and African region witnessed 89,592 confirmed cases and 2,370 deaths. WHO Risk Assessment at global level remained very high.

WHO has published an interim guidance on the clinical management of COVID-19. This guidance document is intended for clinicians caring for COVID-19 patients during all phases of their disease.

WHO has also published an interim guidance on ethical considerations to guide the use of digital proximity tracking technologies for COVID-19 contact tracing. This document provides guidance to policy-makers and other stakeholders about the ethical and appropriate use of digital proximity tracking technologies for COVID-19.

WHO Regional Director for the Americas, Dr Carissa F. Etienne said the response to the COVID-19 pandemic in the Region of the Americas must include chronic disease care, as 1 in 4 people are at increased risk of poor outcomes from COVID-19 due to underlying non-communicable diseases.

Clinical case management:

The updated Clinical Management Guidance for COVID-19 was published on 27 May 2020. This guidance has been significantly expanded to ensure quality care and meet the needs of frontline clinicians caring for patients with COVID-19. The guidance was updated with the following new sections: the COVID-19 care pathway, treatment of acute and chronic infections, management of neurological and mental manifestations, non-communicable diseases, rehabilitation, palliative care, ethical principles, and reporting of death. The remaining sections have been substantially expanded.

One of the key changes in the guidance is the recommendation to discontinue transmission-based precautions (including isolation) and release from the COVID-19 care pathway for symptomatic patients 10 days after symptom onset, plus an additional three days without symptoms (without fever and respiratory symptoms).

In addition, it is important to note that, limited, published and pre-published information provides estimates on viral shedding of up to nine days for mild patients and up to approximately three weeks in hospitalized patients.

There are also reports that patients can remain consistently polymerase chain reaction (PCR) positive for many weeks, or even test PCR positive days/weeks after a negative test, though preliminary evidence suggests that this is not infectious virus.

Treatment of acute co-infections:  For suspected or confirmed mild COVID-19 cases, the use of antibiotic therapy or prophylaxis should not be used. For suspected or confirmed moderate COVID-19 cases, 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, pharmacological prophylaxis should be used, 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).

Importantly, key previous recommendations that remain are: WHO recommends that the listed drugs including antivirals, immune-modulators and other adjunctive therapies should not be administered as treatment or prophylaxis for COVID-19, outside the context of clinical trials.

WHO recommends against the routine use of systemic corticosteroids for treatment of viral pneumonia. (eom)

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