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How COVID-19 patients are being managed in Malaysia?

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Coronavirus disease 2019 (COVID-19) is defined as an illness caused by a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV).

Stages of COVID-19

According to Malaysia Health-Director General, Dr Noor Hisham Abdullah said coronavirus developed through different 5 stages during the press conference on 2 April 2020.  

Stage 1 – Testing positive without any symptoms. Individuals in the first stage can live as normal and perform their daily routines.

Stage 2 – Testing positive with only mild symptoms. This includes fever, dry cough and lethargy.  Risk of transmission is thought to be the largest in this stage.

Stage 3 – Developing some form of pneumonia. According to the Centers for Disease Control and Prevention (CDC), complications of severe COVID-19 cases include (but are not limited to) pneumonia, hypoxemic respiratory failure, as well as sepsis and septic shock. 

Stage 4 – Having breathing difficulties and requiring oxygen support. Shortness of breath can make it extremely difficult for those infected with COVID-19.

Stage 5 – Put on ventilation and incubation. If a patient reaches this stage, they will need to rely on a ventilator to keep breathing.

Management for mild-COVID 19

Patients with mild COVID-19 can be given symptomatic treatment. Antipyretics can be given to patients who have fever and pain. Adequate nutrition and appropriate rehydration should also be given. At present, there is no evidence to indicate that there are severe adverse events in patients with COVID-19 as a result of the use of non-steroidal anti-inflammatory drugs.

Counselling for patients about signs and symptoms of complications. Urgent care is given to these patients when signs and symptoms of complications exist.

These include difficulty breathing, fast or shallow breathing, blue lips or face, new confusion, chest pain or pressure, inability to awaken, inability to drink or keep down any liquids.

Management for moderate COVID-19

Pneumonia Treatment

Firstly, the isolation of patients with suspected or confirmed moderate COVID-19. The location of isolation will depend on the established COVID-19 care pathway. example of the venue of isolation such as at a health facility, community facility or at home.  The decision of location is made on a case-by-case basis.

Furthermore, it 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.

Patients at high risk for deterioration should be isolated in a hospital. For hospitalized patients, regularly monitoring of vital signs is which include pulse oximetry.

Severe Pneumonia Treatment

Management of care for S=severe patients in the hospital. Equipment such as pulse oximeters, functioning oxygen systems and disposable, single-use, oxygen-delivering interfaces care widely available.

Besides, patient with emergency signs and patient without emergency signs and SpO2 < 90% is given with supplemental oxygen therapy. Besides, monitor signs of clinical deterioration of patients closely such as rapidly progressive respiratory failure and shock.

On top of that, necessary supportive care interventions are available. For instance, haematology and biochemistry laboratory testing and electrocardiogram and chest imaging to monitor for complications.

These complications include acute respiratory distress syndrome and acute liver injury, acute kidney injury, acute cardiac injury, disseminated intravascular coagulation (DIC) and shock.

Furthermore, signs or symptoms of venous or arterial thromboembolism such as stroke, deep venous thrombosis, pulmonary embolism or acute coronary syndrome should be monitored for patients with severe COVID-19.

Understand the current management of COVID-19 and its preventive measures

Currently, there are no drugs or vaccine available for the treatment of COVID-19. In other words, the current management is infection management and supportive care according to the severity of the disease which includes supplemental oxygen and mechanical ventilatory support.

 Apart from that, several drugs are used to manage and control COVID-19 patients.

As such, remdesivir is among drug under investigation that has been authorized by the FDA for emergency use of COVID-19. It is only prescribed for patients that are hospitalized with severe COVID-19.

 

Table 1: Antiviral drugs used for the management of COVID-19 and their MOA
Chloroquine and hydroxychloroquine Inhibiting virus from entering cells and multiplying within it
Remdesivir Inhibit the ability of the virus to reproduce (decrease in viral RNA production) and make copies of itself
Umifenovir Block virus cell membrane fusion
Favipiravir Interrupt RNA replication
Lopinavir/ ritonavir Protease inhibitor

 

Preventive measures of Covid-19

1. Wash your hands regularly and thoroughly
Wash hands with soap and water for at least 20 seconds to kill the virus on hands. Coronavirus has a sticky and thick cell membrane so it is not easy to break down its outer layer or remove from our body parts. It may easily stick on other body parts such as eyes, nose and face.

Once contaminated, hands can transmit the virus to your eyes, nose and mouth so we have to make sure our hands are clean before touching anything.

2. Social distancing
Keep distance at least 1m (3ft) between yourself and others. As we know COVID-19 can be transmitted by small liquid droplets from infected persons’ mouths and noses when they are coughing, sneezing or talking.
3. Minimize your exposure to the public

How? We can avoid going to crowded places such as shopping malls, supermarkets and night markets. When getting into crowds, it is more difficult to maintain social distancing which is 1m. Thus, you have a higher risk to close contact with someone having COVID-19.

 4. Wear a mask when you need to leave your house
To protect yourself from inhaling liquid droplets from people around you. Practising good respiratory hygiene by covering your mouth and nose with tissues when coughing or sneezing. Then, quickly dispose of the used tissues and wash your hands thoroughly.
5. Do not hesitate to seek medical attention
Calling for local health authorities nearby when you find yourself with any sign and symptoms such as fever, sore throats or difficulty in breathing. It helps to prevent or minimize the spread of viruses and other infections.
6. Keep yourself up to date on the latest information about COVID-19 from trusted sources
For example, the WHO website or local and national health authorities. Make sure that the information you share is reliable and accurate.
Do not spread or share information from untrusted websites and fake news through social media.

Used of Dexamethasone

  •       Anti-inflammatory effect. To relieve inflammation in parts of the body. It helps in wound healing.
  •       Suppression of immune response by decreasing lymphocyte production and macrophage function.
  •       To treat and prevent an allergic reaction.
  •       Treatment for arthritis, breathing problems, certain bowel disorders, skin and eye conditions.

Current use of Dexamethasone in COVID-19

Patients with severe COVID-19 can develop a systemic inflammatory response. For example, injury to heart, kidneys and other organs.
Therefore, the use of anti-inflammatory actions of Dexamethasone to prevent these effects.

For example, the treatment of a dose of 6 mg per day administered either orally or intravenously for up to 10 days or hospital discharge, whichever came first.

In pregnancy, routine use of Dexamethasone to encourage fetal lung maturity and decrease the risk of neonatal respiratory distress syndrome in premature. Dexamethasone can cross the placenta and has a low risk of fetal adverse effects.

Therefore, the COVID-19 Treatment Guideline Panels recommends that Dexamethasone also uses in pregnant women with COVID-19 who are mechanically ventilated or requires supplemental oxygen but not mechanically ventilated.

Moreover, it is important to closely monitor the adverse effects when a patient is on dexamethasone. As such, hyperglycemia, secondary infections and psychiatric effects.

In a nutshell, the recommendation for the use of Dexamethasone only in the critically ill hospitalized patient. The customers are not recommended to take dexamethasone without advice from the doctors. The community pharmacist should advise the customer on the precautions step to prevent COVID-19 infection.

 

More Information About:
Content Sources:
  1. Press conference ( explaining stages of COVID19)
  2. These are the 5 stages of coronavirus infection according to Malaysia’s Health Ministry
  3. WHO – Q&A: Dexamethasone and COVID-19
  4. WHO – Coronavirus disease (COVID-19) advice for the public
  5. NIH – COVID-19 Treatment Guidelines

 

 

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