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121. Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts

Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts 1 Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts Interim guidance 17 March 2020 Background WHO has developed this interim guidance to meet the need for recommendations on safe home care for patients with suspected COVID-19 who present with mild symptoms a and on public health measures related to the management (...) and infection prevention and control (IPC) professionals, health care managers and health care workers (HCWs) when addressing issues related to home care for patients with suspected COVID-19 who present with mild symptoms and when managing their contacts. This guidance is based on evidence about COVID-19 and the feasibility of implementing IPC measures at home. For the purpose of this document, “caregivers” refers to parents, spouses, and other family members or friends without formal health care training

2020 WHO Coronavirus disease (COVID-19) Pandemic

122. Operational considerations for case management of COVID-19 in health facility and community

. For clinical care, six major interventions must be put into place immediately, and then scaled up according to epidemiologic scenarios (see Table 3). Operational considerations for case management of COVID-19 in health facility and community: interim guidance 2 The document is organized to guide key actions by transmission scenario to enable timely surge of clinical operations. Scenario and strategic priorities Table 1. Key recommendations based on case severity and risk factors, irrespective (...) Operational considerations for case management of COVID-19 in health facility and community 1 Operational considerations for case management of COVID-19 in health facility and community Interim guidance 19 March 2020 Background This document is intended for health ministers, health system administrators, and other decision-makers. It is meant to guide the care of COVID-19 patients as the response capacity of health systems is challenged; to ensure that COVID-19 patients can access life-saving

2020 WHO Coronavirus disease (COVID-19) Pandemic

123. Clinical management of severe acute respiratory infection when COVID-19 is suspected

). This document is intended for clinicians involved in the care of adult, pregnant and paediatric patients with or at risk for severe acute respiratory infection (SARI) when a SARS-CoV-2 infection is suspected. Considerations for paediatric patients and pregnant women are highlighted throughout the text. It is not meant to replace clinical judgment or specialist consultation but rather to strengthen clinical management of these patients and to provide up-to-date guidance. Best practices for infection (...) local circulation of seasonal influenza, empiric therapy with a neuraminidase inhibitor should be considered for the treatment for patients with influenza with or at risk for severe disease (5). Empiric therapy should be de-escalated on the basis of microbiology results and clinical judgment. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance V 1.2. -8- 8. Management of critical COVID-19: acute respiratory distress syndrome (ARDS

2020 WHO Coronavirus disease (COVID-19) Pandemic

124. Management of patients with severe to critical COVID-19

Management of patients with severe to critical COVID-19 MANAGEMENT OF P A TIENTS WITH SEVERE TO CRITICAL COVID- 19 DISEASE Definition of disease severity Severe illness Patients meeting any of the following criteria: • respiratory rate =30 breaths/min • oxygen saturation =92% at a rest state • arterial partial pressure of oxygen (PaO2) / inspired oxygen fraction (FiO2) =300 Critical illness Patients meeting any of the following criteria: • respiratory failure Occurence of severe respiratory (...) manoeuvres are used, we recommend against using staircase or stepwise (incremental PEEP) recruitment manoeuvres. [Taskforce/SSC] PRONE POSITIONING TF6.5 Current reports suggest prone ventilation is effective in improving hypoxia associated with COVID-19. This should be done in the context of a hospital guideline that includes suitable PPE for staff and minimises the risk of adverse events, e.g. accidental extubation. [Taskforce/ANZICS] TREATMENTS GENERAL 00.06 Maximise best supportive care and symptom

2020 National COVID-19 Clinical Evidence Taskforce

125. Assessing the infection prevention and control measures for the prevention and management of COVID-19 in healthcare settings

also supports indirect contact. 1, 6, 7, 9, 10 These transmission routes are supported by National 12-14 and international guidance. 15, 16 Currently there is no clear evidence of airborne transmission of SARS-CoV-2. Aerosol- generating procedures (AGPs) have been associated with an increased risk of transmission of previous coronaviruses (SARS-CoV and MERS-CoV) 16 and a number of AGPs (mostly airway management) have been implicated as risk factors for SARS-CoV- 2. 9 Therefore airborne precautions (...) and control measures for the prevention and management of COVID-19 in healthcare settings HPS: 3 April 2020 V1.1 page 13 of 21 For general patient care (i.e. non-AGP situations), the first edition of the UK IPC pandemic COVID-19 guidance initially recommended FRSMs, disposable aprons and disposable gloves, with the decision to wear eye protection based on risk assessment, and fluid- resistant long sleeve gowns recommended for confirmed cases and all AGPs. 14 The UK IPC pandemic COVID-19 guidance

2020 Covid-19 Ad hoc guidelines

126. Water, sanitation, hygiene and waste management for COVID-19

for the COVID-19 virus: interim guidance -3- WASH in health care settings Existing recommendations for water, sanitation and hygiene measures in health-care settings are important for providing adequate care for patients and protecting patients, staff g and caregivers from infection risks. 20 The following WASH- related actions are particularly important: • engaging in frequent hand hygiene using appropriate techniques; • implementing regular environmental cleaning and disinfection practices; • managing (...) and does not leak from the system before it reaches a functioning treatment and/or disposal site. Risks related to the adequacy of the collection system or to treatment and disposal methods should be assessed following a sanitation safety planning approach. 29 h Further resources are available at https://www.who.int/infection-prevention/campaigns/clean- hands/5moments/en/ Water, sanitation, hygiene, and waste management for the COVID-19 virus: interim guidance -4- If health-care facility toilets

2020 WHO Coronavirus disease (COVID-19) Pandemic

127. CSC Expert Consensus on Principles of Clinical Management of Patients with Severe Emergent Cardiovascular Diseases during the COVID-19 Epidemic

/CIRCULATIONAHA.120.047011 6 standard protocols. For patients in whom COVID-19 has not been ruled out temporarily (in areas outside Hubei Province, without epidemiological history of COVID-19, with 1-2 clinical manifestations of COVID-19, but not fulfilling diagnostic criteria for COVID-19), medical management should comply with guidance from a COVID-19 expert panel in the hospital, as well as senior hospital administrative leadership. This includes quarantine in a single-bed room (initiating second grade (...) of infection and transmission, all patients with severe emergent cardiovascular diseases should be managed as suspected cases of COVID-19 in Hubei Province. II. Recommended principles of clinical treatment of patients with severe emergent cardiovascular diseases during the epidemic (I) General principles During the epidemic, the over-arching principles of treatment should be the following: Epidemic control as the first priority, prompt risk assessment, preference for conservative medical therapy

2020 Covid-19 Ad hoc guidelines

128. Consensus guidelines for managing the airway in children with COVID-19

; COVID-19; difficult airway; anaesthesia; paediatric 2 Summary Airway management of patients with COVID-19 is high risk to staff and patients. Guidance has been published directed at adult practice. The vast majority of this guidance is also applicable to paediatric patients. This consensus statement provides advice for anaesthetists who undertake airway management in paediatric patients suspected or confirmed to have COVID-19 and seeks to provide clarity where that guidance differs for paediatric (...) patients. It is not directly relevant to neonatal practice in neonatal ICUs (NICUs). This document does not stand alone as advice but should be read with the adult advice [1] at https://icmanaesthesiacovid- 19.org/covid-19-airway-management-principles It is important to recognise that globally there have been very few children admitted to critical care units with COVID-19. This has several implications: firstly, there is less published literature relating to paediatric practice, and guidance

2020 ICM Anaesthesia COVID-19

129. Updated advice regarding PPE to be worn when managing pregnant women with known or suspected COVID-19

Updated advice regarding PPE to be worn when managing pregnant women with known or suspected COVID-19 PPE Jargon Buster FRSM fluid resistant surgical mask FRDG fluid resistant disposable gown PPE personal protective equipment AGP aerosol generating procedure FFP mask filtering face piece respirator 11 April 2020 | Dr Nuala Lucas, Dr Jim Bamber, Dr Fiona Donald, Dr Felicity Platt | icmanaesthesiacovid-19.orgChoice of PPE for obstetric anaesthetists according to mode of transmission risk Non (...) Theatre Caesarean section with neuraxial anaesthesia 1 (low risk of GA, e.g. elective CS for breech) Apron, sterile 2 FRDG, sterile gloves, FRSM, eye protection Caesarean section with neuraxial anaesthesia (but higher risk of GA 3 e.g. Category 1 CS) Apron, sterile FRDG, sterile gloves, FRSM or FFP3, eye protection Caesarean section with general anaesthesia Apron, FRDG, gloves, FFP3, eye protection Non-CS obstetric theatre cases Trial of instrumental delivery in theatre, removal of retained placenta

2020 ICM Anaesthesia COVID-19

130. Covid-19: Management of acute diabetes patients

delay and expedite discharge to minimise length of stay. • Secondary care services: Outpatient attendances should be kept to the safe minimum. Consider using virtual clinics and remote consultations. • Primary care delivered diabetes services: Implications for routine diabetes care should be considered in the context of broader long-term condition management and prioritisation, taking into account individual risk factors and clinical needs.2 | Clinical guide for the management of people (...) ). Primary care delivered diabetes services Implications for routine diabetes care should be considered in the context of broader long- term condition management and prioritisation, taking into account individual risk factors and clinical needs. 3 | Clinical guide for the management of people with diabetes during the coronavirus pandemic General considerations • Diabetes services should look to maintain and optimise the health of individuals within their services over the course of the pandemic

2020 Covid-19 Ad hoc guidelines

131. Covid-19: Management of non-coronavirus patients requiring acute treatment: general and internal medicine

tests to support that visit. Consider whether the visit can be delayed, cancelled, distance-managed (eg via primary care or telephone consultation) or remains necessary. 5. Other pathways: Within GIM there are pathways of patient care that either confer additional risk through therapy or the underlying condition or have complex and multiple interactions with the health system. Examples include complex home ventilation, patients on biologics or other immunosuppressive regimes, cystic fibrosis (...) , dialysis and solid organ transplantation. These pathways need to be identified and risk-assessed to mitigate harm. These pathways often have small teams and are therefore fragile. Individual specialties are providing guidance via the royal colleges, specialist societies and the commissioning bodies https://www.rcplondon.ac.uk/news/covid-19-expert-update-doctors Leadership 3 | General and internal medicine: considerations around COVID-19 • A consultant must be designated as ‘medical specialty lead

2020 Covid-19 Ad hoc guidelines

132. Covid-19: Management of emergency department patients

to the latest advice available (which may change from the information contained in this document). Guidance from NHSI/E and PHE is being frequently updated as the national caseload and required response is evolving. Your Trust will have an Incident Management Team in place and you will have plans on what activity continues in light of pressure on services and staffing. Please consult with your local management team. We must engage with those planning our local response. We may also need to work outside (...) . It will be necessary for each admission area for medical patients (AMU, ED) to create parallel systems to separate patients with respiratory symptoms from those with other clinical presentations. The management of the non-respiratory cohort should: – aim to manage without admission – use capacity from other specialties for whom elective work will be stepped down; especially T&O, O&G, ENT and ophthalmology as these can be rapidly streamed at the front door – make appropriate use of staff most at risk to their own

2020 Covid-19 Ad hoc guidelines

133. Covid-19: Management of non-coronavirus cancer patients

patients receiving systemic therapies. Clinicians will also need to consider the level of immunosuppression associated with an individual therapy and the condition itself, and patients' other risk factors. 5 | Guidance for trusts on the management of non-coronavirus patients requiring acute treatment: cancer Categorisation of patients This will differ according to tumour type, but it is suggested that clinicians begin to categorise patients into priority groups 1-6. If services are disrupted, patients (...) services while protecting resources for the response to coronavirus. In addition, we need to consider the small possibility that the facility for cancer services may be compromised due to a combination of factors including staff sickness and supply chain shortages among others. This is an unlikely scenario but plans are needed. The most vulnerable cancer patients Some people with cancer are more at risk of becoming seriously ill if they contract the coronavirus infection: 2 | Guidance for trusts

2020 Covid-19 Ad hoc guidelines

134. Covid-19: Management of surge during the coronavirus pandemic: rapid learning

patient management. Please refer to Guidance for the role and use of non-invasive respiratory support in adult patients with coronavirus (confirmed or suspected) https://www.england.nhs.uk/coronavirus/secondary-care/other- resources/specialty-guides/#coronavirus-treatment NIV: see guide on NIV https://www.england.nhs.uk/coronavirus/secondary-care/other- resources/specialty-guides/#coronavirus-treatment Proning patients early in medical management both on the ward and in critical care may reduce (...) Covid-19: Management of surge during the coronavirus pandemic: rapid learning Publications approval reference: 001559 NHS England and NHS Improvement Specialty guides for patient management during the coronavirus pandemic Clinical guide for the management of surge during the coronavirus pandemic: rapid learning 12 April 2020, Version 2 – updates highlighted The majority of patients recover from coronavirus infection following an uncomplicated clinical course. However, a small but significant

2020 Covid-19 Ad hoc guidelines

135. Covid-19: Clinical guide for the management of stroke patients during the coronavirus pandemic

be prioritised and to consider 7/7 working (if not already in operation); risk assessment is needed to migitate harm and to support these often small teams. – Individual specialties are providing guidance via the royal colleges, specialist societies and the commissioning bodies. – Discussion with, and support for, therapy teams to redefine ‘safe discharge’ and ensure only those patients that have no potential to be 5 | Clinical guide for the management of stroke patients during the coronavirus pandemic cared (...) as more evidence emerges this guidance may change. – Encourage administration staff within the service to take telephone calls that may have ordinarily come to stroke specialist nurses to offer basic advice for FAQ and triage other calls. 6 | Clinical guide for the management of stroke patients during the coronavirus pandemic – It may not be possible to maintain data entry into the national Stroke Audit (SSNAP). There will be national guidance offered regarding data entry and reporting over the next 3

2020 Covid-19 Ad hoc guidelines

136. Covid-19: Clinical guide for the management of people with alcohol dependence during the coronavirus pandemic

given time from available staff. The COVID-19 alcohol lead will be responsible for offering specialist support to staff across the organisation in terms of the protocols for safest management of patients, and pathways to partner agencies. • Alcohol leads must be competent to offer guidance on current best practice specifically relating (but not limited) to alcohol-dependent patients presenting with: – COVID-19, and risks of respiratory depression during medically assisted alcohol withdrawal (...) | Clinical guide for the management of people with alcohol dependence during the coronavirus pandemic, Version 1 Due to the minimal provision of alcohol teams, identification and management will need to be undertaken by general staff. Categories of people with alcohol dependence to consider • Emergency department presentations: Consideration for the proper management and diversion of patients presenting in alcohol withdrawal to minimise harm and reduce representation, taking into account individual risk

2020 Covid-19 Ad hoc guidelines

137. Covid-19: Clinical guide for the management of essential cancer surgery for adults during the coronavirus pandemic

surgery in a COVID-free hub, with centralised triage to prioritise patients based on clinical need: https://www.england.nhs.uk/coronavirus/publication/advice-to-trusts-on-maintaining-cancer- treatment-during-the-covid-19-response/ This supplementary guidance, which builds on the experience in China, Italy and London, supports cancer services on the prioritisation and management of essential cancer surgery 2 | Clinical guide for the management of essential cancer surgery for adults during (...) the relevant organising unit (Cancer Alliance, ICS or lead provider) to undertake a rapid assessment of need, in line with the guidance previously issued, and to develop a proposed solution. This step should involve trusts, specialised commissioners and local systems/CCGs. • Where the solution uses independent sector capacity, the cancer SRO should ensure that cancer activity is part of local system planning to make optimum use of the available capacity. Management of priority cancer patients for surgery

2020 Covid-19 Ad hoc guidelines

138. Covid-19: Management of palliative care in hospital during the coronavirus pandemic

and support for ward staff, for example, syringe drivers, prescribing, conversations to plan treatment escalation. • Help to facilitate rapid discharge out of hospital using established connections with hospices, community palliative care teams and primary and community health care services. Symptom management Even though many patients will survive and recover from coronavirus, managing their symptoms during this period remains important. This guidance assumes that a patient has received all appropriate (...) referral to a coroner is required by virtue of its notifiable status Coordination of support for the bereaved family and those close to the patient should be managed by the hospital’s bereavement services, signposting them to locally and nationally available support services, including those provided by the voluntary sector. National guidance on the use of PPE, verification of death and medical certification should be followed. 5 | Clinical guide for the management of palliative care in secondary care

2020 Covid-19 Ad hoc guidelines

139. Covid-19: Management of patients with a learning disability, autism or both

Covid-19: Management of patients with a learning disability, autism or both Publications approval reference: 001559 NHS England and NHS Improvement Speciality guides for patient management during the coronavirus pandemic Clinical guide for front line staff to support the management of patients with a learning disability, autism or both during the coronavirus pandemic – relevant to all clinical specialities 24 March 2020 Version 1 “…and there are no more surgeons, urologists, orthopaedists, we (...) are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us…” Dr Daniele Macchine, Bergamo, Italy. 9 March 2020 As health professionals we all have general responsibilities in relation to coronavirus and for these we should seek and act on national and local guidelines. We also have a specific responsibility to ensure that essential patient care continues with the minimum burden on the NHS. We must engage with management and clinical teams planning the local

2020 Covid-19 Ad hoc guidelines

140. What is known about the spread and management of COVID-19 in non-health workplaces, including workplaces where light-touch services are offered such as government administration offices (e.g., Service Canada or Service Ontario) and social services (e.g.,

in non-health workplaces School closure and management practices during COVID-19 (AMSTAR rating 5/9) Last searched 9 March 2020 3 Guidance developed using some type of evidence synthesis and/or expert opinion • Spread of COVID-19 in non-health workplaces • Management of COVID- 19 in non-health workplaces Risk-informed decision-making guidelines for workplaces and businesses during the COVID-19 pandemic Last updated 17 April 2020 • Spread of COVID-19 in non-health workplaces • Management of COVID- 19 (...) in non-health workplaces INSPQ Interim recommendations on occupational health Last updated 2020 • Management of COVID- 19 in non-health workplaces CDC guidance on communities, schools, workplaces, and events Last updated 17 April 2020 • Management of COVID- 19 in non-health workplaces OHSA/HHS guidance on Preparing Workplaces for COVID-19 Last updated March 2020 • Spread of COVID-19 in non-health workplaces • Management of COVID- 19 in non-health workplaces Public Health England guidance on cleaning

2020 McMaster Health Forum

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