COVID-19: Corona Virus Disease-19

Description

General Measures

Medicine Treatment

Referral

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ICD-10 codes: U07.1/U07.2

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Note: notifiable medical condition.

Consult the most recent guidelines on the clinical management of suspected or confirmed Covid-19 disease available at: https://www.knowledgehub.org.za/content/covid-19

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DESCRIPTION

• Viral respiratory illness caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).
• The mean incubation period is 4-5 days but may be up to 14 days. Patients may however be infectious for 2-3 days prior to the onset of symptoms.
• The elderly are at high risk for severe COVID-19 disease. Other risk factors include cardiopulmonary comorbidities, uncontrolled diabetes mellitus, obesity, TB, HIV, mental illness and substance use disorders.

LoE:IIIb¹⁸

• COVID-19 presents as an asymptomatic infection; or as a respiratory tract infection that may range from mild to severe, with atypical manifestations such as diarrhoea, skin manifestations, hyperglycaemic syndromes, and large vessel strokes.
• A suspected COVID-19 case includes any person presenting with an acute (≤14 days) respiratory tract infection or other clinical illness compatible with COVID-19, or an asymptomatic person who is a close contact to a confirmed case.
• In the context of COVID-19, the key respiratory syndrome consists of ANY of:
  • Cough
  • Sore throat
  • Shortness of breath
  • Anosmia (loss of smell) or dysgeusia (loss of taste)
• This may present with or without other symptoms (such as fever, weakness, myalgia or diarrhoea).
• Complications include refractory hypoxaemia, acute respiratory distress syndrome (ARDS), long-COVID and multisystem inflammatory syndrome in children (MIS-C) and in adults (MIS-A).

Testing

• Rapid antigen tests or PCR-based tests are both acceptable options to use for diagnosis. Rapid antigen tests may be performed on all patients for whom the PCR test is indicated in situations where no PCR tests are available, or when the PCR turnaround time limits the clinical or public health response utility.
• Upper respiratory tract (nasopharyngeal or oropharyngeal) samples should be sent on all patients. Sputum can be sent when available.
•  A single positive rapid or PCR test is sufficient proof of COVID-19 infection.
• A negative rapid test should be followed up by a PCR test if the patient has symptoms compatible with COVID or if the patient has had a recent exposure to a confirmed case.
• Due to poor sensitivity within the first 1-2 weeks after symptom onset, serology (antibody test) is not recommended for the diagnosis of acute COVID-19 infection.
• All healthcare workers should wear appropriate personal protective equipment (PPE) for both contact and respiratory precautions when obtaining specimens.
• Record and report and notify all confirmed COVID-19 cases.

LoE:IVb¹⁹

GENERAL MEASURES

• Manage patients who are asymptomatic or who meet criteria for mild disease at home, provided they can safely self-isolate and seek urgent health care if required.
• Give strict advice to patients who self-isolate at home and how to reduce possible transmission to others.

Criteria for management at home (for age >12 years):

Mild disease:

• SpO2 ≥95%
• Respiratory rate <25 breaths/minute
• HR <120 beats/minute
• Mental status normal

Able to safely self-isolate:

• Separate bedroom available for patient to self-isolate in
• Able to maintain physical distancing at home
• Able to maintain hand hygiene
• Patient able to contact, and return to, healthcare facility in case of progression to severe disease

MEDICINE TREATMENT

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Note:

Antibiotics are of no value for the treatment of confirmed COVID-19, unless there is clear evidence of a coexisting infection.

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Paracetamol is recommended for symptomatic treatment of patients with pain in preference to nonsteroidal anti-inflammatory drugs (NSAIDs).

Children

• Paracetamol, oral, 10–15mg/kg/dose 6 hourly when required. See dosing table.

Adults

• Paracetamol, oral, 1g 4–6 hourly when required.
  • Maximum dose: 15mg/kg/dose.
  • Maximum dose: 4g in 24 hours.

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Note:

- Any deterioration in the ability to perform activities of daily living at home as a result of dyspnoea should prompt re-evaluation at a healthcare facility.

- Corticosteroids should not be used for the treatment of COVID-19 in patients who do not require supplemental oxygen or mechanical ventilation, unless they are required for another reason such as an acute exacerbation of asthma or chronic obstructive pulmonary disease.

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COVID-19 HOTLINE NUMBER
0800029999
http://www.nicd.ac.za/ ; https://sacoronavirus.co.za/

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Infection Prevention and Control (IPC)

• Practice hand hygiene.
• Use healthcare worker PPE: gloves, gown (or apron), and a medical mask.
• Practice safe waste management.
• Use either disposable or dedicated equipment (e.g. stethoscopes, blood pressure cuffs and thermometers). If equipment needs to be shared among patients, clean and disinfect between each patient use.
• Limit patient movement within the institution and ensure that patients wear medical masks when outside their rooms.

Comprehensive national IPC guidelines for COVID-19 are available at:
https://www.knowledgehub.org.za/content/covid-19

REFERRAL

Urgent
Refer cases urgently where there is a respiratory rate of >25 breaths/minute, SpO2 <94% in patients breathing room air or oxygen, heart rate of >120 beats/minute, are confused, agitated or have decreased consciousness. Administer oxygen and monitor oxygen saturation during referral. If unsure, consult with ID expert or NICD (see above).
LoE:IIIb²⁰

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.1_20 January 2025

Chapter 10: Infections and Related Conditions_10.19 Emerging respiratory pathogens, e.g. COVID-19: coronavirus disease-19; Middle East respiratory syndrome coronavirus infection: MERS CoV_ 10.19.1 COVID-19: Coronavirus Disease-19