COVID19
Evidence-Based Use of Therapeutics for Ambulatory Patients with COVID-19
Currently only a few treatments available help mildly ill patients – people who have COVID-19 who do not require admission to hospital. Drugs like azithromycin, bamlanivimab, colchicine, hydroxychloroquine, ivermectin, lopinavir-ritonavir, and vitamin D do not help patients with COVID-19, and may cause harm.
Dexamethasone, a steroid that can be given in pill form, may benefit patients who are at home but need supplemental oxygen, but does not help patients who are mildly ill who do not need supplemental oxygen.
Budesonide, a steroid that can be inhaled (from a “puffer”), has no effect on whether patients with mild COVID-19 get sicker, are hospitalized, or die. But there is weak evidence that inhaled budesonide 800 mcg twice daily for 14 days may make patients feel better a few days earlier, so doctors may consider prescribing it.
Guidelines on Case Management of COVID-19 in Kenya
These consolidated guidelines for the prevention, control and management COVID-19 in Kenya provide updated recommendations for comprehensive prevention and case management strategies in Kenya. They cover infection prevention and control measures including the use of vaccines. They also target the diagnosis and case management of COVID-19.
A living WHO guideline on drugs for COVID-19
A baseline review of the ability of hospitals in Kenya to provide emergency and critical care services for COVID-19 patients
A baseline review of the ability of hospitals in Kenya to provide emergency and critical care services for COVID-19 patients
Wachira B, Mwai M.
Afr J Emerg Med. 2021;Jun;11(2):213-217. doi: 10.1016/j.afjem.2021.01.001
Home Based Isolation and Care Guidelines for Patients with COVID-19
Patients who are assessed by a Health Care Worker and meet all the criteria below will be considered for home-based isolation and care:
- Laboratory confirmed COVID-19
- Asymptomatic patients or patients with mild symptoms of COVID-19
- Absence of comorbidities
- Access to a suitable space for home-based isolation and care
Giving Oxygen to COVID-19 Patients in Kenya
As the COVID‐19 pandemic continues to unfold here in Kenya, more and more patients are requiring oxygen. To increase the capacity of healthcare facilities to provide oxygen to more patients, we have installed Oxygen Gas Manifolds in the emergency departments at the county referral hospitals in Machakos, Kiambu (COVID-19 isolation centre) and Kajiado counties and at the Alupe Sub-County Hospital COVID-19 isolation centre in Busia county. These are the hardest hit counties at the moment and we continue to seek additional support to support more facilities.
The Recovery Trial: Effect of Dexamethasone in Hospitalized Patients with COVID-19 – Preliminary Report
The findings of this well done randomized controlled trial indicate that in patients with COVID-19 pneumonia, that dexamethasone improves 28d mortality compared to placebo in patients requiring invasive mechanical ventilation (IMV) (NNT = 8.5) and those patients requiring oxygen therapy (NNT = 29). There was no benefit to patients not requiring oxygenation support and even a signal for harm. It is important to remember this is a preprint, preliminary report, which is better than a press release. At this time, in patients requiring any oxygen therapy, HFNC, NIV, IMV, or ECMO I would recommend dexamethasone until further evidence disproves this benefit.
COVID-19 Rx: Treatment Simulations
You are a health care provider in a developed country. Several patients await your care. These patients are suspected of having COVID-19 and have been triaged by severity of illness. We recommend starting with the mildly ill patient, but you are free to see them in any order.