Revised National Clinical Management Guidelines For COVID-19 by Indian Government
COVID-19: ASTCT Interim Guidelines for Transplantation
The American Society for Transplantation and Cellular Therapy (ASTCT) has released interim guidelines for the care of hematopoietic cell transplantation (HCT) and cellular therapy patients in the light of the global SARS-CoV-2 pandemic.
The guidelines, summarized briefly below, focus on diagnostic and treatment considerations, evaluation of patients prior to initializing HCT and cellular therapy, and cell donor evaluation. Much of the guideline relies upon recommendations developed by the European Society for Blood and Marrow Transplantation (ESBMT). These guidelines were updated on March 23.
The ASTCT document focuses on patient-treatment specifics and does not cover specific infection-prevention policies and procedures, instead suggesting that local and institutional guidelines, such as those from the Centers for Disease Control and Prevention, should be followed. They did recommend that, in the local presence of COVID-19, “clinic visits that are not critical should be either deferred or substituted with telemedicine visits if deemed appropriate and feasible.”
Diagnostic Considerations
In any patient with upper or lower respiratory symptoms, obtain polymerase chain reaction (PCR) testing for SARS-CoV-2, where possible, in addition to other respiratory virus PCR testing from any respiratory sample obtained, following CDC recommendations for sample collection and processing, which are continuously being updated on the CDC website.
These recommendations include nasal sampling, rather than oral sampling, and the discouraging of nasal washes where avoidable. If nasal washing is performed, it should be done with appropriate personal protective equipment as described by the CDC. The CDC has also provided additional infection prevention and control information for known and suspected COVID-19 patients in health care settings.
Rapid Advice for COVID-19 Clinical Practice Guidelines (2020)
Rapid advice clinical practice guidelines for COVID-19 were released in February 2020 by the Zhongnan Hospital of Wuhan University Novel Coronavirus Management and Research Team and the Evidence-Based Medicine Chapter of China International Exchange and Promotive Association for Medical and Health Care (CPAM).
Close Contacts and Possible Exposure Guidance
Strictly adhere to the 14-day observation period.
Should symptoms such as fever or cough develop, go to the hospital for diagnosis and treatment. If possible, notify the hospital in advance and have it arrange transportation to the hospital.
Wearing of N95 masks is the priority strategy, with the alternate strategy being a disposable surgical mask.
Public transportation should be avoided as a method of transport to the hospital; priority methods are an ambulance or a private vehicle; vehicle windows should be open to provide ventilation.
While in public (eg, walking on the road, waiting in the hospital), wear a mask and attempt to stay at least 1 meter away from other people.
Family members who accompany people going to the hospital for examination should immediately adhere to the monitoring recommendations for close contacts; additionally, they should practice proper respiratory hygiene and wash their hands properly.
The local or community hospital must be notified before arrival of the suspected contact at the hospital. The vehicle used to transport the suspected close contact should be disinfected with chlorine-containing solution (500 mg/L) and the vehicle windows should be opened for ventilation.
Isolation & Home Care Guidance for Those With Mild Symptoms
The preferred strategy is a well-ventilated, single-occupancy room; alternatively, attempt to stay at least 1 meter away from the patient.
Household articles should be cleaned and disinfected with a chlorine-containing solution (500 mg/L) frequently every day.
Visits from relatives and friends should be limited.
The caregiver should be a healthy family member who does not have any underlying diseases.
The patient’s activity should be restricted.
Windows in shared, communal areas (eg, bathrooms, kitchens) should be opened to provide ventilation.
Do not share household items (eg, toothbrush, towel, tableware, bedsheets) with patients. The items used by the patient for daily necessities should be for single use only; they should be stored separately from those used by family members.
When the patient coughs or sneezes, he or she should be wearing a medical mask or should cover the mouth with a paper towel and bent elbow; his or her hands should be cleaned immediately after coughing and sneezing.
The preferred strategy is that caregivers wear an N95 mask when in the same room with the patient; alternatively, a disposable surgical mask can be worn.
The mask should be used with strict adherence to the instruction manual.
After washing hands, the preferred strategy is to dry them with a paper towel; alternatively, a towel can be used but should be washed and disinfected daily.
COVID-19 Interim Guidelines by ISUOG
The guideline on coronavirus disease (COVID-19) infection control during pregnancy and puerperium was released on March 11, 2020 by the International Society of Ultrasound in Obstetrics and Gynecology.
Screening
During the COVID-19 epidemic period, a detailed history regarding recent travel, occupation, significant contact and cluster (TOCC) and clinical manifestations should be acquired routinely from all pregnant women attending for routine care.
On presentation to triage areas, pregnant patients with TOCC risk factors should be placed in an isolation room for further assessment.
Pregnant patients with known TOCC risk factors and those with mild or asymptomatic COVID-19 infection should delay antenatal visit and routine ultrasound assessment by 14 days.
In units in which routine group B streptococcus (GBS) screening is practiced, acquisition of vaginal and/or anal swabs should be delayed by 14 days in pregnant women with TOCC risk factors or should be performed only after a suspected/probable case tests negative or after recovery in a confirmed case. Intrapartum prophylactic antibiotic cover for women with ante- or intrapartum risk factors for GBS is an alternative.
Chest Radiography during Pregnancy
In a pregnant woman with suspected COVID-19 infection, a chest CT scan may be considered as a primary tool for the detection of COVID-19 in epidemic areas. Informed consent should be acquired (shared decision-making) and a radiation shield be applied over the gravid uterus.
Treatment during Pregnancy
Management of COVID-19-infected pregnant women should be undertaken by a multidisciplinary team (obstetricians, maternal–fetal-medicine subspecialists, intensivists, obstetric anesthetists, midwives, virologists, microbiologists, neonatologists, infectious disease specialists).
Suspected, probable, and confirmed cases of COVID-19 infection should be managed initially by designated tertiary hospitals with effective isolation facilities and protection equipment.
Suspected/probable cases should be treated in isolation and confirmed cases should be managed in a negative-pressure isolation room. A patient with a confirmed case who is critically ill should be admitted to a negative-pressure isolation room in an ICU.
Designated hospitals should set up a dedicated negative-pressure operating room and a neonatal isolation ward. All attending medical staff should don personal protective equipment (PPE; respirator, goggle, face protective shield, surgical gown, and gloves) when providing care for patients with confirmed cases of COVID-19 infection. However, in areas with widespread local transmission of the disease, health services may be unable to provide such levels of care to all suspected, probable, or confirmed cases.
Pregnant women with a mild clinical presentation may not initially require hospital admission and home confinement can be considered, provided that this is possible logistically and that monitoring of the woman’s condition can be ensured.
If negative-pressure isolation rooms are not available, patients should be isolated in single rooms, or grouped together once COVID-19 infection has been confirmed.
For transfer of confirmed cases, the attending medical team should don PPE and keep themselves and their patient a minimum distance of 1–2 meters from any individuals without PPE.
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