COVID- 19 Treatment guideline in Tanzania
Posted by ULY CLINIC
25 Machi 2021 06:48:59
The guidance in this document is based on proper case management aspects intended for clinicians involved in the care of patients with suspected or confirmed COVID-19. It is not meant to replace clinical judgment or specialist consultation but rather to strengthen frontline clinical management and the public health response.
DISCLAIMER. THIS GUIDELINE IS THE POPERTY OF MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN
15. DISCHARGE AND FOLLOW UP
The discharging clinician should consider complications which might arise due to COVID-19 and react accordingly, the important things to note are;
• Post Hospital Discharge management,
• The post-COVID-19 syndrome and
• Post-COVID-19 pulmonary fibrosis
Post Hospital Discharge management
Patients have an increased risk of thromboembolic events post-discharge. Extended thromboprophylaxis should be considered in high-risk patients.
Risk factors includes:
• Increased D dimer (> 2 times ULN)
• Increased CRP (> 2 times ULN) 
• Age > 60
• Prolonged immobilization
The post-COVID-19 syndrome
The post-COVID-19 syndrome is characterized by prolonged malaise, headaches, generalized fatigue, painful joints, dyspnea, chest pain and cognitive dysfunction. Up to 50% of patients experience prolonged illness after COVID-19.
• The post-COVID-19 syndrome may persistent for months after the acute infection and almost half of patients report reduced quality of life. The neurological symptoms may be related micro- and/or macrovascular thrombotic disease, which appears to be common in severe COVID-19 disease. Brain MRI three (3) months’ post-infection demonstrated micro-structural changes in 55% of patients.
• Similar to patients who have recovered from septic shock, a prolonged (many months) immune disturbance with elevated pro- and anti-inflammatory cytokines may contribute to the post-COVID-19 syndrome. Consequently, A CRP should be measured prior to discharge and a tapering course of corticosteroids should be considered in those with an elevated CRP.
• It should be noted that much like omega-3 fatty acids corticosteroids have been demonstrated to increase expression of pro-resolving lipids including Protectin D1 and Resolvin D4.
• Other interventions that should be considered include:
• Atorvastatin 40mg daily (increase resolving synthesis)
• Melatonin for its antioxidant properties and stabilization of the circadian rhythms.
• Adequate vitamin D.
• Ivermectin has been reported to have a role in the treatment of post- COVID--19 syndrome. The anti-inflammatory properties of Ivermectin may mediate this benefit.
Post-COVID-19 pulmonary fibrosis.
An unknown number of patients who have recovered from COVID-19 organizing pneumonia will develop pulmonary fibrosis with associated limitation of activity. These patients should be referred to a pulmonologist with expertise in pulmonary fibrosis.
Maintaining mental health and the avoiding the misinformation pandemic and seek professional help if anxiety is overwhelming
Important measures to be taken by the patient while at home (7 to 14days)
• WEAR A MASK when in contact with others
• Establish social distancing; stand/sit about 2meters away from others
• Limit attendance at large gatherings
• Eliminate your contact with those who are ill
• Good sleep, balanced diet, exercise
• Mindfulness/Meditation/Relaxation activities
25 Machi 2021 06:50:09
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