Screening and Triaging of COVID -19

The primary objective of COVID-19 response is to:

1. Interrupt transmission

2. Rapidly identify suspected cases

3. Sort and test patients appropriately

4. Provide timely care

5. Prevent complications and mortality

Patients may receive care either:

• At a designated health facility

• At home (for mild disease)

Screening must be performed at the health facility entry point.

Infection Prevention During Screening

Health Care Workers (HCWs) must:

• Wear appropriate PPE

• Ensure patient wears a mask

• Avoid direct face-to-face positioning

• Maintain ≥ 1 meter distance

• Follow respiratory hygiene protocols

Communication Principles

During screening:

• Be respectful and compassionate

• Ensure privacy

• Ask open-ended questions

• Use language understood by the patient

• Coordinate with contact-tracing teams

• Collect collateral history from relatives when needed

Triage Principles

Triage must be rapid and based on disease severity to optimize outcomes.

Standardized triage tools should be used.

Severity classification:

1. Mild disease

2. Moderate disease (pneumonia)

3. Severe disease (severe pneumonia)

4. Critical disease – Acute Respiratory Distress Syndrome

5. Critical disease – Sepsis

6. Critical disease – Septic shock

Symptoms Associated With COVID-19

Common Symptoms

Other Non-Specific Symptoms

• Sore throat

• Nasal congestion

• Headache

• Diarrhea

• Nausea/vomiting

• Loss of smell (anosmia)

• Loss of taste (ageusia)

Special Populations

Elderly / Immunocompromised

Often atypical:

• Delirium

• Reduced mobility

• Loss of appetite

• Fatigue

• No fever

Children

Less frequently present with fever or cough.

TRIAGE BY DISEASE SEVERITY

A. Mild COVID-19

DefinitionSymptomatic patient meeting case definition without pneumonia or hypoxia

Findings

• Clear lungs

• Normal oxygen saturation

• Normal chest X-ray (if done)

B. Moderate COVID-19 (Pneumonia)

Adults / Adolescents

• Fever

• Cough

• Dyspnea

• Fast breathing

• SpO₂ ≥ 90% (room air)

Children

Cough or difficulty breathing PLUS fast breathing:

No severe pneumonia signs

Imaging (optional but helpful)Typical finding:

• Bilateral ground-glass opacities

C. Severe COVID-19 (Severe Pneumonia)

Adults

Pneumonia PLUS one:

• RR > 30/min

• Severe respiratory distress

• SpO₂ < 90% (room air)

Children

Pneumonia PLUS one:

• Central cyanosis

• SpO₂ < 90%

• Severe distress

• Inability to feed

• Lethargy/unconsciousness

• Convulsions

D. Critical Disease – Acute Respiratory Distress Syndrome (ARDS)

Onset

Within 1 week of pneumonia or worsening respiratory symptoms.

Imaging

• Bilateral lung opacities

• Not explained by cardiac failure or fluid overload

Oxygenation Impairment (Adults)

Alternative:

• SpO₂ < 80% room air

• SpO₂ < 90% despite ≥10 L/min oxygen

Oxygenation Impairment (Children)

E. Critical Disease – Sepsis

Adults

Life-threatening organ dysfunction due to infection:

Signs:

• Altered mental state

• Tachypnea

• Hypoxia

• Oliguria

• Hypotension

• Mottled skin

• Acidosis

• Elevated lactate

Children

Suspected infection + ≥2 SIRS criteria:(one must be abnormal temperature or WBC)

F. Critical Disease – Septic shock

Adults

• Persistent hypotension after fluids

• Requires vasopressors

• MAP ≥65 mmHg

• Lactate >2 mmol/L

Children

Hypotension OR ≥2:

• Altered mental status

• Bradycardia/tachycardia

• Capillary refill >2 sec

• Weak pulse

Key Monitoring Warning Signs

Patients require urgent escalation if:

• SpO₂ < 90%

• Altered consciousness

• Persistent hypotension

• Respiratory exhaustion

• Cyanosis

• Convulsions

Important Note

Severity triage classification guides management but does NOT replace confirmatory RT-PCR testing.