What will happen if you are diagnosed with COVID-19?

By hitapnews

“If you know the enemy and know yourself, you need not fear the result of a hundred battles.” This statement can be applied to any situations, even to the current COVID-19 pandemic. To prepare ourselves, everyone should have an adequate knowledge about the disease. If you are diagnosed with COVID-19 (which means the test detects SAR-CoV2), what kinds of treatments will you receive? Can people with mild symptoms recover by themselves? How to treat patients with severe symptoms? Here are the guidelines for medical practice, diagnosis, treatment and prevention of infection in hospital in case of COVID-19 created by Department of Medical Services (Revised version dated March 30th 2020)

If you are diagnosed with COVID-19, the treatments you will receive depend on severity of the symptoms and related risk factors. First of all, if you test positive, HITAP just wants you to remain calm as 80 percent of the patients with COVID-19 only have mild symptoms, the same as common cold. The ones who have severe symptoms are mostly people who have risk factors with one of the following characteristics:

- Age 60 years or older/age 5 years or younger

 - Chronic lung diseases 

- Chronic kidney disease (CKD)

- Chronic cardiovascular disease (CVD)

- Congenital heart disease

- Stroke

- Hypertension

- Diabetes

- Obesity

- Cirrhosis

- Immunocompromised
etc.

Scenario 1: If you have no symptoms
As most of the patients with COVID-19 show no symptoms, you might be hospitalised for 2-7 days. If no complications are detected, you might be transferred to designated hospital or temporary patient ward for COVID-19 for at least 14 days from date of onset. After that, if you still show no symptoms, you will be allowed to go home and asked to take extra caution, such as wearing a surgical mask, avoiding interacting with other people, or keep physical distance from others until reaching 1 month from the date of disease onset.

Scenario 2: If you have mild symptoms and no risk factors
If you have mild symptoms, have no risk factors, and your result of chest x-ray (chest radiograph) shows that your lungs are normal, the medical treatments will be as follows.

- You will receive symptomatic treatment e.g. cough medicine for coughing and antipyretics for fever, as treating for a common cold, and since this is like a cold, there is still no medicine specifically for COVID-19 treatment.

- The doctor might prescribe you with 2 kinds of medicines, which might be hydroxychloroquine or chloroquine in combination with darunavir/ritonavir, or lopinavir/ritonavir, or azithromycin for 5 days.

- You will need to be hospitalised for 2-7 days. During that period, you may barely meet doctor or nurse in order to reduce the risk of spreading the disease to medical staff as it might lead to shortage of staff for other patients.

- When the conditions have improved and chest radiograph does not become worse, the doctor might consider keeping you hospitalised, or allow you to go home if your body temperature is not over 37.8 degrees Celsius for 48 hours consecutively, your respiratory rate is not over 20 breaths per minute and etc.

- However, you still need to stay in home quarantine for 14 days, keep distance from people you are living with, and eat separately from others to ensure that the virus will not spread to others.

- After 14 days of quarantine, you should still wear surgical mask and pay extra attention to hygiene until reaching 1 month from the date of illness onset.

Scenario 3: If you have mild symptoms and risk factors
If you have the risk factors as listed earlier, the medications will be as follows. 

- The doctor will prescribe 3 kinds of medicines: hydroxychlroquine or chloroquine (twice a day) in combination with darunavir + ritonavir, or lopinavir/ritonavir in combination with Azithromycin, for the minimum of 5 days.

- If the lungs x-ray result becomes worse within 24-28 hours, favipiravir may need to be added to the regimen for 5-10 days.

Scenario 4: If you have pneumonia
If you are diagnosed with COVID-19 and the chest radiograph shows that the lungs are damaged, the treatment will depend on severity of the symptoms as detailed below.

- In case of mild symptoms, you will receive the same 3 medicines as the above scenario (scenario 3), but will also receive double dosage of hydroxychlroquine or chloroquine. If the lungs radiograpgh result worsen, favipiravir will to be added to the regimen for 5-10 days.

Scenario 5: if you have pneumonia and risk factors, or if the symptoms become more severe
If you are diagnosed with COVID-19, chest radiograph indicates that you have pneumonia, and have risk factors, or if the symptoms become more severe – presence of extrapulmonary organ dysfunction, needing respiratory support with high-flow nasal cannula (HFNC) or non-invasive ventilation (NIV), the treatment procedure will be as follows.

- You will receive 4 kinds of medications: hydroxychlroquine or chloroquine (double dosage) in combination with darunavir + ritonavir, or lopinavir/ritonavir in combination with Azithromycin, for the minimum of 10 days, along with receiving favipiravir for 5-10 days depending on the symptoms.

- You will be provided symptomatic treatment. If any ventilation is needed, the doctor will use bag-mask ventilation prior to invasive ventilation and probably give a treatment of organ support for necessity.

Nevertheless, there are only 9 percent of patients who have severe Pneumonia, and the death rates of which are only 0.97 percent in Thailand.