Covid-19 Home Care Guidelines (Kannada Version)

HOME CARE TIPS FOR MANAGING COVID-19

Covid19 Home Isolation Easy Guide

Protocol for Management of Covid - 19 in the Paediatric Age Group ( children )

Management of children with Covid – 19 disease:

Clinical Features:

Majority of children with covid infection may be asymptomatic or mildly symptomatic. Common symptoms include- fever, cough,

breathlessness/ shortness of breath, fatigue, myalgia, rhinorrhea, sore throat, diarrhea, loss of smell, loss of taste etc. Few children may

present with gastrointestinal symptoms and atypical symptoms. A new syndrome with name of multi system inflammatory syndrome has

been described in children. Such cases are characterized by: unremitting fever > 38oC, epidemiological linkage with SARS CoV – 2 and

clinical features suggestive of Multi System Inflammatory Syndrome.

Management of children with Covid – 19 disease:

Children with Covid 19 infection may be asymptomatic, mildly symptomatic, moderately sick or severe illness.

Asymptomatic children are usually identified while screening, if family members are identified. Such children do not require any treatment

except monitoring for development of symptoms and subsequent treatment according to assessed severity.

Mild disease: Children with mild disease may present with sore throat, rhinorrhea, cough with no breathing difficulty. Few children may have

gastrointestinal symptoms also.

Such children do not need any investigations

These children can be managed at home with home isolation and symptomatic treatment.

For home isolation it is important to assess whether home isolation is feasible by following steps:

• i. There is requisite facility for isolation at his/her residence and also for quarantining the family contacts

• ii. Parents or other care taker who can monitor and take care of child

• iii. If available, Arogya Setu App should be downloaded

• iv. The parents/care giver has agreed to monitor health of the child and regularly inform his/her health status to the Surveillance Officer/ doctor

• v. The parents/ care giver has filled an undertaking on self-isolation and shall follow home isolation/quarantine guidelines

Children with underlying comorbid condition including: congenital heart disease, chronic lung diseases, chronic organ dysfunction, Obesity

(BMI> 2SD) may also be managed at home, if they have features of mild disease and there is easy access to health facility in case of any

deterioration. In case there is lack of proper arrangement to manage these children at home/ access to health facility is difficult, such children

may be admitted.

Treatment of mild illness in home isolation is symptomatic.

For Fever: Paracetamol 10-15 mg/kg/dose; may repeat every 4-6 hours

For Cough: Throat soothing agents like warm saline gargles- in older children and adolescents

Fluids & feeds: Ensure oral fluids to maintain hydration, and nutritious diet

Antibiotics: Not indicated

There is No role of Hydroxychloroquine, Favipiravir, Ivermectin, lopinavir/ritonavir, Remdesivir, Umifenovir, Immunomodulators including

Tocilizumab, Interferon B 1 a, Convalescent plasma infusion or dexamethasone.

Monitoring at home: Explain parents/ care taker to maintain a monitoring chart including counting of respiratory rates 2-3 times a day when child

is not crying, looking for chest indrawing, bluish discolouration of body, cold extremities, urine output, oxygen saturation monitoring (hand held

pulse oximeter) if feasible, fluid intake, activity level, esp for young children.

There should be regular communication to doctor or health care worker. Parents/ caregiver should be explained whom to contact in case of

emergency.

Management of children with Moderate Covid – 19 disease:

A child with Covid-19 will be categorized as having moderate disease if he/ she has the following:

Rapid respiration as follows

Age: less than 2 months: respiratory rate >60/ min, Age: 2 to 12 months: respiratory rate >50/min, Age: 1 to 5 years: respiratory rate

>40/min, Age: more than 5 years: respiratory rate >30/min. And oxygen saturations above 90%.

Children with moderate Covid – 19 disease may be suffering from pneumonia which may not be clinically apparent.

Investigations: No lab tests are required routinely unless indicated by associated co-morbid conditions.

Treatment: Children with moderate Covid-19 disease should be admitted in Dedicated Covid Health Centre or Secondary level Healthcare

Facility and monitored for clinical progress. Maintain fluid and electrolyte balance. Encourage oral feeds (breast feeds in infants); if oral intake

is poor, intravenous fluid therapy should be initiated.

Children with moderate Covid – 19 disease should be administered:

i. For fever: Paracetamol 10-15 mg/kg/dose. May be repeated every 4-6 hourly. (temperature > 38oC, i.e. 100.4oF).

ii. Amoxycillin to be administered, if there is evidence/ strong suspicion of bacterial infection.

iii. For SpO2 below 94%, oxygen supplementation is required.

iv. Corticosteriods may be administered in rapidly progressive disease. It is not required in all children with moderate illness, specifically during

first few days of illness.

v. Supportive care for comorbid conditions, if any.

Management of children with Severe Covid-19 disease:

Children with SpO2 level less than 90% are categorized as having severe degree of Covid-19 infection. Such children may be having severe

pneumonia, Acute Respiratory Distress Syndrome, Septic Shock, Multi-organ dysfunction syndrome (MODS), or pneumonia with cyanosis.

Clinically, such children may present with grunting, severe retraction of chest, lethargy, somnolence, seizure.

Such children should be admitted in Dedicated Covid Hospital/ Secondary/ Tertiary level healthcare facility. Few children may required care in

HDU/ICU areas of these facilities. They should be assessed for: thrombosis, haemophagocytic lymphohistiocytosis (HLH), and organ failure.

Investigations: Complete blood counts, liver and renal function tests, Chest X-ray

Treatment

1. Intravenous fluid therapy

i. Corticosteriods: Dexamethasone 0.15 mg/kg per dose (max 6 mg) twice a day is preferred. Equivalent dose of methylprednisolone may be

used for 5 to 14 days depending on continuous clinical assessment.

ii. Anti-viral agents: Remdesivir is antiviral agent. There is lack of sufficient safety and efficacy data in children below 19 years of age.

Randomized controlled trials of this drug in patients above 18 years of age has not shown significant survival benefits. An emergency use

authorization for children has been granted. Till more data are available, it should be used in restricted manner in children with severe illness

within three days of onset of symptoms after ascertaining that child’s renal and liver functions are normal and they are monitored for side

effects of medicine. Suggested doses if body weight > 40 kg: 200 mg on 1st day then 100 mg once daily for 4 days. If body weight is between

3.5 kg to 4 kg: 5mg/kg on 1st day, 2.5 mg/kg once daily for 4 days. There is No role of Hydroxychloroquine, Favipiravir, Ivermectin,

lopinavir/ritonavir, Umifenovir.

iii. Children may need organ support in case of organ dysfunction; e.g. Renal Replacement Therapy.

iv. Management of Acute Respiratory Distress Syndrome (ARDS): The principles of treatment are similar to that of ARDS due to any other

underlying illness.

➢ Mild ARDS: High Flow Nasal Oxygenation, Non-invasive ventilation may be given.

➢ Severe ARDS: Mechanical ventilation may be given with low tidal volume (<6 mL/kg and High Positive End Expiratory Pressure).

➢ If the child does not improve clinically even then, may consider (if available) High Frequency Oscillatory Ventilation, Extracorporeal

Membrane Oxygenation (ECMO).

➢ Awake prone position may be considered in older hypoxemic children if they tolerate.

Management of Shock: If the child develops septic shock or myocardial dysfunction then he/ she may require:

➢ Crystalloid bolus administration: 10 to 20 ml/kg over 30 to 60 minutes; be cautious if cardiac dysfunction is there.

➢ Early inotrope support with monitoring of fluid overload like any other cause of shock.

Management of Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19 (MIS-C):

A new syndrome with name of multisystem inflammatory syndrome as been described in children. Such cases are characterized by:

unremitting fever > 380 C, epidemiological linkage with SARS CoV – 2 and clinical features suggestive of Multi System Inflammatory

Syndrome.

Diagnostic criteria of MISC in Children (WHO criteria): a constellation of clinical and laboratory parameters has been suggested for

diagnosis. These include:

Children and adolescents 0–19 years of age with fever ≥ 3 days

AND two of these:

Rash or bilateral non-purulent conjunctivitis or muco-cutaneous inflammation signs (oral, hands or feet).

Hypotension or shock.

Features of myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities (including ECHO findings or elevated Troponin/NTproBNP),

Evidence of coagulopathy (by PT, PTT, elevated d-Dimers).

Acute gastrointestinal problems (diarrhoea, vomiting, or abdominal pain).

AND

Elevated markers of inflammation such as ESR, C-reactive protein, or procalcitonin.

AND

No other obvious microbial cause of inflammation, including bacterial sepsis, staphylococcal or streptococcal shock syndromes.

AND

Evidence of COVID-19 (RT-PCR, antigen test or serology positive), or likely contact with patients with COVID-19.