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the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials (5, 6). There are few data on the clinical presentation of COVID-19 in specific populations, such as children and pregnant women. In children with COVID-19 the symptoms are usually less severe than adults and present mainly with cough and fever, and coinfection has been observed (7, 8). Relatively few cases have been reported of infants confirmed with COVID-19; those experienced mild illness (9). There is currently no known difference between the clinical manifestations of COVID-19 pregnant and non-pregnant women or adults of reproductive age. Pregnant and recently pregnant women with suspected or confirmed COVID-19 should be treated with supportive and management therapies, as described below, taking into account the immunologic and physiologic adaptations during and after pregnancy. 1. Screening and triage: early recognition of patients with SARI associated with COVID-19 Screening and triage: Screen and isolate all patients with suspected COVID-19 at the first point of contact with the health care system (such as the emergency department or outpatient department/clinic). Consider COVID-19 as a possible etiology of patients with acute respiratory illness under certain conditions (see Table 1). Triage patients using standardized triage tools and start first-line treatments. Remark 1: Although the majority of people with COVID-19 have uncomplicated or mild illness (81%), some will develop severe illness requiring oxygen therapy (14%) and approximately 5% will require intensive care unit treatment. Of those critically ill, most will require mechanical ventilation (2, 10). The most common diagnosis in severe COVID-19 patients is severe pneumonia. Remark 2: Early recognition of suspected patients allows for timely initiation of appropriate IPC measures (see Table 3). Early identification of those with severe illness, such as severe pneumonia (see Table 2), allows for optimized supportive care treatments and safe, rapid referral and admission to a designated hospital ward or intensive care unit according to institutional or national protocols. Remark 3: Older patients and those with comorbidities, such as cardiovascular disease and diabetes mellitus, have increased risk of severe disease and mortality. They may present with mild symptoms but have high risk of deterioration and should be admitted to a designated unit for close monitoring. Remark 4: For those with mild illness, hospitalization may not be required unless there is concern about rapid deterioration or an inability to promptly return to hospital, but isolation to contain/mitigate virus transmission should be prioritized. All patients cared for outside hospital (i.e. at home or non-traditional settings) should be instructed to manage themselves appropriately according to local/regional public health protocols for home isolation and return to a designated COVID-19 hospital if they get worse (https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infectionpresenting-with-mild-symptoms-and-management-of-contacts). Table 1. Definitions of SARI and surveillance case definitions for COVID-19* Surveillance case definitions for COVID19* Suspect case See latest WHO case definitions for suspect case of COVID-19* Confirmed case A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms. * See Global Surveillance for human infection with coronavirus disease (COVID-19) for latest case definitions. 3 Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance Table 2. Clinical syndromes associated with COVID-19 Mild illness Patients uncomplicated upper respiratory tract viral infection may have non-specific symptoms such as fever, fatigue, cough (with or without sputum production), anorexia, malaise, muscle pain, sore throat, dyspnea, nasal congestion, or headache. Rarely, patients may also present with diarrhoea, nausea, and vomiting (3, 11-13). The elderly and immunosuppressed may present with atypical symptoms. Symptoms due to physiologic adaptations of pregnancy or adverse pregnancy events, such as dyspnea, fever, GI-symptoms or fatigue, may overlap with COVID19 symptoms. Pneumonia Adult with pneumonia but no signs of severe pneumonia and no need for supplemental oxygen. Child with non-severe pneumonia who has cough or difficulty breathing + fast breathing: fast breathing (in breaths/min): < 2 months: ≥ 60; 2–11 months: ≥ 50; 1–5 years: ≥ 40, and no signs of severe pneumonia. Severe pneumonia Adolescent or adult: fever or suspected respiratory infection, plus one of the following: respiratory rate > 30 breaths/min; severe respiratory distress; or SpO2 ≤ 93% on room air (adapted from 14). Child with cough or difficulty in breathing, plus at least one of the following: central cyanosis or SpO2 < 90%; severe respiratory distress (e.g. grunting, very severe chest indrawing); signs of pneumonia with a general danger sign: inability to breastfeed or drink, lethargy or unconsciousness, or convulsions (15). Other signs of pneumonia may be present: chest indrawing, fast breathing (in breaths/min): < 2 months: ≥ 60; 2–11 months: ≥ 50; 1–5