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Union Health Ministry releases new Clinical Management Protocol for COVID-19, adds two new symptoms that are observed before respiratory issues

The health ministry protocol says that Real time or Conventional RT-PCR test is recommended for diagnosis. SARS-CoV-2 antibody tests are not recommended for diagnosis of current infection with COVID-19.

The Ministry of Health and Family Welfare has added two new symptoms of coronavirus in order to identify the contagious disease at an earlier stage. The two new symptoms include Anosmia-loss of smell, and Aguesia- Loss of taste. The MoHFW revealed that the symptoms have been observed before the respiratory issues occur in persons with COVID-19.

Other symptoms of COVID-19 include:

  1. Fever
  2. Cough
  3. Fatigue
  4. Shortness of breath
  5. Expectoration
  6. Myalgia
  7. Rhinorrhea, Sore throat, Diarrhoea

This was mentioned in the Clinical Management Protocol for COVID-19 issued by the health ministry today.

The protocol said that older people and immune-suppressed patients, in particular, may present with atypical symptoms such as fatigue, reduced alertness, reduced mobility, diarrhoea, loss of appetite, delirium, and absence of fever. Children might not have reported fever or cough as frequently as adults.

As per data from Integrated Health Information Platform (IHIP)/ Integrated Disease Surveillance Programme (IDSP) portal case investigation forms for COVID 19 (n=15,366), the details on the signs and symptoms reported are (as on 11.06.2020), fever (27%), cough (21%), sore throat (10%), breathlessness (8%), Weakness (7%), running nose (3%) and others 24%.

The protocol states that the persons infected by the novel coronavirus are the main source of infection. Direct person-to-person transmission occurs through close contact, mainly through respiratory droplets that are released when the infected person coughs, sneezes, or talks. These droplets may also land on surfaces, where the virus remains viable. Infection can also occur if a person touches an infected surface and then touches his or her eyes, nose, or mouth.

Most patients with COVID-19 predominantly have a respiratory tract infection associated with SARS-CoV-2 infection. However, in a small proportion of cases, they can progress to a more severe and systemic disease characterized by the Acute Respiratory Distress Syndrome (ARDS), sepsis and septic shock, multiorgan failure, including acute kidney injury and cardiac injury.

Definitions of COVID-19 cases

The protocol also defines the suspect, probable and confirmed cases of coronavirus.

Suspect cases include:
A. A patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath), AND a history of travel to or residence in a location reporting community transmission of COVID-19 disease during the 14 days prior to symptom onset;
OR
B. A patient with any acute respiratory illness AND having been in contact with a confirmed or probable COVID-19 case in the last 14 days prior to symptom onset;
OR
C. A patient with severe acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath; AND requiring hospitalization) AND in the absence of an alternative diagnosis that fully explains the clinical presentation.

The probable cases will be a suspect case for whom testing for the COVID-19 virus is inconclusive, or a suspect case for whom testing could not be performed for any reason.

While the confirmed case will mean a person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms.

Age of more than 60 years (increasing with age), and underlying non-communicable diseases like diabetes, hypertension, cardiac disease, chronic lung disease, cerebro-vascular disease, chronic kidney disease, immune-suppression and cancer are listed as the risk factors of the COVID-19.

The health ministry protocol says that Real time or Conventional RT-PCR test is recommended for diagnosis. SARS-CoV-2 antibody tests are not recommended for diagnosis of current infection with COVID-19.

In comparison to the population, the effect of the virus is very low-ICMR Chief

The Chief of Indian Council of Medical Research Dr. Balram Bhargava on Thursday revealed that according to population the effect of the virus in India is very low. He stated that “We had one lab in February and now we have over 850 labs in the country today. A total of 52,13,140 samples have been tested as of date with 1,51,808 samples tested in the past 24 hours. We do have the capacity to test up to 2 lakh cases and will ramp up testing accordingly.”

The ICMR Chief also said at the Centre’s press briefing on COVID-19 situation that India is still not experiencing neither reached the community transmission stage.

Coronavirus situation in India

As per the data of the Ministry of Health and Family Welfare, India has experienced 3,08,993 cases till so far with a surge of 11458 cases in the last 24 hours. 154330 people have been recovered from the contagious disease while 8884 people succumbed to the epidemic. Fortunately, as per MoHFW, the recovery rate in India has risen to 49 percent.

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