Published by Department of Health & Family Welfare, Govt of West Bengal
LABORATORY CONFIRMED COVID 19 PATIENT
1. All asymptomatic patients.
2. Comorbid patients with no
symptoms (prioritise to control the
comorbid state)
3. Mild symptoms (low fever, dry
cough, anosmia, ageusia,
weakness, diarrhea, myalgia etc)
with
 No comorbidity
 Low fever (<100.4 F)
 No signs of respiratory distress
 Normal SpO2
 Normal mental status, systolic
BP > 100 mmHg and
Respiratory rate < 22/min
HOME ISOLATION/ SAFE HOME
 MONITOR: Temp, Pulse, BP, SpO2,
Sensorium
 Preferable Investigations: CBC,
CRP, D-Dimer
 ECG, CBG, Serum Creatinine: as
required
 Supportive Management
 Mask, Hand Hygiene, Physical
distancing, droplet precaution
 PARACETAMOL (if fever/bodyache)
 Vit C ● Laxative (if required)
 Inhalational BUDESONIDE 800
mcg twice daily for 5 days if fever
persists for more than 5 days
and/ or distressing cough.
 Systemic Steroids should NOT be
used routinely in mild cases.
Following therapy should be used in
high risk patients:
 Monoclonal antibody therapy
(Cocktail of Casirivimab and
Imdevimab): 600 mg each single
dose (NOT MUCH EFFECTIVE AGAINST
OMICRON)
 Molnupiravir: 800 mg (four 200-
mg capsules) orally every 12
hours for 5 days (TO BE USED
WITHIN 5 DAYS)
Warning Signs
 Difficulty in breathing
 Persistent Fever/ High grade fever/
Recurrence of Fever
 Palpitations
 Chest pain/ Chest tightness
 Severe Cough
 Any new onset symptoms
 SpO2 <95% ( Room Air)
 CRP > 5 times of ULN
 D-Dimer > 2 times of ULN
 NLR > 3.13
 Or, as advised by physician
specially in High-Risk Group
Admit the patient at Covid Ward/
HDU/ ICU
Symptomatic patientswith the following co- Symptomatic patients (irrespective of comorbid
morbidities conditions) with any of the following signs:
 Age > 60 yrs  Fever > 100.4 F
 DM  Respiratory rate > 22/ min
 HTN /IHD  Systolic BP <= 100 mmHg
 COPD/Chronic lung disease  SpO2 <95%
 Immuno-compromised state  Respiratory distress
 Immunosuppressive drugs  Chest pain
 CKD  Change in mental status
 Chronic Liver Disease  Cyanosis
 Obesity
No oxygen requirement or Oxygen requirement >10 L/min
Oxygen requirement <10 L/min
COVID WARD HDU/ ICU
Pneumonia (LRTI) Pneumonia (LRTI) WITH RESPIRATORY SUPPORT
WITHOUT respiratory failure (RR> 24
 HFNC if work of breathing is HIGH
respiratory failure /min,
(Fever/ cough/ SpO2 < 95% on room air,  A cautious trial of NIV /CPAP with full face
dyspnea & SpO2 PaO2 < 60 mmHg) mask/ oronasal mask
≥95% on room air,  Consider Intubation if work of breathing is
PaO2 > 60 mmHg &
RED FLAG SIGNS high/ NIV is not tolerated
RR< 24/min)
1. SBP<100
 Lung protective ventilation strategy by
2. Altered sensorium
ARDS net protocol
RED FLAG SIGNS 3. Raised Troponin-I /
1. NLR > 3.13 CPK-MB  Prone ventilation in refractory Hypoxemia
2. CRP > 5 times of 4. P:F ratio <200
ULN 5. Sepsis/ Septic Shock STEROID
7. Multi Organ
3. D-Dimer > 2 times  Dexamethasone 0.2 to 0.4 mg/kg for at
of ULN Dysfunction Syndrome
least 5-10 days
8. Rapidly increasing
Oxygen Demand
ANTICOAGULATION
Prophylactic dose of UFH or LMWH (e.g.
ANTIPYRETICS: Paracetamol for fever
Enoxaparin 0.5 mg/kg BD SC), if not at high
OXYGEN SUPPORT
 Target SpO2 ≥ 95% (≥90% in pts. with COPD) risk of bleeding (consider UFH if CrCl<30)
 appropriate Oxygen delivery device (cannula / Face
ANTIVIRAL
mask/ non-re-breathing face mask)
Antiviral agents are less likely to be
 Conscious proning may be used in whom hypoxia
beneficial at this stage; use of Remdesivir
persist despite use of high flow oxygen. (position
to be decided on case to case basis, Not to
change at every 1-2 hours)
th
start after 10 days of symptom onset
STEROID
 Dexamethasone 0.1 to 0.2 mg/kg for at least 5-10 /Test date
days
TOCILIZUMAB may be considered on a case
ANTICOAGULATION
 Prophylactic dose of UFH or LMWH (Enoxaparin to case basis after shared decision making
40mg/ day SC)
MONOCLONAL ANTIBODY THERAPY (Cocktail of
ANTIBIOTICS should be used judiciously as
Casirivimab and Imdevimab): 600 mg each per Antibiotic protocol
ANTIVIRAL INVESTIGATIONS
 REMDESIVIR: to be decided on case to case basis. Not to Essential investigations along with Cultures
start after 10th days of symptom onset /Test date
(Blood / Urine), FBS, PPBS, CBC, CRP,
 MOLNUPIRAVIR: 800 mg (four 200-mg capsules)
Ferritin, D-Dimer, Trop-T/ Quantitative
orally every 12 hours for 5 days (NOT TO BE USED IN
PATIENTS WITH O2 THERAPY) Troponins, Procalcitonin, Coagulation
Profile, HRCT Thorax.
ANTIBIOTICS
(Antibiotics should be used judiciously as per Antibiotic
SUPPORTIVE MEASURES
protocol)
MONITORING • Maintain euvolemia
 CBC, CRP, D-Dimer: 48-72 hourly • Sepsis/septic shock: manage as per
 LFT, KFT: 48-72 hourly protocol and antibiotic policy
 Trop T, ECG, Coagulation Profile • Sedation and Nutrition therapy along with
 HRCT Chest/ CXR - PA as per existing guidelines (FAST HUG)
 Change in oxygen requirement, Work of breathing,
Hemodynamic instability