Treatment Guidelines for SARS-CoV-2 Positive Patients at Al Ain Hospital General Wards

(Version 17 – Aug 16, 2021)

SARS-CoV-2 Positive Patient Presents to ED

Supp
Basic clinical assessment, vitals, labs
Pregnant / lactating patient COVID re-screening O2 Dexamethasone 6 mg PO / IV (4)
with pneumonia, consult ID / Clinical assessment for O 2 support once daily
MDT and consider remdesivir Clinical assessment for anticoagulation

Consider sotrovimab
based on criteria

Negative HRCT / CXR Positive

Asymptomatic with abnormal
inflammatory markers or Mild
Disease
No Yes Favipiravir + camostat for 7 days
Risk Factors (1)

Moderate/Severe Disease
(2) Favipiravir + Camostat for 7 Days
Asymptomatic(2) Asymptomatic Consider remdesivir criteria
Sotrovimab criteria + OR upon MDT/ID approval
Supportive care
supportive care
Important Notes:
o For admitted patients, start enoxaparin if no contraindications.

Symptomatic(2) Symptomatic (2)

o Consider NOT starting antibiotics if procalcitonin
Sotrovimab criteria + -ve and no clinical suspicion of bacterial infection.
ED Mono Pack
ED Monopack
(Favipiravir for 5 days)
(Favipiravir for 5 days)
Remdesivir Eligibility Criteria
RED: Must | Green: Any
Total score >4: Eligible
(Consider remdesivir in patients having intolerance or
contraindications to favipiravir)

COVID-19 Medications Doses and Duration Criteria Details Score

Medication Dose Duration(Days) Moderate or severe CT lung

HRCT Changes 1
COVID-19 changes
1600 mg BID for 1 day,
Favipiravir 7 Hypoxia and O2 SPo2 < 92% or PaO2 < 70 or RR > 20 +
then 600 mg bid 1
requirement supplemental O2 > 2 L
Camostat 200 mg TID 7 Age ≥ 50, DM, CAD 1
200 mg loading dose day 1 Comorbidities
COPD or CKD 1
Remdesivir 5 (1 or ≥ 1)
then 100 mg OD Active Immunosuppression 1
Inteferon beta 1b 8M IU (250 mcg) neb bid 7
Obesity BMI > 35 1
Multivitamins 1 tab daily 5-10
LDH, CRP, ferritin, LDH > 360 or CRP > 75 or ferritin > 600
Vitamin D 50,000 weekly 14 1
urea or urea > 8
 Anticoagulation in SARS-CoV-2 Positive Patients
Anticoagulation
Contraindications (CI)
 Recent or active bleeding All admitted patients should be started on weight adjusted
 Hemoglobin <80 g/L prophylactic dose enoxaparin except when meeting following
criteria for increasing enoxaparin dose.
 Platelet count <50 x 109/L
 INR >1.8 Criteria for Intermediate Dose Enoxaparin
 Coagulopathy  On supp O2 >5 L
 Dual antiplatelet therapy (relative CI – eligible if  moderate or severe (CT finding)
one of the antiplatelets can be safely stopped)
 Pregnancy (relative CI – consult OBGYN)  No contraindications to anticoagulation

Enoxaparin Prophylactic Weight-based Dosing Enoxaparin Intermediate Dose

Cr.Cl>30ml/min 0.5 mg/kg of actual body weight twice daily
Weight Enoxaparin dose Enoxaparin Therapeutic Dose
<50 kg 20 mg SC daily Cr.Cl>30ml/min
50 - 100 kg 40 mg SC daily
Weight Enoxaparin dose
100 - 150 kg 40 mg BID
> 150 kg 60 mg SC BID <100 kg 1 mg / kg / dose bid
Enoxaparin Prophylactic Renal Function based-Dosing Please consult MDT and
> 100 kg
Creatinine Clearance Enoxaparin dose clinical pharmacist
CrCl > 30 ml/min Weight-based dosing as above. Enoxaparin Renal Function Based Therapeutic Dose
Weight >50 kg, SC 30 mg daily Creatinine Clearance Enoxaparin dose
CrCl < 30 ml/min
Weight <50 kg , SC 20 mg daily CrCl > 30 ml/min Weight-based dosing as above.
Dialysis Consider UFH SC 5000 units BID CrCl < 30 ml/min 1 mg / kg / dose daily
General Information and Foot Notes
Notes:
Tocilizumab Eligibility Criteria (1) Comorbidities and risk factors: CVD, diabetes, hypertension, chronic
(Should be approved by MDT / ID) lung disease, cancer, chronic kidney disease, immunocompromised,
 Extensive or bilateral lung disease and severely ill patients obesity BMI > 30 or weight > 100 kg, age > 60 years, smoking.
(2) Symptomatic: Sore throat, myalgia, runny nose, headache, dry cough.
 Worsening of respiratory exchanges such as require non-invasive (3) Remdesivir: Patients with mild CT lung COVID19 changes do not
(> 5 L) or invasive ventilation. qualify. Consult ID for remdesivir consideration if patient is worsening on
 Laboratory parameters supportive of cytokine syndrome dual therapy. If ALT raised > 10 times the ULN, consider remdesivir
discontinuation.
 Serum IL-6 ≥ 5 X upper normal limit (4) Dexamethasone: Monitor for hyperglycemia (both in diabetic and
 Ferritin ≥ 1000 non-diabetic), hypokalemia and psychiatric manifestations. Please add
 LDH > 300 U/L POCT glucose monitoring for all patients started on dexamethasone.
(5) Camostat can be used as an alternative agent
 CRP >75 mg/dL
Significant Adverse Drug Reactions:
Favipiravir: Increased LFTs, neutropenia, increased uric acid, increased
q Dose: triglycerides, hypokalemia.
 >90kg: 800mg Remdesivir: Increased LFTs, Infusion related reaction, nausea,
 >65kg & ≤90kg: 600mg vomiting, hypotension, diaphoresis, shivering.
 >40kg & ≤65kg: 400mg Camostat: Hyperkalemia, Increased LFTs,, increased serum creatinine,
 ≤40kg: 8mg/kg thrombocytopenia, leukopenia, eosinophilia, xerostomia

Approved by clinical guide team, Al Ain Hospital