2019 Novel Coronavirus Update - Page 3

Dexamethasone Update: Based on preliminary results of a large, multicenter, randomized, open-label trial for hospitalized patients in the United Kingdom called the RECOVERY study, “The COVID-19 Treatment Guidelines Panel (the Panel) recommends using dexamethasone (at a dose of 6 mg per day for up to 10 days) in patients with COVID-19 who are mechanically ventilated (AI) and in patients with COVID-19 who require supplemental oxygen but who are not mechanically ventilated (BI). The Panel recommends against using dexamethasone in patients with COVID-19 who do not require supplemental oxygen (AI).” Source: (NIH COVID-19 Treatment Guidelines Panel, 2020) Clinicians should refer to the Additional Considerations section in the Guidelines for further direction before prescribing dexamethasone for a patient with COVID-19. IDENTIFY, ISOLATE, AND INFORM There are several situations which increase the risk of exposure to COVID-19. You are at an elevated risk if you are: • A healthcare worker caring for patients with COVID-19 • Living, working or spending time in communities* which are highly populated and have an intense and ongoing spread of SARS CoV-2 (e.g. Florida, New York City, and Chicago) • A close contact of someone who has COVID-19, such as family member • A traveler who is returning from international location where there is community spread *You can check the case count in any U.S. community by visiting the CDC website data page, then clicking on a state and then a specific county. At risk individuals include those who: • Are 65 years of age and older - Risk increases with age, and those in their 60s and 70s are at higher risk than those in their 50s. • Are 85 years of age and older - They are at greatest risk of severe illness from COVID-19. • Have an underlying medical condition Healthcare providers must obtain a risk history for individuals being evaluated who have fever and acute respiratory illness. People with fever and symptoms of lower respiratory illness (cough or shortness of breath) should be isolated if, within the past 14 days, they have traveled to a high-risk area or have been in close contact with a confirmed infection. Isolation precautions include: • Placing a facemask on the patient • Placing them in a private room or separate area • Healthcare workers wearing appropriate personal protective equipment (PPE) Given the availability of more tests, certain groups are appropriate for testing. These groups include: • Individuals with signs and symptoms of COVID-19 • Asymptomatic individuals with known or suspected exposure to SARS-CoV-2 to control transmission • Asymptomatic individuals without known or suspected exposure to SARS-CoV-2 in special settings so they can be identified early (screening) • Those individuals being tested to determine if their infection resolved • Certain groups for public health surveillance TESTING Clinicians are encouraged to use their judgment to determine if a patient has signs or symptoms compatible with COVID-19 and whether the patient should be tested. Clinicians are encouraged to consider testing for other causes of respiratory illness, such as influenza, in addition to testing for SARS-CoV-2. Recognize that detection of one respiratory pathogen (e.g., influenza) does not exclude the potential for co-infection with SARS-CoV-2. People in vulnerable populations such as healthcare workers who have even mild symptoms should be promptly considered for testing to prevent potential transmission if they are infected. Additional information is available in the CDC’s Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19.