Publication: Pragmatic recommendations for identification and triage of patients with COVID-19 in low- And middle-income countries
Issued Date
2021-03-01
Resource Type
ISSN
14761645
00029637
00029637
Other identifier(s)
2-s2.0-85102832460
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Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
American Journal of Tropical Medicine and Hygiene. Vol.104, No.3 (2021), 3-11
Suggested Citation
Lia M. Barros, Jennifer L. Pigoga, Sopheakmoniroth Chea, Bhakti Hansoti, Sarah Hirner, Alfred Papali, Kristina E. Rudd, Marcus J. Schultz, Emilie J. Calvello Hynes Pragmatic recommendations for identification and triage of patients with COVID-19 in low- And middle-income countries. American Journal of Tropical Medicine and Hygiene. Vol.104, No.3 (2021), 3-11. doi:10.4269/ajtmh.20-1064 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77321
Research Projects
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Title
Pragmatic recommendations for identification and triage of patients with COVID-19 in low- And middle-income countries
Other Contributor(s)
Hopital Calmette
University of Washington Medical Center
University of Colorado School of Medicine
University of Colorado Hospital Denver
Mahidol University
Nuffield Department of Medicine
Johns Hopkins Medicine
University of Pittsburgh School of Medicine
University of Cape Town
University Medical Center Amsterdam
Division of Pulmonary and Critical Care Medicine
University of Washington Medical Center
University of Colorado School of Medicine
University of Colorado Hospital Denver
Mahidol University
Nuffield Department of Medicine
Johns Hopkins Medicine
University of Pittsburgh School of Medicine
University of Cape Town
University Medical Center Amsterdam
Division of Pulmonary and Critical Care Medicine
Abstract
Effective identification and prognostication of severe COVID-19 patients presenting to healthcare facilities are essential to reducing morbidity and mortality. Low- and middle-income country (LMIC) facilities often suffer from restrictions in availability of human resources, laboratory testing, medications, and imaging during routine functioning, and such shortages may worsen during times of surge. Low- and middle-income country healthcare providers will need contextually appropriate tools to identify and triage potential COVID-19 patients. We report on a series of LMIC-appropriate recommendations and suggestions for screening and triage of COVID-19 patients in LMICs, based on a pragmatic, experience-based appraisal of existing literature. We recommend that all patients be screened upon first contact with the healthcare system using a locally approved questionnaire to identify individuals who have suspected or confirmed COVID-19. We suggest that primary screening tools used to identify individuals who have suspected or confirmed COVID-19 include a broad range of signs and symptoms based on standard case definitions of COVID-19 disease. We recommend that screening include endemic febrile illness per routine protocols upon presentation to a healthcare facility. We recommend that, following screening and implementation of appropriate universal source control measures, suspected COVID-19 patients be triaged with a triage tool appropriate for the setting. We recommend a standardized severity score based on the WHO COVID-19 disease definitions be assigned to all suspected and confirmed COVID-19 patients before their disposition from the emergency unit. We suggest against using diagnostic imaging to improve triage of reverse transcriptase (RT)-PCR–confirmed COVID-19 patients, unless a patient has worsening respiratory status. We suggest against the use of point-of-care lung ultrasound to improve triage of RT-PCR–confirmed COVID-19 patients. We suggest the use of diagnostic imaging to improve sensitivity of appropriate triage in suspected COVID-19 patients who are RT-PCR negative but have moderate to severe symptoms and are suspected of a false-negative RT-PCR with high risk of disease progression. We suggest the use of diagnostic imaging to improve sensitivity of appropriate triage in suspected COVID-19 patients with moderate or severe clinical features who are without access to RT-PCR testing for SARS-CoV-2.