key: cord-0973632-20fpbnrp authors: Rezaei, Mitra; Jamaati, Hamidreza; Tabarsi, Payam; Moniri, Afshin; Marjani, Majid; Velayati, Ali Akbar title: NRITLD Protocol for the Management of Outpatient Cases of COVID-19 date: 2021-03-03 journal: Tanaffos DOI: nan sha: a213da47d6ddbd8d5c94403009058847d83799d9 doc_id: 973632 cord_uid: 20fpbnrp Despite the fact that about two years have passed since the onset of the COVID-19 pandemic, there is still no curative treatment for the disease. Most cases of COVID-19 have mild or moderate illness and do not require hospitalization. This guideline released by the National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital COVID-19 Expert Group to provide a treatment guide for outpatient management of COVID-19. To date, there has been no proven curative treatment for this virus supported by any randomized clinical trials (5) . However, various antiviral and anti-inflammatory drugs have been studied, and different and sometimes contradictory results have been reported. In the NRITLD guideline, the severity of respiratory problems in COVID-19 is classified as follows: (7) Mild: Symptomatic patients without pulmonary infiltration Moderate: Patients with pulmonary infiltration less than 50% of the lung field and at rest oxygen saturation (SpO2) ≥ Severe: Patients with one of the criteria, including a respiratory rate of ≥ 30 breaths/minute, SpO2 ≤ 93% with ambient air, or pulmonary infiltrates in more than 50% of the lung field, and not in a critical state Critical: Patient requiring critical care in an intensive care unit, with high flow oxygen, noninvasive ventilation, mechanical ventilation, and acute respiratory syndrome distress or shock. In the presence of any suspicious symptoms (e.g., fever, myalgia, arthralgia, cough, and dyspnea) or a history of contact with an affected individual, a reverse transcriptionpolymerase chain reaction (RT-PCR) test should be requested. A nasopharyngeal swab is a preferred method to obtain a specimen for testing (8) . Clinicians should consider that a single negative RT-PCR is insufficient to exclude COVID-19, especially if clinical suspicion is high. Clinicians should consider test repetition and finally might rely on compatible symptoms, exposure history, and typical computed tomography (CT) imaging features for COVID-19 diagnosis (9) . Negative RT-PCR test does not change the therapeutic management or prevention measures (i.e., isolation). In the case of mild illness and SpO2 1 of 94 or higher, other laboratory tests, such as C-reactive protein (CRP), complete blood count (CBC), and ferritin, should be avoided. Serological testing (e.g., immunoglobulin M and Immunoglobulin G) has no place except in special cases (10) . Any individual suspected of COVID-19 with any of the following conditions should undergo a chest imaging examination: 1 In this instruction, oxygen saturation refers to SpO2 at rest, sitting, and room air. -Feeling shortness of breath -Arterial SpO2 of 93 or less -Fever persistence for 5 days or more -Those at higher risk for disease progression: Underlying heart or lung disease, diabetes mellitus, hypertension, body mass index of >30, sickle cell disease, transplant recipients, chronic renal failure, and individuals over 60 years of age. The most sensitive modality is a lung CT scan (11) , and it is recommended to undergo a low-dose spiral lung CT scan as the preferred examination. In symptomatic immunocompromised individuals, especially if they are hypoxic or febrile, a CT scan of the lungs should be performed, and a normal chest X-ray should not be relied upon. The CT scans in mild cases (SpO2 of 94 and above without shortness of breath) should be avoided. Additionally, the routine use of CT scan as a screening test among asymptomatic cases is highly deferred (12, 13) . -In the case of pulmonary involvement below 50%, if OR -In the case of lung involvement below 50%, even if SpO2 is above 93; however, there is a very high suspicion of hypoxia in the following days 2 (7, 10, 14, 15). : (7, 10, 16) -Remdesivir injection at home is not recommended. -Kaletra® (lopinavir/ritonavir) is not recommended. -Hydroxychloroquine is not recommended. -Colchicine is not recommended. -Prednisolone and dexamethasone are not recommended in cases without hypoxia. -In the absence of evidence of secondary bacterial infection, antibiotics (e.g., azithromycin and levofloxacin) are not recommended. -Sofosbuvir/daclatasvir is not recommended. -There is no evidence that Ivermectin is effective. -Aspirin and anticoagulants are not recommended without other indications. -Interferon beta is not recommended, especially in severe cases or in the second week of the illness. -Prescribing vitamins (e.g., C and D), zinc, and other supplements have no effect. We recommend against the start of Remdesivir after the 10 th day of the onset of symptoms. For candidates of outpatient remdesivir therapy, the following combination is recommended: (7) to more than five times the upper limit of normal (ULN) or if there was an increase in ALT level to more than three times the ULN consistent with the signs or symptoms of liver inflammation (i.e., nausea, vomiting, weakness, or anorexia). A Novel Coronavirus from Patients with Pneumonia in China The required confronting approaches Management of Outpatient Cases of COVID-19 efficacy and time to control COVID-19 outbreak in Iran The current COVID-19 situation. Iran profile Severe Covid-19 NRITLD Protocol for the Management of Patients with COVID-19 Admitted to Hospitals COVID-19) Treatment Guidelines. 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