Covid-19 Clinical Algorithm

This is for use by a non-healthcare worker

This document poses a series of questions that the ‘Caller’ (a concerned patient) will be asked by the strong. The ‘Call Centre’ operator will have a tablet computer or any other suitable device in front of him/her and all responses from the ‘caller’ will be documented.

This document will be shared with a doctor on-line (I can arrange for the medical team to provide that support, including SMST medical faculty). The doctor will evaluate and advise the ‘Call centre’ appropriately who, in turn, will instruct the ‘Caller’. On a real-time basis, the response time (from the caller making the call and receiving instruction) should not exceed 5 mins which is acceptable.

Question tree:

  1. Your Name, Address, Phone No.
  2. Your age (Text box)
  3. Your gender (Text box)
  4. Have you travelled abroad during a period upto Feb. 2019? (Y/N)
  5. Have you travelled to any state other than your home state in last 2 weeks?(Y/N)
  6. Have you come in contact with any person who has been diagnosed to be Covid-19 positive? (Y/N)
  7. Do you think you have come in contact with a person who is symptomatic but has not been tested? (Y/N)
     a. If Yes, Describe the nature of contact (We need a free text box here)
  8. Do you have fever? (Y/N)
     a. If Yes, for how many days? (We need a data box here) (Red colour will appear if the duration is less than 7 days).
  9. Are you coughing (Y/N)
     a. If Yes, do you have sputum (Y/N)
  10. Sore-throat (Y/N)
     a. If yes, do you have any difficulty in swallowing? (Y/N)
  11. Shortness of breath (Y/N)
     a. If yes, is it only on exertion, or even at rest (E/R)
  12. Have you noticed any decrease in your sense of smell? (Y/N)
    13.
  13. Have you noticed any decrease in your sense of taste? (Y/N)
    14.
  14. Any watery discharge through nose? (Y/N)
    15.
  15. Pain in your ears (Y/N)
    16.
  16. Difficulty in hearing (Y/N)
    17.
  17. Chest pain (Y/N)
    18.
  18. Fatigue (Y/N)
    19.
  19. Headache (Y/N)
    20.

Decision tree:

  • Positive response to any of the questions 4, 5 or 6 will lead to advice for self-quarantine even if all other answers are negative.
  • Positive answer to question 7, when all others are negative – Doctor will take a qualified decision.
  • Positive answer to question 8, in association with a positive response to anyone of the questions 9, 10 or 11 – Attend Fever Clinic immediately at BCRTH (specifically if fever is of less than 7 days. For fever more than 14 days, it will be a qualified medical decision).
  • Positive answer to question 8; negative answers to questions 9, 10 and 11 – see a doctor if age is >40 yrs;/wait for another day or two/take paracetamol-stay at home-drink plenty of fluids for others, except children below 5 yrs).
  • Positive answer to question 8; negative answers to questions 9, 10 & 11; but positive answer to any of the questions 12-19 – see a doctor.

Clinical examination tree (if HCW is available close to patient):

  1. Tachypnea (Respiratory Rate>25/min)
  2. Decreased O2 Saturation (Use finger pulse oximeter)
  3. Fever (Temp. >38 celsius)
  4. Congestion of Oropharyngeal mucosa (Use torch)
  5. Tonsillar enlargement (Use torch)
  6. Sinus tenderness (Gentle finger pressure 1” below lower margin of orbit at its mid-point)