Table 2.

Clinical features and management tool.

COVID like mild symptoms Stay at home and monitor vitals if able Self-quarantine 14 days if testing not feasible Avoid ER if haemodynamically stable and no clinical worsening. Supportive care till more definitive treatment recommendation	Diagnostic tests: •CBC: Lymphopaenia, thrombocytopaenia •CMP: Elevated liver function tests •Coagulation: PT/INR, D dimer •LDH, CRP; fibrinogen, ferritin, procalcitonin •Infection: viral panel, blood, urine, sputum cultures, symptom specific cultures and imaging. •Cardiac biomarkers: Troponin, BNP •Telemetry: Continuous QTc monitoring on high risk therapy or pathology •ECG to assess ischaemia, myopericarditis, QTc, rhythm •Echocardiogram if clinically indicated (symptoms, BNP troponin elevation, ECG changes, shock) •Cortisol level (if persistent hypotension) •CT chest without contrast for pneumonia evaluation, with contrast to rule out PE in suspected cases with significant D dimer elevation or atrial arrhythmias Follow-up tests: as needed •ECG: Repeat if QTc prolonging medications. •ESR, CRP, LDH, ferritin, D dimer, IL-6, procalcitonin •Troponin; NT ProBNP •Mixed/central venous saturation (daily if shock) Supportive therapy: •Supplemental oxygen to maintain oxygen saturation 90–96% •Early intubation/ARDS lung protective strategy •Avoid aerosolisation. Do not disconnect from ventilator without following the precautionary steps even during code. •Avoid unnecessary transportation; encourage bedside procedure when feasible with full PPE.
Day 1–5: Early viral prodromeSTAGE 1: Observe or Admit ifrisk factors or COVID+ and more than mild symptoms Observe at home if haemodynamically stable or admit if increased risk assessment score like SOFA, patients with comorbidities (age >65, male, hypertension, chronic disease, diabetes, immunocompromised, malignancy) or haemodynamically unstable
Day 5–10 Inflammatory pulmonary phaseSTAGE 2: Admit if: Cardiopulmonary: Increased shortness of breath, hypoxia or other unstable vitals, ECG changes, worsening labs.
Day> 9: Hyperinflammatory/cytokine releaseSTAGE 3: ICU level care Sepsis Hypoxia/ARDS Cardiac failure Multiorgan dysfunction Shock Disseminated intravascular coagulation

Abbreviations: CBC, complete blood count; CMP, complete metabolic profile; NTpBNP, N terminal pro brain natriuretic peptide; ESR, drythrocyte sedimentation rate; ICU, intensive care unit; SOFA, Sequential Organ Failure Assessment; PE, pulmonary embolism; PPE, personal protective equipment; LDH, lactate dehydrogenase; ECG, electrocardiograph; CT, computed tomography; INO, inhaled nitric oxide.