Prevmed Main Handout April 2024 PDF

TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch sin...

TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. o Peritoneal Dialysis for End stage Renal Disease o Colon and Rectum Cancer o Premature and Small Newborn o Children with Developmental Disabilities o Children with Mobility Impairment o Children with Visual Disabilities o Children with Hearing Impairment o purchasing of services (the payment or allocation of resources to health service providers) SDG RELATED • Following the United Nations Sustainable Development Goals (SDG), PhilHealth has established medical packages for members diagnosed with or undergoing procedures o Outpatient malaria o Outpatient HIV-AIDS o Anti-TB through DOTS o Animal bite o Voluntary surgical contraception procedure SUPPLEMENT: NBB: NO BALANCE BILLING • No other fees or expenses shall be charged or be paid by the indigent patients above and beyond the packaged rates during their confinement period • NBB PATIENTS o Indigents o Sponsored o Domestic worker or Kasambahay o Senior Citizen o Lifetime members CURRENT UPDATES ON PHILHEALTH PHILEALTH EXPANDS HEMODIALYSIS PACKAGE • Members with chronic kidney disease (CKD) stage V can now avail 156 sessions of hemodialysis from 90. In one patient, three sessions normally per week, multiply that to 52 weeks = 156 sessions. This means that their requirement per week for the whole year shall be covered by Philhealth. Dr. Virata PHILHEALTH INCREASES COVERAGE FOR ACUTE STROKE • Increasing prevalence of stroke cases nation-wide • Ischemic stroke: Php76,000 from Php28,000 • Hemorrhagic stroke Php90,100 from Php32,000 PHILEALTH TO TEST NEW PAYMENT SCHEME FOR PRIMARY CARE PROVIDERS • From “frontloading scheme” that uses reimbursement mechanism, Philhealth will now move to a service-level agreement. A “capitation fee” of 500 and 750 per year for every registered patient will be allotted to a public health facility and private clinics, respectively. • Capitation is a payment arrangement used in the healthcare industry wherein a set amount for each eligible member is given to a provider to cover a period of time, whether or not that person seeks care services. The new payment scheme will be implemented to prevent financial losses from fraudulent claims and ghost memberships. Dr. Virata PHILHEALTH LAUNCHES OUTPATIENT MENTAL HEALTH BENEFITS PACKAGE • Includes consultations, diagnostic follow-up, psychoeducation, and psychosocial support • ≥10 years old • General mental health services: Php9,000 • Specialty mental health services: Php16,000 HEALTH FINANCING • According to the WHO, it is the core function of health systems that can enable progress towards universal health coverage by improving effective service coverage and financial protection. • Common problems: o People do not access services due to the cost o People receive poor quality of services even when they pay out-of-pocket • WHO’s approach to health financing focuses on core functions: o revenue raising (sources of funds, including government budgets, compulsory or voluntary prepaid insurance schemes, direct out-of-pocket payments by users, and external aid) o pooling of funds (accumulation of prepaid funds on behalf of some or all of the population) Figure: Influence of health financing in achieving UHC (adapted from WHO 2019) PHILIPPINE CONTEXT • Health financing system in the country is complex as it involves different layers of financial sources, regulatory bodies and health service providers • Four main sources of financing: o national and local government o social health insurance through PhilHealth o user fees/out of pocket: still biggest source of funds in PH o donors • UHC Law introduces reforms to the 3 main health financing functions: revenue collection and resource generation, pooling, and purchasing • In the past years, increases in government resources for health have been driven by “sin tax” collections HEALTH MAINTENANCE ORGANIZATIONS • HMO or Health Maintenance Organization: healthcare delivery system that most employees are entitled to use as part of the benefit they receive from their employers. • Enable individuals to receive a wide range of medical help for a fraction of a price since it’s subsidized by their employers • HMO membership can be used along with PhilHealth. • As of November 2022, there are a total of 29 HMOs registered under the Insurance Commission of the Department of Finance. If one will be confined, PhilHealth will partially cover bills from anywhere (about 15-30%). The remaining balance will then be paid by the HMO. Dr. Tan COVID-19 MICROBIOLOGY • A zoonotic disease caused by SARS-CoV-2, previously known as novel coronavirus 2019 (nCoV) • Positive sense, single-stranded enveloped RNA virus belonging to the family Coronaviridae. • Transmission o By respiratory droplets, though aerosolization is possible (especially indoors/prolonged exposure, areas with poor ventilation). o Lower risk transmissions: § Fomites § Viral shedding by asymptomatic people o Some are super-spreaders, which may be due to inherent characteristics (e.g., their speech generates aerosol, loud speaking, etc.). o Mass gatherings especially indoors in smaller spaces or with poor ventilation appear to enhance transmission. o Stool shedding is also described later in the disease, but its role in the spread of the disease is still uncertain • Incubation: 2-14 days; Mean is 4-5 days. o Omicron allegedly faster at 1-2 days • Viral titers are highest in the earliest phases of infection, 1-2 days before the onset of symptoms, and then in the first 4-6 days of illness in patients without immunosuppression. • Continuous rapid evolution of the SARS-CoV-2 may be attributed to the inherent infidelity of RNA viruses that generate random mutations and the millions of daily infections. TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 41 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. SYMPTOMS MOST COMMON • Fever • Cough (dry) • Fatigue LESS COMMON • Myalgia • Pharyngitis (or other respiratory symptoms) • Headache • GI including diarrhea • Conjunctivitis • Loss of taste or smell • Rash (chilblains, discoloring on fingers/toes) • • • • • SERIOUS / WARNING SYMPTOMS Shortness of breath Chest pain / pressure Confusion Lethargy Cyanosis Note that symptoms of Omicron infection may be milder, resembling a URTI, in both immunized and unimmunized but still capable of producing a severe infection. VARIANT CLASSIFICATION CRITERIA European Centre for Disease Prevention and Control as of June 29, 2023 CRITERIA Genetic changes predicted/known to impact virus characteristics: transmissibility, virulence, immune evasion, therapeutics, detectability VUM* VUI* VOC* Yes Yes (Weak) (LowMod) (ModHigh) Yes Yes Yes Unclear Possible Likely No Yes Yes N/A No Yes Yes Strength of evidence Predicted growth advantage in the EU/EEA Predicted EU/EEA epi impact (increases in cases or other measure) ECDC risk assessment to be undertaken Risk assessment confirms with moderate/high certainty any of • increased severity • risk of healthcare system compromise • reduced vaccine effectiveness *ECDC and WHO utilize three categories of variant classification to communicate increasing levels of concern about a new or emerging SARSCoV-2 variant: variant under monitoring (VUM), variant of interest (VOI) and variant of concern (VOC). DE-ESCALATED VARIANTS OF CONCERN (VOC) https://www.ecdc.europa.eu/en/covid-19/variants-concern WHO label Alpha Beta Epsilon Gamma Delta Eta Kappa Lambda Mu Theta Zeta Omicron* Country first detected United Kingdom South Africa United States of America Brazil India Nigeria India Peru Colombia Philippines Brazil South Africa and Botswana Year and Month First Detected September 2020 September 2020 September 2020 December 2020 December 2020 December 2020 December 2020 December 2020 January 2021 January 2021 January 2021 November 2021 MNEMONIC: US-IBS United Kingdom – Alpha variant South Africa – Beta variant India – Delta variant Brazil – Gamma variant South Africa – Omicron variant COVID-19 CASE DEFINITIONS DOH Department memorandum No 2022-0501. Interim Revised Case Definitions for COVID-19. October 13, 2022 COVID-19 SUSPECT A. Meets either clinical OR epidemiological criteria EPIDEMIOLOGICAL CLINICAL CRITERIA CRITERIA • Acute onset of fever AND cough OR • Acute onset of ANY THREE OR MORE of the following signs or symptoms: • Contact of a probable or o fever, cough, general confirmed case or linked to weakness / fatigue, a COVID-19 cluster OR headache, myalgia, sore throat, coryza, dyspnea, anorexia / nausea/ vomiting, diarrhea, altered mental status. • B. A patient with suspect, probable, or confirmed severe acute respiratory illness (SARI) as defined in the Philippine Integrated Disease Surveillance and Response (PIDSR) Manual of procedures OR • C. A person: o With neither clinical signs or symptoms NOR meeting epidemiologic criteria, AN o With a positive professional use OR self-test SARSCOV-2 rapid antigen test. COVID-19 PROBABLE • A patient who meets the clinical criteria AND is a contact of a probable or confirmed case, or epidemiologically linked to a cluster of cases which had had at least one confirmed identified within that cluster • A suspect case with chest imaging showing findings suggestive of COVID-19 disease. Typical chest imaging findings include (Manna, 2020): o Chest radiography: hazy opacities, often rounded in morphology, with peripheral and lower lung distribution o Chest CT: multiple bilateral ground glass opacities, often rounded in morphology, with peripheral and lower lung distribution o Lung ultrasound: thickened pleural lines, B lines (multifocal, discrete, or confluent), consolidative patterns with or without air bronchograms • A person with recent onset of anosmia (loss of smell), ageusia (loss of taste) in the absence of any other identified cause • Death, not otherwise explained, in an adult with respiratory distress preceding death AND who was a contact of a probable or confirmed case or epidemiologically linked to a cluster which has had at least one confirmed case identified with that cluster COVID-19 CONFIRMED • A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms. ✓GUIDE QUESTIONS Michael recently tested positive on COVID-19 RT-PCR test. He denies any COVID-19 symptoms such as cough, colds, and difficulty of breathing. What is his classification? A. COVID-19 suspect B. COVID-19 probable C. COVID-19 confirmed D. For repeat COVID-19 testing Answer: C Patient already had a laboratory confirmation of COVID-19. Regardless of his symptoms, he is already classified as COVID-19 confirmed. Dr. Virata DIAGNOSTIC TESTING Dr. Virata Omicron had ~20 lineages / additional mutations that became variants of concern from November 2021 to January 2022. However, as of January 2023, all of these variants have been de-escalated from the VOC list As of January 2023, there are SARS-CoV-2 variants meeting the VOC Criteria. However, it is still important for us to discuss this since this has been asked in previous exams. NUCLEIC ACID AMPLIFICATION TESTS (NAAT) • Commonly used method of NAAT testing is Reverse transcription polymerase chain reaction (RT-PCR) • Remains to be the gold standard in testing for SARS-COV-2 • Nasopharyngeal (NP) swab specimen is the norm. Other samples used include nasal, oropharyngeal, saliva, and lower respiratory samples. Dr. de la Rosa TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 42 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. ANTIGEN TESTING • Tests detect viral proteins, e.g., SARS-CoV-2 spike protein. • Sensitivity is lower than in molecular tests (ranging from 5090% in studies); however, the advantage is a quick turnaround time, usually < 15 minutes. • Detects high viral loads, typically occurring with the onset of symptoms until day 7. ANTIBODY TESTING • Serologic testing, higher chances of false-positives • Not recommended as the sole basis for diagnosis. • Do not equate with an "immunity passport" if positive • Unclear at what level they may equate with protective immunity. • May be used to support a clinical diagnosis if a patient has a high likelihood of infection but negative viral RNA testing PHILIPPINE TESTING PROTOCOLS DOH Department Memorandum 2022-0043 September 13, 2022 Who is being tested? Those eligible for COVID-19 medications, especially A2 (senior citizens), A3 (individuals with comorbidities and immunocompromised), and at high risk for disease Why is testing being done? For clinical management Recommended repeat testing of severely immunocompromised upon completion of isolation Asymptomatic close contact and not high risk Confirming COVID-19 after exposure to positive case OPTIONAL Mild symptoms/ suspect case and not high risk Confirming COVID-19 after onset of symptoms OPTIONAL Who is being tested? Why is testing being done? A1 or Health Care Workers Surveillance to plan for adequate health system capacity YES National sampling for genomic surveillance YES Should you test? Remarks Antigen test when symptomatic RT-PCR to confirm negative test and to send for WGS RT-PCR necessary for Surveillance VACCINATION CATEGORY / SUBGROUP PRIORITY ELIGIBLE A A1. Workers in Frontline Health Services A2. All Senior Citizens A3. Persons with Comorbidities A4. Frontline personnel in essential sectors, including uniformed personnel A5. Indigent Population PRIORITY ELIGIBLE B B1. Teachers, Social Workers B2. Other Government Workers B3. Other Essential Workers B4. Socio-demographic groups at significantly higher risk other than senior citizens and poor population based on the NHTS-PR B5. Overseas Filipino Workers B6. Other Remaining Workforce PRIORITY ELIGIBLE C C. Rest of the Filipino population not otherwise included in the above groups Remarks Antigen when symptomatic; Confirming COVID-19 to know if investigational drugs can be given SURVEILLANCE TESTING CHDs, LHOs / LESUs, Hospitals Should you test? YES RT-PCR as confirmatory if antigen negative Quarantine, except if vaccinated with at least primary series; RTPCR test preferred or for active surveillance Isolate immediately (Prefer home isolation and teleconsult) Antigen when symptomatic; RTPCR as confirmatory if antigen negative or if for active surveillance Why is there a need to prioritize? To decrease mortality and preserve the health system capacity of the country (DOH) Mas naging priority ang mga higher ang chances of mortality if infected with the virus saka ang healthcare workers na makakatulong magaugment ng healthcare system. Due to the limited supply of COVID-19 vaccines globally, the country has utilized a prioritization framework with guidance from the World Health Organization and advice from various experts and technical working groups. Dr. de la Rosa and Dr. Tan VACCINES • Multiple vaccines available for primary series worldwide. Two doses needed for individual to be completely immunized (except for Janssen) • Initial high efficacy of 94-95% for the mRNA vaccines are now lower due to the Delta and Omicron variants; however, remain effective in reducing hospitalization or death from COVID-19. • Booster doses are recommended for ages ≥ 12 years, which improves vaccine efficacy against the Omicron variant. o Booster doses given 3 months after completing the primary series (2 months only for Janssen) o FDA has fully approved Pfizer/BioNTech for two doses and Moderna COVID-19 for two doses. Booster doses are also approved for Pfizer ages ≥ 12 yrs. o Pfizer now has a EUA for children ≥ 6 months of age in the US. o In the Philippines, 2nd booster already open for A1, A2, A3 including the pediatric population 12 to 17 years old (both immunocompromised and non-immunocompromised, either homologous or heterologous as of September 2022). The following COVID-19 vaccines with approved EUAs issued by the Philippine FDA are indicated for use as 2nd booster doses: § Pfizer § Moderna § Sinovac § Sinopharm § AstraZeneca • As of June 22, 2023, the DOH starts inoculating priority groups such as HCWs and the elderly with bivalent vaccines as third booster dose against COVID-19. TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 43 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. COVID-19 VACCINES Vaccine Brand Doses Eligible Age Groups Interval Primary series (twodose) 5 years and above 3 weeks (21 days) Contraindications 12-17 years: Pfizer Adults: 3 months after primary dose Booster Pfizer BioNTech Comirnaty mRNA Oxford AstraZeneca / ChAdOx1S[recombinant] VAXZEVRIA Viral vector (nonreplicating) Sinovac / CoronaVac Inactivated virus Gamaleya Sputnik V Viral vector (non-replicating) Gamaleya Sputnik Light Viral vector (non-replicating) Johnson and Johnson Janssen Viral Vector Moderna Spikevax mRNA 12 years and above Immunocompromised 12-17 years: 28 days after primary dose 5 months after primary dose Booster (bivalent) 12 years and above 12 years and above: 4-6 months from last dose of COVID-19 Pfizer Bivalent and COVID-19 vaccine primary dose Primary series (twodose) 18 years and above 4-12 weeks Booster 18 years and above 3 months after primary dose Primary series (twodose) 6 years old and above 4 weeks (28 days) Booster 18 years and above 3 months after primary dose 18 years and above 3-6 weeks (21-42 days) Primary series (single dose) 18 years and above N/A Booster 18 years and above 2 months after primary series Primary series (single dose) 18 years and above N/A Booster Primary series (twodose) Booster 18 years and above 12 years and above 6-11 years (not yet being implemented) 18 years and above Hypersensitivity to any of the component of the Pfizer vaccine Patients who have experienced major venous and/or arterial thrombosis in combination with thrombocytopenia following vaccination with any COVID19 vaccine. Hypersensitivity to any of the component of the AstraZeneca vaccine Primary series (twodose) 2 months after primary series 4 weeks (28 days) Brand of First Booster Hypersensitivity to any of the component of the Sinovac vaccine Pregnant and lactating women Hypersensitivity to any of the component of the Sputnik V vaccine Pregnant and lactating women Hypersensitivity to any of the component of the Sputnik Light vaccine Hypersensitivity to any of the component of the Janssen vaccine 18 years and above: Pfizer Moderna 12 years and above: Pfizer (indicated for individuals who have previously received at least a primary vaccination course against COVID-19) Astrazeneca Pfizer Moderna Gamaleya Sputnik Light Janssen Sinovac Astrazeneca Pfizer Moderna Gamaleya Sputnik Light Janssen AstraZeneca Pfizer Moderna AstraZeneca Pfizer Moderna Janssen Janssen AstraZeneca Pfizer Moderna 12-17 years: Pfizer Hypersensitivity to any of the component of the Moderna vaccine 3 months after primary dose 18 years and above: Moderna AstraZeneca Pfizer Gamaleya Sputnik Light Janssen Pregnant and lactating women Sinopharm Inactivated virus Primary series (twodose) 18 years and above 21 to 28 days With uncontrolled epilepsy and other progressive nervous system diseases, and individuals with a history of Guillain-Barre syndrome Hypersensitivity to any of the component of the Sinopharm vaccine Sinopharm AstraZeneca Moderna Pfizer Janssen *All vaccines above have EUA. SUPPLEMENT MOLNUPIRAVIR • Oral prodrug of beta-D-N4-hydroxycytidine (NHC), a ribonucleoside • Given EUA for treatment of adults with mild to moderate COVID-19 who are within 5 days of symptom onset, who are at high risk of progressing to severe disease (eg,. never received a COVID-19 vaccination, older people, immunodeficiency, and with chronic comorbidity.) • Comes in a 200mg capsule with a recommended regimen of 800mg (4 capsules) to be taken twice a day for 5 days • Contraindicated among pregnant, children and breastfeeding patients o People who engage in sexual activity that may result in conception should use effective contraception during and following treatment with molnupiravir TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 44 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. MASKING, QUARANTINE, AND ISOLATION PROTOCOLS DOH Department Memorandum 2022-0324 July 23, 2023 Confirmed COVID-19 positive case with mild symptoms OR individuals with acute respiratory symptoms • No need to quarantine; and • Wear a well-fitted face mask for 10 days • Home isolation for 5 days OR until afebrile / fever free for at least 24 hours without using antipyretics and with improvement of respiratory symptoms, whichever is earlier; and wear a well fitted face mask for 10 days Confirmed COVID-19 positive case with moderate to severe symptoms OR immunocompromised* • Isolation for at least 10 days from onset of signs and symptoms following advice of the attending physician, including whether to be admitted in a health care facility; and wear a well-fitted face mask for 10 days Asymptomatic close contact exposed to confirmed COVID-19 positive individual Asymptomatic but confirmed COVID-19 positive case Note: Isolation may be shortened upon the advice of your healthcare provider Note: For severe disease and immunocompromised, discontinue isolation only upon the advice of your healthcare provider. *Immunocompromised includes (1) individuals receiving active chemotherapy for cancer; (2) Being within one year out from receiving a hematopoietic stem cell or solid organ transplant; (3) Untreated HIV infection with CD4 <200; (4) Primary Immunodeficiency; (5) Taking immunosuppressive medications (e.g. drugs to suppress rejection of transplanted organs or to treat rheumatologic conditions such as mycophenolate and rituximab); (6) Taking more than 20mg a day of prednisone for more than 14 days; (7) The degree of immunocompromise is determined by the health care provider, and preventive actions are adapted to each individual and situation. Repeat RT-PCR testing shall also be recommended for this group upon completion of the recommended isolation period. If results turn out negative, they may be discharged from isolation. If results turn out positive, they shall be referred to an Infectious Disease Specialist who may issue clearance and discharge if warranted. UPDATED PROTOCOLS ON MINIMUM PUBLIC HEALTH STANDARDS DOH Department Memorandum No. 2022-0324 JULY 23, 2023 PROTOCOLS FROM TO • Required in healthcare facilities, medical transport vehicles, and public transportation. Masking • Mask wearing recommended for o Elderly o Individuals with comorbidities o Immunocompromised individuals o Pregnant women o Unvaccinated individuals; and o Symptomatic individuals Minimum Public Health Standards Vaccination • Good hygiene, frequent hand washing, observance of physical distancing, and good ventilation For Health Facilities • While no longer mandated, the DOH recommends retention of the mandatary use of masks in health facilities. Infection Prevention and Control Committees (IPCC) of health facilities can choose to retain mandatory masking and issue specific guidelines applicable to their facilities. • For all other stationary or mobile healthcare providers without IPCC, DOH still recommends masking to be continued. For public transportation • Wearing masks is no longer mandatory but not prohibited. • Mask wearing still recommended especially in crowded or poorly ventilated public spaces for: o Elderly o Individuals with comorbidities o Immunocompromised individuals o Pregnant women o Unvaccinated individuals; and o Symptomatic individuals • Good hygiene, frequent hand washing and good ventilation; especially in situations where close interaction with vulnerable populations cannot be avoided such as the elderly populations, those with comorbidities and immunocompromised individuals • Recommended *The DOH reiterates that neither repeat testing (showing a negative COVID-19 test) nor requiring medical certificates are required for resumption of work or entrance to school. Note: Use decongestants with caution in individuals ✓GUIDE QUESTIONS with elevated blood pressure or hypertension Based on the new guidelines, how many days should Michael Antihistamines (e.g., first-generation undergo home isolation antihistamines such as Chlorpheniramine maleate; A. No need for home isolation Itchy throat second generation antihistamines such as B. Only wear a well-fitted face mask for 10 days Cetirizine, Loratadine) C. Home isolation for 5 days Note: Antihistamines may cause sleepiness D. Home isolation for 10 days Throat lozenges, Gargle, and mouthwash* (e.g., E. Until 24 hours with use of antipyretics. Sore throat Answer: C Hexetidine, Povidone-Iodine gargle) Since he is asymptomatic but tested positive on COVID-19. He needs to Nausea or Antiemetics (e.g., Bismuth subsalicylate, undergo home isolation for 5 days OR until afebrile WITHOUT the use vomiting Metoclopramide) of antipyretics AND wear a well fitted face mask for 10 days. Oral rehydration salts, Anti-diarrheals (e.g., Dr. Virata Loperamide) Note: Loperamide can be used by patients without fever or bloody stools Non-pharmacological supportive management • Provide adequate nutrition and appropriate rehydration • Provide psychosocial support and counsel patients about signs and symptoms of complications that should prompt urgent care *While not recommended by the PSMID COVID-19 Living CPG as adjunctive treatment for COVID-19, these drugs might be of benefit for symptomatic relief only. Diarrhea MANAGEMENT Common COVID-19 Symptoms Fever or chills Muscle or body aches Headache Dry Cough Productive Cough Nasal itching or sneezing Congested or runny nose Medicines for Symptomatic Relief (Supportive Treatment Only) Antipyretic (e.g., Paracetamol) Analgesics/ Pain Ibuprofen*) reliever (e.g., Paracetamol, Antitussive/ Cough suppressants (e.g., Dextromethorphan, Butamirate citrate, Levodropropizine) Expectorant (e.g., Guaifenesin, Lagundi*) Mucolytic (e.g., N-acetylcysteine, Carbocisteine) Antihistamines (e.g., first generation antihistamines such as Chlorpheniramine maleate; second generation antihistamines such as Cetirizine, Loratadine) Note: Antihistamines may cause sleepiness Saline nasal spray* Decongestants (e.g., Drugs containing Phenylephrine, Phenylpropanolamine) COVID-19 IN PREGNANCY • Pregnant or recently pregnant individuals have higher chances of severe illness • Other factors can further increase the risk for getting very sick from COVID-19 during or recently after pregnancy, such as: • People who have COVID-19 during pregnancy are also at increased risk for complications that can affect their pregnancy and developing baby. For example, COVID-19 during pregnancy increases the risk of delivering a preterm (earlier than 37 weeks) and/or a stillborn infant. TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 45 of 77