In view of the acceleration of the spread of the new coronavirus in Morocco, a reorganization of the patient care protocol would be necessary, according to health professionals. The Moroccan Society of Emergency Medicine (SMMU) and the Moroccan Society of Anesthesia, Analgesia and Resuscitation (SMAAR) have proposed a roadmap, readjusted to needs.
In a recent document consulted by Yabiladi, the two structures propose to take into account “the feared exponential increase in cases of SARS-CoV-2 contamination” to “reflect on a management strategy”. This would make it possible to “effectively control the evolution of the infection”, especially since over the last ten days, “the active cases recorded daily have increased tenfold and deaths have multiplied by 5”.
Another “important indicator of the pressure on the hospital system”, the number of cases in intensive care “continues to increase”, warn the authors of the document. As a result, they advise taking into account “the adaptation of the means available to the intensity of the viral spread and to local hospital reception capacities”.
Serological tests to follow up late identified cases of infection
In this sense, the document drafted by 27 health professionals notably covers the management of serological tests, the management of patients, symptomatic or not, as well as the strengthening of preventive measures. They recommend this form of testing in case of “initial diagnosis for symptomatic patients without signs of severity, with immediate unavailability of an RT-PCR test”.
The document emphasizes that the serology analysis should primarily target patients “followed in outpatient, private practices or clinics” or those in remote areas, in whom the symptoms are suggestive of a possible virus infection.
According to doctors, this test should also be carried out to detect antibodies in asymptomatic nursing staff, “every 15 days” or in addition to detecting contact cases. The same protocol must be followed to detect antibodies in these contact cases, “on D7 in addition to detection by RT-PCR”.
In addition, the serological test will be used by collective accommodation staff who do not show symptoms. This analysis will be initial or complementary to an identification of contact cases by RT-PCR.
Reserve hospital structures for severe cases
Regarding the patient care component, the authors of the document consider that the diagnosis and follow-up of lung lesions linked to a covid-19 infection “must be carried out as a priority within public and private hospital structures”, so that they “are sufficient on their own to make the positive diagnosis”.
In the same vein, doctors recommend a chest scan, “without injection and in low dose mode”, in the event of “suggestive respiratory symptoms, requiring hospital care, in a covid + or suspect patient”. A CT scan with injection is also recommended, “in case of secondary worsening of symptoms or in intensive care”. This protocol will not be indicated for screening asymptomatic cases.
In view of the current epidemiological situation, “the SAMU-Center 141 cannot, on its own, be the entry point for all calls and remain fully available for emergencies, in a context of strong mobilization”. Thus, they consider “necessary” to “preserve exclusively access to the capacities for taking charge of vital emergencies, serious and / or complex cases” to this service. For other cases, it will be necessary “to favor other existing circuits”, such as free numbers, civil protection services, private SAMU or town doctors.
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