/COVID-19

COVID-19 BPMN Flowchart

Creative Commons Zero v1.0 UniversalCC0-1.0

COVID-19 BPMN Flowchart

Aluna Health specializes in automation and support of clinical decision making. Our goal is to help health professionals navigate medically complex situations and to facilitate collaboration between departments. To demonstrate the capability of our algorithms, we created the COVID-19 aggregated flowchart.

We used a BPMN format that provides a standard, easy-to-read way to define and analyze complex processes. It is readily understandable by clinicians, management personnel, analysts and developers, which allows for universal use of this tool across health systems. BPMN is an executable format, it can aid in medical decision making by providing the healthcare professional with a map of possible clinical options for each patient at the time a decision needs to be made.

In creating the COVID-19 workflow chart we used clinical guidelines of CDC, NIH, WHO and the emerging body of clinical research. Please see the reference list for details. Please feel free to contribute and elaborate on this flowchart.

Flowchart Cover

BPMN Diagram

Download CC-0 license

References

  1. Al-Tawfiq et al. Update on therapeutic options for Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Expert review of anti-infective therapy. 2017. 15. № 3. pp. 269–275.
  2. Alserehi H et al. Impact of Middle East respiratory syndrome coronavirus (MERS-CoV) on pregnancy and perinatal outcome. BMC Infect Dis. 2016. №16, p. 105
  3. Assiri A et al. Middle East respiratory syndrome coronavirus infection during pregnancy: areport of 5 cases from Saudi Arabia. Clin Infect Dis. 2016. № 63. pp. 951-953.
  4. Australian Government | Department of Health. COVID-19 current information.
  5. Baig A M et al. Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution,Host–Virus Interaction, and Proposed Neurotropic Mechanisms. ACS Chem. Neurosci. 2020.
  6. Bassetti M. The Novel Chinese Coronavirus (2019‐nCoV) Infections: challenges for fighting the storm.
  7. Behzadi M A et al. Overview of Current Therapeutics and Novel Candidates Against Influenza, Respiratory Syncytial Virus, and Middle East Respiratory Syndrome Coronavirus Infections. Frontiers in microbiology. 2019. № 10. p. 1327.
  8. Beloncle F et al. Approaches and Techniques to Avoid Development or Progression of Acute Respiratory Distress Syndrome. Curr Opin Crit Care 2018 Feb;24(1): 10-15.
  9. Bernheim A et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology, 2020.
  10. Carmeli Y et al. Health and economic outcomes of antibiotic resistance in Pseudomonasaeruginosa. Arch Intern Med. 1999 May 24;159(10): 1127-32.
  11. Caro L et al. Lung penetration, bronchopulmonary pharmacokinetic/ pharmacodynamic profile and safety of 3 g of ceftolozane/tazobactam administered to ventilated, critically ill patients with pneumonia. Journal of Antimicrobial Chemotherapy, 24 March 2020.
  12. CDC. Interim guidance for healthcare professionals about coronavirus (2019-nCoV).
  13. CDC. COVID-19 current information.
  14. China CDC. Diagnosis and treatment. COVID-19 Prevention and Control.
  15. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: Interim Guidance.
  16. Coronavirus cases.
  17. China CDC. Diagnosis and treatment. COVID-19 Prevention and Control.
  18. Chen N et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet, 2020.
  19. Chong Y P et al. Antiviral Treatment Guidelines for Middle East Respiratory Syndrome. Infection & chemotherapy. 2015. 47. № 3. pp. 212–222.
  20. Cinatl J et al. Treatment of SARS with human interferons. Lancet. 2003. 362. № 9380. pp. 293–294.
  21. Colson P et al. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. International Journal of Antimicrobial Agents, 2020.
  22. Cortegiani A et al. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. Journal of Critical Care, 2020.
  23. Dayer M R et al. Lopinavir; A Potent Drug against Coronavirus Infection: Insight from Molecular Docking Study. Arch Clin Infect Dis, 2017.
  24. Devaux CA et al. New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19?. Int J Antimicrob Agents. 2020 Mar 12: 105938.
  25. Dyall J. et al. Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome: Current Therapeutic Options and Potential Targets for Novel Therapies. Drugs. 2017. 77. № 18. pp. 1935–1966.
  26. European Centre for Disease Prevention and Control. An agency of the European Union. COVID-19 current information.
  27. European Commission. COVID-19 current information.
  28. Fan H H et al. Repurposing of clinically approved drugs for treatment of coronavirus disease 2019 in a 2019-novel coronavirus (2019-nCoV) related coronavirus model. Chin Med J (Engl). 2020 Mar 6.
  29. FDA. COVID-19 current information.
  30. Gao J et al. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. BioScience Trends 2020 Mar 16;14(1): 72-73.
  31. Gautret F et al. Hydroxychloroquine and azithromycin as a treatment of COVID19: results of an openlabel non-randomized clinical trial. Int J Antimicrob Agents, 2020.
  32. Gautret Ph et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents, 2020.
  33. German Federal Ministry of Health. COVID-19 current information.
  34. Gorbalenya A E et al. Severe acute respiratory syndrome-related coronavirus: The species and its viruses – a statement of the Coronavirus Study Group. 2020.
  35. GOV.UK. Coronavirus (COVID-19).
  36. Hart B J et al. Interferon-β and mycophenolic acid are potent inhibitors of Middle East respiratory syndrome coronavirus in cell-based assays. The Journal of general virology. 2014. 95. Pt 3. pp. 571–577.
  37. Huang C et al. Cinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15; 395(10223): 497-506.
  38. Infection Prevention and Control (IPC) for COVID-19 virus.
  39. Inui S et al. Chest CT Findings in Cases from the Cruise Ship “Diamond Princess” with Coronavirus Disease 2019 (COVID-19). Radiology: Cardiothoracic Imaging, 2020.
  40. Ji W et al. Cross-species Transmission of the Newly Identified Coronavirus 2019-nCoV. Journal of Medical Virology, 2020.
  41. Jeong S Y et al. MERS-CoV Infection in a Pregnant Woman in Korea. J Korean Med Sci. 2017 Oct; 32(10): 1717-1720.
  42. Junqiang L et al. CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia.
  43. Le Chang et al. Coronavirus Disease 2019: Coronaviruses and Blood Safety. Transfusion Medicine Reviews, 2020.
  44. Lee Kyung Soo. Pneumonia Associated with 2019 Novel Coronavirus: Can Computed Tomographic Findings Help Predict the Prognosis of the Disease?. Korean Journal of Radiology(2020), 21 (3): 257
  45. Li Q et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020 Jan 29.
  46. Li X et al. Potential of large 'first generation' human-to-human transmission of 2019-nCoV. J Med Virol. 2020 Jan 30.
  47. Lu H. Drug treatment options for the 2019-new coronavirus (2019-nCoV). Biosci Trends, 2020.
  48. Ludvigsson J F. Systematic review of COVID‐19 in children show milder cases and a better prognosis than adults. 2020.
  49. Lupia T. et al. 2019 novel coronavirus (2019-nCoV) outbreak: A new challenge. Journal of Global Antimicrobial Resistance Volume 21, June 2020, Pages 22-27
  50. Mandell L.A. et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clinical infectious diseases. – 2007. – Т. 44. – №. Supplement_2. – pp. S27-S72.
  51. Mao L. et al. Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: A retrospective case series study. 2020.
  52. Maude S L et al. Managing Cytokine Release Syndrome Associated With Novel T Cell-Engaging Therapies. Cancer J. 2014 Mar-Apr; 20(2): 119–122.
  53. Mehta P et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020 Mar 28; 395(10229): 1033-1034.
  54. Mo Y et al. A review of treatment modalities for Middle East Respiratory Syndrome. The Journal of antimicrobial chemotherapy. 2016. 71. № 12. pp. 3340–3350.
  55. Momattin H et al. Therapeutic options for Middle East respiratory syndrome coronavirus (MERS-CoV)-possible lessons from a systematic review of SARS-CoV therapy. Int J Infect Dis. 2013 Oct; 17(10): e7928
  56. National Health Commission of the People's Republic of China.
  57. Netland J et al. Severe Acute Respiratory Syndrome Coronavirus Infection Causes NeuronaL Death in the Absence of Encephalitis in Mice Transgenic for Human ACE2. J Virol. 2008; 82: 7264–75.
  58. NHS. Coronavirus (COVID-19).
  59. Omrani A S et al. Ribavirin and interferon alfa-2a for severe Middle East respiratory syndrome coronavirus infection: a retrospective cohort study. The Lancet Infectious Diseases. 2014. Т. 14. №. 11. pp. 1090-1095
  60. Park M H et al. Emergency cesarean section in an epidemic of the Middle East respiratory syndrome: a case report. Korean J Anesthesiol, 69 (2016), pp. 287-291.
  61. Pogue J et al. "Real World" treatment of multi-drug resistant (MDR) or extensively-drug resistant (XDR) P. aeruginosa infections with ceftolozane/tazobactam (C/T) versus a polymyxin or aminoglycoside (Poly/AG) based regimen: a multicenter comparative effectiveness study. 2018.
  62. Phan L T et al. Importation and Human-to-Human Transmission of a Novel Coronavirus in Vietnam. New England Journal of Medicine, 2020.
  63. Phylogeny of SARS-like betacoronaviruses including novel coronavirus (nCoV).
  64. Royal Pharmaceutical Society of Great Britain. Coronavirus (COVID-19). Latest updates, advice and information for pharmacy.
  65. Tang N et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost, 2020 Mar 27.
  66. The official website of the Government of Canada. COVID-19 current information.
  67. The State Council The People's Republic Of China.
  68. Touret F et al. Of chloroquine and COVID-19. Antiviral Research, 2020 May; 177: 104762.
  69. Upchurch C P et al. Community-acquired pneumonia visualized on CT scans but not chest radiographs: pathogens, severity, and clinical outcomes. Chest. – 2018. – Т. 153. – №. 3. – pp. 601-610.
  70. Villar J et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med. 2020 Mar; 8(3): 267-276.
  71. Wang L. C-reactive Protein Levels in the Early Stage of COVID-19. Med Mal Infect. 2020 Mar 31
  72. Wang Z et al. Clinical characteristics and therapeutic procedure for four cases with 2019-novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci Trends, 2020.
  73. World Health Organization. Clinical management COVID-19. Interim Guidance. 2020.
  74. World health organization. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected. Interim guidance.
  75. World health organization. Managing Ethical Issues in Infectious Disease Outbreaks. 2016.
  76. World Health Organization. WHO Blood Regulators Network (BRN). Position Paper on Use of Convalescent Plasma, Serum or Immune Globulin Concentrates as an Element in Response to an Emerging Virus*. September 2017.
  77. Wu P et al. Real-time Tentative Assessment of the Epidemiological Characteristics of Novel Coronavirus Infections in Wuhan, China, as at 22 January 2020. Euro Surveill, 2020.
  78. Xiao A et al. Ceftolozane/tazobactam Pharmacokinetic/Pharmacodynamic-Derived Dose Justification for Phase 3 Studies in Patients With Nosocomial Pneumonia. J Clin Pharm, 2016.
  79. Yuan M et al. Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China. PLoS ONE, 2020.
  80. Zhang J et al. Therapeutic and triage strategies for 2019 novel coronavirus disease in fever clinics. Lancet Respir Med, 2020.
  81. Zhang L et al. Potential Interventions for Novel Coronavirus in China: A Systematic Review. J Med Virol, 2020.
  82. Zhang W et al. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from China. Clin Immunol, 2020 May.
  83. Zumla A et al. Coronaviruses - drug discovery and therapeutic options. Nature reviews Drug discovery. 2016. 15. № 5. pp. 327–347.