The following answers were compiled through consultation within the Wasting TWG

a. Currently, there are no separate guidelines for the treatment of COVID 19 and malnutrition and the advice is to use National/ WHO inpatient guidelines for the treatment of SAM with medical complications as well as to follow the Infection Prevention and Control (IPC) guidelines for COVID 19 in all health facilities. It is important to also consider that SAM children with complications are immunocompromised irrespective of COVID 19 infection status and high standards of infection control are always indicated.

b. Yes triage is recommended. WHO recommends in its interim guidance setting up screening and triage protocols for COVID19 at all points of access to the health system, including primary health centres, clinics, hospital emergency units, community settings and care for all suspected and confirmed COVID-19 patients. Isolation of cases is also recommended by WHO. However, considerations would need to be made before isolating cases, such a) where the child would be isolated? b) how would safe and appropriate care (nutrition treatment and COVID-19 management) be ensured? c) what would be the referral pathway if the condition of the child deteriorated?

It should also be noted that the paediatric case definition of COVID 19 is very broad (including - fever, cough, diarrhoea, poor feeding or poor appetite) and a high number of malnourished children not infected with COVID 19 may present with these symptoms. In the absence of testing, isolation of suspected cases may be challenging to implement.