Management of Patients with COVID-19

Target Audience: General internists, family practitioners, emergency department physicians, hospitalists, intensivists, infectious disease specialists, and pulmonary specialists

Background and Objective

Since its first identification in Wuhan, China, in January 2020, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has so far infected more than 50 million individuals and caused more than 1.2 million deaths worldwide, and the numbers are still soaring.

Now, three major organizations — the WHO, the Infectious Diseases Society of America (IDSA), and the NIH — have coincidently, but independently, published updated guidelines on the management of patients with SARS-CoV-2-infection (COVID-19), reflecting the rapidly increasing knowledge and emerging evidence from completed studies. All three guidelines were developed by panels of experts using evidence-based assessment methods.

The continuously updated NIH guideline is the most comprehensive of the three publications, giving guidance for various management situations, including special populations and investigational treatments, whereas the WHO and IDSA guidelines focus more on treatment issues of the most widely discussed agents, primarily remdesivir and corticosteroids.

Key Recommendations

• All three guidelines advise against the use of chloroquine, hydroxychloroquine, lopinavir/ritonavir, or azithromycin for the treatment of COVID-19 patients.

• The IDSA and NIH guidelines recommend 5 days of remdesivir for patients on supplemental oxygen, but not for those on mechanical ventilation or extracorporeal membrane oxygenation.

• The NIH guideline suggests coadministration of remdesivir and dexamethasone for patients with severe disease as well as for those on noninvasive ventilation and those who were recently intubated.

• The WHO guideline recommends against the use of remdesivir in any situation.

• All three guidelines agree that dexamethasone at a dose of 6 mg once daily (or an equivalent corticosteroid) should be administered to hospitalized critically ill patients with requirement for oxygen supplementation or ventilation (noninvasive or invasive), and they advise against its use in those with mild disease without oxygen requirement, even if hospitalized.

• The IDSA and NIH guidelines do not recommend routine use of tocilizumab, bamlanivimab, or reconvalescent plasma.