Confirmed SARS-CoV-2 infection with pneumonia or comorbidities

confirmed SARS-CoV-2 infection
with pneumonia or
1st hospital admission and infection
prevention and control procedures
» Promptly admit patients with pneumonia or
respiratory distress to an appropriate healthcare
facility. Patients with impending or established
respiratory failure should be admitted to an
intensive care unit.
» Immediately isolate all confirmed cases in
an area separate from other patients, and
implement appropriate infection prevention
and control procedures. Detailed guidance is
available from the WHO and the CDC:
» [WHO: infection prevention and control during
health care when novel coronavirus (nCoV)
infection is suspected]
» [CDC: interim infection prevention and control
recommendations for patients with confirmed
2019 novel coronavirus (2019-nCoV) or persons
under investigation for 2019-nCoV in healthcare
» Report all confirmed cases to your local health
» Consider home care, if suitable, in
symptomatic patients who no longer require
plus supportive care plus monitoring
Treatment recommended for ALL patients in
selected patient group
» Immediately start supportive care.
» Oxygen: give supplemental oxygen at a rate
of 5 L/minute to patients with severe acute
respiratory infection and respiratory distress,
hypoxaemia, or shock. Titrate flow rates to reach
a target SpO₂ ≥90%.[68]
» Fluids: manage fluids conservatively in
patients with severe acute respiratory infection
when there is no evidence of shock as
aggressive fluid resuscitation may worsen
» Symptom relief: give an antipyretic/analgesic
for the relief of fever and pain.[68]
» Monitor patients closely for signs of clinical
deterioration, such as rapidly progressive
respiratory failure and sepsis, and start general
supportive care interventions as indicated
(e.g., haemodialysis, vasopressor therapy, fluid
resuscitation, ventilation, antimicrobials) as
» Some patients with severe illness may require
continued antimicrobial therapy once COVID-19
has been confirmed depending on the clinical
adjunct mechanical ventilation
Treatment recommended for SOME patients in
selected patient group
» Intubation and mechanical ventilation are
recommended in patients who are deteriorating
and cannot maintain an SpO₂ ≥90% with oxygen
therapy.[68] Some patients may develop severe
hypoxic respiratory failure, requiring a high
fraction of inspired oxygen, and high air flow
rates to match inspiratory flow demand. Patients
may also have increased work of breathing,
demanding positive pressure breathing
» High-flow nasal oxygen and non-invasive
ventilation are recommended in select patients.
Mechanically ventilated patients with acute
respiratory distress syndrome should receive a
lung-protective, low tidal volume/low inspiratory
pressure ventilation strategy. Those with
persistent severe hypoxic failure should be
considered for prone ventilation.[68]
» The risk of treatment failure is high in patients
with non-acutely reversible conditions, and there
is also concern about nosocomial transmission
with open ventilation systems and suboptimal
non-invasive face mask or nasal pillow seals.
More research to define the balance of benefits
and risks to patients and health workers is
» Some patients may require extracorporeal
membrane oxygenation (ECMO) according to
availability and expertise.[68]
» It is important to follow local infection
prevention and control procedures to
prevent transmission to healthcare workers.
Endotracheal intubation should be performed
by an experienced provider using airborne
adjunct experimental therapies
Treatment recommended for SOME patients in
selected patient group
» Consider using experimental drug therapies.
Antivirals and other drugs are being used in
patients with COVID-19; however, unlicensed
or experimental treatments should only be
administered in the context of ethically-approved
clinical trials.[68] See the Emerging section for
more information about these treatments.
without pneumonia or
1st consider home care and isolation
» Consider home care in patients who have
mild symptoms only (e.g., low-grade fever,
cough, fatigue, rhinorrhoea, sore throat), with
no warning signs (e.g., shortness of breath or
difficulty breathing, haemoptysis, increased
sputum production, gastrointestinal symptoms,
mental status changes), and no underlying
health conditions.[69] Otherwise, hospital
admission is required.
» Infection prevention and control procedures
are still important during home care.
Recommend patients use a single room and a
single bathroom (if possible), minimise contact
with other household members, and wear a
surgical mask if contact is necessary.[69]
» More detailed guidance on home care is
available from the WHO and the CDC:
» [WHO: home care for patients with suspected
novel coronavirus (nCoV) infection presenting
with mild symptoms and management of
» [CDC: interim guidance for implementing
home care of people not requiring hospitalization
for 2019 novel coronavirus (2019-nCoV)]
» The location of home care may depend on
guidance from local health authorities as forced
quarantine orders are being used in some
plus supportive care plus monitoring
Treatment recommended for ALL patients in
selected patient group
» Recommend symptomatic therapies such as
an antipyretic/analgesic, and advise patients to
keep hydrated but not to take too much fluid as
this can worsen oxygenation.[69]
» Monitor patients closely and advise them to
seek medical care if symptoms worsen as mild
illness can rapidly progress to lower respiratory
tract disease.