What are the treatment guidelines for a patient diagnosed with Covid-19?

Treatment Guidelines for COVID-19 Patients

For patients diagnosed with COVID-19, avoid routine antibiotic use and focus on symptom management, oxygen support when needed, and specific antiviral therapy with remdesivir for high-risk patients. 1

Initial Assessment and Management

Symptom Management

• Cough management:

  • Encourage patients to avoid lying on their back as this makes coughing ineffective
  • Use simple measures first: recommend honey (for patients over 1 year old)
  • For distressing cough, consider short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution 1

• Fever management:

  • Advise regular fluid intake (no more than 2 liters per day) to avoid dehydration
  • Use paracetamol for fever and other symptoms (preferred over NSAIDs)
  • Only continue antipyretics while symptoms persist 1

• Breathlessness management:

  • Recommend controlled breathing techniques:
    • Pursed-lip breathing (inhale through nose, exhale slowly through pursed lips)
    • Sitting upright to increase ventilation
    • Leaning forward with arms bracing a chair to improve ventilatory capacity
    • Relaxing shoulders to reduce hunched posture associated with anxiety 1

Oxygen Support

• For patients with hypoxemia (SpO2 <90%), provide supplemental oxygen
• Consider high-flow oxygen or non-invasive ventilation for hypoxemic respiratory insufficiency
• For severe hypoxemia or high respiratory rate, consider intubation and invasive ventilation 2

Medication Recommendations

Antiviral Therapy

• Remdesivir (VEKLURY) is recommended for:

  • Non-hospitalized patients: Start as soon as possible after diagnosis and within 7 days of symptom onset
  • For mild-to-moderate COVID-19 patients at high risk for progression: 3-day course
  • For hospitalized patients not requiring mechanical ventilation: 5-day course (may extend to 10 days if no clinical improvement)
  • For hospitalized patients requiring mechanical ventilation/ECMO: 10-day course 3

  Dosing for adults and pediatric patients ≥40kg:

  • Loading dose: 200 mg IV on Day 1
  • Maintenance dose: 100 mg IV daily from Day 2 3

Corticosteroid Therapy

• Dexamethasone is recommended for patients with severe or critical COVID-19 to decrease mortality 2

Thromboprophylaxis

• Provide prophylaxis against thromboembolism, especially for patients with:
  • Obesity
  • Known thrombophilia
  • Intensive care treatment
  • Elevated D-dimers 2
• Consider intensified prophylaxis for high-risk patients

Infection Control Measures

Personal Protection

• Implement strict droplet and contact precautions
• Use appropriate personal protective equipment (PPE) when caring for COVID-19 patients
• For aerosol-generating procedures, use N95/FFP2/FFP3 masks or higher protection 1

Patient Isolation

• Isolate confirmed COVID-19 patients for at least 5 days 4
• For patients requiring procedures:
  • Designate specific rooms and equipment for COVID-19 patients
  • Adjust schedules to allow time for decontamination between patients
  • Limit patient companions during examinations 1

Special Considerations

Diagnostic Testing

• Test all admitted patients without a recent PCR test immediately
• For patients with exposure to COVID-19:
  • Recommend testing and mask wearing
  • Test if symptomatic and isolate for ≥5 days if infected 4

High-Risk Patients

• Ensure patients understand their individual risk factors
• Prioritize vaccination and early therapeutic interventions for:
  • Older adults
  • Those with underlying medical conditions
  • Immunocompromised individuals 4

Common Pitfalls to Avoid

1. Unnecessary antibiotic use: Do not routinely prescribe antibiotics for COVID-19 patients. Base antibiotic decisions on clinical justification, disease severity, imaging, and laboratory data 1

2. Delayed antiviral treatment: Start remdesivir as soon as possible after diagnosis for eligible patients, especially high-risk individuals 3

3. Inadequate isolation measures: Failure to follow isolation protocols can lead to intra-hospital transmission 5

4. Overlooking thromboprophylaxis: COVID-19 increases thrombotic risk, particularly in critically ill patients 2

5. Neglecting non-COVID care: Ensure that patients with COVID-19 who have other medical conditions continue to receive appropriate care for those conditions

By following these evidence-based guidelines, healthcare providers can optimize outcomes for patients diagnosed with COVID-19 while minimizing transmission risk.