What is the management approach for upper respiratory infection due to COVID-19?

Management of Upper Respiratory Infection Due to COVID-19

For patients with upper respiratory infection due to COVID-19, supportive care with symptom management is the primary approach, with systemic corticosteroids strongly recommended only for patients requiring oxygen or ventilatory support.

Initial Assessment and Triage

Symptom Severity Assessment

• Evaluate for:
  • Respiratory distress (respiratory rate, oxygen saturation)
  • Fever level
  • Cough severity
  • Presence of dyspnea
  • Systemic symptoms (myalgia, fatigue)

Risk Stratification

• High-risk factors for disease progression:
  • Age >65 years
  • Comorbidities (cardiovascular disease, diabetes, COPD, immunosuppression)
  • Obesity
  • Unvaccinated status

Management Approach for Mild COVID-19 (Outpatient)

Symptom Management

1. Fever and Pain Management:

   • Paracetamol (acetaminophen) is preferred first-line 1
   • NSAIDs may be used for myalgia, arthralgia, or headache if no contraindications 2

2. Cough Management:

   • Encourage patients to avoid lying on their back to improve cough effectiveness 1
   • Honey for patients over 1 year of age 1
   • For distressing cough: consider short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution 1
   • Benzonatate may be helpful for cough suppression 2

3. Lower Respiratory Symptoms:

   • Guaifenesin for productive cough 2
   • For patients with asthma or reactive airway symptoms: albuterol MDI 2

4. Upper Respiratory Symptoms:

   • Non-sedating antihistamines for rhinorrhea 2
   • Nasal steroid sprays for nasal congestion 2

5. Breathlessness Management Techniques 1:

   • Controlled breathing techniques
   • Positioning (sitting upright or leaning forward with arms bracing)
   • Pursed-lip breathing (inhale through nose, exhale slowly through pursed lips)
   • Relaxation of shoulders to reduce hunched posture

6. Hydration:

   • Regular fluid intake (up to 2 liters per day) 1

General Recommendations

• Rest
• Isolation according to current public health guidelines
• Monitor for worsening symptoms
• Clear instructions on when to seek medical attention

Management of Moderate-to-Severe COVID-19 (Requiring Hospitalization)

Pharmacological Management

1. Systemic Corticosteroids:

   • Strongly recommended for patients requiring oxygen or ventilatory support 1
   • Not recommended for patients not requiring oxygen 1

2. Anticoagulation:

   • Strongly recommended for all hospitalized patients 1

3. Antiviral Therapy:

   • Remdesivir:
     • No recommendation for patients requiring supplemental oxygen 1
     • Not recommended for patients requiring invasive mechanical ventilation 1
     • For non-hospitalized patients at high risk for progression: initiate within 7 days of symptom onset, 3-day course 3

4. IL-6 Receptor Antagonists:

   • Consider for patients requiring oxygen or ventilatory support 1
   • Not recommended for patients not requiring supplementary oxygen 1

Respiratory Support

• High-flow nasal oxygen (HFNO) or continuous positive airway pressure (CPAP) for patients with hypoxemic respiratory failure without immediate indication for invasive ventilation 1

Special Considerations

Cautions and Contraindications

• Hydroxychloroquine: Strongly recommended against use 1
• Lopinavir-ritonavir: Strongly recommended against use 1
• Azithromycin: Not recommended in the absence of bacterial infection 1
• Hydroxychloroquine + Azithromycin combination: Not recommended 1
• Colchicine: Not recommended for hospitalized patients 1

Monitoring

• Regular assessment of vital signs
• Oxygen saturation monitoring
• Laboratory monitoring:
  • Hepatic function before and during remdesivir treatment 3
  • Prothrombin time before and during remdesivir treatment 3

When to Escalate Care

• Worsening respiratory status (increasing oxygen requirements)
• Development of severe dyspnea
• Persistent high fever unresponsive to antipyretics
• Altered mental status
• Inability to maintain oral hydration

Common Pitfalls to Avoid

1. Overuse of antibiotics without evidence of bacterial co-infection
2. Using corticosteroids in mild cases not requiring oxygen
3. Delaying initiation of appropriate respiratory support when needed
4. Failing to recognize deterioration requiring hospital admission
5. Using unproven or potentially harmful therapies based on anecdotal evidence

The management of COVID-19 continues to evolve as new evidence emerges. This guidance represents the current best practices based on available evidence, with emphasis on symptom management for upper respiratory infection manifestations while monitoring for disease progression.