What are the recommended measures to protect against and treat Covid-19?

COVID-19 Prevention and Treatment Recommendations

Vaccination is strongly recommended as the primary preventive measure against COVID-19, along with hand hygiene, face masks, social distancing, and proper ventilation of rooms to reduce transmission risk. 1

Prevention Strategies

General Preventive Measures

• Hand hygiene: Enhanced hand washing and sanitizing
• Face masks: Properly worn masks covering nose and mouth
• Social distancing: Maintain physical distance from others
• Room ventilation: Ensure adequate air circulation in indoor spaces 1

Vaccination

• Primary vaccination series should be completed by all eligible individuals 1
• Booster doses provide additional protection against hospitalization, with particularly strong benefits for:
  • Adults aged ≥65 years
  • Individuals with underlying medical conditions 2, 3
• Special populations:
  • Hematological malignancy patients: Should receive full vaccination program even if previously infected with SARS-CoV-2 1
  • Hematopoietic stem cell transplant (HSCT) recipients: Should be vaccinated preferably at least 6 months after transplant if community transmission is low 1
  • Immunocompromised patients: May require assessment of antibody response 3-5 weeks after vaccination 1

Pre-exposure and Post-exposure Prophylaxis

• For high-risk immunocompromised patients:
  • Pre-exposure prophylaxis with long-acting anti-SARS-CoV-2 monoclonal antibodies is recommended for non-immunized patients at risk for severe COVID-19 1
  • Post-exposure prophylaxis with anti-SARS-CoV-2 monoclonal antibodies is recommended for high-risk patients (non-vaccinated, vaccine non-responders) 1

Treatment Recommendations

Mild COVID-19

For patients with mild symptoms, the following treatments are recommended (in order of preference):

1. Anti-SARS-CoV-2 monoclonal antibodies 1
2. Nirmatrelvir/ritonavir (Paxlovid) - oral antiviral that should be initiated within 5 days of symptom onset 4
3. Remdesivir - antiviral administered intravenously 1
4. Molnupiravir - oral antiviral 1
5. High-titer convalescent plasma (within 72 hours from symptom onset if monoclonal antibodies not available) 1
6. Inhaled IFN β-1a 1

Important note: Dexamethasone should NOT be used to treat mild COVID-19 1

Moderate COVID-19 (O₂ support, saturation >90%)

1. Remdesivir 1
2. Dexamethasone 1
3. For seronegative patients:
   • Casirivimab/imdevimab or convalescent plasma 1

Severe COVID-19 (saturation <90-94%, respiratory rate >30/min)

1. Dexamethasone - primary treatment 1
2. Remdesivir 1
3. If worsening despite dexamethasone with COVID-19-related inflammation:
   • Consider adding a second immunosuppressant:
     • Anti-IL-6 (tocilizumab, sarilumab)
     • Anti-IL-1 (anakinra)
     • JAK inhibitors (baricitinib/tofacitinib) 1

Critical COVID-19 (ARDS, sepsis, shock, mechanical ventilation)

1. Dexamethasone - cornerstone of treatment 1
2. Remdesivir 1
3. For seronegative patients on non-invasive ventilation: casirivimab/imdevimab 1
4. Add second immunosuppressant if COVID-19-related inflammation is present:
   • Anti-IL-6 (tocilizumab, sarilumab) 1

Special Considerations

Nirmatrelvir/Ritonavir (Paxlovid) Use

• Initiate as soon as possible after diagnosis and within 5 days of symptom onset
• Significant drug interactions: Review all medications before prescribing due to ritonavir's strong CYP3A inhibition
• Renal dosing adjustments required:
  • Moderate impairment (eGFR ≥30 to <60 mL/min): 150 mg nirmatrelvir with 100 mg ritonavir twice daily
  • Severe impairment (eGFR <30 mL/min): 300 mg nirmatrelvir with 100 mg ritonavir once on day 1, then 150 mg nirmatrelvir with 100 mg ritonavir once daily for days 2-5 4

Healthcare Setting Precautions

• Personal protective equipment (PPE): Healthcare workers should use appropriate PPE when caring for COVID-19 patients
• Isolation: COVID-19 positive patients should be isolated in single rooms
• Environmental cleaning: Frequent disinfection of high-touch surfaces
• Limiting exposure: Reduce traffic in patient care areas and limit personnel 1

Common Pitfalls to Avoid

1. Delaying treatment - Antivirals are most effective when started early in disease course
2. Inappropriate steroid use - Dexamethasone is not recommended for mild disease
3. Failing to assess drug interactions - Particularly with nirmatrelvir/ritonavir
4. Neglecting vaccination - Even previously infected individuals should complete vaccination
5. Overlooking special populations - Immunocompromised patients may need modified approaches to vaccination and treatment

By following these evidence-based recommendations, healthcare providers can optimize outcomes for patients with or at risk for COVID-19, focusing on reducing morbidity, mortality, and improving quality of life.