Management Plan for Mild COVID-19
For patients with mild COVID-19, supportive care with adequate hydration, nutrition, rest, and over-the-counter medications for symptom management is the recommended approach, with no routine need for antibiotics or antiviral therapy. 1
Definition of Mild COVID-19
Mild COVID-19 symptoms include:
- Sore throat, running nose, nasal congestion
- Anosmia (loss of smell) or dysgeusia (altered taste)
- Fatigue, generalized or local myalgia, arthralgia without clinical swelling
- Anorexia, diarrhea
- Temperature elevation (<38°C) 2
Supportive Care Recommendations
Hydration and General Measures
- Ensure adequate hydration and nutrition
- Encourage rest
- Monitor for signs of clinical deterioration 1
Symptom Management
For Fever:
- Acetaminophen (Tylenol) as first-line treatment
- Ibuprofen or other NSAIDs may also be used 3
For Cough:
- Encourage patients to avoid lying on their back as this makes coughing ineffective
- Consider honey for patients over 1 year of age
- For distressing cough, consider short-term use of:
- Codeine linctus
- Codeine phosphate tablets
- Morphine sulfate oral solution 2
For Respiratory Symptoms:
- Simple measures first, including proper positioning
- For patients with pre-existing asthma who develop respiratory symptoms, consider albuterol MDI 4
Monitoring and Follow-up
Warning Signs Requiring Medical Attention
- Temperature ≥38°C
- Subjective shortness of breath
- Tachypnea (>20 breaths/min)
- Hypoxia or cyanosis 2
Patient Education
- Instruct patients on when to seek medical attention if symptoms worsen
- Provide clear guidance on isolation protocols to prevent transmission 1
Special Considerations
Antibiotic Use
- Restrict use of antimicrobial drugs in mild-to-moderately ill patients with COVID-19, especially in those with low procalcitonin levels (<0.25 ng/mL) 2
- Avoid empiric antibiotics unless bacterial coinfection is suspected 1
Treatment Escalation Planning
- Put treatment escalation plans in place as patients may deteriorate rapidly and need urgent hospital admission
- For patients with pre-existing advanced comorbidities, document any advance care plans or advance decisions to refuse treatment 2
Common Pitfalls to Avoid
Unnecessary Antibiotic Use: Avoid prescribing antibiotics for viral infections without evidence of bacterial co-infection, as this contributes to antimicrobial resistance 2
Corticosteroid Use in Mild Cases: Avoid corticosteroids in mild cases without hypoxemia as they may increase viral shedding duration and potentially worsen outcomes 1
Off-label Use of DMARDs: The off-label use of disease-modifying antirheumatic drugs (DMARDs) outside clinical trials should be discouraged for COVID-19 treatment 2
Overlooking Deterioration: Be vigilant for signs of clinical deterioration, as patients with COVID-19 can worsen rapidly, requiring prompt hospital admission 2
By following these recommendations, healthcare providers can effectively manage patients with mild COVID-19 while monitoring for potential deterioration that would necessitate escalation of care.