What are the current National Health Service (NHS) guidelines for managing a COVID-19 positive inpatient?

From the Guidelines

The current NHS guidelines for managing COVID-19 positive inpatients recommend offering treatment with corticosteroids for patients requiring oxygen, noninvasive ventilation, or invasive mechanical ventilation, as stated in the European Respiratory Society living guideline 1. The management of COVID-19 positive inpatients is primarily focused on supportive care and targeted treatments based on disease severity.

Key Recommendations

• For patients with COVID-19 requiring oxygen, noninvasive ventilation, or invasive mechanical ventilation, corticosteroids are recommended with a strong strength of recommendation and moderate quality of evidence 1.
• IL-6 receptor antagonist monoclonal antibody therapy may be considered for hospitalized patients with COVID-19 requiring oxygen or ventilatory support, although the strength of recommendation is conditional and the quality of evidence is low 1.
• Anticoagulation is recommended for hospitalized patients with COVID-19, with a strong strength of recommendation, despite the quality of evidence being very low 1.

Therapy Considerations

• The use of hydroxychloroquine, azithromycin, colchicine, lopinavir–ritonavir, and interferon-β is not recommended for hospitalized patients with COVID-19, due to the lack of benefit and potential harm 1.
• Remdesivir may be considered for patients hospitalized with COVID-19 who do not require invasive mechanical ventilation, although no formal recommendation is made 1.
• Noninvasive ventilatory support, including high-flow nasal cannula oxygen therapy (HFNC) and continuous positive airway pressure (CPAP), may be used for patients with COVID-19 and hypoxaemic acute respiratory failure without an immediate indication for invasive mechanical ventilation 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Current NHS Guidelines for Managing COVID-19 Positive Inpatients

The current guidelines for managing COVID-19 positive inpatients in the National Health Service (NHS) are based on various studies and recommendations. Some of the key points include:

• The use of remdesivir, which has been shown to reduce mortality and improve clinical outcomes in hospitalized patients with COVID-19 2, 3, 4
• The use of corticosteroids, such as dexamethasone, which has been shown to reduce mortality in critically ill patients with COVID-19 2, 5, 4, 6
• The use of tocilizumab, which has been shown to reduce mortality in hospitalized patients with severe or critical COVID-19 2, 5, 6
• The use of prone positioning, noninvasive ventilation, and high-flow oxygen therapy in patients with hypoxemic respiratory insufficiency 5, 6
• The use of therapeutic anticoagulation in patients who do not require intensive care and have an elevated risk of thromboembolism 6
• The use of SARS-CoV-2-specific monoclonal antibodies, such as casirivimab and imdevimab, in patients with IgG-seronegativity and low-flow oxygen requirements 6
• The use of janus kinase (JAK) inhibitors in patients who need no more than low-flow oxygen 6

Treatment Recommendations

Based on the available evidence, the following treatment recommendations can be made:

• Remdesivir + dexamethasone is associated with lower mortality risk compared to dexamethasone alone in patients hospitalized for COVID-19 4
• Remdesivir is generally administered in mild-to-moderate COVID-19 patients 5
• Dexamethasone is recommended for use in critically ill COVID-19 patients 5, 6
• Tocilizumab is recommended for use in hospitalized severe/critical COVID-19 patients with elevated markers of systemic inflammation 5, 6
• Noninvasive ventilation, high-flow oxygen therapy, prone positioning, and invasive ventilation are important elements of the treatment of hypoxemic patients with COVID-19 6

Key Considerations

Some key considerations when managing COVID-19 positive inpatients include:

• Disease severity and oxygen requirements should be taken into account when making treatment decisions 3, 4, 6
• Patients with elevated risk of thromboembolism may benefit from therapeutic anticoagulation 6
• Patients with IgG-seronegativity and low-flow oxygen requirements may benefit from SARS-CoV-2-specific monoclonal antibodies 6
• Patients who need no more than low-flow oxygen may benefit from janus kinase (JAK) inhibitors 6