What are the CDC guidelines for managing Covid-19 in a hospital setting?

CDC Guidelines for COVID-19 Management in Hospital Settings

The CDC guidelines for managing COVID-19 in hospital settings recommend corticosteroids for patients requiring oxygen or ventilatory support, anticoagulation for all hospitalized patients, and against the use of hydroxychloroquine, lopinavir-ritonavir, and azithromycin without bacterial infection. 1, 2

Disease Classification and Initial Management

• COVID-19 severity is classified as mild, moderate, severe, or critical based on clinical presentation and oxygen requirements, with mild illness characterized by symptoms without respiratory distress, moderate illness by lower respiratory disease with SpO2 ≥94% on room air, severe illness by SpO2 <94% on room air, and critical illness by requiring ICU admission or mechanical ventilation 2

• Patients should be assessed for risk factors for disease progression and triaged accordingly, with hospitalization recommended for those with severe or critical disease 2

Pharmacological Management

Corticosteroids

• Strong recommendation for corticosteroids (dexamethasone 6 mg daily for up to 10 days) in patients requiring oxygen, noninvasive ventilation, or invasive mechanical ventilation 1, 2
• Strong recommendation against corticosteroids for patients not requiring supplementary oxygen 1, 2

IL-6 Receptor Antagonists

• Conditional recommendation for IL-6 receptor antagonist monoclonal antibody therapy (tocilizumab, sarilumab) for patients requiring oxygen or ventilatory support 1
• These should be administered to patients already receiving corticosteroids unless contraindicated 1
• Most benefit seen in patients within 24 hours of requiring ventilatory support or those at high risk of progression despite corticosteroid treatment 1

Anticoagulation

• Strong recommendation for anticoagulation in all hospitalized COVID-19 patients, though evidence quality is very low 1, 2
• Prophylactic-dose anticoagulation is recommended for patients requiring oxygen 2

Remdesivir

• No definitive recommendation for remdesivir in patients not requiring invasive mechanical ventilation 1
• Conditional recommendation against remdesivir for patients requiring invasive mechanical ventilation 1
• FDA approved for hospitalized patients and non-hospitalized patients with mild-to-moderate COVID-19 at high risk for progression 3

Medications NOT Recommended

• Strong recommendation against hydroxychloroquine for all COVID-19 patients 1
• Strong recommendation against lopinavir-ritonavir 1
• Conditional recommendation against azithromycin without bacterial infection 1
• Conditional recommendation against hydroxychloroquine and azithromycin in combination 1
• Conditional recommendation against colchicine 1
• Conditional recommendation against interferon-β 1

Respiratory Support

• Conditional recommendation for high-flow nasal cannula (HFNC) or noninvasive CPAP delivered through either a helmet or facemask for patients with hypoxemic respiratory failure without immediate indication for invasive mechanical ventilation 1

• If patients do not improve or worsen within 1-2 hours on noninvasive support, tracheal intubation and invasive mechanical ventilation should be performed promptly 1

• Target SpO2 should be maintained between 92-96% in patients without chronic lung disease 4

• Prone positioning is recommended for patients with refractory hypoxemia 5

Infection Control Practices

• Spatial control with designated "risk" and "clean" zones in the hospital is recommended to prevent cross-contamination 1

• Healthcare workers must wear appropriate PPE (tertiary protection for aerosol-generating procedures) 1

• Patients with confirmed COVID-19 should be examined last in the daily schedule to minimize exposure risk 1

• Dedicated medical equipment should be used for COVID-19 patients 1

Discharge Criteria

Patients can be discharged when meeting all the following criteria:

• Temperature returned to normal for more than 3 days 1
• Respiratory symptoms significantly improved 1
• Significant absorption of pulmonary chest lesions on CT imaging 1
• Two consecutive negative nucleic acid tests from respiratory samples (at least 24 hours apart) 1

Common Pitfalls to Avoid

• Delaying corticosteroid therapy in patients requiring oxygen 2
• Using corticosteroids in patients not requiring oxygen 2
• Routine use of antibiotics without evidence of bacterial infection 2
• Delaying intubation when non-invasive respiratory support fails 2
• Overlooking the need for anticoagulation in hospitalized patients 2
• Using hydroxychloroquine despite evidence against its efficacy 1

The guidelines emphasize a structured approach to COVID-19 management based on disease severity, with specific recommendations for pharmacological interventions, respiratory support, and infection control measures to optimize patient outcomes and reduce mortality.