COVID-19 and Influenza Exposure Prevention and Management Guidelines
All individuals should implement hand hygiene, face masks, social distancing, and room ventilation as core preventive measures against both COVID-19 and influenza, with vaccination being the single most critical intervention for reducing severe disease, hospitalization, and death. 1, 2
Prevention Strategies
Universal Preventive Measures
Hand hygiene is the cornerstone of infection prevention and should be performed using soap and water for 20-40 seconds, ensuring no areas are missed. 1 When soap and water are unavailable, alcohol-based hand sanitizers containing 60-85% alcohol provide adequate protection. 1
Face masks should be worn in indoor settings and crowded spaces to reduce transmission risk. 1 Surgical masks are appropriate for general public use, while N95 respirators are not necessary for low-risk individuals. 1
Social distancing and avoiding the "3Cs" (closed spaces, crowded places, and close-contact settings) significantly reduces exposure risk. 3, 4
Room ventilation is essential for reducing airborne transmission in indoor environments. 1
Routine surface disinfection of frequently touched objects (phones, keyboards, tablets) minimizes environmental contamination. 1
Vaccination Recommendations
Influenza vaccination is strongly recommended for all individuals, particularly those with chronic medical conditions or immunosuppression. 1 A two-dose series of high-dose influenza vaccine, administered at least one month apart, may increase seroprotection in immunocompromised patients. 1
COVID-19 vaccination should be administered according to CDC or local health authority guidelines, with full vaccination series recommended for all eligible individuals. 1 Vaccination substantially reduces the risk of medically significant illness, hospitalization, and death. 3
Pneumococcal vaccination is recommended for immunocompromised individuals to prevent co-infections. Patients not previously vaccinated should receive PCV13 followed by PPSV23 at least 8 weeks later. 1
High-Risk Population Considerations
Immunocompromised patients require enhanced protective measures including strict adherence to hand hygiene, masking, and consideration of preexposure prophylaxis where appropriate. 1, 3
Healthcare workers should use appropriate personal protective equipment (PPE) including gowns, gloves, face masks, and N95 respirators when caring for suspected or confirmed COVID-19 patients. 1
Exposure Management
Testing and Diagnosis
Individuals with suspected COVID-19 should undergo PCR testing of nasopharyngeal or respiratory secretions, which remains the gold standard for diagnosis. 1 Rapid antigen testing may be used for point-of-care diagnosis but should be confirmed with molecular testing. 1
Influenza testing should be performed via direct PCR of nasopharyngeal or respiratory secretions when influenza is suspected. 1
Post-Exposure Actions
Exposed individuals should wear masks and undergo testing regardless of vaccination status. 3 Testing should be performed if symptoms develop or after known exposure.
Symptomatic individuals should isolate for at least 5 days if infected with SARS-CoV-2, with isolation continuing until clinical improvement. 3
Treatment Approaches
COVID-19 Treatment
Remdesivir is indicated for hospitalized COVID-19 patients and non-hospitalized patients with mild-to-moderate disease at high risk for progression. 5 The recommended dosage is 200 mg loading dose on Day 1, followed by 100 mg daily maintenance doses. 5 Treatment duration is 5 days for non-ventilated patients and up to 10 days for those requiring mechanical ventilation or ECMO. 5
Symptomatic management includes paracetamol (preferred over NSAIDs) for fever and pain relief, taken only while symptoms are present. 2 Adequate hydration with up to 2 liters of fluid daily is essential. 2
Honey is first-line treatment for cough in adults, with short-term codeine or morphine sulfate oral solution reserved for distressing cough unresponsive to simple measures. 2
Corticosteroids (methylprednisolone 40-80 mg daily, not exceeding 2 mg/kg) may be considered for patients with rapid disease progression or severe illness, typically for 3-5 days. 6
Antibiotics should not be routinely prescribed unless there is clear evidence of secondary bacterial infection based on clinical justification, microbiologic workup, and inflammatory markers. 1, 6, 2
Influenza Treatment
Oseltamivir or baloxavir should be administered if influenza is confirmed, following standard treatment guidelines. 1
Monitoring Requirements
Patients require monitoring of vital signs including heart rate, pulse oximetry, respiratory rate, and blood pressure. 2 Oxygen saturation should be maintained above 94% on room air. 2
Immediate medical attention is warranted for worsening breathlessness, persistent chest pain, confusion, inability to stay awake, or oxygen saturation below 94%. 2
Nutritional support with protein-rich foods is essential, targeting energy intake of 25-30 kcal/(kg·day) and protein intake of 1.5 g/(kg·day). 6, 2
Common Pitfalls to Avoid
Do not reduce or discontinue immunomodulatory therapy in stable patients solely to prevent SARS-CoV-2 infection, as the risk of disease flare outweighs infection risk in most cases. 1
Avoid empirical antibiotic use without clinical justification, as bacterial co-infection rates are low (3.5-8%) compared to secondary infections (13-20%). 1
Do not delay necessary medical treatments for asymptomatic SARS-CoV-2 positive patients; weigh individual risks and benefits. 1
Preventive measures and vaccination work synergistically—neither alone is sufficient for optimal protection. Vaccinated individuals who neglect preventive measures have 3.77 times higher risk of requiring COVID-19 treatment. 7