What is the recommended management for hospitalized patients with infection caused by human coronavirus HKU1?

Management of Human Coronavirus HKU1 in Hospitalized Patients

Primary Recommendation

There is no specific antiviral treatment for human coronavirus HKU1 infection; management consists entirely of supportive care with oxygen therapy as the primary intervention, similar to other mild-to-moderate respiratory viral infections. 1, 2, 3

Clinical Context and Disease Severity

Human coronavirus HKU1 is one of the four endemic human coronaviruses (along with 229E, OC43, and NL63) that typically cause mild, self-limiting upper respiratory tract infections like the common cold. 4, 2, 3 However, HKU1 can cause severe respiratory illness requiring hospitalization in adults:

• In one U.S. cohort, 54% of HKU1-positive adults required hospitalization, with 71% of hospitalized patients needing supplemental oxygen and 29% requiring ICU admission. 1
• Median length of hospitalization was 5 days. 1
• The infection can be fatal, particularly in patients with underlying conditions. 1

Supportive Care Management

Oxygen Therapy

• Provide supplemental oxygen to maintain SpO2 ≥94% on room air for patients with hypoxemia. 1
• Monitor oxygen saturation at least twice daily. 5
• Target SpO2 no higher than 96% if supplemental oxygen becomes necessary. 5

Respiratory Monitoring

• Monitor respiratory rate at least twice daily, as this is often the earliest sign of deterioration before oxygen desaturation occurs. 5
• Watch for increased work of breathing and signs of respiratory distress. 5

Advanced Respiratory Support

• For patients with hypoxemic respiratory failure, consider high-flow nasal cannula (HFNC) or noninvasive CPAP if they do not have immediate indication for invasive mechanical ventilation. 6, 7
• Perform tracheal intubation and invasive mechanical ventilation promptly if patients do not improve or worsen within 1-2 hours on noninvasive support. 6

What NOT to Do

Avoid Inappropriate Antibiotic Use

• Do not routinely prescribe antibiotics unless there is documented bacterial coinfection or strong clinical suspicion of bacterial superinfection. 6, 5 Despite this recommendation, 62% of HKU1-positive adults in one study received antibiotics unnecessarily. 1

Avoid Corticosteroids

• Do not administer corticosteroids to patients with HKU1 infection who do not require supplemental oxygen, as this provides no mortality benefit and causes harm. 6, 7, 5 Note that 38% of HKU1-positive adults in one study were using inhaled steroids, which may have been a risk factor. 1

No Specific Antivirals Available

• There are no specific antiviral drugs recommended or proven effective for HKU1 infection. 2, 3
• Do not use hydroxychloroquine, lopinavir-ritonavir, or other antivirals empirically, as these have no proven benefit for endemic coronavirus infections. 6, 7, 5

Infection Control Measures

• Implement standard respiratory precautions with appropriate PPE for healthcare workers. 6
• Use spatial control with designated "risk" and "clean" zones to prevent cross-contamination. 6
• Examine confirmed HKU1 patients last in the daily schedule to minimize exposure risk. 6
• Use dedicated medical equipment for infected patients. 6

Special Considerations

Risk Factors to Monitor

• History of smoking (85% of HKU1-positive adults in one study were smokers). 1
• Use of inhaled corticosteroids (38% in one study). 1
• Presence of gastrointestinal symptoms (38% reported GI symptoms in addition to respiratory symptoms). 1

Coinfection Assessment

• Check for viral coinfections, particularly influenza, which was detected in 15% of HKU1-positive adults. 1
• Perform appropriate infectious workup if clinical deterioration occurs despite supportive care. 1

Discharge Criteria

Patients can be discharged when they meet all of the following:

• Temperature returned to normal for more than 3 days. 6
• Respiratory symptoms significantly improved. 6
• No longer requiring supplemental oxygen with stable SpO2 ≥94% on room air. 6

Critical Pitfalls to Avoid

• Do not delay recognition of deterioration—respiratory rate elevation and increased work of breathing often precede oxygen desaturation. 5
• Do not delay intubation when noninvasive respiratory support fails or signs of exhaustion appear. 5
• Do not prescribe antibiotics reflexively without evidence of bacterial infection. 6, 5, 1
• Do not use corticosteroids in non-hypoxic patients with HKU1 infection. 6, 7, 5