What is the appropriate management for an adult patient presenting with a dry cough due to human coronavirus HKU1 infection?

Management of Dry Cough in Human Coronavirus HKU1 Infection

For adults with dry cough from coronavirus HKU1 infection, treatment is entirely supportive with symptomatic management, as this is a self-limiting viral upper respiratory infection with no specific antiviral therapy available. 1, 2

Initial Assessment and Risk Stratification

The primary goal is to determine whether the patient can be managed at home or requires hospitalization based on oxygen requirements and severity of symptoms. 3

• Monitor for red flags requiring hospital evaluation: fever with respiratory distress, oxygen saturation <94%, respiratory rate >30/min, or inability to maintain adequate hydration 3
• Most HCoV-HKU1 infections are mild and self-limiting, affecting both upper and lower respiratory tracts without requiring hospitalization 2
• Assess for high-risk features: advanced age, cardiac disease, chronic respiratory disease, diabetes, or immunosuppression that may predict progression to severe disease 3, 4

Home Management for Mild Cases (No Oxygen Requirement)

Non-Pharmacological First-Line Measures

• Start with honey to suppress cough if not contraindicated (most effective simple measure) 1
• Ensure adequate hydration to help thin mucus secretions 1
• Position patient sitting upright rather than lying flat, as this makes coughing more effective and relieves breathlessness 1
• Implement pursed-lip breathing and forward-leaning posture with arms bracing a chair to improve ventilatory capacity 1

Pharmacological Options for Persistent Distressing Cough

• Use paracetamol (acetaminophen) for fever and symptom relief rather than NSAIDs 1
• Consider short-term codeine linctus or codeine phosphate tablets for distressing cough that interferes with sleep or daily function 1

Infection Control at Home

• Isolate in a well-ventilated single room (strong recommendation) 3
• Maintain at least 1 meter distance from other household members 3
• Wear a medical mask when coughing or sneezing, or cover with tissue/bent elbow, and clean hands immediately afterward 3
• Clean and disinfect household surfaces daily with 500 mg/L chlorine-containing disinfectant 3
• Avoid sharing personal items (toothbrush, towels, tableware, bedding) 3

Monitoring and Follow-Up

• Perform daily monitoring of symptoms, temperature, and clinical status by healthcare personnel through phone or face-to-face visits 3
• Return immediately if symptoms worsen or fail to improve within 7-10 days, particularly if developing shortness of breath, persistent fever beyond 3-5 days, or chest pain 1
• Watch for secondary bacterial infection indicated by worsening after initial improvement, which may require antibiotic therapy and can be distinguished by elevated C-reactive protein and procalcitonin 1

Hospital Management (If Oxygen Required)

If the patient develops hypoxemia or respiratory distress requiring supplemental oxygen, management escalates significantly:

• Provide supplemental oxygen to maintain saturation ≥94% 3, 5
• Administer dexamethasone 6 mg daily for patients requiring oxygen (reduces mortality by 3%) 3, 5
• Initiate prophylactic anticoagulation with low molecular weight heparin 3, 5
• Consider high-flow nasal cannula or CPAP for hypoxemic respiratory failure before intubation 3, 5

Critical Pitfalls to Avoid

• Do NOT use corticosteroids in patients not requiring oxygen, as there is no benefit and potential harm 3, 5
• Do NOT prescribe antibiotics without evidence of bacterial coinfection, as HCoV-HKU1 is viral and antibiotics provide no benefit 3
• Do NOT delay hospital evaluation if breathlessness develops, as this can create an anxiety-breathlessness cycle and may indicate progression to pneumonia 1
• Do NOT use hydroxychloroquine, lopinavir-ritonavir, or azithromycin, as these have no proven benefit and may cause harm 3, 5

Expected Clinical Course

• Most infections resolve within 7-10 days with supportive care alone 1, 2
• HCoV-HKU1 incidence peaks in winter months and has a global median incidence of 0.9% among respiratory infections 2
• Diagnosis is typically by RT-PCR from nasopharyngeal samples if confirmation is needed, though treatment remains supportive regardless 2