COVID19 Treatment Guidelines

By Katerina Papadopoulou Travel Health January 27, 2024

COVID 19 Treatment Guidelines

Current guidelines are based off February 11, 2020 CDC guidelines[1]
- Hospitalized patients should be treated in an Airborne Infection Isolation Room (AIIR) with standard contact, airborne and eye protection precautions
At present, treatment is largely supportive care for non-ICU level cases
- Fever control with antipyretics such as acetaminophen and ibuprofen
- Hydration either oral or Intravenous (IV) routes
- Respiratory support up to intubation and mechanical ventilation
- There are current studies underway for antiviral medications (see below)
Patients with a mild clinical presentation may not initially require hospitalization. Clinical signs and symptoms may worsen with progression to lower respiratory tract disease in the second week of illness[2]
Possible risk factors for progressing to severe illness may include, but are not limited to, older age, and underlying chronic medical conditions such as lung disease, cancer, heart failure, cerebrovascular disease, renal disease, liver disease, diabetes, immunocompromising conditions, and pregnancy17
In another report, the mean time from illness onset to hospital admission with pneumonia was 9 days17
20% of infected patients require hospitalization17
- 20-32% of hospitalized patients require ICU level support for respiratory problems 17
Acute respiratory distress syndrome (ARDS) developed in 17–29% of hospitalized patients, and secondary infection developed in 10%.17
Cytokine Storm concept
- Similar to features of bacterial sepsis or hemophagocytic lymphohistocytosis (HLH)[3]
- Clinical features can be tracked with C-reactive protein (CRP) and ferretin
  - Correlate with disease severity and mortality
- In one study, among critically ill patients admitted to an intensive care unit, 11% received high-flow oxygen therapy, 42% received noninvasive ventilation, and 47% received mechanical ventilation.17
- Some hospitalized patients have required advanced organ support with endotracheal intubation and mechanical ventilation (4–10%), and a small proportion have also been supported with extracorporeal membrane oxygenation (ECMO, 3–5%).17
- Other reported complications include acute cardiac injury, arrhythmia, shock, and acute kidney injury.17
- Prone ventilation for ICU/ventilated patients has been show as a promising adjunct[4]
- Lower tidal volumes of 4-8mL/kg are advised[5]
- Lower inspiratory pressures (<30 cmH20) are also advised[6]
- Patients with moderate to severe ARDS are advised to be treated with higher PEEP (positive expiratory end pressure)
- Avoid routine use of continual infusion of neuromuscular blockade agents