Management of Low-Risk COVID-19

Supportive Care

The British Medical Journal recommends that patients with low-risk COVID-19 avoid lying on their back as this makes coughing ineffective, and use simple measures first, including honey for patients aged over 1 year, and consider short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution for distressing cough, and controlled breathing techniques including positioning, pursed-lip breathing, and breathing exercises may help 1
Patients should drink fluids regularly to avoid dehydration, with no more than 2 liters per day, and be aware that fever is typically most common around five days after exposure to infection 1
Treatment escalation plans should be put in place as patients may deteriorate rapidly and need urgent hospital admission, and discuss risks, benefits, and possible outcomes of treatment options with patients and their families, and document any advance care plans or advance decisions to refuse treatment 1
Patients should be instructed on who to contact if symptoms worsen, such as a national health service hotline 1
Older patients or those with comorbidities, frailty, impaired immunity, or reduced ability to cough are more likely to develop severe pneumonia, and patients may deteriorate rapidly, requiring close monitoring and prompt escalation of care when needed 1

The Clinical and Molecular Hepatology society notes that the effects of immunosuppression on COVID-19 development have not been fully established, and for immunosuppressed COVID-19-negative patients, no adjustment of immunosuppressant dose is necessary in advance, and steroids or immunosuppressants can be used when potential benefits outweigh risks for immunosuppressed COVID-19-positive patients 2, 3
Consider minimizing high-dose steroids while maintaining sufficient dose to avoid adrenal insufficiency, and in cases of pneumonia aggravation, lymphopenia, and persisting fever, consider reducing or discontinuing azathioprine or mycophenolate, and calcineurin inhibitors may be reduced but should not be discontinued 2, 4
Patients should minimize hospital visits to decrease infection risk, and non-emergency procedures should be postponed for COVID-19 positive patients, and consider remote medical support when possible 2, 4

The Military Medical Research journal recommends that discharge criteria include two consecutive negative RT-PCR tests from respiratory tract samples, temperature returned to normal for more than 3 days, respiratory symptoms significantly improved, and significant absorption of pulmonary chest lesions on CT imaging 5

Do not use combinations of three or more antiviral drugs simultaneously, as recommended by the Military Medical Research journal 6