COVID-19 Management in Hospital Settings

Disease Classification and Initial Management

The CDC recommends classifying COVID-19 severity as mild, moderate, severe, or critical based on clinical presentation and oxygen requirements, with mild illness characterized by symptoms without respiratory distress, moderate illness by lower respiratory disease with SpO2 ≥94% on room air, severe illness by SpO2 <94% on room air, and critical illness by requiring ICU admission or mechanical ventilation 3
Patients should be assessed for risk factors for disease progression and triaged accordingly, with hospitalization recommended for those with severe or critical disease 3

The European Respiratory Society recommends strong use of corticosteroids (dexamethasone 6 mg daily for up to 10 days) in patients requiring oxygen, noninvasive ventilation, or invasive mechanical ventilation 1, 2
The European Respiratory Society recommends against corticosteroids for patients not requiring supplementary oxygen 1, 2
The European Respiratory Society conditionally recommends IL-6 receptor antagonist monoclonal antibody therapy (tocilizumab, sarilumab) for patients requiring oxygen or ventilatory support 1, 4, 5
The European Respiratory Society strongly recommends anticoagulation in all hospitalized COVID-19 patients, though evidence quality is very low 1, 2
The European Respiratory Society conditionally recommends against remdesivir for patients requiring invasive mechanical ventilation 1, 2
The European Respiratory Society strongly recommends against hydroxychloroquine for all COVID-19 patients 1, 2, 6
The European Respiratory Society strongly recommends against lopinavir-ritonavir 1, 2
The European Respiratory Society conditionally recommends against azithromycin without bacterial infection 1, 2
The European Respiratory Society conditionally recommends against colchicine 1, 2
The European Respiratory Society conditionally recommends against interferon-β 1, 2

The European Respiratory Society conditionally recommends high-flow nasal cannula (HFNC) or noninvasive CPAP delivered through either a helmet or facemask for patients with hypoxemic respiratory failure without immediate indication for invasive mechanical ventilation 1, 2
Tracheal intubation and invasive mechanical ventilation should be performed promptly if patients do not improve or worsen within 1-2 hours on noninvasive support 7

Spatial control with designated "risk" and "clean" zones in the hospital is recommended to prevent cross-contamination 8
Healthcare workers must wear appropriate PPE (tertiary protection for aerosol-generating procedures) 8
Patients with confirmed COVID-19 should be examined last in the daily schedule to minimize exposure risk 8
Dedicated medical equipment should be used for COVID-19 patients 8

Patients can be discharged when meeting all the following criteria: temperature returned to normal for more than 3 days, respiratory symptoms significantly improved, significant absorption of pulmonary chest lesions on CT imaging, and two consecutive negative nucleic acid tests from respiratory samples (at least 24 hours apart) 7