COVID-19 Treatment Guidelines

Disease Severity Assessment

The American Thoracic Society recommends classifying patients into mild, moderate, severe, or critical illness based on symptoms, oxygen requirements, and imaging findings 2, 1
Mild illness is characterized by a variety of symptoms without respiratory distress or abnormal imaging, as defined by the Journal of Microbiology, Immunology and Infection 2
Moderate illness is evidenced by lower respiratory disease with SpO2 ≥94% on room air, according to the Journal of Microbiology, Immunology and Infection 2
Severe illness is indicated by SpO2 <94% on room air, PaO2/FiO2 <300 mmHg, respiratory rate >30 breaths/min, or lung infiltrates >50%, as stated by the Journal of Microbiology, Immunology and Infection 2
Critical illness requires ICU admission, mechanical ventilation, or presents with septic shock, as defined by the Journal of Microbiology, Immunology and Infection 2

The American College of Physicians recommends initiating treatment as soon as possible after diagnosis and within 7 days of symptom onset for high-risk patients with mild-to-moderate COVID-19 1
Anti-SARS-CoV-2 monoclonal antibodies are recommended for high-risk outpatients with mild to moderate disease, especially for unvaccinated individuals or those with impaired immune response, as stated by the American College of Physicians 1
Nirmatrelvir/ritonavir can be considered as an oral antiviral option for outpatient treatment, according to the American College of Physicians 1
Molnupiravir may be considered when other options are unavailable, as recommended by the American College of Physicians 1
Home isolation for an appropriate duration based on local health department guidelines is recommended for patients not at high risk for disease progression, as stated by the Military Medical Research 3

The American Thoracic Society recommends remdesivir for hospitalized patients, with a 5-day course for non-ICU patients and a 10-day course for ICU patients 1
Dexamethasone 6 mg daily for up to 10 days is recommended for patients requiring supplemental oxygen, as stated by the American College of Physicians 1
Thromboprophylaxis with anticoagulation is recommended as per guidelines, according to the American College of Chest Physicians 4, 1
Continue patient's antiplatelet therapy if previously prescribed for conditions like stroke and add prophylactic-dose LMWH, as recommended by the American College of Chest Physicians 4

The American Thoracic Society recommends a 10-day course of remdesivir for patients requiring mechanical ventilation and/or ECMO 1
Dexamethasone 6 mg daily for up to 10 days is recommended for critically ill patients, as stated by the American College of Physicians 1
Consider IL-6 inhibitors when condition deteriorates dramatically, according to the Military Medical Research 5, 6
Early endotracheal intubation and invasive mechanical ventilation should be performed promptly if oxygenation index <150 mmHg within 1-2 hours, as recommended by the Military Medical Research 5, 6

The Infectious Diseases Society of America recommends avoiding routine prescription of antibiotics in COVID-19 patients, except when clinically justified 2
Base antibiotic decisions on clinical justifications, disease manifestations, severity, imaging, and laboratory data, as stated by the Infectious Diseases Society of America 2
Perform comprehensive microbiologic workup before administering empirical antibiotics to facilitate adjustment or discontinuation, according to the Infectious Diseases Society of America 2

The American College of Physicians recommends discharge criteria, including temperature returned to normal for >3 days, significant improvement in respiratory symptoms, and significant absorption of pulmonary lesions on CT imaging 5, 6, 3
Home quarantine for 2 weeks after discharge with PCR tests at 2 and 4 weeks post-discharge is recommended, as stated by the Military Medical Research 5, 6, 3
Patients retesting positive should be isolated again, according to the Military Medical Research 5, 6

The American Heart Association recommends considering therapeutic-dose parenteral anticoagulation regardless of CHA2DS2-VASc score for patients with new-onset atrial fibrillation and COVID-19 4
The American Psychiatric Association recommends establishing early warning mechanisms for adverse mental states and providing psychosocial support for convalescent patients 7
Consider psychological interventions including breath relaxation training, mindfulness training, and cognitive behavioral therapy for patients experiencing anxiety and depression, as stated by the American Psychiatric Association 7

The American College of Physicians recommends avoiding delaying treatment initiation in high-risk patients, as treatment should begin as soon as possible after diagnosis 1
Inappropriate use of antibiotics without clinical justification should be avoided, as stated by the Infectious Diseases Society of America 2
Using multiple antiviral drugs simultaneously should be avoided, according to the Military Medical Research 5, 6
Failing to monitor for drug interactions, especially with anticoagulants and antiplatelet agents, should be avoided, as recommended by the American College of Chest Physicians 4
Neglecting mental health aspects of COVID-19 recovery should be avoided, according to the American Psychiatric Association 7