Patient with

COVID-19 Management of Patient with Probable or Confirmed COVID-19 Pneumonia

pneumonia
As of March 26, 2020
RR<30/min
Home or
pO2 >92 <60 years MILD /
mmHg Y old AND no
Y Community
LOW RISK
Not in co-morbid Isolation
respiratory conditionsa
distress
N N CQ or HCQ Y
MODERATE Admit eligibleb?

Home Quarantine

SEVERE/ CQ or HCQ Y Consider CQ

HIGH RISK
Admit eligibleb? or HCQ

N
Worsening
a Co-morbid conditions: cardiac (hypertension, coronary artery disease),
respiratory distress
diabetes, structural lung disease (COPD, bronchiectasis), immunocompromised Consider Y Critical
OR progressing
(HIV, on chronic steroids, advanced malignancy LPV/r radiographic ARDS
b Patient NOT eligible if with any of the ff: (1) Prolonged QTc >500, (2) Any
progression
arrhythmia, (3) ALT or AST >5x elevated, (4) G6PD deficiency, (5) Hypersensitivity
N
to CQ or HCQ, (6) Decompensated heart failure
Note: GET INFORMED BEFORE using COVID-19 investigational drugs: Continue Consider
CQ- chloroquine HCQ- hydroxychloroquine LPV/r- lopinavir/ritonavir Tocilizumab management tocilizumab

Management of Adult Patients with Probable or Confirmed COVID-19 Pneumonia
Mild/Low risk (A/B)
Age > 60 years
OR
YES
Co-morbid
conditions?
(1) RR >30/min OR SpO2 <92%; (2) Mechanical
NO
ventilation; (3) PaO2/FiO2 <300 mm Hg; (4) Shock
- Supportive Care
- Admit to designated
Community Isolation Facility
or send home with strict
Isolation Instructions
Using Chloroquine or
Hydroxychloroquine
for COVID-19 prophylaxis
or prevention is NOT
RECOMMENDED
As of March 22,
2020^^
Pneumonia classification
Moderate (C) Severe/Critical (C/D)
May Consider COVID-19 Investigational Drugs – Get INFORMED CONSENT
^ Pls see supplementary guidance
on tocilizumab use.
Any of the following? YES
Consider tocilizumab^
400mg IV single dose
^ Review
contraindications
NO
with or
without
Any of the following?
(1) Prolonged QTc >500, (2) Any arrhythmia,
(3) ALT or AST >5x elevated YES Consider
Lopinavir/ ritonavir+
(4) G6PD deficiency
200/ 50mg 2 tabs BID
(5) Hypersensitivity to CQ or HCQ
(6) Decompensated heart failure PO x 14 days
+
May be associated
NO
with QT prolongation
Chloroquine 500mg BID x 10 days or with or without
Hydroxychloroquine 200mg 2 tabs BID ^^Management recommendations may
day 1 then 1 tab BID x 9 days change depending on available evidence.
All drugs are currently investigational.
 Management of Adult Patients with Probable or Confirmed COVID-19 Pneumonia As of March 22, 2020

Pneumonia classification

Mild/Low risk (A/B) Moderate (C) High risk/Critical (C/D)

Age >60 years YES May Consider COVID-19 Investigational Drugs – Get INFORMED CONSENT
OR
Co-morbid
conditions? Any of the following? ^ Pls see supplementary guidance
Any of the following? on tocilizumab use.
(1) Evidence of multiorgan YES (1) RR >30/min OR SpO2 YES
NO failure; (2) Pressor-requiring; Consider tocilizumab^
<92%; (2) Mechanical
(3) Creatinine clearance <30
ventilation; (3) PaO2/FiO2
400mg IV single dose
mL/min or on RRT; (4) ALT or ^ Review
- Supportive Care <300 mm Hg; (4) Shock
AST >5x ULN contraindications with or
- Admit to designated
NO without
community isolation facility
If not
or send home with strict available Any of the following?
isolation instructions NO (1) Prolonged QTc >500, Consider
(2) Any arrhythmia, YES
Lopinavir/ritonavir+
Using Chloroquine or (3) ALT or AST >5x elevated,
200/50mg 2 tabs BID
Hydroxychloroquine for (4) G6PD deficiency,
Consider remdesivir IV* (5) Hypersensitivity to CQ or HCQ, PO x 14 days
COVID-19 prophylaxis 200mg IV x 1 then 100mg (6) Decompensated heart failure +
May be associated
or prevention is NOT IV daily until 10 days with QT prolongation
NO
RECOMMENDED
* Cannot be used with Chloroquine 500mg BID x 10 days or
^^Management recommendations may CQ/ HCQ or LPV/ r with or
change depending on available evidence.
Hydroxychloroquine 200mg 2 tabs without
All drugs are currently investigational. BID day 1 then 1 tab BID x 9 days