Clinical management protocol of COVID

19
The COVID-19 Treatment Guidelines Panel (the Panel) continues to review the most recent clinical data to provide up-to-date
treatment recommendations to clinicians who are caring for patients with COVID-19
Severe covid

• Patients with severe or critical COVID-19 are likely to require aerosol-generating procedures, so they should
be placed in an airborne infection isolation room (AIIR), if available.

• Supplemental oxygen therapy should immediately be administered to patients with severe COVID-19 who
have severe acute respiratory infection (SARI) and respiratory distress, hypoxemia, or shock, with the
peripheral oxygen saturation target being greater than 94%. [4]

• Patients with severe COVID-19 should be closely monitored for signs of clinical deterioration (eg, rapidly
progressive respiratory failure and sepsis), with supportive care interventions administered immediately.
• Fluid management: When shock is not evident, conservative fluid management should be used in patients
with SARI.

• Empiric antimicrobial therapy should be administered as soon as possible to treat all likely pathogens causing
SARI and sepsis, with such treatment provided within 1 hour of initial evaluation for patients with sepsis.

• Severe hypoxemic respiratory failure must be recognized when standard oxygen therapy is failing in a patient
with respiratory distress; prepare for administration of advanced oxygen/ventilatory support.
Rationale for the Use of Remdesivir

• In the final analysis of ACTT-1 (Adaptive COVID-19 Treatment Trial, May 2020), remdesivir was associated
with improved time to recovery (recovery rate ratio 1.45; 95% CI, 1.18–1.79) in a subgroup of 435
participants. In a post hoc analysis of deaths by Day 29, remdesivir appeared to confer a substantial survival
benefit (HR for death 0.30; 95% CI, 0.14–0.64).
Rationale for the Use of Remdesivir Plus Dexamethasone

• The safety and efficacy of using remdesivir plus dexamethasone for the treatment of COVID-19 has not been
evaluated in clinical trials. Despite the lack of clinical trial data, there is a theoretical rationale for combining
remdesivir and dexamethasone.
• Patients with severe COVID-19 may develop a systemic inflammatory response that leads to lung injury and
multisystem organ dysfunction. The potent anti-inflammatory effects of corticosteroids might prevent or
mitigate these hyperinflammatory effects.
• Thus, combining an antiviral with an anti-inflammatory agent may treat the viral infection as well as dampen
the potentially injurious inflammatory response that is a consequence of the infection.