Last update: December 9, 2020
The backbone of the treatment strategy for COVID-19 is good quality supportive care as in any viral pneumonia. Certain therapies have shown benefit for COVID-19 and are included in the recommendations below, including inpatient and outpatient treatments. This document will be updated continually as new evidence emerges and based on the availability of treatment regimens.
Patient Admitted on Nasal Cannula
Disposition: Consider admission to intensive care unit if older than 65 years of age with a new oxygen requirement, D-dimer > 1,000 ng/L, or RR > 22 breaths/min
Evaluate hematologic abnormalities and treat as appropriate. See Anticoagulation Dosing Recommendations for COVID-19 Patients.
Target SpO2 >90%. If oxygen requirement increases to 5 L, call primary team and ICU for evaluation.
Consider high-flow nasal cannula at 15 – 30 LPM with surgical mask over patient’s face.
Patient Admitted to Intensive Care Unit
Conservative fluid management strategy such as daily net neutral fluid balance in patients without evidence of shock
Evaluate for enrollment in clinical trials
Target SpO2 >92%. Consider HFNC at 15-30LPM with surgical mask over patients face.
If PaO2/FiO2 < 150, consider early proning and use of paralytics.
Information about ongoing or potential clinical trials at UMMC can be found in our Clinical Trials database.
The agents listed below have no evidence supporting the use for treatment of COVID-19 but can be used for alternative diagnoses or in the context of clinical trials. * = drugs with low supply (recent shortage or currently on allocation) – contact Pharmacy with questions.
5 days or until no longer hypoxic
FDA approved for patients >12 years old weighing >40 kg. Available through emergency use authorization for pediatric patients <12 years old and/or <40 kg.
Preferred: Dexamethasone 6-10 mg IV/PO* daily
Duration: 10 days or until no longer hypoxic
Decreased mortality shown in the RECOVERY trial
Not recommended for the treatment of non-hospitalized or non-hypoxic patients at this time
Pediatric - >3 months
No benefit in multiple RCT for COVID-19
400 mg PO BID x2 doses followed by 200 mg PO BID x4 days
6.5 mg/kg (max: 400 mg/dose) q12h PO x2 doses followed by 3.5 mg/kg (max: 200 mg/dose) PO q12h x 4 days
A/E: retinopathy, rash, nausea, glucose fluctuations
A/E: hepatotoxicity, pancreatitis, QTc prolongation, diarrhea
Combination with ribavirin has been suggested based on synergistic action with lopinavir/ritonavir. Additional studies are needed before recommending this combination.
Pediatric – 2 years of age and older
Duration: 1 dose
Information on drug interactions and administration for patients who cannot swallow can be found at: http://www.covid19-druginteractions.org/
The FDA has approved two monoclonal antibodies for the use in outpatients who are at high risk of disease progression:
The criteria defined by the EUA for both monoclonal antibodies are below and can easily be accessed using the SmartPhrase “.COVIDABINFSCREENING”:
Patient must meet the 3 criteria above PLUS 1 of the following risk factors for disease progression:
12-64 years of age AND have
≥55 years of age AND have
12-17 years of age AND have
The monoclonal antibodies should not be used for patients who are hospitalized with COVID-19, require oxygen therapy for COVID-19, or have an increase in baseline oxygen flow rate due to COVID-19.
Currently UMMC only has access to bamlanivimab. If you are a UMMC provider and have a patient who you think may qualify for bamlanivimab, please fill out the screening form (.COVIDABINFSCREENING) in Epic and send it to “P COVID-19 MONOCLONAL ANTIBODIES REQUEST”. Prior to sending the requests, please ensure the positive COVID-19 test is available to review in the chart.
These documents and content on this website are guidelines during the COVID-19 pandemic. Because new information is released rapidly, these documents can be updated or changed at any time. These documents are in no way to be considered as a standard of care and the content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The information in these documents is provided with no guarantees, accuracy, or timeliness. All content in these documents and website are for informational purposes only and do not constitute the providing of medical advice.