Last update: September 9, 2021
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 page 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
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
O2 /Mechanical Ventilation
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.
Duration: 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
Corticosteroids are recommended in pediatric patients who require mechanical ventilation, high flow oxygen, non-invasive ventilation, ECMO. They are not routinely recommended for patients only on low flow oxygen.
Corticosteroids are recommended for all patients requiring oxygen.
Only available through clinical trials
8 mg/kg IV x1 dose
Insufficient evidence for tocilizumab in hospitalized children with COVID or MIS-C. Dosing: <30 kg = 12 mg/kg; ≥30 kg = 8 mg/kg (max 800 mg)
Mortality benefit shown in certain adult patient populations REMAP-CAP and RECOVERY trials; the FDA EUA for tocilizumab applies to patients 2 years of age and older.
**Adults and peds ID MUST be consulted to use tocilizumab. Tocilizumab should only be used in combination with corticosteroids.**
Risk/benefit discussion for pregnant women.
A/E: Increased ALT/AST, infusion related reactions, hematologic dyscrasias, increased LDL, secondary infections
400 mg x 1 dose
Insufficient evidence for tocilizumab in hospitalized children with COVID or MIS-C.
Duration: 1 dose
Mortality benefit shown in certain adult patient populations REMAP-CAP trial.
**Adults and peds ID MUST be consulted to use sarilumab. Sarilumab should only be used in combination with corticosteroids.**
Information on drug interactions and administration for patients who cannot swallow can be found at: http://www.covid19-druginteractions.org/
At this time, no therapies have shown a favorable risk/benefit profile for outpatient treatment of COVID-19, including corticosteroids, azithromycin, and ivermectin. The FDA has approved the REGEN-COV™ (casirivimab/imdevimab) monoclonal antibodies for the use in outpatient adult and pediatric patients with mild-moderate COVID-19 who are at high risk of disease progression. In addition, it can be used in high-risk patients with a COVID-19 exposure who are either not fully vaccinated or fully vaccinated but immunocompromised. 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.
The criteria defined by the EUA for both monoclonal antibodies are below and can easily be accessed using the SmartPhrase “.COVIDABINFSCREENING”:
FOR TREATMENT OF MILD-MODERATE COVID-19
Initial Screening Criteria
FOR POST-EXPOSURE PROPHYLAXIS (PEP) OF COVID-19
Patient must meet the 3 criteria above (for treatment PEP) PLUS 1 of the following risk factors for disease progression:
12-64 years of age AND have
*AIDS or CD4 count < 200, Complement deficiency, Grafts-Vs-Host disease (GVHD), HIV infection, Immunoglobulin deficiency/ Immunodeficiency, Immunosuppressive therapy (within the last 12 months), Leukemia, Lymphoma (Hodgkin’s/ Non-Hodgkin’s (NHL)), Metastatic cancer, Multiple Myeloma, Solid organ malignancy, Steroid therapy (within past 2 weeks), Bone marrow transplant (BMT) or peripheral stem cell transplant (PSCT), Solid organ transplant
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 REGEN-COV. If you are a UMMC provider and have a patient who you think may qualify for the monoclonal antibodies, 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.