A

(This Level of Evidence Filter is in Beta testing)
Data from multiple randomized controlled trials (RCTs) or meta-analyses of RCTs

B

(The Level of Evidence Filter is in Beta)
Data derived from a single large, well-designed RCT, or smaller RCTs with limitations due to experimental design.

C

(This Level of Evidence Filter is in Beta testing)
Data from observational, retrospective, cohort, or registry studies; or expert opinion if only case series, case studies, preclinical data, or data extrapolated from other diseases are available.

Do

More than 1 guideline currently support this practice/therapy, and no guidelines currently oppose this practice/therapy.

Inconclusive

Only 1 guideline addresses this topic in support or opposition; or multiple guidelines make recommendations that are not in alignment.

Don't

More than 1 guideline currently oppose this practice/therapy, and no guidelines currently support this practice/therapy.

Last updated January 14, 2021

COVID Guidelines Dashboard

By collaborators from:

This resource consolidates current guidelines regarding care of COVID-19 patients from leading global health authorities into a single recommendation to guide and improve care of COVID-19 patients worldwide.
Categorizations of recommendations are generated as noted below and do not necessarily reflect the views of UCSF, BWH, or other listed or collaborating institutions or authorities.

Recommended
Not Recommended
Not recommended unless in clinical trial
No recommendation or Uncertain
Do

What does it mean?

More than 1 guideline currently support this practice/therapy, and no guidelines currently oppose this practice/therapy.

Systemic Corticosteroids

A

Guidelines and available data recommend the use of dexamethasone or an alternative equivalent corticosteroid for hospitalized patients with COVID-19 who require supplemental oxygen, including those who are mechanically ventilated.

Recently moved from Inconclusive

High Flow Nasal Oxygen

C

High Flow Nasal Oxygen/Cannula (HFNO/HFNC) may be used to maintain SpO2 >90-94% in patients with hypoxemic respiratory failure who otherwise do not meet criteria for intubation and have escalating conventional oxygen requirements. HFNO/HFNC is considered an Aerosol Generating Procedure by many organizations; appropriate PPE and precautions should be used. Guideline support for this therapy is largely based on its efficacy in trials on non-COVID hypoxemic respiratory failure.

Protocolized Lung Protective Ventilation

C

Lung protective ventilation should be pursued for all ARDS patients undergoing mechanical ventilation. This includes targeting tidal volumes 4-6mL/kg Ideal Body Weight, maintaining target Plateau Pressure < 30mmHg, and titrating FiO2 and PEEP per ARDSnet protocols. Available guidelines do not support deviation from existing ARDS ventilation protocols in the care of COVID-19 patients.

NIPPV/CPAP for COVID-19 Respiratory Failure

C

In adults with acute hypoxemic respiratory failure, if HFNC is not available and intubation/mechanical ventilation is not indicated or available, a trial of CPAP or NIPPV/BiPAP may be considered. Many authorities support this practice only in mild to moderate ARDS patients or in subsets of patients with established indications for NIPPV (e.g. COPD or heart failure exacerbation). Risks include delayed intubation; some experts believe NIPPV/BiPAP may confer risk of direct pulmonary injury. Airborne precautions should be utilized.

Prone Positioning (Non-Intubated Patients)

C

Data for proning patients non-intubated patients is evolving, although case series and limited pre-COVID studies suggest feasibility and possible benefit of "awake" proning combined with oxygen therapy in avoiding intubation. Patients who are self-proned require close monitoring including pulse oximetry, telemetry, and frequent clinical observation.

Recently moved from Don't

Inconclusive

What does it mean?

Only 1 guideline addresses this topic in support or opposition; or multiple guidelines make recommendations that are not in alignment.

Remdesivir

A

Guidelines on the use of remdesivir are mixed. The ACTT-1 trial revealed improved time to recovery with remdesivir, but another large RCT (SOLIDARITY, funded by WHO) found that remdesivir did not improve mortality. Current guidelines stratify recommended use of remdesivir based on illness severity; for example, some guidelines and institutions recommend use in hospitalized patients who require supplemental oxygen, but are not on mechanical ventilation.

Baricitinib (JAK inhibitor)

B

There are inadequate data to recommend routine use of the anti-JAK1/JAK2 drug baricitinib in hospitalized patients with COVID-19, although newer trial data suggest improvement in time to recovery in patients who received remdesivir and baricitinib. As such, guidelines are evolving. Current guideline recommendations depend on whether steroids are available, whether remdesivir is available, and whether patients are on supplemental oxygen.

Surgical/Medical Masks for Routine COVID-19+ Patient Care

C

Multiple guidelines suggest that the use medical/surgical masks provides adequate protection during routine care (that is, no AGPs are ordered or expected) of COVID19 patients, but many institutions encourage the use of respirators instead of medical/surgical masks at all times when providing direct care for COVID19 patients if adequate supplies of respirators are available.

Recently moved from Do

Empiric Antimicrobials in Critically Ill Patients

C

There are inadequate data regarding the use of empiric antibacterial agents in patients with severe COVID-19. Cohort studies show a low incidence of concurrent bacterial pneumonia in patients who present with COVID-19, but many guidelines recommend empiric antibiotics for critically ill or hypotensive patients admitted with COVID-19, and prompt de-escalation of therapy if no clinical evidence of bacterial infection is found.

Recently moved from Do

Don't

What does it mean?

More than 1 guideline currently oppose this practice/therapy, and no guidelines currently support this practice/therapy.

Hydroxychloroquine

A

Existing guidelines recommend against the use hydroxychloroquine (HCQ) outside of clinical trials. Published randomized trials have not shown efficacy for treatment, or pre- or post-exposure prophylaxis. In June 2020, the US FDA revoked emergency use authorization of hydroxychloroquine for COVID-19.

Recently moved from Inconclusive

ACEi Inhibitor – Stopping Chronic Therapy on Admission for COVID-19

C

COVID-19 patients already on an ACEi or ARB for cardiovascular disease should continue these medication in the absence of other contraindications.

Lopinavir/Ritonavir

A

Several large trials indicate that the antiviral agent lopinavir alone or in combination with ritonavir among patients with COVID-19 is an ineffective therapy. All major guidelines currently recommend against the use of lopinavir/ritonavir as treatment for COVID-19.

Antibody (Serology) Testing for Persons with Suspected Acute COVID-19

C

Testing for antibodies against SARS-CoV2 virus to diagnose acute COVID-19 is generally not recommended, but may be used in patients presenting >7-14 days after initial symptoms who have had multiple negative PCR tests but still have high clinical suspicion of COVID-19. Data are lacking to establish whether that a positive test for SARS-CoV2 antibodies confers immunity from recurrent infection.

IL-6 Inhibitors

A

Examples include tocilizumab, sarilumab, and siltuximab. Current guidelines largely suggest against the routine use of agents that inhibit IL-6 among patients with COVID-19 due to a number of negative randomized clinical trials, although evidence is evolving.

Recently moved from Inconclusive

ACE Inhibitor as Treatment for COVID-19

C

There are inadequate data to inform guidelines on the Initiation of ACE inhibitor (ACEi) or Angiotensin Receptor Blocker (ARB) therapy among patients hospitalized with COVID-19. Patients already on an ACEi or ARB for cardiovascular disease should continue these medication in the absence of other contraindications.

Recently moved from Inconclusive

Famotidine

C

There are inadequate data to recommend use of the H2-blocker famotidine as an antiviral therapy among patients with COVID-19.

Recently moved from Inconclusive

Neutralizing Monoclonal Antibodies – Hospitalized Patients

B

There are inadequate data to recommend routine use of lab-generated SARS-CoV-2-specific antibodies, such as bamlanivimab or casirivimab-imdevimab, in hospitalized patients.

Recently moved from Inconclusive

Empiric Antimicrobials in Non-Critically Ill Patients

C

There are inadequate data regarding the use of empiric antibacterial agents in patients with mild or moderate COVID-19. Most guidelines recommend against use of empiric antimicrobials in patients admitted to the hospital with non-severe COVID-19.

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* This dashboard presents existing guidelines and is not an interpretation of primary data. Content is categorized as 'do, don't or inconclusive' based on the criteria below, and this categorization may not reflect the views of collaborating institutions. Statements here should not replace clinical judgement. Data presented here may not be the most currently available evidence. Please review primary data as cited and current literature.

Categorization criteria:
Do: More than 1 guideline currently support this practice/therapy, and no guidelines currently oppose this practice/therapy.
Don't: More than 1 guideline currently oppose this practice/therapy, and no guidelines currently support this practice/therapy.
Inconclusive: Only 1 guideline addresses this topic in support or opposition; or multiple guidelines make recommendations that are not in alignment.
Topics categorized as 'Not recommended outside a clinical trial' are counted as equivalent to a recommendation against.

(WHO - World Health Organization; CDC - Centers for Disease Control and Prevention; SCCM - Society for Critical Care Medicine; ESICM - European Society of Intensive Care Medicine; NIH - National Institutes for Health; IDSA - Infectious Diseases Society of America; UCSF - University of California, San Francisco Medical Center, San Francisco, USA; BWH - Brigham and Women's Hospital, Boston, USA).

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