COVID-19 Guidelines Dashboard

Last updated: June 23, 2022

In hospitalized patients with severe or critical COVID-19 and acute hypoxaemic respiratory failure not needing emergent intubation, WHO suggests high-flow nasal oxygen (HFNO) rather than standard oxygen therapy. WHO does not make a recommendation regarding high flow nasal oxygen versus noninvasive ventilation or continuous positive pressure ventilation due to lack of data comparing these modalities.

Last updated: January 28, 2021

Last updated: January 28, 2021

Last updated: December 17, 2020

NIH recommends HFNC over NIPPV/CPAP for initial therapy for patients who are hypoxemic despite conventional oxygen therapy.

Last updated: March 24, 2021

Last updated: March 09, 2020

Last updated: May 01, 2023

AIIMS recommends the use of high flow nasal oxygen for those who require increasing oxygen support with high disease severity. (This includes those those admitted to the HDU/ICU experiencing breathlessness, a respiratory rate of >30/ min, and/or SpO < 90% on room air.)

Last updated: January 12, 2023

Last Updated January 12, 2023 (though states still in review): "We suggest awake prone positioning of severely ill patients hospitalized with COVID-19 requiring supplemental oxygen (includes high flow nasal oxygen) or non-invasive ventilation (conditional, low certainty evidence)."

Last updated: December 17, 2020

Last updated 12/17/20. NIH guidelines support awake proning, but note that it should not be used as "rescue" therapy for patients who otherwise have indications for intubation.

Last updated: September 03, 2020

Self-proning may be used on stable patients or as therapy for patients with escalating oxygen needs.

Last updated: January 05, 2023

AIIMS encourages awake pronation in all patients requiring supplemental oxygen therapy with sequential position changes every 2 hours.

Last updated: January 12, 2023

Last Updated January 12, 2023 (though states still in review): "We suggest awake prone positioning of severely ill patients hospitalized with COVID-19 requiring supplemental oxygen (includes high flow nasal oxygen) or non-invasive ventilation (conditional, low certainty evidence)."

Last updated January 28, 2021

Last updated January 28, 2021

Last updated 12/17/20

Last updated 3/24/21

Last updated September 5, 2020: Early proning is recommended when P:F < 150 or FiO2 > 60% to improve oxygenation.

1/5/2023: AIIMS encourages awake pronation in all patients requiring supplemental oxygen therapy with sequential position changes every 2 hours.

Last updated: January 12, 2023

January 12, 2023: In hospitalized patients with severe or critical COVID-19 and hypoxemic respiratory failure not needing emergent intubation, WHO suggests high-flow nasal oxygen, non-invasive ventilation, or continuous positive pressure ventilation, rather than standard oxygen therapy. WHO does not make a recommendation regarding high flow nasal oxygen versus noninvasive ventilation or continuous positive pressure ventilation due to lack of data comparing these modalities.

Last updated: January 28, 2021

SCCM/ESICM guidelines suggest HFNC as first line therapy for hypoxemia refractory to conventional oxygen; if HFNC is unavailable, a trial of NIV may be appropriate if there are no indications for urgent intubation.

Last updated: January 28, 2021

SCCM/ESICM guidelines suggest HFNC as first line therapy for hypoxemia refractory to conventional oxygen; if HFNC is unavailable, a trial of NIV may be appropriate if there are no indications for urgent intubation.

Last updated: December 17, 2020

Last updated 12/17/20. A trial of NIPPV is recommended for hypoxemia refractory to conventional oxygen therapy if HFNC is not available and there is no current indication for intubation.

Last updated: January 05, 2023

NIV by helmet or face mask may be considered in patients with increasing oxygen requirement and *low* work of breathing. (This includes those those admitted to the HDU/ICU experiencing breathlessness, a respiratory rate of >30/ min, and/or SpO < 90% on room air.)

Last updated January 28, 2021

Last updated January 28, 2021

Last updated 12/17/20

Last updated 3/24/21

9/3/2020

1/5/2023: For those admitted to the ICU, AIIMS recommends use of institutional protocol for ventilatory management when required.

Last updated: January 12, 2023

Last Updated Jan 12, 2023:: WHO clarifies that it recommends standard dose chemical thromboprophylaxis for all hospitalized patients with COVID-19, but acknowledges that data informing this decision is limited.

Last updated: January 28, 2023

Last updated January 28, 2021. Chemical prophylaxis should be used in patients with severe or critical COVID-19. SCCM/ESICM does not specifically recommend a dose of prophylaxis for VTE, but does note that there are no data supporting the use of intermediate dose VTE prophylaxis versus standard dose.

Last updated: January 28, 2023

Last updated January 28, 2021. Chemical prophylaxis should be used in patients with severe or critical COVID-19. SCCM/ESICM does not specifically recommend a dose of prophylaxis for VTE, but does note that there are no data supporting the use of intermediate dose VTE prophylaxis versus standard dose.

Last updated: July 21, 2023

Per NIH, all adult patients with COVID-19, including pregnant patients, should receive either standard-dose or therapeutic-dose anticoagulation in absence of confirmed venous thromboembolism. NIH offers guidance regarding which hospitalized patients should receive therapeutic-dose anticoagulation, and which should receive prophylactic-dose. The panel recommends against therapeutic dose rivaroxaban for VTE prophylaxis or prevention of COVID-19 progression while saying there is insufficient evidence to recommend either for or against use of therapeutic dose of apixaban for the same indications. The panel also recommends routinely continuing VTE prophylaxis in patients with COVID-19 after hospital discharge unless there is another indications for antigoagulation. See our tiles specifying therapeutic and prophylactic anticoagulation for specific types of hospitalized patients for more information on NIH recommendations.

UCSF recommends different doses of anticoagulation for VTE prophylaxis for different patient populations. Click the link or see our tiles on therapeutic anticoagulation for patients in and outside of the ICU for more details.

Last updated: September 20, 2021

BWH recommends standard-dose prophylactic anticoagulation (AC) for hospitalized COVID-19 patients who are NOT in the ICU. For COVID-19 patients in the ICU, BWH recommends "intermediate-dose" prophylactic AC.

Last updated: January 05, 2023

Prophylactic dose of unfractionated heparin or Low Molecular Weight Heparin (weight based e.g., enoxaparin 0.5mg/kg per day SC) is recommended for patients who are hospitalized with COVID-19 in the ICU. There should be no contraindication or high risk of bleeding.

Last updated: January 12, 2023

January 13, 2023. WHO conditionally recommends use of remdesivir for severe COVID-19 due to possible reduction in mortality and need for mechanical ventilation.

Last updated January 28, 2021. Remdesivir is recommended for patients with severe COVID-19 (defined as COVID pneumonia with respiratory distress, SpO2<90%, or Respiratory Rate > 30/minute) who are not mechanically ventilated.

Last updated January 28, 2021. Remdesivir is recommended for patients with severe COVID-19 (defined as COVID pneumonia with respiratory distress, SpO2<90%, or Respiratory Rate > 30/minute) who are not mechanically ventilated.

Last updated 2/7/22 : IDSA guidelines recommend use of remdesivir among hospitalized patients with severe COVID-19defined as patients with SpO2 ≤94% on room air, or patients who require supplemental oxygen, mechanical ventilation or extracorporeal mechanical oxygenation. IDSA recommends a 5 day course for patients not on mechanical ventilation or ECMO.

8/8/22. NIH recommends remdesivir along other other agents depending on severity of illness for the treatment of patients admitted to the hospital for COVID-19 who require supplemental oxygen but who are not receiving mechanical ventilation or ECMO. In certain patients, including those hospitalized with COVID-19 who have high-risk of progression of illness but do not currently require supplemental oxygen, and those who require "minimal" conventional supplemental oxygen.

3/24/21: Recommended for inpatients with moderate, severe, or critical COVID-19. May be considered for inpatients with mild disease but high risk for clinical deterioration.

Last updated Jan 14, 2022: Recommended for patients with hypoxia, defined as SpO2 < 95% on room air, who do not require intubation.

1/5/2023: Remdesivir 200mg on day 1 and then 100mg for day 2-5 may be considered for patients who require supplemental oxygen and had symptom onset within 10 days.

Last updated: January 12, 2023

1/13/2023 (LO) WHO recommends 6mg dexamethasone daily for up to a 10 day course for hospitalized patients with severe (who need supplemental oxygen) or critical (need oxygen and life support measures, or have ARDS) COVID-19. WHO recommends against corticosteroid therapy in patients with non-severe COVID-19.

Last updated January 28, 2021. Patients with severe or critical COVID-19 should receive a short course of systemic steroids. Dexamethasone, at a dose of 6mg per day for up to 10 days, is preferred over other corticosteroids.

Last updated January 28, 2021. Patients with severe or critical COVID-19 should receive a short course of systemic steroids. Dexamethasone, at a dose of 6mg per day for up to 10 days, is preferred over other corticosteroids.

Last updated Oct 28 2021 : IDSA guidelines recommend use of 6mg dexamethasone daily for 10 days or until hospital discharge among hospitalized patients with severe COVID-19 (defined as patients with SpO2 ≤94% on room air, or patients who require supplemental oxygen, mechanical ventilation or extracorporeal mechanical oxygenation). The IDSA suggests against the routine use of dexamethasone among patients who do not require supplemental oxygen.

Last updated 8/8/21: NIH recommends administration of 6mg dexamethasone daily for 10 days or until hospital discharge in most patients hospitalized for COVID-19 who require supplemental oxygen, with the exception of those who require "minimal" conventional supplemental oxygen. For patients on dexamethasone who have rapidly increasing conventional oxygen needs and systemic inflammation, NIH recommends the addition a second immunomodulatory drug such as tocilizumab or baricitinib. Similarly, if a patient requires oxygen by HFNC, noninvasive ventilation, or invasive mechanical ventilation, the patient should receive baricitinib, tocilizumab, or sarilumab in addition to dexamethasone. Dexamethasone should not be used in patients with COVID-19 who do not require supplemental oxygen, including non-hospitalized patients.

11/17/22: UCSF recommends dexamethasone 6mg daily for 10 days or until hospital discharge in patients with severe or critical COVID-19 illness. Patients who are not receiving supplemental oxygen, or who are only receiving 1-2L/min O2 and do not have evidence of a worsening clinical trajectory should not receive steroids.

Last updated 11/8/21: 6mg dexamethasone daily for 10 days is recommended for patients who require supplemental O2 or are critically ill.

1/5/2023: Systemic corticosteroids are not indicated in mild disease. However, for patients admitted to the ICU, the recommended dose should be dexamethasone 6 mg/day or equivalent dose of methylprednisolone (32 mg in 4 divided doses) usually for 5 to 10 days or until discharge, whichever is earlier. No evidence for benefit in higher doses.).

Last updated: January 12, 2023

Last Updated January 12, 2023: WHO recommends IL-6 inhibitors, such as tocilizumab or sarliumab, in addition to steroids, in patients with severe or critical COVID-19. Additional data from RECOVERY showed combining corticosteroids, IL-6 receptor inhibitors and baricitinib provided incremental safety benefit and can be administered jointly. However, clinicians may opt for less aggressive immunosuppressive therapy and/or combine medications in a stepwise fashion in patients who are deteriorating.

Feb 27, 2023: Among hospitalized adults with progressive severe (requring supplemental O2) or critical (requiring invasive mechanical ventilation or ECMO) COVID-19 who have elevated markers of systemic inflammation, the IDSA guideline panel suggests tocilizumab in addition to standard of care (i.e., steroids) rather than standard of care alone.. When tocilizumab is not available, for patients who would otherwise qualify for tocilizumab, the IDSA suggests sarilumab in addition to standard of care.

Last updated 1/26/2023 For patients admitted to the hospital with severe or critical COVID-19, and who have rapidly increasing oxygen needs and have increased markers of inflammation, the NIH recommends the use of baricitinib or tocilizumab in addition to systemic corticosteroids. For patients on NIV, HFNC, ECMO or mechanical ventilation, tocilizumab or baricitinib is recommended in addition to systemic corticosteroids. Baricitinib should not be used at the same time as an IL-6 inhibitor.

Last updated 11/17/22. UCSF suggests tocilizumab as an alternative to baricitinib if hospitalized < 3 days AND in ICU < 24 hours AND rapid disease progression with imminent requirement for mechanical ventilation, or who are already on invasive mechanical ventilation. UCSF does not make a recommendation regarding sarilumab. UCSF notes that IL-6 inhibitors and baricitinib should NOT be used concurrently, one should not replace the other if a dose or course has already already been given.

12/22/21. BWH recommends either baricitinib or tocilizumab in addition to systemic coritcosteroids for patients with severe to critical COVID who have critical or rapidly progressing respiratory failure. These medications should only be given within 4 days of hospital admission for respiratory failure or onset of respiratory failure if already hospitalized for a separate issue. Tocilizumab should only be given if CRP ≥75; there is no such requirement for baricitinib. See link for details.

1/5/2023: Tocilizumab may be considered in patients with severe disease, elevated inflammatory markers, and no evidence of fungal or bacterial co-infection who are not improving despite the use of steroids.

Last updated: January 01, 2022

1/13/22. WHO makes a strong recommendation for use of baricitinib in addition to corticosteroids in patients with severe or critical COVID-19, including those requiring mechanical ventilation. Baricitinib (or IL-6 inhibitors) should be used with systemic steroids. Additional data from RECOVERY showed combinng corticosteroids, IL-6 receptor inhibitors and baricitinib provided incremental safety benefit and can be administered jointly. However, clinicians may opt for less agressive immunosuppressive therapy and/or combine medications in a stepwise fashion in patients who are deteoriating. WHO does recommend baricitinib over IL-6 inhibitors or vice-versa, and instead suggests that selection of one agent or another may depend on experience and comfort using the drugs; local institutional policies; route of administration (baricitinib is oral; IL-6 receptor blockers are intravenous); and cost. Additionally, clinical trials were not representative of the global population and risk benefit may be less advantageous, particularly in areas where certain infectious diseases such as HIV, TB, and certain fungal infections are endemic or in patients with increased risk of opportunistic infections.

Feb 8, 2023: Among hospitalized adults with severe COVID-19, the IDSA suggests baricitinib with corticosteroids rather than no baricitinib. The IDSA also recommends baricitinib plus remdesivir as an alternative for corticosteroids among hospitalized patients with severe COVID-19 who cannot receive a corticosteroid (which is standard of care) because of a strong contraindication. "Severe" in this context refers to patients with SpO2 ≤ 94% on room air, including patients on suppoemental oxygen, oxygen through a high-flow device, or non-invasive ventilation. Despite not including patients on ECMO or mechanical ventilation as a part of this definition or recommendation, IDSA notes that "limited additional data suggest a mortality reduction even among patients requiring mechanical ventilation."

Last updated 8/8/22. For patients admitted to the hospital with severe or critical COVID-19, and who have rapidly increasing oxygen needs and have increased markers of inflammation, the NIH recommends the use of baricitinib or tocilizumab in addition to systemic corticosteroids. For patients on ECMO or mechanical ventilation, tocilizumab or baricitinib should be givein in addition to systemic corticosteroids. Baricitinib should not be used at the same time as an IL-6 inhibitor.

12/28/21. UCSF recommends baricitinib in addition to steroids in patients with severe or critical disease who have escalating oxygen requirements via nasal cannula oxygen, or currently require HFNC or non-invasive mechanical ventilation. Baricitinib may be used in place of steroids if patients meet criteria for systemic steroid use but have a strong contraindication to the use of steroids. Tocilizumab should be used in place of baricitinib with rapidly escalating respiratory failure in which mechanical ventilation is considered imminent, or if a patient is already receiving invasive mechanical ventilation. UCSF notes that IL-6 inhibitors and baricitinib should NOT be used concurrently, one should not replace the other if a dose or course has already already been given.

12/22/21. BWH recommends either baricitinib or tocilizumab in addition to systemic coritcosteroids for patients with severe to critical COVID who have critical or rapidly progressing respiratory failure. These medications should only be given within 4 days of hospital admission for respiratory failure or onset of respiratory failure if already hospitalized for a separate issue. Tocilizumab should only be given if CRP ≥75; there is no such requirement for baricitinib. See link for details.

4/21/21 : Patients COVID-19 who are taking NSAIDs chronically may continue to take these medications if appropriate.

Last updated 3/24/21.

Last updated May 2020: Initial concerns about NSAIDs worsening COVID-19 disease have not been clinically proven to date.

Among hospitalized adults with severe* COVID-19, but not on non-invasive or invasive mechanical ventilation, the IDSA suggests tofacitinib rather than no tofacitinib. Tofacitinib should not be given at the same time as baricitinib or tocilizumab.

8/25/21. NIH recommends tofacitinib as an alternative to barcitinib if baricitinib is indicated but unavailable or not feasible to use.

2/24/22. Per BWH, tofacitinib may be used for the same indications as tocilizumab or baricitinib if those medications are not available. See tiles for tocilizumab or baricitinib for details on indications.

Last updated: December 01, 2023

1/13/23 WHO makes a strong recommendation for the use of nirmatrelvir-ritonavir in patients with non-severe COVID-19 who are at the highest risk of hospitalization. WHO notes that "nirmatrelvir-ritonavir represents a superior choice because it may have greater efficacy in preventing hospitalization than the alternatives, has fewer concerns with respect to harms than does molnupiravir; and is easier to administer than intravenous remdesivir and [neutralizing monoclonal] antibodies." Shared decision making should be used for pregnant or breast feeding women given possible benefit and residual uncertainty regarding potential undesirable effects.

January 31, 2023: The CDC website states: "Serious adverse events are uncommon with Paxlovid treatment. Paxlovid is given twice daily for 5 days, starting as soon as possible and within 5 days of symptom onset, and is approved for use in adult and pediatric patients (12 years of age and older weighing at least 40kg)." However, the CDC also recommends checking with your provider to ensure your eligibility.

June 26 2023: In ambulatory patients with mild to moderate COVID-19 at high risk for progression to severe disease, the IDSA guideline panel suggests nirmatrelvir/ritonavir initiated within five days of symptom onset rather than no nirmatrelvir/ritonavir

Last updated: July 21, 2023

NIH has issued combined guidance for the use of nirmatrelvir-ritonavir, remdesivir, certain monoclonal antibodies, and molnupiravir for non-hospitalized patients with mild-moderate COVID and high risk for progression to severe disease. NIH recommends the following drugs for these patients, in order of preference: Nirmatrelvir-ritonavir orally twice daily for 5 days within 5 days of symptom onset or remdesivir IV for 3 days; or, ONLY if neither of these preferred options are available or feasible to deliver molnupiravir 800mg BID for 5 days within 5 days of symptom onset. NIH specifies that care must be taken to avoid drug-drug interactions when using nirmatrelvir-ritonavir. The NIH also notes that without definitive data, clinicians could consider longer courses of nirmatrelvir/ritonavir or remdesivir in people who are immunocompromised who are symptomatic with evidence of ongoing SARS-CoV-2 replication. See link for details.

UCSF has issued combined guidance for use of 3 therapies for mild-moderate COVID in non-hospitalized patients with high risk of disease progression: IV remdesivir, nirmatrelvir-ritonavir (Paxlovid), and molnupiravir. Nirmatrelvir-ritonavir is considered first line therapy, IV remdesivir for 3 days is second line, and molnupiravir are considered third line. Due to limited availability of these medications, UCSF has recommended a tiered approach to dispensing these medications according to degree of underlying immunocompromise and risk factors for progression to severe disease, including age and level of vaccination (older and incompletely vaccinated persons are prioritized). See link for more details.

1/14/22: If available, BWH recommends nirmatrelvir/ritonavir for the treatment of mild-to-moderate COVID-19 in outpatients ≥ 12 years old who are at high risk for progression and within 5 days of symptom onset and without drug-drug interaction contraindications

Last updated: April 01, 2022

April 13, 2022: WHO has extended Emergency Use Listing approval to 7 vaccine candidates and has developed a guide for vaccine rollout. Initial supplies of vaccines should be prioritized for health workers, but WHO recommends all adults receive vaccinatino when eligible. According to the WHO: "The current COVID-19 vaccines provide strong protection against serious illness and death caused by the Omicron and Delta variants of the virus that causes COVID-19. Being fully vaccinated will also help reduce the likelihood of new variants emerging."

February 1, 2023: The US CDC recommends vaccination for everyone ages 6 months or older. Primary series vaccination is recommended with three monovalent COVID-19 vaccines Moderna (mRNA), Novavax (protein subunit) and Pfizer-BioNTech (mRNA) and the same product should be used for all primary series doses. mRNA vaccines are preferred over Johnson & Johnson's Janssen viral vector vaccine and is only authorized for adults ages 18 year or older. Certain populations who are moderately to severely immunocompromised may require additional primary series doses. The timing and dosing of primary series doses vary on the type of vaccine used. Click the link for more guidance on special population groups, including pregnant women. See our other topics on vaccine boosters and vaccination in children and adolescents for more information.

Sept 4, 2022: The IDSA supports the CDC decisions to authorize COVID-19 vaccinations. See link for vaccine dose recommendations for each age group.

Last updated April 1, 2022: UCSF recommends that all eligible children adults be vaccinated against COVID-19.

May 13 2021. BWH recommends that all adults receive vaccinations when eligible. BWH recommends that pregnant women discuss vaccination with their obstetrician prior to getting a vaccine.

4/22/21

Last updated: May 01, 2022

May 17,2022 (LO) WHO recommends that moderately and severely immunocompromised persons should be offered an additional dose of all WHO EUL COVID-19 vaccines as part of an extended primary
series since these individuals are less likely to respond adequately to vaccination following a standard primary vaccine series and are at high risk of severe COVID-19 disease. WHO does not specify the exact definition of moderate or severe immunocompromise. WHO further recommends that all persons age 60 and older who received the Sinovac or Sinopharm vaccines be offered a third dose as part of an extended primary series.

January 25, 2023: The US CDC recommends that people ages 5 years or older to receive 1 bivalent mRNA vaccine dose, also known as a "booster" dose, 2 months after completing monovalent primary series or previously received monovalent booster dose(s). The CDC also recommends boosters for children aged 6 months–4 years who completed the Moderna primary series and if it has been at least 2 months since their last dose.

Oct. 19 2021. The NIH agrees with CDC recommendations for vaccine boosters.

April 1, 2022. UCSF recommends that those who have received an initial primary series of any SARS-CoV2 vaccine receive a booster dose of an mRNA vaccine. Moderately to severely immunocompromised patients aged 12 and older are recommended to complete an extended primary series by receiving a 3rd dose, and then a 4th "booster" dose at least 4 months after their most recent dose. UCSF notes that adults age 50 and up who are not immunocompromised may also choose to receive a 4th "booster" dose at least 5 months after their most recent dose.

March 2 2022. All eligible adolescents and adults age 12 and older should receive a 3rd "booster" dose of an mRNA vaccine, or a 2nd "booster" dose if they initially received the Johnson and Johnson vaccine. Immunocompromised patients should complete a 3-dose primary series and receive an mRNA vaccine booster at least 3 months after their most recent dose.

January 25, 2023: The US CDC recommends that all children ages 6 months through 11 years old should be vaccinated against COVID-19 and only mRNA vaccines are authorized in these age groups. The timing and dosing of vaccination depends on age group (6 months-4 years vs. 5-11 years) and type of vaccine used. Children who are moderately or Severely Immunocompromised should also receive additional primary series doses depending on age group and type of vaccine originally used. Bivalent boosters are also authorized for children ages 5 years or older (depending on age) administered 2 months after completing primary series or monovalent booster dose. Note that Pfizer BioNTech bivalent booster is authorized for children ages 5 years or older while Moderna bivalent booster is only authorized for children ages 6 years or older.

Jan 27, 2023: IDSA supports FDA and CDC decisions to authorize the Pfizer-BioNTech COVID-19 vaccine for children aged 6 months to 4 years, 5 to 11 years, and those 12 years and older. See link for recommended vaccine dose scheduling for children.

10/19/21. NIH recommends COVID-19 vaccination for everyone who is eligible according to the United States Advisory Committee on Immunization Practices. This includes children and adolescents.

12/8/21. UCSF recommends vaccination of all eligible children.

12/1/21: BWH recommends vaccination for all children who are eligible per CDC recommendations.

Last updated: April 01, 2023

01/13/ 2023 (LO). Particle respirators should be worn along with other PPE (gown, gloves and eye protection) by health workers performing aerosol-generating procedures (AGPs) and by health workers on duty in settings where AGPs are regularly performed on patients with suspected or confirmed COVID-19, such as intensive care units, semi-intensive care units or emergency departments. Respirators should also be worn in areas of poor ventilation. WHO also notes that respirator use in healthcare settings should also be based on health workers’ values and preferences and on their perception of what offers the highest protection possible to prevent SARS-CoV-2 infection.

September 23, 2022: N95-grade respirators should be worn by healthcare workers caring for patients with COVID-19 who are undergoing AGPs. Facilities in counties with substantial or high transmission may consider implementing universal use of NIOSH-approved N95 or equivalent or higher-level respirators for healthcare workers during all patient care encounters or in specific units or areas of the facility at higher risk for SARS-CoV-2 transmission.

Last updated January 28 2021

Last updated January 28 2021

2/8/22. The IDSA guideline panel recommends that healthcare personnel caring for patients with suspected or known COVID-19 use either a medical/surgical mask or N95 (or N99 or PAPR) respirator compared with no mask. The IDSA guideline panel recommends that healthcare personnel involved with aerosol-generating procedures on suspected or known COVID-19 patients use an N95 (or N99 or PAPR) respirator instead of a medical/surgical mask.

October 2020

1/28/22. UCSF mandates use of N95 for routine care of all patients with confirmed COVID-19, including during aerosol-generating procedures. UCSF "strongly recommends" that healthcare workers use N95 masks during all patient contacts, even with patients who have had a negative test for COVID-19.

Last updated: April 01, 2023

01/13/2023 (LO). In settings where there is community transmission of SARS-CoV-2, irrespective of vaccination status or history of prior infection, wearing a well-fitting mask that covers the nose and mouth is recommended for the public when interacting with individuals who are not members of their household in most indoor locations and outdoors if a distance of 1 meter cannot be maintained.

1/14/22. Per IDSA: "Everyone should mask up in indoor public settings, and infected individuals who leave isolation after five days must continue to wear their mask around others."

July 15, 2021. UCSF maintains a universal masking system for all visitors and staff.

BWH mandates universal masking for all employees and visitors while on BWH campuses.

Last updated: April 01, 2022

September 28, 2022: NAATs, such as PCR-based tests, are most often performed in a laboratory. They are typically the most reliable tests for people with or without symptoms. These tests detect viral genetic material, which may stay in your body for up to 90 days after you test positive. Therefore, you should not use a NAAT if you have tested positive in the last 90 days.

Last updated December 9, 2020: IDSA recommends NAAT for all individuals with high suspicion of symptomatic or asymptomatic SARS-CoV2 infection.

Last updated: 4/21/21

Last updated October 27, 2020

Last updated December 5, 2020: The current standard of care for diagnostic testing for active COVID-19 is PCR testing.

Last updated: May 01, 2022

May 9,2022 WHO recommends that Ag-RDTs meeting minimum performance requirements can be used for primary case detection, contact tracing, during outbreak investigations and to monitor trends of disease incidence in communities. WHO further notes that Ag-RDTs should be prioritized for use in symptomatic individuals meeting the case definition for COVID-19, and to test asymptomatic individuals at high risk of infection, including contacts and health workers, particularly in settings where NAAT testing capacity is limited.

September 28, 2022: Antigen tests are rapid tests which produce results in 15-30 minutes. They are less reliable than NAATs, especially for people who do not have symptoms. A single, negative antigen test result does not rule out infection. To best detect infection, a negative antigen test should be repeated at least 48 hours apart (known as serial testing). Sometimes a follow-up NAAT may be recommended to confirm an antigen test result.

1/7/22

Last updated: April 01, 2023

January 12, 2023:. WHO suggests use of home pulse oximetry in patients with symptomatic COVID-19 and risk factors for progression of disease. Patient education and appropriate followup must accompany any home use of pulse oximetry.

Last Updated January 21, 2022: As part of a recommendation for use of community health workers in low-resource settings, CDC suggests that home pulse oximetry, administered by the community health workers, should be considered for at-home monitoring of patients with new diagnoses of COVID-19 but who have not been admitted to the hospital.

4/21/21. If a non-hospitalized patient with COVID-19 has access to a pulse oximeter at home, he or she should inform their health provider if the SpO2 at sea level is less than 95%.

9/20/21. For critically ill COVID-19 patients in the ICU, BWH recommends slightly higher "intermediate-dosing" prophylactic anticoagulation.

Last updated: July 31, 2023

The NIH recommends therapeutic-dose heparin for hospitalized nonpregnant patients who are not receiving ICU-level care, but do require conventional, "low-flow" oxygen, have a D-dimer above the upper limit of normal (ULN), and have no increased bleeding risk. LMWH is preferred over unfractionated heparin. If patients with non-critical COVID do not qualify for therapeutic anticoagulation, they should receive prophylactic-dose anticoagulation unless there is a contraindication. The NIH recommends against the use of therapeutic-dose oral anticoagulants outside of clinical trials.

11/17/22: UCSF suggests therapeutic anticoagulation with heparin for inpatients with COVID-19 who require HFNC at rates < 20L/min, and recommends consideration of therapeutic anticoagulation with heparin in patients inpatients with COVID-19 who require supplemental oxygen via conventional nasal cannula.

Last updated 11/17/22: Recommended for inpatients with critical COVID-19 who are undergoing mechanical ventilation or extracorporeal membrane oxygenation.

Last updated: January 12, 2023

1/13/23. WHO conditionally recommends outpatient remdesivir for 3 days among patients with non-severe COVID-19 who are at highest risk of hospitalization. WHO notes that "nirmatrelvir-ritonavir represents a superior choice because it may have greater efficacy in preventing hospitalization than the alternatives, has fewer concerns with respect to harms than does molnupiravir; and is easier to administer than intravenous remdesivir and [neutralizing monoclonal] antibodies."

January 31, 2023: The antiviral drug remdesivir (Veklury) is a preferred treatment for eligible adult and pediatric patients who are at high risk for progression to severe COVID-19. A 3-day course of intravenous remdesivir initiated within 7 days of symptom onset is the second preferred treatment option after Paxlovid for adults and pediatric patients (age >28 days and weight > 3kg).

Feb 8, 2023: "Among ambulatory patients with mild to moderate COVID-19 at
high risk for progression to severe disease, the IDSA guideline panel suggests remdesivir
initiated within seven days of symptom onset rather than no remdesivir."

8/18/22. NIH has issued combined guidance for the use of nirmatrelvir-ritonavir, remdesivir, certain monoclonal antibodies, and molnupiravir for non-hospitalized patients with mild-moderate COVID and high risk for progression to severe disease. NIH recommends the following drugs for these patients, in order of preference: Nirmatrelvir-ritonavir orally twice daily for 5 days within 5 days of symptom onset or remdesivir IV for 3 days; or, ONLY if neither of these preferred options are available or feasible to deliver: Bebtelovimab 175mg once as a single injection within 7 days of symptom onset or molnupiravir 800mg BID for 5 days within 5 days of symptom onset. The NIH also notes that without definitive data, clinicians could consider longer courses of nirmatrelvir/ritonavir or remdesivir in people who are immunocompromised who are symptomatic with evidence of ongoing SARS-CoV-2 replication. NIH specifies that care must be taken to avoid drug-drug interactions when using nirmatrelvir-ritonavir. See link for details.

2/6/23: UCSF has issued combined guidance for use of 3 therapies for mild-moderate COVID in non-hospitalized patients with high risk of disease progression: IV remdesivir, nirmatrelvir-ritonavir (Paxlovid), and molnupiravir. Nirmatrelvir-ritonavir is considered first line therapy, IV remdesivir for 3 days is second line, and molnupiravir is considered third line. Due to limited availability of these medications, UCSF has recommended a tiered approach to dispensing these medications according to degree of underlying immunocompromise and risk factors for progression to severe disease, including age and level of vaccination (older and incompletely vaccinated persons are prioritized). See link for more details.

Last updated January 14, 2022: A 3 day course of remdesivir is recommended for outpatients with COVID-19 disease and risk factors for progression within 7 days of symptom onset, if the drug is available and it is clinically feasible to deliver it.

Feb 8 2022. Among ambulatory patients with mild to moderate COVID-19 at high risk for progression to severe disease who have no other treatment options, the IDSA guideline panel suggests FDA-qualified high-titer COVID-19 convalescent plasma within 8 days of symptom onset rather than no high-titer COVID-19 convalescent plasma. IDSA notes that this is a conditional recommendation with low certainty of evidence.

Last updated: January 12, 2023

Last Updated January 13, 2023. WHO recommends that empiric antibiotics be started for patients with COVID-19 who also have septic shock. WHO concurrently notes that antibiotics should not be prescribed routinely for patients with critical COVID-19 in whom bacterial infection is not suspected.

Last updated: December 01, 2023

Janury 13, 2023. WHO recommends molnupiravir for outpatients with non-severe COVID-19 with high (>10%) risk for hospital admission (excluding people who are pregnant, breastfeeding, and children). This group includes older people, those who are immunocompromised or have chronic illnesses, or those who are unvaccinated. WHO notes that molnupiravir should be given as early as possible in the course of illness.

January 26, 2023: The CDC recommends adults start treatment with molnupiravir at home by mouth (orally)as soon as possible; specifically, treatment must begin within 5 days of when symptoms start.

2/23/23. IDSA recommends molnupiravir for ambulatory patients with mild to moderate COVID-19 at high risk for progression to severe disease who have no other treatment options (i.e. nirmatrelvir-ritonavir, remdesivir, etc).

4-20/23 NIH has issued combined guidance for the use of nirmatrelvir-ritonavir, remdesivir, certain monoclonal antibodies, and molnupiravir for non-hospitalized patients with mild-moderate COVID and high risk for progression to severe disease. NIH recommends the following drugs for these patients, in order of preference: Nirmatrelvir-ritonavir orally twice daily for 5 days within 5 days of symptom onset or remdesivir IV for 3 days; or, ONLY if neither of these preferred options are available or feasible to deliver molnupiravir 800mg BID for 5 days within 5 days of symptom onset. NIH specifies that care must be taken to avoid drug-drug interactions when using nirmatrelvir-ritonavir. See link for details.

UCSF has issued combined guidance for use of 3 therapies for mild-moderate COVID in non-hospitalized patients with high risk of disease progression: IV remdesivir, nirmatrelvir-ritonavir (Paxlovid), and molnupiravir. Nirmatrelvir-ritonavir is considered first line therapy, IV remdesivir for 3 days is second line, and molnupiravir are considered third line. Due to limited availability of these medications, UCSF has recommended a tiered approach to dispensing these medications according to degree of underlying immunocompromise and risk factors for progression to severe disease, including age and level of vaccination (older and incompletely vaccinated persons are prioritized). See link for more details.

12/9/22: If available, molnupiravir is recommended for the treatment of mild-to-moderate COVID-19 in adult outpatients who are at high risk for progression and within 5 days of symptom onset only if other outpatient treatments (nirmatrelvir/ritonavir, remdesivir) are not accessible or clinically appropriate

Last updated: December 01, 2023

January 13, 2023. WHO recommends against treatment with neutralizing monoclonal antibodies given reduction of in vitro neutralization activity of sotrovimab and casirivimab-imdevimab against circulating Omicron subvariants and other available therapeutic options across severity spectrium. Of note, WHO does not comment specifically to bebtelovimab which has also been recently found to have reduced activity against Omicron subvariant BQ.1, BQ.1.1, and XBB and not recommend by other institutions.

4/5/22. BWH recommends use of tixagevimab-cilgavimab in patients who have moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications and may not mount an adequate immune response to vaccination, or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction. Patients must not be infected with COVID-19 to receive this therapy.