Molnupiravir: As per IDSA 2023 guidelines, consider initiating molnupiravir (800 mg for 5 days) within 5 days of symptom onset in adult outpatients with mild-to-moderate COVID-19 at high risk for progression to severe disease no other treatment options exist for the patient. C As per WHO 2023 guidelines, consider initiating molnupiravir in patients with non-severe COVID-19 at the highest risk of hospitalization (excluding pregnant, breastfeeding, and pediatric patients). C Landmark trials: PANORAMIC In adult patients with relevant comorbidities with confirmed COVID-19 for 5 days in the community, molnupiravir was not superior to standard care only with respect to hospitalizations or death from all causes at day 28. Christopher C Butler et al. Lancet. 2022 Dec 22. As per ACP 2022 guidelines, consider initiating molnupiravir for the treatment of ambulatory patients with confirmed mild-to-moderate COVID-19 presenting within 5-7 days of the onset of symptoms and at high risk for progressing to severe disease. C Landmark trials: MOVe-OUT In nonhospitalized, unvaccinated adults with mild-to-moderate, laboratory-confirmed COVID- 19 and at least one risk factor for severe COVID-19 illness, molnupiravir was superior to placebo with respect to hospitalization or death at day 29. Ang lica Jayk Bernal et al. N Engl J Med. 2022 Feb 10. Other antivirals, chloroquine/hydroxychloroquine: As per IDSA 2023 guidelines, do not use hydroxychloroquine D or hydroxychloroquine plus azithromycin D in hospitalized patients with COVID-19. D As per WHO 2023 guidelines, do not use hydroxychloroquine or chloroquine in patients with COVID-19, regardless of disease severity. D https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 15/38 6/29/23, 3:24 AM COVID-19 infection Pathway As per ACP 2022 guidelines, do not use chloroquine or hydroxychloroquine for the treatment of ambulatory patients with confirmed mild-to-moderate COVID-19. D As per NIH 2021 guidelines, do not use chloroquine or hydroxychloroquine (with or without azithromycin) for the treatment of patients with COVID-19. D As per SCCM 2021 guidelines, do not use hydroxychloroquine in adult patients with severe or critical COVID-19. D Other antivirals, lopinavir/ritonavir: As per IDSA 2023 guidelines, do not use lopinavir/ritonavir in ambulatory patients with mild-to- moderate COVID-19 nor in hospitalized patients with COVID-19. D Landmark trials: ACTIV-6 (ivermectin) In patients aged 30 years with confirmed COVID-19, experiencing 2 symptoms of acute infection for 7 days, ivermectin was not superior to placebo with respect to median time to sustained recovery. Susanna Naggie et al. JAMA. 2022 Oct 25. As per WHO 2023 guidelines, do not use lopinavir-ritonavir in patients with COVID-19, regardless of disease severity. D As per ACP 2022 guidelines, do not use lopinavir-ritonavir for the treatment of ambulatory patients with confirmed mild-to-moderate COVID-19. D As per NIH 2021 guidelines, do not use lopinavir/ritonavir or other human immunodeficiency virus protease inhibitors for the treatment of ambulatory patients with COVID-19. D Landmark trials: LOTUS China In hospitalized adult patients with confirmed COVID-19 infection, lopinavir-ritonavir was not superior to standard care with respect to time to clinical improvement. Cao B et al. N Engl J Med. 2020 May 7. Other antivirals, ivermectin: As per IDSA 2023 guidelines: Avoid using ivermectin for the treatment of hospitalized patients with COVID-19. D Do not use ivermectin for the treatment of ambulatory patients with COVID-19. D Landmark trials: COVID-OUT (ivermectin) https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 16/38 6/29/23, 3:24 AM COVID-19 infection Pathway In nonhospitalized adults aged between 30 to 85 years with a confirmed diagnosis of COVID- 19 within the past 3 days, ivermectin was not superior to placebo with respect to the composite outcome of hypoxemia, emergency department visit, hospitalization, or death. Carolyn T Bramante et al. N Engl J Med. 2022 Aug 18. As per WHO 2023 guidelines, do not use ivermectin in patients with COVID-19, regardless of disease severity, except in the context of a clinical trial. As per ACP 2022 guidelines, do not use ivermectin for the treatment of ambulatory patients with confirmed mild-to-moderate COVID-19. D As per NIH 2021 guidelines, insufficient evidence to recommend for or against the use of ivermectin for the treatment of COVID-19. I Other antivirals, nitazoxanide: As per ACP 2022 guidelines, do not use nitazoxanide for the treatment of ambulatory patients with confirmed mild-to-moderate COVID-19. D Landmark trials: COVID NT-300 In patients presenting within 72-hour onset of mild or moderate COVID-19, nitazoxanide was not superior to placebo with respect to time to sustained clinical recovery. Jean-Fran ois Rossignol et al. EClinicalMedicine. 2022 Feb 28. As per NIH 2021 guidelines, do not use nitazoxanide for the treatment of COVID-19 outside clinical trials. D Antibiotics: As per WHO 2023 guidelines, do not use antibiotic therapy or prophylaxis in patients with suspected or confirmed mild COVID-19. D Show 2 more As per ACP 2022 guidelines, do not use azithromycin for the treatment of ambulatory patients with confirmed mild-to-moderate COVID-19. D As per NIH 2021 guidelines, do not use antibiotics (such as azithromycin, doxycycline) in patients with COVID-19 in the absence of another indication. D Show 2 more Antipyretics: As per WHO 2023 guidelines, prescribe antipyretics for fever and pain in patients with mild COVID-19. A As per NIH 2021 guidelines, use strategies for antipyretic therapy (such as acetaminophen, NSAIDs) in patients with COVID-19 similar to the approaches used in other patients. B As per SCCM 2021 guidelines, consider administering acetaminophen for temperature control in critically ill adult patients with COVID-19. C https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 17/38 6/29/23, 3:24 AM COVID-19 infection Pathway Thromboproprophylaxis, indications: As per NIH 2021 guidelines, do not initiate anticoagulant or antiplatelet therapy for the prevention of VTE or arterial thrombosis in nonhospitalized patients (or in the emergency department if the patient is not being admitted to the hospital) with COVID-19, unless the patient has other indications for the therapy or is participating in a clinical trial. D Show 3 more As per SCCM 2021 guidelines: Initiate pharmacologic VTE prophylaxis in adult patients with severe or critical COVID-19. B Consider avoiding the routine use of therapeutic anticoagulation outside of clinical trials in adult patients with severe or critical COVID-19 and no evidence of VTE. D As per ACCP 2020 guidelines, consider initiating anticoagulant thromboprophylaxis, if not contraindicated, in acutely ill or critically ill hospitalized patients with COVID-19. E Thromboproprophylaxis, choice of agent: As per ISTH 2022 guidelines, consider initiating oral sulodexide therapy within 3 days of symptom onset to reduce the risk of hospitalization in nonhospitalized patients with COVID-19 at higher risk of disease progression. C Show 9 more Landmark trials: COVID-PACT (antiplatelet therapy) In adult patients with COVID-19 infection requiring ICU-level of care, clopidogrel was not superior to no clopidogrel with respect to the rate of death due to venous and arterial thrombotic events through hospital discharge or 28 days. Erin A Bohula et al. Circulation. 2022 Nov. As per NIH 2021 guidelines: Prefer LMWH or UFH over OACs in hospitalized critically ill patients with COVID-19 because the two types of heparin have shorter half-lives, can be administered IV or SC, and have fewer drug-drug interactions. B Take into account the potential drug-drug interactions with other concomitant drugs whenever anticoagulant or antiplatelet therapy is used. B Updated evidence: ACTIV-4A In non-critically ill patients hospitalized for COVID-19, P2Y12 inhibitor plus heparin was not superior to usual care with respect to organ support-free days. Jeffrey S Berger et al. JAMA. 2022 Jan 18. https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 18/38 6/29/23, 3:24 AM COVID-19 infection Pathway As per ACCP 2020 guidelines, consider initiating LMWH as the first-line agent for anticoagulant thromboprophylaxis in acutely ill hospitalized patients with COVID-19. E Show 2 more Thromboproprophylaxis, dosing and duration: As per WHO 2023 guidelines, consider administering standard thromboprophylaxis dosing of anticoagulation rather than therapeutic or intermediate dosing in hospitalized patients with COVID-19 without an established indication for higher dose anticoagulation. C As per ASH 2021 guidelines, consider administering prophylactic-intensity over intermediate- intensity anticoagulation in critically ill patients with coronavirus disease without suspected or confirmed VTE. C As per NIH 2021 guidelines, administer prophylactic dose of anticoagulation in hospitalized nonpregnant adult patients with COVID-19 unless contraindicated (such as active hemorrhage or severe thrombocytopenia). B Show 2 more Updated evidence: COVID-PACT (anticoagulant therapy) In adult patients with COVID-19 infection requiring ICU-level of care, full-dose anticoagulation strategy was superior to standard-dose prophylactic anticoagulation strategy with respect to the rate of death due to venous or arterial thrombosis, PE, clinically evident DVT, type 1 myocardial infarction, ischemic stroke, systemic embolic event or acute limb ischemia, or clinically silent DVT, through hospital discharge or 28 days, time-to-first event analysis. Erin A Bohula et al. Circulation. 2022 Nov. As per ACCP 2020 guidelines, administer standard dose anticoagulant thromboprophylaxis over intermediate (BID or increased weight-based dosing) in acutely ill hospitalized patients with COVID-19. E Show 2 more Antithrombotic therapy, for thromboembolism: As per NIH 2021 guidelines, initiate therapeutic doses of anticoagulant therapy in patients with COVID-19 experiencing an incident thromboembolic event or highly suspected to have thromboembolic disease, when diagnostic imaging is not possible. B As per ACCP 2020 guidelines, consider initiating initial parenteral anticoagulation with therapeutic weight-adjusted LMWH or IV UFH in acutely ill hospitalized patients with COVID-19 and proximal DVT or PE. Consider initiating initial (or after initial parenteral anticoagulation) oral anticoagulation with apixaban or rivaroxaban in patients without any drug-to-drug interactions. Consider initiating vitamin K antagonist therapy after overlap with initial parenteral anticoagulation. E Show 5 more https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 19/38 6/29/23, 3:24 AM COVID-19 infection Pathway Antithrombotic therapy (for other indications): continue anticoagulant or antiplatelet therapies in patients with COVID-19 receiving these treatments for underlying conditions. B Show 3 more Thrombolytic therapy: do not administer systemic thrombolytic therapy in most patients with COVID-19 and acute, objectively confirmed PE not associated with hypotension (systolic BP < 90 mmHg or BP drop of 40 mmHg lasting > 15 minutes). D Show 4 more Intravenous fluids: As per WHO 2023 guidelines, use cautious fluid management in patients with COVID-19 without tissue hypoperfusion and fluid responsiveness. A Show 5 more As per NIH 2021 guidelines, use dynamic parameters, skin temperature, capillary refilling time, and/or lactate levels over static parameters to assess fluid responsiveness in adult patients with COVID-19 and shock. B Show 4 more As per SCCM 2021 guidelines, consider using a conservative over a liberal fluid strategy: for acute resuscitation of adult patients with COVID-19 and shock for mechanically ventilated adult patients with COVID-19 and ARDS. C Show 6 more Intravenous vasopressors: As per WHO 2023 guidelines, administer vasopressors in adult patients with COVID-19 when shock persists during or after fluid resuscitation. Set mean arterial pressure 65 mmHg as the initial BP target in adult patients and improvement of markers of perfusion. A Show 3 more As per NIH 2021 guidelines, administer norepinephrine as the first-choice vasopressor in adult patients with COVID-19 and shock. A Show 6 more As per SCCM 2021 guidelines, consider using norepinephrine as first-line vasoactive agent in adult patients with COVID-19 and shock. C Show 5 more Other medications (general principles): do not use unproven drugs as treatment or prophylaxis for COVID-19, outside of the context of clinical trials. D Other medications (RAAS inhibitors): do not use medications off-label, including ACEIs, ARBs, statins, and famotidine, for the treatment of patients with COVID-19, except in a clinical trial. D Show 2 more Updated evidence: CLARITY In adult patients admitted to the hospital for the management of COVID-19, ARB was not superior to placebo with respect to WHO Scale score at day 14. https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 20/38 6/29/23, 3:24 AM COVID-19 infection Pathway Meg J Jardine et al. BMJ. 2022 Nov 16. Other medications (statins): do not use statins for the treatment of COVID-19 outside clinical trials. D Updated evidence: INSPIRATION-S In adult patients with COVID-19 admitted to the ICU, atorvastatin was not superior to placebo with respect to venous or arterial thrombosis, treatment with ECMO, or death from any cause at day 30. INSPIRATION-S Investigators. BMJ. 2022 Jan 7. Other medications, colchicine: As per IDSA 2023 guidelines: Do not use colchicine in hospitalized patients with COVID-19. D Avoid using colchicine in ambulatory persons with COVID-19. D Landmark trials: ECLA PHRI COLCOVID In adults hospitalized with COVID-19 symptoms and had severe acute respiratory syndrome, colchicine was not superior to usual care with respect to mechanical ventilation or death at day 28. Rafael Diaz et al. JAMA Netw Open. 2021 Dec 1. As per WHO 2023 guidelines, do not use colchicine in patients with non-severe COVID-19. D As per NIH 2021 guidelines, insufficient evidence to recommend for or against the use of colchicine for the treatment of non-hospitalized patients with COVID-19. I Other medications, famotidine: As per IDSA 2023 guidelines, avoid using famotidine for the treatment of ambulatory patients with mild-to-moderate COVID-19 or hospitalized patients with severe COVID-19. D As per NIH 2021 guidelines, do not use famotidine for the treatment of COVID-19 outside clinical trials. D Other medications, fluvoxamine: As per IDSA 2023 guidelines, initiate fluvoxamine in ambulatory patients with COVID-19 only in the context of a clinical trial. B Landmark trials: COVID-OUT (fluvoxamine) https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 21/38 6/29/23, 3:24 AM COVID-19 infection Pathway In nonhospitalized adults aged between 30 to 85 years with a confirmed diagnosis of COVID- 19 within the past 3 days, fluvoxamine was not superior to placebo with respect to the composite outcome of hypoxemia, emergency department visit, hospitalization, or death. Carolyn T Bramante et al. N Engl J Med. 2022 Aug 18. As per WHO 2023 guidelines, do not use fluvoxamine in patients with non-severe COVID-19, except in the context of a clinical trial. As per ACP 2022 guidelines, do not use fluvoxamine for the treatment of ambulatory patients with confirmed mild-to-moderate COVID-19. D As per NIH 2021 guidelines, insufficient evidence to recommend for or against the use of fluvoxamine for the treatment of COVID-19. I Other medications (concomitant drugs): do not discontinue concomitant medications (such as ACEIs, ARBs, statins, systemic or ICSs, NSAIDs, acid-suppressive therapy) during acute management of COVID-19 in patients receiving these medications for underlying medical conditions unless discontinuation is otherwise warranted by their clinical condition. D Management of neuropsychiatric and neurological complications: Implement measures to prevent delirium, an acute neuropsychiatric emergency, in patients with COVID-19. Evaluate patients using standardized protocols for the development of delirium. Ensure immediate evaluation by a clinician, if detected, to address any underlying cause of delirium and treat appropriately. A Evaluate patients as soon as possible when presenting with rapidly developing neurological symptoms suggestive of stroke, and follow standard stroke protocols including systemic thrombolysis and/or intra-arterial thrombectomy, if indicated. Signs and symptoms of stroke can include weakness of limbs or face, sensory loss, speech difficulties, impairment of vision, ataxia, confusion, or decreased consciousness. Follow standard infection prevention and control measures during the clinical evaluation, neuroimaging or procedures for patients with stroke. A Management of anxiety and depressive symptoms: assess patients for anxiety and depressive symptoms in the context of COVID-19 and initiate psychosocial support strategies and first-line interventions for the management of new anxiety and depressive symptoms. A Management of preexisting non-communicable diseases: Continue or modify previous medical therapy according to the patient's clinical condition when caring for patients with suspected and confirmed COVID-19 that have underlying non- communicable diseases. A Do not routinely stop antihypertensive drugs in patients with COVID-19, but consider adjusting therapy based on general considerations for patients with acute illness, with particular reference to maintaining normal BP and renal function. D 6. Nonpharmacologic interventions https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 22/38 6/29/23, 3:24 AM COVID-19 infection Pathway Nutrition: advise adequate nutrition and appropriate rehydration for patients with mild COVID-19. A Dietary supplements: Insufficient evidence to recommend either for or against the use of vitamin C, vitamin D, or zinc for the treatment of patients with COVID-19. Do not use zinc supplementation above the recommended dietary allowance for the prevention of COVID-19, except in a clinical trial. D Psychosocial support: provide basic mental health and psychosocial support for all patients with suspected or confirmed COVID-19 by asking about patients' needs and concerns, and addressing them. A Show 2 more Rehabilitation: consider interventions by rehabilitation professionals relieving respiratory distress, preventing complications and supporting communication in hospitalized patients during the acute phase of illness. B Show 4 more 7. Therapeutic procedures Intermittent pneumatic compression: Avoid adding mechanical prophylaxis routinely to pharmacological thromboprophylaxis in critically ill patients with COVID-19. D Consider performing mechanical thromboprophylaxis in critically ill patients with COVID-19 with a contraindication to pharmacological thromboprophylaxis. E Mesenchymal stem cells: do not use mesenchymal stem cells for the treatment of patients with COVID-19, except in a clinical trial. D Renal replacement therapy: Perform continuous RRT, if available, in critically ill patients with AKI developing indications for RRT. B Perform prolonged intermittent RRT rather than intermittent hemodialysis if continuous RRT is not available or not possible due to limited resources. B Cardiopulmonary resuscitation: Use personal protective equipment for aerosol generating procedures during resuscitation. B Consider defibrillation before donning aerosol generating personal protective equipment in situations where the healthcare provider assesses the benefits may exceed the risks. E 8. Specific circumstances Pediatric patients: recognize that most pediatric patients with mild or moderate disease can be managed with supportive care alone. B https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 23/38 6/29/23, 3:24 AM COVID-19 infection Pathway Show 12 more Older patients: screen older patients for COVID-19 at the first point of access to the health system, promptly recognize if they are suspected to have COVID-19 and treat appropriately according to the established COVID-19 care pathways. Ensure this practice in all settings where older people may seek care, included but not limited to facility-based emergency units, primary care, prehospital care settings and long-term care facilities. A Show 3 more Pregnant and breastfeeding patients: As per WHO 2023 guidelines, monitor all pregnant patients with a history of contact with a patient with confirmed COVID-19. A Show 6 more As per NIH 2021 guidelines, manage pregnant patients with COVID-19 generally same as nonpregnant patients. Show 7 more Patients with HIV: offer COVID-19 vaccination in patients with human immunodeficiency virus regardless of CD4 T lymphocyte cell count or human immunodeficiency virus viral load, because the potential benefits outweigh the potential risks. B Show 13 more Patients with cancer: As per ITAC 2022 guidelines, do not prescribe routine primary thromboprophylaxis in ambulatory patients with cancer and COVID-19. D Show 5 more As per NIH 2021 guidelines, offer COVID-19 vaccination in patients with active cancer and in patients receiving treatment for cancer. B Show 8 more Transplant recipients and donors: offer COVID-19 vaccination in potential transplant and cellular immunotherapy candidates, potential donors, and recipients. B Show 10 more 9. Patient education Patient education: As per WHO 2023 guidelines: Counsel patients with mild COVID-19 about signs and symptoms of complications that should prompt urgent care. A Educate and provide support to patients with COVID-19 for the self-management of breathlessness and resumption of activities, both in a hospitalized and a nonhospitalized setting caring for COVID-19. A As per NIH 2021 guidelines: https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 24/38 6/29/23, 3:24 AM COVID-19 infection Pathway Advise outpatients with COVID-19 on when to contact a healthcare provider and seek an in- person evaluation. B Provide information about ongoing clinical trials of investigational therapies to eligible outpatients with COVID-19 so they can make informed decisions about participating in clinical trials. B 10. Preventative measures Vaccination (COVID-19): offer COVID-19 vaccination for everyone eligible according to the Advisory Committee on Immunization Practices. A Vaccination (influenza): offer an inactivated influenza vaccine in patients with acute COVID-19. B Show 2 more Pre-exposure prophylaxis: As per IDSA 2023 guidelines, consider administering pre-exposure prophylaxis with tixagevimab/cilgavimab in moderately or severely immunocompromised individuals in areas where predominant regional variants are susceptible to the agent and if COVID-19 vaccination is not likely to be adequate or is not possible. C As per WHO 2023 guidelines: Do not administer hydroxychloroquine prophylaxis in individuals not having COVID-19. D Avoid administering tixagevimab-cilgavimab in individuals not having COVID-19. D As per NIH 2021 guidelines, do not use any drug for SARS-CoV-2 pre-exposure prophylaxis, except in a clinical trial. D Post-exposure prophylaxis: As per IDSA 2023 guidelines: Consider administering casirivimab/imdevimab for post-exposure prophylaxis in persons exposed to COVID-19 at high risk of progression to severe COVID-19. C Do not use lopinavir/ritonavir D nor hydroxychloroquine for post-exposure prophylaxis in persons exposed to COVID-19. D Landmark trials: COVID-19 Phase 3 Prevention In asymptomatic individuals with positive RT-PCR for COVID-19 who are living with an infected household contact, casirivimab and imdevimab were superior to placebo with respect to progression to symptomatic COVID-19 disease. Meagan P O'Brien et al. JAMA. 2022 Feb 1. As per WHO 2023 guidelines: Do not administer hydroxychloroquine prophylaxis in individuals not having COVID-19. D https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 25/38 6/29/23, 3:24 AM COVID-19 infection Pathway Avoid administering tixagevimab-cilgavimab in individuals not having COVID-19. D As per NIH 2021 guidelines, administer anti-SARS-CoV-2 monoclonal antibodies - bamlanivimab 700 mg plus etesevimab 1,400 mg administered as an IV infusion, B or casirivimab 600 mg plus imdevimab 600 mg administered as subcutaneous injections A or an IV infusion; administered as soon as possible and preferably within 7 days of high-risk exposure B - for post-exposure prophylaxis in patients at high risk of progressing to severe COVID-19, if infected with SARS-CoV-2 and meeting the following criteria for vaccination status and exposure history: vaccination status: not fully vaccinated - never vaccinated, received the first dose of a two- dose series, or received the second dose of a two-dose series or a single-dose vaccine < 2 weeks ago; fully vaccinated, but not expected to mount an adequate immune response, such as in immunocompromising conditions or taking immunosuppressive medications exposure history: a recent exposure to a patient with SARS-CoV-2 infection consistent with CDC close contact criteria; at high risk of exposure to patients with SARS-CoV-2 infection because of a recent occurrence of SARS-CoV-2 infection in other patients in the same institutional setting, such as nursing homes, prisons. B Show 2 more Mask use: Implement universal mask use in healthcare facilities in areas of known or suspected community or cluster SARS-CoV-2 transmission: wearing a well-fitting medical mask by all healthcare workers (including community healthcare workers and caregivers, other staff, visitors, outpatients, and service providers) in settings where caring for non-COVID-19 patients, unless differently specified (such as aerosol- generating procedures), at all times within the health facility and in any common area (such as cafeteria, staff rooms) not mandatory for inpatients unless physical distancing of at least 1 meter cannot be maintained (for example, during examinations or bedside visits) or when outside of their care area (for example, when being transported), provided the patient is able to tolerate the mask and there are no contraindications. B Implement targeted continuous medical mask use in healthcare facilities in areas of known or suspected sporadic SARS-CoV-2 transmission: wearing a well-fitting medical mask by healthcare workers (including community healthcare workers and caregivers working in clinical areas) continuously during routine activities throughout the entire shift in settings when caring for non-COVID-19 patients, unless differently specified (for example, when performing aerosol-generating procedures) and apart from when eating and drinking not mandatory during routine activities in non-patient areas with no patient contact B Landmark trials: Medical masks in COVID-19 In healthcare workers who provided direct care to patients with suspected or confirmed COVID-19, medical mask was noninferior to N95 respirator with respect to reverse https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 26/38 6/29/23, 3:24 AM COVID-19 infection Pathway transcriptase-PCR-confirmed COVID-19. Mark Loeb et al. Ann Intern Med. 2022 Dec. Personal protective equipment, routine care: As per WHO 2023 guidelines, advis using a respirator or a medical mask along with other personal protective equipment (gown, gloves, and eye protection) for healthcare workers before entering a room of a patient with suspected or confirmed COVID-19. B As per IDSA 2021 guidelines, advise using either a medical/surgical mask or respirator (N95 or N99 or powered air-purifying respirator) as part of appropriate personal protective equipment (including a mask or respirator, eye protection, gown and gloves) for healthcare personnel caring for patients with suspected or known COVID-19. B Show 3 more As per NIH 2021 guidelines: Advise using an N95 (or equivalent or higher-level) respirator or a surgical mask in addition to other personal protective equipment (gloves, gown, and eye protection such as a face shield or safety goggles) for healthcare workers who are providing usual care for nonventilated patients with COVID-19. B Advise using an N95 (or equivalent or higher-level) respirator in addition to other personal protective equipment (gloves, gown, and eye protection such as a face shield or safety goggles) for healthcare workers who are performing non-aerosol-generating procedures on patients with COVID-19 who are on closed-circuit mechanical ventilation because ventilator circuits may become disrupted unexpectedly. B As per SCCM 2021 guidelines, consider advising the use of surgical/medical masks instead of respirator masks in addition to other personal protective equipment (gloves, gown, and eye protection, such as a face shield or safety goggles) for healthcare professionals: providing usual care for non-ventilated patients with COVID-19 performing non-aerosol-generating procedures on mechanically ventilated (closed circuit) patients with COVID-19. C Personal protective equipment, aerosol-generating procedures: As per WHO 2023 guidelines, advise using a respirator along with other personal protective equipment for healthcare workers performing aerosol-generating procedures and for healthcare workers on duty in settings (such as ICUs, semi-ICUs, or emergency departments) where aerosol-generating procedures are regularly performed on patients with suspected or confirmed COVID-19. B As per IDSA 2021 guidelines, advise using an respirator (N95 or N99 or powered air-purifying respirator) instead of a medical/surgical mask, as part of appropriate personal protective equipment for healthcare personnel performing aerosol-generating procedures on suspected or known COVID-19 patients. Appropriate personal protective equipment includes a mask or respirator, eye protection, gown and gloves. B Show 3 more https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 27/38 6/29/23, 3:24 AM COVID-19 infection Pathway As per NIH 2021 guidelines: Advise using an N95 (or equivalent or higher-level) respirator rather than surgical masks, in addition to other personal protective equipment (gloves, gown, and eye protection such as a face shield or safety goggles) for healthcare workers performing aerosol-generating procedures on patients with COVID-19. B Advise minimizing the use of aerosol-generating procedures on ICU patients with COVID-19 and carrying out any necessary aerosol-generating procedures in a negative-pressure room, also known as an airborne infection isolation room, when available. B As per SCCM 2021 guidelines: Advise using fitted respirator masks (N95 respirators, filtering facepiece 2, or equivalent) instead of surgical/medical masks in addition to other personal protective equipment (gloves, gown, and eye protection, such as a face shield or safety goggles) for healthcare professionals performing aerosol-generating procedures on patients with COVID-19 in the ICU. E Perform aerosol-generating procedures on ICU patients with COVID-19 in a negative pressure room. E Environment for airway management: use negative pressure ventilation rooms with an antechamber during airway management to minimize exposure to aerosol and droplet particles. If this is not feasible, use normal pressure rooms with closed doors. E Standard transmission precautions: apply standard precautions and transmission-based precautions in all patients. A Isolation: isolate and cohort patients with suspected or confirmed COVID-19. A Show 3 more 11. Follow-up and surveillance Monitoring for disease progression: consider obtaining pulse oximetry monitoring at home as part of a package of care in patients with COVID-19, including patient and provider education and appropriate follow-up, in symptomatic patients with COVID-19 and risk factors for progression to severe disease who are not hospitalized. C Show 2 more Monitoring for adverse effects of medications: take into careful consideration the numerous, clinically significant side effects of medications that may be used in the context of COVID-19, as well as drug-drug interactions between medications, both of which may affect COVID-19 symptomatology (including effects on respiratory, cardiac, immune and mental and neurological function). Take into consideration both pharmacokinetic and pharmacodynamic effects. A Monitoring for thromboembolism: monitor patients with COVID-19 for signs or symptoms suggestive of thromboembolism, such as stroke, DVT, PE or acute coronary syndrome. Immediately proceed with appropriate diagnostic and management pathways, if these are clinically suspected. A https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 28/38 6/29/23, 3:24 AM COVID-19 infection Pathway 12. Quality improvement COVID-19 care pathways: Establish COVID-19 care pathways for patients with suspected or confirmed COVID-19 at local, regional and national levels. A Ensure that community health workers continue to follow usual protocols for recognition and treatment of other common illnesses and danger signs while activating the COVID-19 care pathway (including for referral as needed) for suspect cases. Refer to WHO/IFRC/UNICEF guidance on community-based healthcare, including outreach and campaigns, in the context of the COVID-19 pandemic. A Care bundles: consider using existing care bundles (defined as 3 evidence-informed practices delivered together and consistently to improve care), chosen locally by the hospital or ICU and adapted as necessary for local circumstances, in critically ill patients with COVID-19 with or without invasive mechanical ventilation. C Equipment and care availability: Ensure that all areas, where severe patients may be cared for, are equipped with pulse oximeters, functioning oxygen systems and disposable, single-use, oxygen-delivering interfaces (nasal cannula, Venturi mask and mask with reservoir bag). A Ensure palliative care interventions are accessible at each institution providing care for patients with COVID-19. A Care optimization during pandemic: ensure that hospitals and health systems at local, regional, national and global level have plans, are prepared and ready to surge clinical care capacity (staff, structure, supplies and systems) in order to be able to provide appropriate care of all COVID-19 patients and maintain essential health services. A Show 4 more International classification of diseases coding: use emergency International classification of diseases codes for mortality, as outlined in the International guidance for certification and coding of COVID-19 as cause of death. A Clinical research: As per WHO 2023 guidelines, collect standardized clinical data on all hospitalized patients to improve understanding of the natural history of the disease and contribute data to the WHO Global COVID-19 Clinical Data Platform (see website for details). A As per NIH 2021 guidelines, provide information about ongoing clinical trials of investigational therapies to eligible outpatients with COVID-19 so they can make informed decisions about participating in clinical trials. B Studies 2023 ReCOVer https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 29/38 6/29/23, 3:24 AM COVID-19 infection Pathway In patients being severely fatigued 3-12 months following COVID-19, CBT was superior to care as usual with respect to reduction in fatigue severity. Tanja A Kuut et al. Clin Infect Dis. 2023 May 8. 2023 BRACE In healthcare workers, BCG vaccine was not superior to placebo with respect to the rate of symptomatic COVID-19 by 6 months. Laure F Pittet et al. N Engl J Med. 2023 Apr 27. Show 60 more References 1. Adarsh Bhimraj, Rebecca L. Morgan, Amy Hirsch Shumaker et al. IDSA Guidelines on the Treatment and Management of Patients with COVID 19. IDSA. 2023 May 15. Open 2. Lisa K. Moore, Tobias Tritschler, Shari Brosnahan et al. Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019. Chest. 2020 Sep; 158 3 1143 1163. Open 3. No authors listed. Therapeutics and COVID 19 living guideline. Geneva: World Health Organization; 2023. Open 4. John B. Lynch, Perica Davitkov, Deverick J. Anderson et al. IDSA Guidelines on Infection Prevention in Patients with Suspected or Known COVID 19. IDSA. 2021 Apr 30;Part 2:v1.0.1. Open 5. No authors listed. Living guidance for clinical management of COVID 19. WHO living guidance. 2023 Jan 13. Open 6. Amir Qaseem, Jennifer Yost, Matthew C Miller et al. Outpatient Treatment of Confirmed COVID 19 Living, Rapid Practice Points From the American College of Physicians Version 1 . Ann Intern Med. 2022 Nov 29. Open 7. National Institutes of Health. Coronavirus Disease 2019 COVID 19 Treatment Guidelines. National Institutes of Health. 2021 Oct. Open 8. Waleed Alhazzani, Laura Evans, Fayez Alshamsi et al. Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 COVID 19 in the ICU First Update. Crit Care Med. 2021 Mar 1;49 3):e219-e234. Open 9. Brewster D, Chrimes N, Do T et al. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID 19 adult patient group. Med J Aust 2020. Mar 16. Open 10. No authors listed. Drugs to prevent COVID 19 living guideline. Geneva: World Health Organization; 2023. Open 11. Kimberly E Hanson, Angela M Caliendo, Cesar A Arias et al. The Infectious Diseases Society of America Guidelines on the Diagnosis of COVID 19 Molecular Diagnostic Testing. Clin Infect Dis. 2021 Jan 22;ciab048. Open https://web.pathway.md/diseases/rec2UFiNfrEGXdLl0 30/38 6/29/23, 3:24 AM COVID-19 infection Pathway 12. Mary K Hayden, Kimberly E Hanson, Janet A Englund et al. The Infectious Diseases Society of America Guidelines on the Diagnosis of COVID 19 Antigen Testing. Clin Infect Dis. 2023 Jan 26;ciad032. Open 13. Sam Schulman, Michelle Sholzberg, Alex C Spyropoulos et al. ISTH guidelines for antithrombotic treatment in COVID 19. J Thromb Haemost. 2022 Oct;20 10 2214 2225. Open 14. Couper K, Taylor-Phillips S, Grove A et al. COVID 19 infection risk to rescuers from patients in cardiac arrest. Consensus on Science with Treatment Recommendations Internet] Brussels, Belgium: International Liaison Committee on Resuscitation ILCOR , 2020 March 30. Open 15. APSF and partner organisations. Joint Statement on Multiple Patients Per Ventilator. APSF Website 2020. 26 Mar. Open 16. Kimberly E Hanson, Angela M Caliendo, Cesar A Arias et al. Infectious Diseases Society of America Guidelines on the Diagnosis of COVID 19 Serologic Testing. Clin Infect Dis. 2020 Sep 12;ciaa1343. Open 17. Dominique Farge, Corinne Frere, Jean M Connors et al. 2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID 19. Lancet Oncol. 2022 Jul;23 7):e334-e347. Open 18. American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID May update on the use of intermediate-intensity anticoagulation in critically ill patients. American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID 19 May 2021 update on the use of intermediate-intensity anticoagulation in critically ill patients. Blood Adv. 2021 Oct 26;5 20 3951 3959. Open 19. Sun P, Lu X, Xu C et al. Understanding of COVID 19 based on current evidence. J Med Virol. 2020 Feb 25. Open