Management of Mild or Moderately Ill Patients

Below is a compilation of guidelines and resources related to the management of mild and moderate COVID-19 in various clinical settings as well at home.

Guidelines

OVERVIEW

Comprehensive Guidelines for Management of COVID-19 patients 

Guidelines set by the Government of India on how to monitor symptoms and treat COVID-19 patients utilizing a variety of techniques and therapeutics.  

  • Language: English 
  • For:  Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations 
  • Created by: Directorate General of Health Services, Government of India 

IDSA Guidelines on Treatment and Management of Patients with COVID-19
Pharmacologic therapies for treatment of COVID-19 with frequent updates and addendums based on critical evaluation of rapidly emerging literature

  • Language: English
  • For: Nurses, Physicians,  Respiratory Therapists, Hospital and Health Systems
  • Created by: IDSA. Updated: 6/25/2021 

US NIH COVID-19 Treatment Guidelines

  • Language: English
  • For: Nurses, Physicians,  Respiratory Therapists, Hospital and Health Systems
  • Created by: NIH. Updated: 6/17/2021 

Therapeutic Agents for Bedside Care
Manual covers medication regimens to optimize the patient’s clinical presentation and recommends a treatment strategy based on severity of disease and availability of therapies 

  • Language: English
  • For: Nurses, Physicians,  Respiratory Therapists, Hospital and Health Systems
  • Created by: Amy Dzierba, ASHP

ANTICOAGULATION 

Antithrombotic Therapy: The Evidence
Manual discusses thrombosis and its underlying pathophysiology in COVID-19

  • Language: English
  • Aimed at: Nurses, Physicians,  Hospital and Health Systems
  • Created by: Dr. Moores, MD, F. Edward Hebert School of Medicine and CHEST

ANTIBIOTIC USE

COVID-19: Sepsis Without an Antibiotic
Manual discusses sepsis in COVID-19 and antibiotic stewardship principles pertaining to it

  • Language: English
  • For: Physicians, Nurses, Hospital and Health Systems
  • Created by: Angel Coz, MD, University of Kentucky and CHEST

NEUROLOGY AND COVID

How to Approach Neurological Manifestations of COVID-19 Patients
Manual discusses Spectrum of Neurological Manifestations of COVID19, effect of COVID-19 on the nervous system and approaches to neurological disorders

  • Language: English
  • For:  Physicians, Nurses, Hospital and Health Systems
  • Created by: Neha Dangayach, Critical Care Resilience Program and Neurocritical Care Society

TRANSPLANT PATIENTS

Guidance on COVID-19 for Transplant Clinicians

  • Language: English
  • For: Nurses, Physicians, Hospital and Health Systems
  • Created by: The Transplantation Society. Update 6/08/2020

HEALTH SYSTEMS MANAGEMENT 

Transitions of Care and Managing Comorbidities Associated with Covid-19

  • Languages: English, Hindi
  • For: Nurses, Physicians, Hospital and Health Systems
  • Created by: Dr. Truelove, ASHP

Courses

Clinical Management of Patients with COVID-19- General Considerations
3-hour course on pandemic preparedness as it relates to facility operations, preparation, referral systems, transfers, infection prevention & control, palliative care, and ethics

  • Languages: English, Македонски јазик, Shqip
  • For: Nurses, Physicians, Hospital and Health Systems
  • Created by: WHO

Stanford EdX COVID-19 Training for Healthcare Workers Course
2-week training module for healthcare workers dealing with early clinical signs & symptoms, PPE, management, infection prevention and control practices, etc. 

  • Language: English
  • For: Nurses, Physicians,  Respiratory Therapists, Hospital and Health Systems
  • Created by: Stanford University School of Medicine

COVID-19: Phenotypes and Clinical Implications
Slide deck

  • Languages: English and Hindi
  • For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
  • Created by: Society of Critical Care Medicine

INFECTION PREVENTION

Acute Respiratory Infection Basic Training
2-hour course 

  • Languages: English, Français, Bahasa Indonesia, русский, Português, 中文, Español, العربية , Tiếng Việt, বাংলা, Shqip, македонски, Tetun, Polski, සිංහල, ภาษาไทย, தமிழ்
  • For: Nurses, Physicians, Respiratory Therapists
  • Created by: WHO

Webinars

Webinar schedule of COVID-19 of AIIMS New Delhi
Webinar covering epidemiology, clinical diagnosis, infection prevention practices including handwashing techniques, PPE donning, masks, safe social distancing in various settings; patient transportation, post exposure health personnel protocols etc.

  • Language: English
  • Created by: AIIMS. Updated: March 27, 2020

Research

MEDICATIONS

COVID Steroids: RECOVERY- Dexamethasone in Hospitalized Patients with COVID-19- Preliminary Report
Results of a controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with COVID-19, receiving oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days as cases and those patients who did not receive any as controls. The primary outcome was 28-day mortality.

  • Language: English
  • For: Nurses, Physicians, Hospital and Health Systems
  • RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, Staplin N, Brightling C, Ustianowski A, Elmahi E, Prudon B, Green C, Felton T, Chadwick D, Rege K, Fegan C, Chappell LC, Faust SN, Jaki T, Jeffery K, Montgomery A, Rowan K, Juszczak E, Baillie JK, Haynes R, Landray MJ. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021 Feb 25;384(8):693-704. doi: 10.1056/NEJMoa2021436. Epub 2020 Jul 17. PMID: 32678530; PMCID: PMC7383595.

COVID Steroids: REACT: Association Between Administration of Systemic Corticosteroids and Mortality among critically ill patients with COVID-19
Meta-analysis of 7 randomized clinical trials to estimate the association between administration of corticosteroids compared with usual care or placebo and 28-day all-cause mortality. 

  • Language: English
  • For: Nurses, Physicians,  Hospital and Health Systems
  • WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne JAC, Murthy S, Diaz JV, Slutsky AS, Villar J, Angus DC, Annane D, Azevedo LCP, Berwanger O, Cavalcanti AB, Dequin PF, Du B, Emberson J, Fisher D, Giraudeau B, Gordon AC, Granholm A, Green C, Haynes R, Heming N, Higgins JPT, Horby P, Jüni P, Landray MJ, Le Gouge A, Leclerc M, Lim WS, Machado FR, McArthur C, Meziani F, Møller MH, Perner A, Petersen MW, Savovic J, Tomazini B, Veiga VC, Webb S, Marshall JC. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis. JAMA. 2020 Oct 6;324(13):1330-1341. doi: 10.1001/jama.2020.17023. PMID: 32876694; PMCID: PMC7489434.

COVID Steroids: Corticosteroids in ARDS: Evidence and Hope during the Pandemic

  • 3 multicenter RCTs that assessed corticosteroid therapy in critically ill patients with COVID-19, as well as the WHO-sponsored prospective meta-analysis
  • Language: English
  • For: Nurses, Physicians, Hospital and Health Systems
  • Prescott HC, Rice TW. Corticosteroids in COVID-19 ARDS: Evidence and Hope During the Pandemic. JAMA. 2020 Oct 6;324(13):1292-1295. doi: 10.1001/jama.2020.16747. PMID: 32876693.

ANTI-COAGULANTS

Anticoagulation in COVID-19: An Update
Review paper on thrombotic events due to COVID-19 and their prevention and management 

  • Language: English
  • For: Nurses, Physicians,  Hospital and Health Systems
  • Tiwari NR, Khatib KI, Dixit SB, Rathore PK, Melinkeri S, Ganapule A, Borawake KS, Mhatre U. Anticoagulation in COVID – 19: An Update. J Crit Care Med (Targu Mures). 2020 Nov 7;6(4):217-223. doi: 10.2478/jccm-2020-0033. PMID: 33200092; PMCID: PMC7648443.

Prophylactic anticoagulants for people hospitalized with COVID-19
Systematic review to assess the effects of prophylactic anticoagulants versus active comparator, placebo or no intervention, on mortality and the need for respiratory support in people hospitalized with COVID-19.

  • Language: English
  • For: Nurses, Physicians, Hospital and Health Systems
  • Flumignan RL, Tinôco JDS, Pascoal PI, Areias LL, Cossi MS, Fernandes MI, Costa IK, Souza L, Matar CF, Tendal B, Trevisani VF, Atallah ÁN, Nakano LC. Prophylactic anticoagulants for people hospitalised with COVID-19. Cochrane Database Syst Rev. 2020 Oct 2;10:CD013739. doi: 10.1002/14651858.CD013739. PMID: 33502773.

Additional Resources

OVERVIEW

ACT-Accelerator for Collaborative Framework of Testing, Treatments, Vaccines
The ACT-Accelerator is the world’s most comprehensive end-to-end solution to ending the acute phase of the devastating COVID-19 pandemic. It brings together governments, health organizations, scientists, businesses, civil society, and philanthropists to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines. The ACT Accelerator is a framework for collaboration. 

  • Language: English
  • For: Hospital and Health Systems, Public Health Organizations
  • Created by: WHO, the European Commission, France, and the Bill and Melinda Gates Foundation. Updated: 2021

COVID19 Clinical Practice Protocols

  • Language: English
  • Aimed at: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
  • Created by: Brigham’s and Women’s Hospital

HEALTH SYSTEMS MANAGEMENT

Managing and Mitigating Drug Shortages
Manual discusses causes behind drug shortages, supply chain management during a pandemic, and strategies to mitigate drug shortages in advance of a second wave

  • Languages: English, Hindi
  • For: Hospital and Health Systems, Public Health Organizations
  • Created by: Erin Fox, ASHP

Best Practices in Parallel Care: COVID-19 and non-COVID-19 Patients
Manual discusses preparing for subsequent waves of COVID-19 with goal to not disrupt routine care.

  • Created by: Gopi Patel, The Mount Sinai Hospital 
  • Language: English, Hindi
  • For: Nurses, Physicians,  Hospital and Health Systems, Public Health Organizations

RISK CALCULATORS

The JHU COVID Inpatient Risk Calculator: CIRC
CIRC uses factors on admission to the hospital to predict the likelihood that a patient admitted with COVID-19 will progress to severe disease or death within 7 days of arrival. 

  • Language: English
  • For: Nurses, Physicians,  Hospital and Health Systems
  • Created by: Grant Schomock, et al., Johns Hopkins University

JHU Severe COVID-19 Adaptive Risk Predictor (SCARP)
SCARP is a tool that calculates the 1-day and 7-day risk of progression to severe disease or death for adult patients (18 years and older) who are hospitalized with COVID-19.

  • Language: English
  • For: Nurses, Physicians, Hospital and Health Systems
  • Created by: Johns Hopkins University

*The resources for this section were reviewed by Johns Hopkins University students Shiree Patel, Pranjal Agrawal, and Varsha Venkatesh, Research Associate Noor Zanial, Pulmonary Critical Care Fellow Dr. Bhavna Seth, and Faculty Dr. Venkat Gundareddy and Dr. Robert Bollinger on behalf of the Johns Hopkins India Institute COVID-19 Task Force Technical Working Group.