Pregnancy	•Increased risk of severe disease from SARS-CoV2 infection in pregnant persons •Use shared decision-making to discuss the use of investigational drugs or drugs approved for other indications as treatments for COVID-19 in pregnant or lactating patients •In general, treatment options for pregnant patients with COVID-19 should be the same as for nonpregnant patients •The COVID-19 Treatment Guidelines Panel recommends against withholding treatment for COVID-19 and SARS-CoV2 vaccination from pregnant or lactating persons due to theoretic safety concerns
Children	•Infection is generally milder than in adults, most children do not require specific therapy •Children with comorbid conditions (eg, neurologic impairment developmental syndromes, obesity, immune impairment, diabetes, and so forth) as well as non-White children and older teens may be at an increased risk for severe COVID-19 disease •Consultation with a pediatric infectious disease specialist is recommended for hospitalized children with COVID-19 who require supplemental oxygen, are at increased risk for severe disease, or who require treatment with remdesivir or dexamethasone •Multisystem Inflammatory Syndrome in Children (MIS-C) is a serious delayed complication of SARS-CoV2 infection that may develop in a small subgroup of children and young adults
Cancer or immuno-compromised	•Patients who are undergoing active cancer treatment or are immunocompromised are at high risk of progression to severe COVID-19 disease •Vaccination is the best first-line prevention of COVID-19 in these populations. However, vaccine response rates may be lower •They may be eligible to receive antiSARS-CoV2 monoclonal antibodies as preexposure prophylaxis (PrEP) •Treatment of COVID-19 in these patients is the same as the general population •Multiple drug–drug interactions may occur, consult with hematology-oncology or other specialties as appropriate
Transplant	•These patients are eligible to receive the anti-SARS-CoV-2 monoclonal antibodies tixagevimab plus cilgavimab (Evusheld) as PrEP •If SARS-CoV2 is detected or strongly suspected, transplantation should be deferred, if possible •The optimal management and therapeutic approach to COVID-19 in these populations is unknown. At this time, the procedures for evaluating and managing COVID-19 in transplant candidates are the same as those for nontransplant candidates •Multiple drug–drug interactions may occur, consult with transplant specialist before initiation of therapy
HIV	•COVID-19 vaccines should be given regardless of CD4 T lymphocyte (CD4) cell count or HIV viral load because the potential benefits outweigh the potential risks •The Advisory Committee on Immunization Practices recommends that people with advanced or untreated HIV should receive a 3-dose series of an mRNA COVID-19 vaccine, with the third dose at least 28 d after the second dose •Monoclonal antibodies (tixagevimab plus cilgavimab) can be used as PrEP in people with advanced or untreated HIV •The triage, management, and treatment of COVID-19 in people with HIV is generally the same as for the general population •Opportunistic infections should also be considered in the differential diagnosis of febrile illness •Ritonavir-boosted nirmatrelvir (Paxlovid) may be combined with ritonavir-based or cobicistat-based antiretroviral therapy •Multiple drug–drug interactions may occur, consult with HIV specialist before initiation of therapy
Influenza	•Influenza vaccine and COVID-19 vaccine may be administered concurrently at different injection sites • For patients with active COVID-19 infection who have not received influenza vaccine: ○ If asymptomatic or mildly ill: May be vaccinated when isolation period completed or if in a health-care setting for another reason ○ If moderately to severely ill: Defer vaccine until isolation completed and no longer moderately or severely ill •During periods when influenza is circulating, patients hospitalized with severe respiratory illness should be tested for both influenza and COVID-19 •Coinfection with SARS-CoV2 does not alter influenza treatment •Empiric treatment with oseltamivir should be started as soon as possible in hospitalized patients with suspected influenza