Table 1.

Examples of therapeutic alternatives in the management of patients with suspected or confirmed COVID-19 compared to non-infected patients

Patients without COVID-19	Patients dying with COVID-19	Clinical reasoning
Management of respiratory distress for adults, whereby an infusion device is not available
Consider positioning and fan, calm environment and reassurance from family/friends [7]	Give regular subcutaneous doses of morphine 2.5–5 mg every 4 h + clonazepam subcutaneously 0.5–1 mg every 24 h + haloperidol subcutaneously 1 mg every 24 h	Regular repositioning of patients increases risk of staff exposure. Fan is prohibited due to risk of droplet and aerosols circulating. Restricted hours are put in place for all visitors.
AND	AND if required, morphine 2.5–5 mg up to every hour subcutaneously when required [8]	Therefore, regular dosing of morphine will improve the symptoms of dyspnoea without a detrimental effect on respiratory function [7]. Dyspnoea is associated with anxiety so the addition of a long acting benzodiazepine such as clonazepam improves sensation of dypsnoea in presence of anxiety [7]. Haloperidol may help with symptoms of nausea and vomiting with morphine and may also manage agitation or delirium [7].
Give morphine 2.5 mg subcutaneously hourly when required [7]

Patients without COVID-19	Patients with COVID-19	Clinical reasoning
Empirical therapy for patients with moderate-severity community acquired pneumonia (CAP)
Give benzylpenicillin 1.2 g intravenously every 6 h + doxycycline 100 mg orally every 12 h [9]	Give ceftriaxone 2 g intravenously once daily + azithromycin 500 mg intravenously once daily	Patients presenting with suspected or confirmed COVID-19 have symptoms that are very similar to those with high-severity CAP such as respiratory rate greater than 30 breaths per minute, oxygen saturation less than 90% on room air and multi-lobar or rapid progression of chest X-ray infiltrates [9].
		Patients with high severity CAP requiring intensive care support have a high risk of adverse outcomes if they do not receive appropriate initial treatment [9]. Thus, broader-spectrum empirical antibiotic therapy is recommended initially until the results of investigations are available for these patients [9].
		An additional benefit is the once daily dosing of ceftriaxone and azithromycin, thus reducing staff exposure.

Patients without COVID-19	Patients with COVID-19	Clinical reasoning
Bronchodilators for patients with a severe acute asthma attack
Give salbutamol 12 puffs (100microg/actuation) via pressurised metered dose inhaler and spacer [10]. If patient unable to breathe through a spacer, give 5 mg salbutamol nebule via nebuliser. Repeat salbutamol as needed [10]. Give at least every 20 min for first hour [10]	Do not use nebulizer. Spacers and inhalers are for single-patient use only	Nebulisers are not recommended for use in suspected or confirmed COVID-19 patients as it promotes the generation of aerosols and increases risk of airborne transmission [10].
AND	Give salbutamol 12 puffs (100microg/actuation) via pressurised metered dose inhaler and spacer. Repeat as needed. Give at least every 20 min for first hour
Give ipratropium 8 puffs (21microg/actuation) via pressurised metered dose inhaler and spacer every 20 min for first hour [10]. Repeat 4–6 h for 24 h [10]. If salbutamol given via nebuliser, add 500microg ipratropium to nebulised solution every 20 min for first hour [10]. Repeat 4-6 h [10]	AND
	Give ipratropium 8 puffs (21microg/actuation) via pressurised metered dose inhaler and spacer every 20 min for first hour. Repeat 4–6 h for 24 h