General treatment measures	Top priority: hygiene measures and immediate isolation! Symptomatic treatment (a)Moderate volume loading for circulatory stabilisation: restrictive volume management – seek negative fluid balance: consider worsening of oxygenation. (b)Antipyretic medication: paracetamol, ibuprofen. (c)Respiratory therapy: respiratory exercise, expectorating, sodium chloride inhalation.
Supportive therapy	(a)Deep vein thrombosis prophylaxis (enoxaparin sodium 40 mg), if no oral anticoagulation. (b)Intermittent proton pump inhibitor if not urgently indicated (Ulcer? Gastrointestinal bleeding? Gastro-oesophageal reflux disease?). (c)Continue antihypertensives (angiotensin converting enzyme (ACE) inhibitors, do not pause or start administration of angiotensin II type 1 blocker). (d)Breathing exercises, physical mobilisation by nursing staff if possible, Thera-Band®, physiotherapy. (e)Nutrition, especially in patients with disease-related anorexia.
Administration of oxygen	(a)Oxygen administration: preferably cautiously (infectiousness may increase through aerosol formation during oxygen administration); only in distinct dyspnoea in clinically symptomatic patients. (b)Aim: oxygen saturation of 90–95% at breathing frequency <20/min. (c)Oxygen administration if oxygen saturation <92% (no later than 90%). (d)Nasal, mask or high-flow oxygen, as needed (Caveat: increased aerosol formation). Caveat: silent hypoxaemia: persisting breathing frequency >20/min; oxygen demand ≥4 L/min, seek transfer to intensive care unit; in patients with sudden deterioration or persistent breathing frequency >30/min, early fasting is advisable.
Special issues	Antibiotics: only in case of suspected bacterial superinfection – signs: clinical worsening, sudden increase in C-reactive protein, leucocytosis. Procedure (a)Take several blood samples (aerobic + anaerobic). (b)Consider sputum culture. (c)Check lab parameters (C-reactive protein, procalcitonin test, differential blood count). Calculated antibiotic therapy As per guideline: community-acquired pneumonia Amoxicillin/clavulanic acid 3 × 875/125 mg (taken orally) or ampicillin/sulbactam 3 × 3 g i.v. ± azithromycin 1 × 500 mg i.v. Consider combination of azithromycin or moxifloxacin (Caveat: interactions and QTc interval). Azithromycin and other macrolide antibiotics (additional immune modulatory effects) can be preferably administered in patients with coronavirus disease 2019 (COVID-19) with pulmonary involvement.
	Caveat: prophylactic administration of antibiotics without proof of bacterial infection is not recommended. In patients with suspected bacterial superinfection and/or septic course, calculated antibiotic therapy should be initiated, in case of sepsis within 30 min. In case no pathogens are detected and procalcitonin level is in reference range, antibiotic therapy should be terminated within 48 h.
	Corticosteroids: no corticosteroid administration without distinct indication.
	Antiviral therapy (a)Currently no antiviral therapy with confirmed efficacy is available.6 (b)Uncomplicated patients (in-patient or out-patient): no antiviral therapy. (c)Preferred treatment in clinical studies and under careful consideration of risk–benefit balance and in intensive care units.
	ACE inhibitors: continue ACE inhibitors and angiotensin receptor blockers but do not start new administration
Management of psychotropic medication	Lithium: in case of high fever, sufficient intake of fluids, distributed throughout the day. In case of additional vomiting/diarrhoea, dose adjustment; as needed, pause lithium treatment for 24 h. Clozapine: (agranulocytosis!) initial continuation of clozapine (treatment success of psychotic disorder not to be jeopardised by discontinuation or dose reduction; check blood count regularly) (taken from the Consensus statement on the use of clozapine during the COVID-19 pandemic).7 Caveat: in case of bacterial superinfection, calculated antibiotic treatment (see above), close consultation with the internal medical unit. (a)Ongoing psychopharmacological treatments should be prioritised and most doses should be reduced by 25–50% of original dose if the patient receives lopinavir/ritonavir, with some exceptions, including quetiapine, asenapine, olanzapine, sertraline, lamotrigine, bupropion and methadone. (b)If levels of the usual psychopharmacological doses are in the low-to-median range, a dose change is not recommended while COVID-19 drugs are being co-administered. Instead, electrocardiogram (ECG) and clinical monitoring of adverse effects and drug levels, if required. (c)When introducing a psychopharmacological drug, dose titration should be progressive, with ECG monitoring if cardiotoxic interactions are present.8
Management of psychiatric comorbidities	(a)In agitated delirium, olanzapine is recommended as the first-line antipsychotic; quetiapine should be avoided. (b)In severe mental illness, essential treatments should be maintained. (c)In non-severe mental illness with depressive/anxiety symptoms, psychological support should be provided and symptoms identified and treated.8