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Adults/General (May 2020)
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Treatment (General)
Moderate and severe cases should typically be treated in hospital, with more critical cases transferred to the ICU Monitoring of water and electrolyte balance as well as vital signs Oxygen saturation with oxygen therapy initiated if needed starting with low flow, including nasal catheter and mask oxygenation, before moving to high-flow oxygen therapy
Pharmacotherapy (moderate cases)
Steroids—methylprednisolone injection Early norepinephrine for hypotension Broad-spectrum antibiotics, e.g., meropenam IV/based on local antibiograms Remdesivir—discretion of consultant working in the hospital. If favipiravir has already been started in patients with moderate disease, this should be stopped in favour of remdesivir Consider tocilizumab and convalescent plasma therapy for cytokine storm/hemophagocytic lymphohistiocytosis
Severe disease
Additional oxygenation support for patients with severe disease If patients develop ARDS, intubation with mechanical ventilation will be needed; ECMO may be indicated in patients with refractory hypoxia in the ICU setting
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Children (November 2020)
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Diagnosis and comorbidity
Ideally, PCR test to confirm the diagnosis and subsequent management on a designated COVID-19 ward or treatment area Comorbid conditions can include bronchial asthma, chronic kidney or liver disease and rheumatological conditions, including Kawasaki disease
General treatment and ICU
General treatment includes supportive care, electrolyte balancing and providing oxygen when necessary Children should be transferred to the paediatric ICU if they are experiencing severe/critical symptoms, respiratory failure requiring mechanical ventilation, shock, or organ failure. Treatment includes vasoactive drugs if required as well as balanced/buffered crystalloids
Recommended medicines for treating children with COVID-19
Antivirals—potentially reserved for children with severe acute respiratory syndrome. If remdesivir, then ideally part of ongoing clinical trials. Conflicting evidence regarding lopinavir/ritonavir Antibiotics—specific cases only, avoiding excessive use. 1st line—ampicillin plus gentamicin; 2nd line—ceftriaxone Corticosteroids—not used routinely. Low-dose dexamethasone may be beneficial in children with severe disease Vitamins—may be beneficial For suspected Kawasaki Disease/MIS-C—typically admit to paediatric ICU with supportive care, including antibiotics for suspected infections as well as steroids and other immune modifying therapies
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