In Reply

We would like to thank our colleagues for their letters on our publication of selected recommendations from the German S3 guideline “Recommendations on the in-hospital treatment of patients with COVID-19” (1).

We agree with the statements of our colleagues Gottlieb et al. that the target range of acute oxygen therapy for non-ventilated patients without risk of hypercapnia should be saturation levels between 92% and 96% as measured by pulse oximetry. An upper limit of 96% and the avoidance of unnecessary and potentially harmful oxygen therapy are certainly relevant (2).

Figure 1 is intended to provide support for therapeutic measures for COVID-19 and hypoxemia. It seems important to us that patients with hypoxemia and/or tachypnea are adequately monitored and treated. To our knowledge, there are no larger randomized, controlled studies on the described constellations (hypoxemia without tachypnea, or tachypnea without hypoxemia) for COVID-19.

Based on the statements made, we cannot agree with Dr. Möckel’s suggestion to start oxygen therapy at an oxygen saturation of < 95% or to admit patients with an oxygen saturation of < 95% as inpatients.

The drug studies carried out to date for COVID-19 clearly show that individual drugs only lead to a benefit at certain stages of the disease. The British RECOVERY study showed that the administration of dexamethasone in hospitalized patients with COVID-19 who received oxygen leads to a reduction in mortality, but this effect could not be demonstrated in hospitalized patients who were not receiving oxygen (3). To delimit the various stages of the disease, we use the WHO Clinical Progression Scale in the guideline, which reflects the clinical course of patients and is recommended for conducting randomized studies (4).

Monoclonal antibodies against SARS-CoV-2 are an important component in the therapy of COVID-19, especially to avoid a severe course of disease. On 17 December, 2021, the European Commission approved the monoclonal antibody sotrovimab for the treatment of COVID-19. In contrast to casirivimab/imdevimab, sotrovimab also works with the omicron variant and is available in Germany. Based on the available study data, sotrovimab is a good treatment option for patients in the early phase of the disease, if they do not have protection by vaccination but at the same time present risk factors for a severe course (5). In our opinion, it is important to think about this therapy option. This applies to outpatients as well as to patients in the emergency room, severely immunosuppressed patients who are admitted to the hospital even without oxygen requirement, and for early nosocomial infections in the hospital.

Finally, we would like to point out that the German S3 guideline “Recommendations for in-hospital treatment of patients with COVID-19” was updated again in February 2022.