Case management and treatment of COVID-19

Most SARS-CoV-2 infections do not require hospitalisation or medical treatment and can be managed at home or in outpatient settings.

Medical treatment of COVID-19 is mostly supportive, including oxygen for severely ill patients and patients at risk of developing severe disease, and ventilation for critically ill patients. For patients with mild or moderate COVID-19 disease and increased risk for progression (e.g. due to advanced age and/or comorbidities), early medical treatment may be indicated.

A SARS-CoV-2 infection and mild to moderate COVID-19 disease in adults does usually not require specific treatment. Antivirals and antiviral monoclonal antibodies can be considered in consultation with respective clinical specialists and available guidelines for adults and adolescents at risk of developing severe disease such as moderately to severely immunocompromised patients that may have an inadequate immune response to COVID-19 vaccination.

WHO maintains regularly updated guidelines on case management of COVID-19 patients as well as information on COVID-19 therapeutics and drugs to prevent COVID-19 [40].

WHO strongly recommends the use of systemic corticosteroids, interleukin-6 (IL-6) receptor blockers such as tocilizumab, or baricitinib as an alternative to IL-6 receptor blockers for severe or critical COVID-19 disease, in combination with corticosteroids [40].

WHO has issued a strong recommendation against the use of the antimalarial hydroxychloroquine and the antiretrovirals lopinavir-ritonavir for COVID-19, regardless of disease severity, and a recommendation against the antiparasitic ivermectin, except in the context of clinical trials. Convalescent plasma should not be used for non-severe COVID-19 disease, and only for severe disease in the context of clinical trials [40].

The evidence base is continuously evolving. Clinicians and public health practitioners are advised to consult treatment guidelines on a regular basis and follow local standards of care.

Medicines

Several medicinal products are authorised for use in the EU for the treatment of COVID-19 [41].

In the early stages of infection for people at risk of developing severe disease that do not require supplemental oxygen, the following treatments are available:

• a combination of the oral antiviral nirmatrelvir and the protease inhibitor ritonavir;
• antiviral monoclonal antibodies (e.g. sotrovimab, a combination of the two monoclonal antibodies tixagevimab and cilgavimab, regdanvimab, or a combination of the two monoclonal antibodies casirivimab and imdevimab).

For hospitalised patients requiring oxygen, the following treatments are available:

• the antiviral remdesivir;
• immunomodulators such as tocilizumab, anakinra, or baricitinib.

Recommendations on the use of monoclonal antibodies change due to the emergence of variants that are less sensitive to existing therapies. Clinical trials of therapeutic interventions for COVID-19 have focused on adult and adolescent patients, and data on the treatment of COVID-19 in children are still limited.

The evidence base is continuously evolving. Clinicians are advised to consult treatment guidelines on a regular basis and follow local standards of care.