Definitions

• Acute COVID-19: signs and symptoms of infection <4W

• Ongoing symptomatic COVID-19: signs and symptoms of infection from 4–12W

• Post-COVID-19 syndrome: signs and symptoms of infection consistent with COVID-19 >12 weeks.

• Long COVID: signs and symptoms persisting after the first 4 weeks, so encompasses both ongoing symptomatic and post-COVID-19 syndrome.

Diagnosis

• Prodrome (pre-illness phase) 2–10 days

• Commonest symptoms: fever, a new and continuous cough, SOB, fatigue, loss of appetite, anosmia and ageusia (loss of taste)

• Other symptoms include headache, muscle pain, sore throat, nasal congestion, chest pain, nausea / vomiting, diarrhoea, skin rashes (especially in younger people). Delirium and reduced mobility can appear in the elderly and immunocompromised people, often in the absence of fever.

Admission

• Pneumonia (clinical or radiological) or

• ARDS or

• ILI (fever ≥37.8°C & ≥ 1 of:

  1. acute persistent cough [with or without sputum]

  2. hoarseness

  3. nasal discharge or congestion

  4. SOB

  5. sore throat

  6. wheezing

  7. sneezing

Isolation advice

If people have symptoms of coronavirus, they need to stay at home and self-isolate for 10 days after symptoms started. People can stop self-isolating after 10 days if they do not have any symptoms or if they only have a cough or changes to sense of smell or taste, as these can last for weeks after the infection.

People who have been told to self-isolate should self-isolate for 14 days from the day they were last in contact with the person who tested positive for coronavirus

Therapeutics

• Corticosteroids: Dexamethasone (or hydrocortisone or prednisolone) for 10/7 if hypoxic or requiring supplemental oxygen

• Monoclonal antibody against spike protein:

  • Casirivimab/imdevimab (REGEN-COV): if hospitalised AND seronegative (not if detectable antibodies or serostatus unknown)

• Monoclonal antibody against interleukin-6 (cytokine) receptor (IL-6 inhibitor)

  • Tocilizumab: need supplemental oxygen AND CRP ≥75 mg/litre AND no evidence of additional bacterial/viral infection AND completed or having dexamethasone

  • Sarilumab: if tocilizumab not available

• Remdesivir: if COVID-19 pneumonia and needing supplemental oxygen

• LMWH:

• Vitamin D supplementation:

• Antibiotics (inc. azithromycin/doxycline): not for COVID-19, only if clinical suspicion of additional bacterial co-infection

• Budesonide (inhaled): research settings

• Colchichine: not recommended

• Ivermectin: research settings

Reference: Managing COVID-19 (NICE rapid guideline 191), Dec 2021

Resources

• COVID-19 (CKS); Managing COVID-19 (NICE rapid guideline 191)

• Managing symptoms (including at the end of life) in the community [NICE, 2020k]

• Managing suspected or confirmed pneumonia in adults in the community [NICE, 2020b]

• Bone marrow transplant [NICE, 2020o]

• Rheumatological autoimmune, inflammatory and metabolic bone disorders [NICE, 2020j], Severe asthma [NICE, 2020a]

• Radiotherapy [NICE, 2020p]

• Critical Care [NICE, 2020q]

• Renal dialysis [NICE, 2020r]

• Haematopietic stem cell transplantation [NICE, 2020o]

• Systemic anticancer treatments [NICE, 2020i], Chronic obstructive pulmonary disease (COPD) [NICE, 2020e]

• Dermatological conditions [NICE, 2020g]

• Cystic Fibrosis [NICE, 2020f]

• Gastrointestinal and liver conditions treated with drugs affecting the immune response [NICE, 2020h]

• Acute myocardial injury [NICE, 2020c]

• Children and young people who are immunocompromised [NICE, 2020s]

• Antibiotics for pneumonia in adults in hospital [NICE, 2020t]

• Acute kidney injury in hospital [NICE, 2020u]

• Interstitial lung disease [NICE, 2020v]

• Chronic kidney disease [NICE, 2020d]

• Angiotensin-converting inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in people with or at risk of COVID-19 [NICE, 2020m]

• Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) for people with or at risk of COVID-19 [NICE, 2020w]

• Anakinra for COVID-19 associated secondary haemophagocytic lymphohistiocytosis [NICE, 2020x]

• Remdesivir for treating hospitalised patients with suspected or confirmed COVID-19 [NICE, 2020y]

• Renal transplantation [NICE, 2020z]

• Vitamin D [NICE, 2020aa]

• Arranging planned care in hospitals and diagnostic services [NICE, 2020ab].

• Medtech innovation briefings on myCOPD for self-management of chronic obstructive pulmonary disease (COPD) [NICE, 2020ac]

• Cytokine adsorption devices for treating respiratory failure in people with COVID-19 [NICE, 2020ad]

• An evidence standards framework for SARS-CoV-2 and anti-SARS-CoV-2 antibody diagnostic tests [NICE, 2020ae]

• evidence collection guide for medicinal products to prevent or treat COVID-19 [NICE, 2020af]

SARS​

• SARS (NHS Choices)