Patient handout

COVID-19 inpatient management

PRODUCTION

1. Your condition

This handout is for covid-19 inpatient management. Your care team identified this based on: sars-cov-2 pcr or antigen positive (who 2024 case definition).

Other reasons your team may use this plan: acute respiratory illness with covid-19 risk factors (nih covid treatment guidelines 2024); new hypoxemia (spo2 <94%) with confirmed/suspected sars-cov-2 (who 2024 ordinal scale ≥4); bilateral ground-glass opacities on ct consistent with covid-19 pneumonia (rsna 2020 typical pattern).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
nirmatrelvir-ritonavir	300/100 mg	PO	BID × 5 days	NIH COVID Treatment Guidelines 2024 preferred for mild-to-moderate with risk factors; 89% relative risk reduction for hospitalisation (EPIC-HR Hammond NEJM 2022)
remdesivir	200 mg IV day 1, then 100 mg IV daily	IV	daily × 5 days (3 days if not requiring O2)	ACTT-1 shortened recovery by 5 days in O2-requiring patients (Beigel NEJM 2020); WHO 2024 conditional recommendation for severe
dexamethasone	6 mg	IV or PO	daily × 10 days	RECOVERY: 28-day mortality reduced by one-third in ventilated, one-fifth in O2-requiring patients (Horby NEJM 2021); WHO 2024 strong recommendation for O2-requiring
tocilizumab	8 mg/kg IV (max 800 mg)	IV	single dose; repeat at 12-24h if no improvement	REMAP-CAP: reduced organ support duration + 28-day mortality in severe/critical on corticosteroids (Gordon NEJM 2021); WHO 2024 strong recommendation
baricitinib	4 mg	PO	daily × 14 days or until discharge	COV-BARRIER: 38% relative reduction in 28-day mortality in severe patients on standard care including dexamethasone (Marconi Lancet RM 2021); WHO 2024 strong recommendation

Plan: Severity-tiered COVID-19 therapeutics (WHO 2024; NIH COVID Treatment Guidelines 2024)

3. When to call your provider

Contact your care team if any of the following happen:

oxygen level (SpO₂) <94% sustained on room air OR ≥4% drop on ambulation → ED + supplemental O2 + WHO ordinal scale + admission consideration (NIH COVID Treatment Guidelines 2024)
Severe dyspnea, pleuritic chest pain, hemoptysis, unilateral leg swelling → ED for PE screen (CT-PA + D-dimer adjusted for COVID baseline elevation)
New chest pain + troponin elevation suspicion → ED for ACS / myocarditis differentiation (cardio.myocarditis / cardio sibling)
Worsening symptoms after initial improvement on antiviral (biphasic course) → ED for cytokine-storm / superinfection workup
Persistent / worsening fever beyond day 5-7 → consider bacterial superinfection → ED for evaluation + procalcitonin / CXR
PHQ-9 ≥15 OR suicidal ideation at long-COVID screen → mental health urgent referral (routes to psych.depression.core.v1 / psych.suicidality.ed.core.v1)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

oxygen level (SpO₂) drop to <90% on room air or rapid decline ≥4% within 24h suggesting ARDS progression or PE (WHO 2024; NIH COVID Treatment Guidelines 2024)
Ferritin >1000 ng/mL + CRP >100 mg/L + rising O2 requirement ± hemodynamic instability (hyperinflammatory phenotype; NIH COVID Treatment Guidelines 2024)(life-threatening)
PaO2/FiO2 <300 with bilateral opacities not fully explained by effusions/atelectasis within 7 days of COVID-19 worsening (Berlin Definition; ARDS Task Force JAMA 2012)(life-threatening)
Acute desaturation with pleuritic chest pain, tachycardia, D-dimer >5.0 µg/mL, or CT-PA positive for PE (PE incidence 5-15% in hospitalised COVID-19; NIH COVID Treatment Guidelines 2024)
Multisystem inflammatory syndrome in adults (MIS-A): fever + ≥2 organ involvement (cardiac, GI, dermatologic, neurologic) + elevated inflammatory markers 2-12 weeks post SARS-CoV-2 (CDC case definition 2021; NIH COVID Treatment Guidelines 2024)(life-threatening)
Life-threatening rapid desaturation event: oxygen level (SpO₂) drop ≥4% on minimal exertion (e.g., bed-to-chair, 1-minute walk) OR sustained oxygen level (SpO₂) <92% on room air OR baseline despite supplemental O2 (WHO 2024; NIH COVID Treatment Guidelines 2024) — distinct from the broader covid_rapid_desaturation trigger by severity-level (life_threatening vs severe)(life-threatening)
PE risk features in COVID: D-dimer rising / doubling over 24-48 h above already-elevated COVID baseline (typical ≥3-5 µg/mL threshold for CT-PA), hemodynamic instability (tachycardia disproportionate to fever or new hypotension), sudden desaturation disproportionate to parenchymal disease, OR unexplained hypoxia after initial COVID improvement (NIH COVID Treatment Guidelines 2024; Klok TR 2020 — PE incidence 5-15% in hospitalised COVID-19)
COVID secondary bacterial pneumonia: new fever after initial defervescence (typically after day 5-7) + WBC change (new leukocytosis or left-shift) + procalcitonin rise (PCT >0.5 ng/mL with NPV ~90% for bacterial co-infection when PCT <0.5; NIH COVID Treatment Guidelines 2024) + new infiltrate on imaging OR purulent sputum (NIH COVID Treatment Guidelines 2024; IDSA HAP/VAP 2016 for ICU/ventilated patients) — initial COVID-19 bacterial co-infection rate ~3-8% in published cohorts (Langford CMI 2020)

5. Follow-up

Post-COVID sequelae screening at 4-12 weeks (long COVID / PASC); pulmonary function testing if persistent dyspnea; cardiac MRI if myocarditis; VTE extended prophylaxis consideration; vaccination counselling (NIH COVID Treatment Guidelines 2024; WHO 2024)

6. Sources

Guideline: WHO 2024 therapeutics living guideline + NIH COVID-19 Treatment Guidelines 2024 + RECOVERY (Horby NEJM 2021 — dexamethasone) + REMAP-CAP (Gordon NEJM 2021 — tocilizumab) + COV-BARRIER (Marconi Lancet RM 2021 — baricitinib) + ACTT-1 (Beigel NEJM 2020 — remdesivir) + EPIC-HR (Hammond NEJM 2022 — nirmatrelvir-ritonavir) + PROSEVA (Guérin NEJM 2013 — prone positioning) + ARDSnet (Brower NEJM 2000 — lung-protective ventilation) + REMAP-CAP/ACTIV-4a/ATTACC (NEJM 2021 — anticoagulation)