Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. – WHO

CoronaVirus

This is the second edition (version 1.2) of this document for the novel coronavirus SARS-CoV-2, causing COVID-19 disease. It was originally adapted from the publication Clinical management of severe acute respiratory infection when MERS-CoV infection is suspected (WHO, 2019).

This document is intended for clinicians involved in the care of adult, pregnant and paediatric patients with or at risk for severe acute respiratory infection (SARI) when a SARS-CoV-2 infection is suspected. Considerations for paediatric patients and pregnant women are highlighted throughout the text. It is not meant to replace clinical judgment or specialist consultation but rather to strengthen clinical management of these patients and to provide up-to-date guidance. Best practices for infection prevention and control (IPC), triage and optimized supportive care are included.

This document is organized into the following sections:
1. Background
2. Screening and triage: early recognition of patients with SARI associated with COVID-19
3. Immediate implementation of appropriate infection prevention and control (IPC) measures
4. Collection of specimens for laboratory diagnosis
5. Management of mild COVID-19: symptomatic treatment and monitoring
6. Management of severe COVID-19: oxygen therapy and monitoring
7. Management of severe COVID-19: treatment of co-infections
8. Management of critical COVID-19: acute respiratory distress syndrome (ARDS)
9. Management of critical illness and COVID-19: prevention of complications
10. Management of critical illness and COVID-19: septic shock
11. Adjunctive therapies for COVID-19: corticosteroids
12. Caring for pregnant women with COVID-19
13. Caring for infants and mothers with COVID-19: IPC and breastfeeding
14. Care for older persons with COVID-19
15. Clinical research and specific anti-COVID-19 treatments Appendix: resources for supporting management of severe acute respiratory infections in children

These symbols are used to flag interventions:
Do: the intervention is beneficial (strong recommendation) OR the intervention is a best practice statement.
Don’t: the intervention is known to be harmful.
Consider: the intervention may be beneficial in selected patients (conditional recommendation) OR be careful when considering this intervention.

This document aims to provide clinicians with updated interim guidance on timely, effective and safe supportive management of patients with suspected and confirmed COVID-19. It is organized by the patient journey. The definitions for mild and severe illness are in Table 2, while those with critical illness are defined as patients with acute respiratory distress syndrome (ARDS) or sepsis with acute organ dysfunction.

The recommendations in this document are derived from WHO publications. Where WHO guidance is not available, we refer to evidence-based guidelines. Members of a WHO global network of clinicians, and clinicians who have treated SARS, MERS or severe influenza patients, have reviewed the recommendations (see Acknowledgements). For queries, please email: [email protected]who.int with “COVID-19 clinical question” in the subject line.