COVID-19

1. Age ≥ 65

2. Cancer

3. Cardiovascular (HTN included), cerebrovascular, chronic kidney, chronic liver, and chronic lung diseases

4. Diabetes

5. Disabilities

6. Hemoglobin blood disorders

7. Mental health and neurological conditions

8. Overweight or obesity: BMI ≥ 25

9. Physical inactivity

10. Pregnancy and recent pregnancy

11. Smoking: current and former

12. Immunocompromising conditions

13. Race and ethnicity

14. Unvaccinated individuals

Risk factors for COVID-19

Difficulty breathing

Persistent pain or pressure in the chest

New confusion

Inability to wake or stay awake

Pale, gray, or bluish skin, lips, or nail beds

Emergency warning symptoms for COVID-19

Nucleic acid amplification tests (NAATs)

- Real-time reverse transcription-polymerase chain reaction (RT-PCR)

Gold standard for diagnosing COVID-19

Long COVID (PASC)

Symptoms or health problems that persist for ≥4 weeks after acute SARS-CoV-2 infection

First line: Nirmatrelvir/ritonavir (Paxlovid) 300/100 mg PO BID x 5 days

- only given if symptom onset is within 5 days

Second line: Remdesivir (Veklury) 200 mg IV on day 1, then 100 mg IV x 2 days (Total 3 days of therapy)

- only given if symptom onset is within 7 days

Alt: Molnupiravir (Lagevrio) 800 mg PO BID x 5 days

- only given if symptom onset is within 5 days

Treatment for nonhospitalized adults (outpatient) with mild to moderate COVID-19 who are at a high risk of disease progression.

5 days

Nirmatrelvir/ritonavir (Paxlovid) is only given if symptom onset is within _____ days

<30 ml/min

Avoid Nirmatrelvir/ritonavir (Paxlovid) if GFR is <_____

7 days

Remdesivir (Veklury) is only given if symptom onset is within _____ days

5 days

Molnupiravir (Lagevrio) is only given if symptom onset is within _____ days

true

T/F: Antivirals are more effective in the early stages of COVID-19, whereas immunosuppressive and anti-inflammatory therapy is more beneficial in the later stages.

Remdesivir (Veklury) 200 mg on day 1, followed by 100 mg once daily. Duration is generally 5-10 days or until hospital discharge, whichever is first.

Recommended treatment for hospitalized patients who are at a high risk of progression to severe COVID-19 but do not require oxygen supplementation

Remdesivir (Veklury) 200 mg on day 1, followed by 100 mg once daily. Duration is generally 5-10 days or until hospital discharge, whichever is first.

- For most patients, add Dexamethasone 6 mg IV/PO daily x 10 days or until discharged.

Recommended treatment for hospitalized patients who require minimal conventional oxygen

- Remdesivir (Veklury) 200 mg on day 1, followed by 100 mg once daily x 5-10 days or until discharge

- Dexamethasone 6 mg IV/PO daily x 10 days or until discharge

- Add Baricitonib (Olumiant) 4 mg PO daily x14 days or until discharged OR Tocilizumab (Actrema) 8 mg/kg IV x 1 dose (Max: 800 mg)

Recommended treatment for hospitalized patients who are receiving dexamethasone and who have rapidly increasing oxygen needs and systemic inflammation.

Dexamethasone 6 mg IV/PO daily x 10 days should be administered to all patients.

- If the patient has not already received a second immunomodulator, promptly add 1 of the following: Baricitonib (Olumiant) 4 mg PO daily x14 days or until discharged OR Tocilizumab (Actrema) 8 mg/kg IV x 1 dose (Max: 800 mg)

*Remdesivir may be added to patients on HFNC or NIV, but not MV or ECMO*

Recommended treatment for hospitalized patients who require high flow nasal cannula (HFNC) oxygen, non-invasive ventilation (NIV), mechanical ventilation (MV), or ECMO

Sarilumab (Kevzara) 400 mg SQ x 1 dose

Alternative for Tocilizumab (Actrema)

Tofacitinib (Xeljanz) 10 mg PO BID x 14 days or until discharge

Alternative for Baricitinib (Olumiant)

≥ 6 months

1 dose

Recommeded age and dosing for the mRNA vaccines, Comirnaty (Pfizer) and Spikevax (Moderna)

≥12 years

2 doses, 3 weeks apart

Recommeded age and dosing for the protein subunit vaccine, Novavax

Pemgarda (Pemivibart) 4500 mg IV over 60 min

- Can repeat dose every 3 months

- Wait to administer until 2 weeks after COVID-19 vaccine.

Monoclonal antibody for pre-exposure prophylaxis (PEP) of COVID-19 in moderately or severely immunocompromised individuals ≥12 years and ≥ 40 kg