Paul E. Sax, MD prepared useful Practice Aids pertaining to COVID-19 for this CME/MOC/CNE/CPE activity titled "Coronavirus Disease 2019 (COVID-19): Need-to-Know Information and Practical Guidance for Healthcare Professionals on the Front Lines of Patient Care." For the full presentation, monograph, complete CME/MOC/CNE/CPE information, and to apply for credit, please visit us at https://bit.ly/3gBvfOw. CME/MOC/CNE/CPE credit will be available until July 23, 2021.

1. COVID-19: Illness Severity Spectrum1
COVID-19: coronavirus disease 2019; FiO2
: percentage of inspired oxygen; PaO2
: partial pressure of arterial oxygen; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; SpO2
: oxygen saturation.
1. https://www.covid19treatmentguidelines.nih.gov/overview/management-of-covid-19/.
PRACTICE AID
Access the activity, “Coronavirus Disease 2019 (COVID-19): Need-to-Know Information and Practical
Guidance for Healthcare Professionals on the Front Lines of Patient Care,” at PeerView.com/QDX40
Individuals who test positive for SARS-CoV-2 by virologic testing using a molecular diagnostic
(eg, polymerase chain reaction) or antigen test but have no symptoms
Asymptomatic or
presymptomatic infection
Individuals who have any of the various signs and symptoms of COVID 19 (eg, fever,
cough, sore throat, malaise, headache, muscle pain) without shortness of breath, dyspnea,
or abnormal chest imaging
Mild illness
Individuals who have evidence of lower respiratory disease by clinical assessment or
imaging and a saturation of oxygen (SpO2
) ≥94% on room air at sea level
Moderate illness
Individuals who have respiratory frequency >30 breaths per minute, SpO2 <94% on room
air at sea level, ratio of arterial partial pressure of oxygen to fraction of inspired oxygen
(PaO2
/FiO2
) <300 mmHg, or lung infiltrates >50%
Severe illness
Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunctionCritical illness

2. Access the activity, “Coronavirus Disease 2019 (COVID-19): Need-to-Know
Information and Practical Guidance for Healthcare Professionals on
the Front Lines of Patient Care,” at PeerView.com/QDX40
Ten Clinical Tips on COVID-19 for Healthcare
Providers Involved in Patient Care1
PRACTICE AID
COVID-19: coronavirus disease 2019; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.
1. https://www.cdc.gov/coronavirus/2019-ncov/downloads/hcp/fs-ten-clinical-tips.pdf. 2. https://covid19treatmentguidelines.nih.gov/. 3. https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.
html. 4. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html. 5. https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html. 6. https://www.cdc.
gov/coronavirus/2019-ncov/hcp/faq.html. 7. https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations-for-Chest-Radiography-and-CT-for-Suspected-COVID19-
Infection. 8. https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html. 9. https://www.atsjournals.org/doi/pdf/10.1164/rccm.201908-1581ST. 10. https://www.cdc.gov/coronavirus/2019-ncov/hcp/
clinical-guidance-management-patients.html. 11. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html. 12. https://www.cdc.gov/coronavirus/2019-ncov/
hcp/clinical-guidance-management-patients.html.
Treatment and Prophylaxis
1. The National Institutes of Health has developed guidance on treatment, which will be regularly updated as new evidence on
the safety and efficacy of drugs and therapeutics emerges from clinical trials and research publications2
2. There is currently no FDA-approved post-exposure prophylaxis for people who may have been exposed to COVID-193
Symptoms and Diagnosis
3. Nonrespiratory symptoms of COVID-19—such as gastrointestinal (eg, nausea, diarrhea) or neurologic symptoms
(eg, anosmia, ageusia, headache)—might appear before fever and lower respiratory tract symptoms (eg, cough and
shortness of breath)4
4. Children with COVID-19 may have fever and cough at symptom onset as often as adult patients; although most children with
COVID-19 have not had severe illness, clinicians should maintain a high index of suspicion for SARS-CoV-2 infection in children,
particularly infants and children with underlying conditions5
5. CT scans should not be used to screen for COVID-19 or as a first-line test to diagnose COVID-19; CT should be used
sparingly, reserved for hospitalized, symptomatic patients with specific clinical indications for CT6,7
Coinfections
6. Patients can be infected with more than one virus at the same time; coinfections with other respiratory viruses in people
with COVID-19 have been reported, and identifying infection with one respiratory virus does not exclude SARS-CoV-2
virus infection8
7. Several patients with COVID-19 have been reported presenting with concurrent community-acquired bacterial
pneumonia; decisions to administer antibiotics to COVID-19 patients should be based on the likelihood of bacterial infection
(community-acquired or hospital-acquired), illness severity, and antimicrobial stewardship issues9
Severe Illness
8. Clinicians should be aware of the potential for some patients to rapidly deteriorate 1 week after illness onset10
9. The median time to acute respiratory distress syndrome (ARDS) ranges from 8 to 12 days11
10. Lymphopenia, neutrophilia, elevated serum alanine aminotransferase and aspartate aminotransferase levels,
elevated lactate dehydrogenase, high CRP, high ferritin levels, and elevated D-dimer levels may be associated with
greater illness severity12

3. Access the activity, “Coronavirus Disease 2019 (COVID-19): Need-to-Know
Information and Practical Guidance for Healthcare Professionals on
the Front Lines of Patient Care,” at PeerView.com/QDX40
Potential Antiviral Drugs Under Evaluation
for the Treatment of COVID-191,a
PRACTICE AID
Rating of recommendations: A = strong; B = moderate; C = optional.
Rating of evidence: I = one or more randomized trials with clinical outcomes and/or validated laboratory endpoints; II = one or more well-designed, nonrandomized trials or observational cohort
studies; III = expert opinion.
a
This information is accurate as of July 20, 2020.
COVID-19: coronavirus disease 2019; SpO2
: oxygen saturation.
1. https://www.covid19treatmentguidelines.nih.gov/antiviral-therapy.
Recommendations for Hospitalized Patients With Severe COVID-19
• In situations where remdesivir supplies are limited, the COVID-19 Treatment Guidelines Panel
(the panel) recommends that remdesivir be prioritized for use in hospitalized patients with COVID-19
who require supplemental oxygen but who are not mechanically ventilated or on extracorporeal
membrane oxygenation (ECMO)
• The following recommendation statements for the use of remdesivir are currently being revised and
will be updated soon
Recommendation for Duration of Therapy for Patients Who Have Not Shown Substantial Clinical
Improvement After 5 Days of Therapy
• There are insufficient data on the optimal duration of therapy for patients who have not shown
substantial clinical improvement after 5 days of therapy; in these groups, some experts extend the
total remdesivir treatment duration to up to 10 days (CIII)
Recommendation for Patients With Mild or Moderate COVID-19
• There are insufficient data for the panel to recommend for or against remdesivir for the treatment of
patients with mild or moderate COVID-19
Chloroquine/
Hydroxychloroquine
• The panel recommends against the use of
chloroquine or hydroxychloroquine for the
treatment of COVID-19, except in a clinical
trial (AII)
• The panel recommends against the use
of high-dose chloroquine (600 mg twice
daily for 10 days) for the treatment of
COVID-19 (AI)
Remdesivir
Lopinavir/Ritonavir and
Other HIV Protease Inhibitors
• The panel recommends against using
lopinavir/ritonavir (AI) or other HIV protease
inhibitors (AIII) for the treatment of
COVID-19, except in a clinical trial
The panel recommends administering the investigational antiviral agent remdesivir for 5 days for
the treatment of COVID-19 in hospitalized patients with SpO2
≤94% on room air (at sea level)
or those who require supplemental oxygen (AI)
• The panel recommends against using
hydroxychloroquine plus azithromycin for
the treatment of COVID-19, except in a
clinical trial (AIII)
The panel recommends remdesivir for the treatment of COVID-19 in patients who are on
mechanical ventilation or ECMO (BI)
_
_

4. Access the activity, “Coronavirus Disease 2019 (COVID-19): Need-to-Know
Information and Practical Guidance for Healthcare Professionals on
the Front Lines of Patient Care,” at PeerView.com/QDX40
Immune-Based Therapy Under Evaluation
for Treatment of COVID-191,2,a
PRACTICE AID
a
This information is accurate as of July 20, 2020.
COVID-19: coronavirus disease 2019.
1. https://www.covid19treatmentguidelines.nih.gov/immune-based-therapy/. 2. Cao Y et al. J Allergy Clin Immunol. 2020;S0091-6749(20)30738-7.
Summary of Recommendations
There are insufficient data for the COVID-19 Treatment Guidelines Panel (the panel) to
recommend either for or against the use of the following blood-derived products for the
treatment of COVID-19
• COVID-19 convalescent plasma
• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulins
The panel recommends against the use of the following blood-derived products for the treatment
of COVID-19, except in a clinical trial
• Mesenchymal stem cells (AII)
• Non-SARS-CoV-2–specific intravenous immunoglobulin (IVIG; AIII); this recommendation
should not preclude the use of IVIG when it is otherwise indicated for the treatment of
complications that arise during the course of COVID-19
There are insufficient data for the panel to recommend either for or against the use of the
following immunomodulators for the treatment of COVID-19
The panel recommends against the use of the following immunomodulators for the treatment
of COVID-19, except in a clinical trial
• The panel recommends using dexamethasone (at a dose of 6 mg per day for up to 10 days)
for the treatment of COVID-19 in patients who are mechanically ventilated (AI) and in
patients who require supplemental oxygen but who are not mechanically ventilated (BI)
• The panel recommends against using dexamethasone for the treatment of COVID-19 in
patients who do not require supplemental oxygen
• Interleukin-1 inhibitors (eg, anakinra)
• Interleukin-6 inhibitors (eg, sarilumab, siltuximab, tocilizumab)
• Interferon-beta for the treatment of early (ie, <7 days from symptom onset) mild and
moderate COVID-19
• Interferons (alfa or beta) for the treatment of severely or critically ill patients with
COVID-19 (AIII)
• Bruton's tyrosine kinase inhibitors (eg, acalabrutinib, ibrutinib, zanubrutinib) and
Janus kinase inhibitors (eg, baricitinib, ruxolitinib, tofacitinib; AIII)