Synopsis
Diagnose and manage COVID-19 from current severity, host vulnerability and illness phase, linking supportive care, antiviral eligibility, thrombosis prevention, infection control and follow-up.
- COVID-19 ranges from asymptomatic infection to viral pneumonitis and multi-organ critical illness; vaccination and previous infection modify but do not remove severe risk.
- Confirm current infection with a validated test when the result changes treatment, infection control or diagnosis, recognising that detection can persist after infectious illness.
- Assess respiratory rate, oxygen saturation, work of breathing, mental state, hydration and trajectory; older or immunosuppressed adults may deteriorate without high fever.
Key red flags
Increasing breathlessness, hypoxaemia, tachypnoea and bilateral infiltrates indicate lower-respiratory involvement and need hospital severity assessment.
Investigation priorities
Confirm current infection when diagnosis changes treatment, isolation or cohorting.
Management branches
COVID-19 is confirmed or likely, observations are stable and no current high-risk treatment criterion is met.
- Assess duration, breathing, hydration, comorbidity, pregnancy and support; advise symptom care and current infection-control behaviour.
- Explain urgent triggers including worsening breathlessness, hypoxaemia, confusion, persistent chest pain, fainting or inability to drink.
Key medicines
Nirmatrelvir with ritonavirStart within the commissioned early-treatment window; the standard adult course is 300 mg nirmatrelvir with 100 mg ritonavir orally twice daily for 5 days when renal function permits.
Remdesivir for early high-risk community treatmentWhen selected by the current commissioned pathway, give 200 mg intravenously on day 1 then 100 mg intravenously daily on days 2 and 3, starting within the eligible symptom window.