Give supplemental oxygen therapy immediately to patients with low oxygen saturation.

  • Oxygen therapy is likely to be the single most effective supportive measure in COVID-19 patients overall. Target SpO2 ≥90% in non-pregnant adults and SpO2 ≥92% in pregnant patients. Children with emergency signs (obstructed or absent breathing, severe respiratory distress, central cyanosis, shock, coma or convulsions) should receive oxygen therapy during resuscitation to target SpO2 ≥94%; otherwise, the target SpO2 is ≥92%.

  • Titrate oxygen therapy up and down to reach targets by means of nasal cannula, a simple face mask or a face mask with reservoir bag, as appropriate:

Use conservative fluid management in patients with COVID-19 when there is no evidence of shock.  

Aggressive fluid resuscitation may worsen oxygenation, especially in settings where there is limited availability of mechanical ventilation.

If a clinical suspicion for co-infection exists, consider empiric antimicrobials to treat co-pathogens causing the syndrome, particularly in severe cases. 

This may include conventional and atypical bacterial pathogens, influenza and PJP

Empiric treatment of other pathogens
Where the patient fits the appropriate clinical syndrome, consider treatment of other pathogens such as:
Conventional community-acquired pneumonia pathogens (or hospital-acquired pneumonia pathogens if appropriate) – e.g. ceftriaxone [see SA community-acquired pneumonia guidelines]
Atypical pneumonia pathogens – e.g. azithromycin [see SA community-acquired pneumonia guidelines]
Influenza (if influenza epidemiology fits and has severe illness or if patient is at risk of severe influenza) – oseltamivir [see NICD influenza guidelines]
PJP (if appropriate risk factors present, e.g. HIV with low CD4 count)

Closely monitor patients with severe acute respiratory illness for signs of clinical deterioration, such as rapidly progressive respiratory failure and sepsis, and apply supportive care interventions immediately. 

Answers extracted from: Clinical management of suspected or confirmed COVID-19 disease (Version 3, 27th March 2020)

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