Understanding the Latest Guidelines for Doctors Treating COVID Patients

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COVID-related hospitalizations are down to a modest 26.7 per 100,000 people in the United States and it accounts for only 1% of the national death rate. These numbers are well below present rates for heart disease, cancer, and accidental injuries, and effective vaccinations and a better understanding of virus transmission have all contributed to improved health outcomes.

However, vulnerable populations like the elderly and those compromised by chronic illness are still at an extremely elevated risk for serious complications. Also, new COVID variants are constantly emerging, and guidelines for doctors treating COVID patients must be regularly reviewed and refreshed to keep everyone ahead of the game.

High-quality, research-based continuing education courses like Solving the Viral Mystery: COVID-19, Influenza, and Beyond deliver critical information for today’s healthcare professionals as well as valuable AMA PRA Category 1 Credits™ physicians need to maintain their licenses. In the meantime, here are some of the latest guidelines for COVID-19 that doctors in every role should be aware of in their practice.

Vaccination Is Still Key

While COVID-19 can evolve rapidly, widespread vaccination is one of the most important protections against serious illness and death regardless of a person’s risk status. The best and most current research clearly reinforces the general need for people to attain and regularly update their COVID vaccination status.

However, in a world full of misleading and incomplete information, doctors often need to take an active role in explaining the value and nature of vaccines to their patients. For instance, the average person may not know that the effectiveness of their current vaccine will diminish over time. This is because natural immunity from an infection wears off and new variants render existing vaccinations less effective. Repeat vaccinations or boosters are important to the population as a whole for maintaining immunity, mitigating the incidence of spreading the virus, and reducing the severity of illness for those who do become infected.

In general, the following guidelines for doctors treating COVID patients represent current and ongoing best practices:

• Everyone 6 months of age or older should receive and maintain vaccination against COVID.
• It is especially important for people over 65 or those managing other underlying chronic illnesses to receive vaccinations and regularly update their booster shots.
• Recommend vaccinations to individuals living in skilled nursing or extended care facilities as well as people who are pregnant or are trying to become pregnant.

Prevention in Immunocompromised Patients

People who are immunocompromised from a medical condition or as a result of medications and treatments must be given clear and specific recommendations for avoiding respiratory illnesses of all kinds, including the flu, RSV, and COVID-19. Patients undergoing chemo or radiation therapy, solid organ transplant recipients taking anti-rejection medications, patients on long-term corticosteroids, or those with a primary immunodeficiency all face extremely elevated risk.

Doctors should recommend the following measures for immunocompromised patients in their care:

• Become vaccinated (for COVID-19, the flu, etc.) and acquire the latest boosters.
• Avoid high-risk locations during high prevalence periods like fall and winter.
• Practice basic handwashing skills, wear effective masks as necessary, and maintain physical distancing when possible.
• Advocate for yourself when around others to maintain boundaries.
• Monitor immune responses following vaccination for deviations from standard side effects.
• Do not rely on any single measure to keep yourself safe.

Outpatient Treatment of COVID-19

Physicians should consider outpatient antiviral treatment for patients who are exhibiting mild to moderate symptoms but are at high risk for severe COVID-19. Interventions should be administered as early as possible after symptoms are detected, and 5-7 days after onset at the latest.

For patients who are immunocompromised or otherwise at high risk, treatments may be administered as a prophylaxis. Racial, social, and ethnic factors that may limit access to vaccination may also place patients at elevated risk, and clinical judgment on a case-by-case basis is key for identifying the specific risks of any patient.

COVID-19 Pharmacotherapy

Patients who are diagnosed as having COVID-19, even in the absence of a positive test, have several pharmacological treatment options available to them depending on their specific circumstances. The four primary interventions are:

• High-titer convalescent plasma. 250 ml can be administered if a patient takes immunosuppressants or has an immunosuppressive disease and has been exhibiting symptoms for 8 days or fewer.
• Remdesivir (Veklury) is appropriate if the patient has access to outpatient infusion or inpatient administration. Dosages vary for patients under 12 years old.
• Nirmatrelvir/ritonavir (Paxlovid) may be administered on patients with severe renal or hepatic impairment over 18 years of age. Check for drug interactions using evidence-based tools.
• Molnupiravir (Lagevrio). If the patient is 18 years or older, NOT pregnant, and facing severe or life-threatening symptoms, Lagevrio may be authorized for emergency use. Patients of childbearing potential must use contraception during treatment and for 4 days after stopping, and men must use contraception for an additional 3 months.

Guidance for Quarantine and Isolation

The guidelines for exposure and quarantine have lightened up significantly in recent years, but there are still important protocols in place. While they tend to be far less disruptive than in the early stages of the pandemic, this is largely due to ongoing efforts to maintain high vaccination rates and constantly updated guidelines for doctors treating COVID patients.

Suspected Exposure

Patients who have been in close contact with someone with COVID-19 should be maintained according to the CDC’s Transmission-Based Precautions. This includes avoiding close contact with high-risk people and wearing a mask when around others. Patients can be removed from Transmission-Based Precautions on day 7 after their suspected exposure (the day of exposure is considered day 0). If they do not develop symptoms and all viral testing as described for asymptomatic individuals following close contact is negative, they should be in the clear.

COVID-Positive with or without Symptoms

For patients who have tested positive for COVID and are displaying symptoms, the CDC now recommends it is safe to resume normal activities once both of the following are true for more than 24 hours:

• The patient’s symptoms are displaying overall improvement.
• They are fever-free without the use of fever-reducing medications.

However, when resuming normal activities, patients should still take COVID-prevention precautions for 5 additional days. This would include things like wearing a mask, practicing physical distancing, and thoroughly washing hands.

This is because people testing positive for COVID who do not have symptoms can still spread the virus to others. COVID-positive patients without symptoms can begin their five days of added precautions immediately, but doctors should advise them to be cognizant of the development of symptoms in the days following the positive test.

Familiarize Yourself with Current Guidelines for Doctors Treating COVID Patients

Viral illnesses, especially those affecting the respiratory system, are extremely varied and can range from commonplace coughs to life-threatening events. For busy physicians, spotting subtle variations of mild symptoms and adopting correct treatment protocols can be the difference between a happy outcome and a serious crisis.

Premiere is committed to making it easy to update yourself on the latest best practices and CDC guidelines for doctors treating COVID patients. Courses like Solving the Viral Mystery: COVID-19, Influenza, and Beyond deliver a deeper understanding of symptomology, transmission, and management guidelines for a range of common respiratory viruses.

All of the courses in Premiere’s award-winning library are created by industry experts and make it easy for physicians in any role to gain CME credits and develop their professional skills on a timeline that matches their busy schedules.