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COVID-19 Clinical Management Protocol (DOH Living CPG)

Respiratory

1. Assessment & Diagnosis

  • Gold Standard: RT-PCR is the standard for confirmation.
  • Rapid Antigen Tests: Recommended for symptomatic patients within 7 days of onset (Sensitivity ≥80%, Specificity ≥97%).
  • Screening: Symptom check for fever, cough, dyspnea, sore throat, or anosmia/ageusia within the past 14 days.

    • 2. Pharmacologic Management (Adults)

  • Mild to Moderate (High Risk for Progression):
  • Nirmatrelvir + Ritonavir (Paxlovid): Recommended for unvaccinated, non-hospitalized patients within 5 days of onset.
  • Molnupiravir: Alternative for non-oxygen requiring patients within 5 days of onset.
  • Remdesivir: Suggested for patients with risk factors (e.g., >60y, comorbidities).
  • Severe to Critical:
  • Corticosteroids: Dexamethasone (6mg/day for 10 days) is the standard of care.
  • Immunomodulators: Add Tocilizumab or Baricitinib to steroids for patients showing rapid respiratory deterioration or increasing oxygen needs.
  • Anticoagulation: Prophylactic dose is suggested for hospitalized moderate-critical patients.

    • 3. What NOT to Use (Strong Recommendation Against)

  • Ivermectin, Hydroxychloroquine, Azithromycin, Oseltamivir, Colchicine, and Steam Inhalation are NOT recommended for treatment or prevention.
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    Warning Signs

    WARNING SIGNS & RISK FACTORS

  • Severe Respiratory Distress: Hypoxemia (SpO2 < 94%) requiring oxygen.
  • High Risk for Progression: Age >60 years, Obesity, Diabetes, Hypertension, CKD, or Immunocompromised state.
  • Rapid Deterioration: Increasing inflammation (CRP) or rapid escalation of oxygen support.

    • Reference

    1. Department of Health (DOH), PSMID, PCP, and Philippine COVID-19 Living CPG Task Force (2023). Philippine COVID-19 Living Clinical Practice Guidelines.
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