There is no single curative (“magic-bullet”) therapy for COVID-19. The disease is a multi-phase viral-inflammatory syndrome, therefore treatment requires:

• Stage-specific therapy

• Organ support

• Thrombosis prevention

• Careful monitoring for deterioration

Management differs according to severity:

1. Mild disease (Home care)

2. Moderate disease (Pneumonia)

3. Severe disease (Severe pneumonia)

4. Critical disease

A. MILD COVID-19 DISEASE (HOME CARE)

Clinical Definition

Symptomatic patient without hypoxia or pneumonia

Goals of Care

• Prevent progression

• Reduce transmission

• Provide symptom relief

• Educate patient on danger signs

Discharge & Isolation Instructions

Patient must:

• Self-isolate

• Wear mask around others

• Use separate utensils and sleeping area

• Maintain hydration and nutrition

• Monitor symptoms daily

Pharmacologic Treatment

Supportive Supplements

Symptomatic Treatment

• Antipyretics (Paracetamol)

• Antihistamine (if URTI symptoms)

• Cough syrup if needed

Conditional Treatments

Only if clinically suspected:

Patient Education — Danger Signs

Return immediately if:

• Difficulty breathing

• Chest tightness

• Persistent fever

• Confusion

• Reduced consciousness

Remarks

• Early supplements may support immune response

• Community awareness reduces transmission

• Zinc deficiency associated with increased infection risk

B. MODERATE COVID-19 DISEASE (PNEUMONIA)

Clinical Definition

Pneumonia with SpO₂ ≥ 90% on room air

Goals of Care

• Prevent deterioration to severe disease

• Reduce inflammation

• Treat bacterial superinfection

Treatment Protocol

Supportive Care

Same supplements as mild disease.

Anti-Inflammatory Therapy

Antibiotics (If Suspected Superinfection)

Option 1

• Azithromycin 500 mg OD × 5 daysPLUS

• Amoxicillin/Clavulanate 625 mg BD × 7 days

Option 2

• Azithromycin 500 mg OD × 5 daysPLUS

• Amoxicillin 500 mg TDS × 7 days

Option 3

• Azithromycin 500 mg OD × 5 daysPLUS

• Ceftriaxone 1 g OD × 5 days

Monitoring

• Daily symptom review

• Oxygen saturation monitoring

• Educate on danger signs

C. SEVERE COVID-19 DISEASE (SEVERE PNEUMONIA)

Clinical Definition

Pneumonia with hypoxia → risk ofAcute Respiratory Distress Syndrome

Admission Required

Place in oxygen-equipped isolation room

1. Oxygenation Strategy

Encourage awake prone positioning

2. Corticosteroids

3. Anticoagulation

COVID-19 causes micro-thrombosis and may progress toSepsis

Preferred

• Enoxaparin 1 mg/kg SC BD

Alternatives

• Rivaroxaban 10 mg OD

• Aspirin 75 mg OD

• Clopidogrel 75 mg OD

4. Antibiotics

• Azithromycin OR ClarithromycinPLUS

• Piperacillin-tazobactam OR Ceftriaxone-Sulbactam

(Change based on culture results)

5. Additional Supportive Care

• Careful IV fluids

• Proton pump inhibitor

• Nutrition therapy

• Chest physiotherapy

• Psychosocial support

6. Adjunct Therapies

Key Clinical Principle

Main treatment is correction of hypoxia and organ support

D. CRITICAL COVID-19 DISEASE

Includes:

• Respiratory failure

• Septic shock

• Multi-organ dysfunction

May progress toSeptic shock

ICU ADMISSION REQUIRED

i. Airway & Ventilation

• Intubate if airway not protected

• Mechanical ventilation:

  • SpO₂ target > 90%

  • Tidal volume 4–8 mL/kg

  • Plateau pressure < 30 cmH₂O

ii. Oxygenation

• High-flow oxygen → NIV → Mechanical ventilation

• Awake or ventilated proning

iii. Steroids

Same as severe disease

iv. Anticoagulation

Same protocol as severe disease

v. Hemodynamic Support

• IV fluids for shock

• Maintain MAP ≥ 65 mmHg

• Vasopressors if needed

vi. Antibiotics

Broad spectrum therapy then culture-guided

vii. Organ Support

• Renal support (dialysis if needed)

• Nutrition therapy

• Stress ulcer prophylaxis

• Physiotherapy

Investigational/Adjunct Therapies

Used in some settings:

• Remdesivir

• Tocilizumab

• Colchicine

(Used selectively depending on protocol and availability)

CORE PRINCIPLE OF COVID-19 MANAGEMENT

Mild → symptomatic careModerate → anti-inflammatory therapySevere → oxygen + steroids + anticoagulationCritical → organ support + ICU care