Clinical Care Considerations

Table of Contents

Key Points

• The clinical presentation of COVID-19 varies from asymptomatic infection to critical illness; symptoms can change during the course of illness.
• When testing for current SARS-CoV-2 infection, CDC recommends that clinicians use molecular (polymerase chain reaction [PCR] or nucleic acid amplification test [NAAT]) or antigen tests (viral tests) that detect SARS-CoV-2 or its components, not a serologic test that detects antibodies. A chest radiograph or computed tomography (CT) images alone are not recommended to diagnose COVID-19, but might be helpful in assessing and managing COVID-19 patients.
• Clinicians caring for populations including children, pregnant and recently pregnant people, people who are moderately or severely immunocompromised, people with confirmed or suspected multisystem inflammatory syndrome, and people with post-COVID conditions may have additional clinical considerations.
• When treating patients with COVID-19, the National Institutes of Health (NIH) recommends clinicians consider treating patients according to risk of progression to severe COVID-19 or the severity of COVID-19. Patients who are reinfected with SARS-CoV-2 likely will experience less severe illness than during the initial infection, but some patients will experience more severe illness.
• Symptoms during reinfection are likely to be less severe than during the initial infection, but severe reinfections do occur and some people can experience more severe COVID-19 during reinfection. ^{(99,100,102,103,104-107)} Staying up to date on COVID-19 vaccines remains the safest strategy for preventing future SARS-CoV-2 infections, hospitalizations, long-term sequelae, and death.
• Reinfection with SARS-CoV-2 within 90 days of the initial infection can occur. There are additional testing considerations for patients in this time window. Otherwise, strategies to diagnose and treat reinfection are those used to diagnose and treat initial COVID-19 infection. Early testing is recommended for all people who experience symptoms of COVID-19, with rapid initiation of treatment if indicated.

Co-circulation of Influenza, RSV, and SARS-CoV-2

Clinicians can find useful resources below to help in their decision making and action when influenza, respiratory syncytial virus (RSV) and SARS-CoV-2 are co-circulating.

• Information for Clinicians on Influenza Virus Testing: Clinical algorithms to assist clinicians with influenza testing and treatment of patients with acute respiratory illness symptoms during periods of community co-circulation of influenza viruses and SARS-CoV-2.
• Influenza Antiviral Medications: Information on antiviral treatment of influenza.
• NIH COVID-19 Treatment Guidelines: Panel recommendations for management of patients with COVID-19.
• NIH COVID-19 Treatment Guidelines – Special Populations: Summary recommendations including patients with possible influenza and COVID-19.
• RSV: For Healthcare Providers: Guidance on testing, new vaccines for adults 60 years and older, and prophylaxis for infants and young children.

Summary of Updates