Ten Clinical Tips on COVID-19 for Healthcare Providers Involved in Patient Care

Updated June 20, 2020

Treatment and Prophylaxis

  1. The National Institutes of Health has developed guidance on treatmentexternal icon, which will be regularly updated as new evidence on the safety and efficacy of drugs and therapeutics emerges from clinical trials and research publications.
  2. There is currently no FDA-approved post-exposure prophylaxis for people who may have been exposed to SARS-CoV-2.

Symptoms and Diagnosis

  1. Non-respiratory symptoms of COVID-19 – such as gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea), or neurologic symptoms (e.g., anosmia, ageusia, headache), or fatigue or body and muscle aches – may appear before fever and lower respiratory tract symptoms (e.g., cough and shortness of breath).
  2. Children with COVID-19 may have fewer symptoms than adults. Although most children with COVID-19 have not had severe illness, clinicians should maintain a high index of suspicion for SARS-CoV-2 infection in children, particularly infants and children with underlying medical conditions. CDC is investigating multisystem inflammatory syndrome in children, a rare but serious complication associated with COVID-19. CDC recommends monitoring children for worsening of COVID-19 illness.
  3.  CT scansexternal icon should not be used to screen for COVID-19 or as a first-line test to diagnose COVID-19. CT scans should be used sparingly and reserved for hospitalized, symptomatic patients with specific clinical indications for CT scans.

Co-Infections

  1. Patients can be infected with more than one virus at the same time. Coinfections with other respiratory viruses in people with COVID-19 have been reported. Therefore, identifying infection with one respiratory virus does not exclude SARS-CoV-2 virus infection.
  2. Several patients with COVID-19 have been reported presenting with concurrent community-acquired bacterial pneumoniaexternal icon. Decisions to administer antibiotics to COVID-19 patients should be based on the likelihood of bacterial infection (community-associated  or healthcare-associated), illness severity, and current clinical practice guidelinesexternal icon.

Severe Illness

  1. Clinicians should be aware of the potential for some patients to rapidly deteriorate 1 week after illness onset.
  2. The median time to acute respiratory distress syndrome (ARDS) ranges from 8 to 12 days.
  3. Lymphopenia, neutrophilia, elevated serum alanine aminotransferase and aspartate aminotransferase levels, elevated lactate dehydrogenase, high CRP, and high ferritin levels may be associated with greater illness severity.