Last reviewed: 28 Dec 2021
Last updated: 14 Jan 2022
14 Jan 2022

What's new at this update

WHO authorizes Nuvaxovid® and Covovax® vaccines

  • The World Health Organization has issued an emergency-use listing for Nuvaxovid® and Covovax® vaccines (NVX-CoV2373). Nuvaxovid® is the originator product produced by the company Novavax, while Covovax® is produced by the Serum Institute of India. These are the first protein subunit platform vaccines to be authorized for use globally. Regulatory agencies in the UK, Europe, and the US are currently assessing authorization applications.

  • See the Prevention section for more information.

US guideline recommends remdesivir for mild to moderate disease

  • The National Institutes of Health guidelines panel now recommends remdesivir to treat nonhospitalized patients with mild to moderate disease who are at high risk of clinical progression when the Omicron variant represents the majority of infections in a region. It should be initiated as soon as possible within 7 days of symptom onset, with a treatment course of 3 days. Previously, the guideline panel recommended remdesivir only in patients with severe disease.

  • See the Treatment algorithm section for more information.

Oral antivirals authorized for use in patients with mild to moderate disease

  • Molnupiravir and nirmatrelvir/ritonavir have been authorized for use in some countries. They are authorized for the treatment of mild to moderate disease in patients who are at high risk of developing severe disease. These agents should be initiated as soon as possible after diagnosis and within 5 days of symptom onset.

  • See the Emerging section for more information.

com.bmj.content.model.Caption@5c5d0688[Figure caption and citation for the preceding image starts]: Number of COVID-19 cases reported weekly by WHO Region, and global deaths, as of 9 January 2022World Health Organization [Citation ends].

See Epidemiology

Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • fever
  • cough
  • dyspnea
  • altered sense of smell/taste

Other diagnostic factors

  • headache
  • sore throat
  • rhinorrhea/nasal congestion
  • sneezing
  • fatigue
  • myalgia or arthralgia
  • sputum production/expectoration
  • chest tightness
  • gastrointestinal symptoms
  • dizziness
  • neurologic symptoms
  • ocular symptoms
  • audio-vestibular symptoms
  • chest pain
  • hemoptysis
  • bronchial breath sounds
  • tachypnea
  • tachycardia
  • cyanosis
  • crackles/rales on auscultation
  • cutaneous symptoms
  • oral mucosal lesions
  • lower urinary tract symptoms

Risk factors

  • contact with probable or confirmed case
  • residence/work/travel in location with high risk of transmission
  • older age
  • male sex
  • ethnicity
  • residence in a long-term care facility
  • presence of comorbidities
  • obesity
  • cardiovascular disease
  • diabetes
  • chronic respiratory disease
  • chronic kidney disease
  • chronic liver disease
  • pregnancy
  • smoking
  • malignancy
  • cerebrovascular disease
  • mental health disorders
  • solid organ or blood stem cell transplant
  • Down syndrome or disability
  • hemoglobin disorders
  • hypertension
  • dementia
  • immunosuppression
  • HIV infection
  • substance use disorders
  • children with certain underlying conditions
  • vitamin D deficiency
  • proton-pump inhibitor use
  • autoimmune disease
  • thyroid disease
  • Parkinson disease
  • physical inactivity
  • dyslipidemia
  • surgery
  • blood groups A and B
  • gut dysbiosis
  • environmental factors

Diagnostic investigations

1st investigations to order

  • real-time reverse transcription polymerase chain reaction (RT-PCR)
  • pulse oximetry
  • ABG
  • CBC
  • comprehensive metabolic panel
  • thyroid function tests
  • blood glucose level
  • coagulation screen
  • cardiac biomarkers
  • serum C-reactive protein
  • serum erythrocyte sedimentation rate
  • serum lactate dehydrogenase
  • serum interleukin-6 level
  • serum procalcitonin
  • serum ferritin level
  • serum amyloid A level
  • serum creatine kinase and myoglobin
  • blood and sputum cultures
  • chest x-ray

Investigations to consider

  • computed tomography (CT) chest
  • rapid antigen test
  • serology

Emerging tests

  • lung ultrasound
  • reverse transcription loop-mediated isothermal amplification (RT-LAMP)
  • calprotectin

Treatment algorithm

Contributors

Authors

Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, DCH, DTM&H

Consultant and Emeritus Professor of Tropical and Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

Disclosures

NJB is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with the UK Health Security Agency (UKHSA; formerly Public Health England), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or UKHSA.

Tom E. Fletcher, MBE, PhD, MBChB, MRCP, DTM&H

Senior Clinical Lecturer and Defence Consultant in Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

Disclosures

TEF is a consultant/expert panel member to the World Health Organization, and is funded by the UK Surgeon General, the NHS, and Liverpool School of Tropical Medicine. TEF is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with the UK Health Security Agency (UKHSA; formerly Public Health England) in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. He has received research grants from the Wellcome Trust, Medical Research Council, and the UK Public Health Rapid Support Team (UK-PHRST). The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or UKHSA.

Robert Fowler, MDCM, MS (Epi), FRCP(C)

H. Barrie Fairley Professor of Critical Care

University Health Network and Interdepartmental Division of Critical Care Medicine

Director

Clinical Epidemiology and Health Care Research

Institute of Health Policy, Management and Evaluation

Dalla Lana School of Public Health

University of Toronto

Chief

Tory Trauma Program

Sunnybrook Hospital

Toronto

Canada

Disclosures

RF declares that he has no competing interests.

Peer reviewers

William A. Petri, Jr., MD, PhD

Professor

Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

VA

Disclosures

WAP declares that he has no competing interests.

Xin Zhang, MD, PhD

Attending Physician

The Fifth Medical Center of PLA General Hospital

Clinical Division and Research Center of Infectious Disease

Beijing

China

Disclosures

XZ declares that he has no competing interests.

Ran Nir-Paz, MD

Associate Professor in Medicine

Department of Clinical Microbiology and Infectious Diseases

Hadassah Hebrew University Medical Center

Jerusalem

Israel

Disclosures

RNP has received research grants from US-Israel Binational Science Foundation, Hebrew University, Rosetrees Trust, and SpeeDx. He is chair of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC). RNP is a consultant for and has stocks in eDAS Healthcare. He is also chairperson of the Israeli Society for Infectious Diseases guidelines committee.

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