The COVID-19 CARE pathway is designed to be a living tool to support health care workers visualize the current clinical and therapeutic recommendations to be considered in the care plan for patients with COVID-19.

The COVID-19 CARE pathway is aligned with the ninth version of the WHO Therapeutics and COVID-19: living guideline published on the 22 April 2022 and the third version of the WHO COVID-19 Clinical management: living guidance published on the 23 November 2021.

Confirm

SARS-CoV-2 infection

Ensure prompt diagnosis using a molecular (NAAT/PCR) or antigen-detection test (i.e. Ag-RDT).

Assess

symptoms, risk factors and severity

Provide early clinical assessment and evaluation to determine if the patient has emergency signs, symptoms or risk factors that may warrant treatment, clinical referral or admission to hospital care.

Risk factors:

> 60 years, hypertension, diabetes, cardiac disease, chronic lung disease, cerebrovascular disease, dementia, mental disorders, chronic kidney disease, immunosuppression (including HIV), obesity, cancer and unvaccinated against COVID-19.

Risk factors in pregnant or recently pregnant women: advanced maternal age (>=35 years), obesity, chronic medical conditions, and pregnancy specific disorders (e.g. gestational diabetes and pre-eclampsia/eclampsia).

Emergency signs are obstructed or absent breathing, severe respiratory distress, cyanosis, shock, coma and/or convulsions.

Respond

with appropriate care and treatment

Treatment selection is determined by severity of disease and risk factors. ​

For patients with COVID-19 presenting with early onset of mild or ​moderate COVID-19 (non-severe symptoms):

Without ​risk factors for severe disease the treatment care plan includes:​

• Symptom management and supportive care​
• Monitoring (at home, or in the community)​

And with risk factors, for severe disease consider including treatment with one of the following options:

For patients presenting with severe or critical COVID-19 immediately ​assess for emergency signs.​

For patients with severe or critical COVID-19, the treatment ​care plan includes:​

• Oxygen therapy AND​
• Corticosteroids AND ​
• Venous thromboembolism prophylaxis AND​
• Interleukin-6 receptor blocker (tocilizumab OR sarilumab) OR JAK Inhibitor (baricitinib)
• For seronegative patients, consider including neutralizing monoclonal antibodies (casirivimab and imdevimab*)
• Symptom management and supportive care

Evaluate

clinical response and recovery

• All patients receiving COVID-19 treatment require clinical monitoring and follow up by a health care professional throughout their illness and recovery, including those who develop post COVID-19 condition.
• If patients have emergency signs OR SpO2 <90%, seek ​urgent medical assistance. ​
• If patients have SpO2 between 90-94%, worsening symptoms, ​side-effects or concerns, patient or caregiver should immediately seek advice from a health care professional.
• It is important that all COVID-19 treatments are prescribed,
  completed or stopped under guidance of a health care professional.
• Ensure reporting of any adverse events (AE) through local or national
  reporting systems. 

Advise patient or caregivers to monitor for change or worsening of symptoms, such as chest pain, fast or difficulty in breathing (at rest or while speaking), fast heart rate, palpitations, confusion, altered mental status, or any other emergency signs. If present, instruct patient or caregivers to call for emergency help according to national protocols.