Treatment of Mild-to-Moderate COVID-19 in Hospitalized Patients at High Risk for Progression

This protocol addresses hospitalized patients with mild-to-moderate COVID-19 who are not hypoxemic (SpO₂ >94% on room air) but carry significant risk factors for progression to severe disease, presenting within 7 days of symptom onset.

Clinical scenario

Mild-to-moderate illness is defined as SpO₂ >94% not requiring supplemental oxygen. Despite preserved oxygenation at presentation, these patients are identified as high risk for progression — making early, targeted intervention an important clinical decision.

Treatment approach

For patients in this category, an antiviral agent is indicated when treatment can be initiated within 7 days of symptom onset. The complete regimen — including agent selection, dosing schedule, and timing considerations — is detailed in the full protocol. Full regimen and decision algorithm available below.

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References

DOI: 10.1093/cid/ciac724

Mild-to-moderate illness is defined as patient with SpO2 >94% not requiring supplemental oxygen.
Among patients (ambulatory or hospitalized) with mild-to-moderate COVID-19 at high risk for progression to severe disease, the IDSA guideline panel suggests remdesivir initiated within 7 days of symptom onset rather than no remdesivir.
If at high risk for progression and within 7 days of symptom onset, remdesivir × 3 days.

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