This protocol addresses hospitalized patients with severe, non-critical COVID-19 — those with oxygen saturation at or below 94% on room air or receiving low-flow supplemental oxygen, who do not yet require high-flow oxygen, noninvasive ventilation, invasive mechanical ventilation, or ECMO.
Severe illness in COVID-19 is defined as SpO2 ≤94% on room air, including patients already on supplemental oxygen. These patients are hospitalized but have not progressed to critical oxygen requirements — representing an important and time-sensitive treatment window.
Management in this setting involves a corticosteroid as the primary therapeutic backbone, combined with antiviral therapy. For patients who develop progressive disease with elevated markers of systemic inflammation, an additional immunomodulatory agent may be indicated. Specific agent selection, dosing, and escalation criteria are detailed in the full structured protocol.
Treatment targets clinical improvement of COVID-19 by day 28 and a reduction in the need for invasive mechanical ventilation.
Severe illness is defined as patients with SpO2 ≤94% on room air, including patients on supplemental oxygen.
Severe but not critical COVID-19 (SpO2 <94% on room air or needing low-flow supplemental oxygen).
Among hospitalized patients with severe, but noncritical, COVID-19, the IDSA guideline panel suggests dexamethasone rather than no dexamethasone.
In hospitalized patients with severe COVID-19, the IDSA panel suggests remdesivir over no antiviral treatment.
Among hospitalized adults with progressive severe or critical COVID-19 who have elevated markers of systemic inflammation, the IDSA guideline panel suggests tocilizumab in addition to standard of care (ie, steroids) rather than standard of care alone.
Among hospitalized adults with severe COVID-19, the IDSA panel suggests baricitinib with corticosteroids rather than no baricitinib.
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