Treatment of COVID-19 Pneumonia in Hospitalized Patients with Severe Noncritical Disease (SpO₂ ≤94% on Room Air)

This protocol addresses management of hospitalized patients with severe but noncritical COVID-19 — defined by an oxygen saturation of 94% or below on room air, including those on low-flow supplemental oxygen — who have not progressed to requiring mechanical ventilation or ECMO.

Severe illness is defined as SpO₂ ≤94% on room air, including patients on supplemental oxygen. This population is hospitalized and hypoxic but has not yet reached the threshold requiring invasive respiratory support. The distinction from critical illness is clinically important: it identifies a group where specific guideline-recommended therapies apply and where prompt, structured treatment can alter the trajectory of disease.

For hospitalized patients meeting this severity threshold, IDSA guideline recommendations support a combination strategy involving a glucocorticoid together with an antiviral agent. The panel suggests glucocorticoid use over no glucocorticoid in this setting.