Treatment of acute COVID-19 in the community

COVID-19 infection in an otherwise healthy person is usually a mild to moderate self-limiting illness, but certain populations are at higher risk of severe disease (e.g. older age, severe immunocompromise, certain comorbidities). Adults with acute COVID-19 should be assessed for disease severity and underlying risk factors to guide appropriate management. Infection control, including case isolation, is important to reduce spread. Antiviral therapy is reserved for patients most likely to benefit, given its high cost, potential adverse effects and uncertain clinical benefit. Patients showing signs of severe or critical disease should be referred to hospital. Antiviral therapies are most effective when started within 5 days of symptom onset. Nirmatrelvir with ritonavir is the first-line antiviral for patients without contraindications, but it has extensive drug interactions. Molnupiravir is used when nirmatrelvir with ritonavir is unsuitable. Inhaled and oral glucocorticoids and immune therapies have no role in routine community treatment of mild to moderate COVID-19. Vaccination remains the single most effective intervention for reducing the risk of severe disease and should be actively encouraged, particularly in unvaccinated or vaccine-hesitant individuals.