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Home-care guidelines for patients with COVID-19

Managing symptoms and medicines

Table of contents

Refer to the latest National COVID-19 Clinical Evidence Taskforce living guidelines and clinical flowcharts for the management of adults with mild and moderate–severe COVID-19.

Make sure the patient continues to receive care for pre-existing conditions:
- Use inhaled or oral steroids for the management of people with co-existing asthma or chronic obstructive pulmonary disease (COPD) and COVID-19 as you would normally for viral exacerbation of asthma or COPD. Do not use a nebuliser¹⁰
- Do not discontinue angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in patients already receiving these medications unless contraindicated¹¹
- In people with suspected or confirmed COVID-19, the use of other treatments such as insulin, other diabetes medications, or statins should continue as usual⁵
- In patients with suspected or confirmed COVID-19, only cease or change the dose of long-term immunosuppressants, such as high-dose corticosteroids, chemotherapy, biologics or disease-modifying antirheumatic drugs, on the advice of the treating specialist⁵
- In patients who have COVID-19 and who are taking oestrogen-containing contraception or who are taking oral menopausal hormone therapy (MHT), manage these medications as per usual care¹². Patients should not need to stop their gender-affirming hormone therapy¹³

Determine the patient’s eligibility for oral antiviral COVID-19 treatments (Lagevrio (molnupiravir) and Paxlovid (nirmatrelvir with ritonavir)) or other treatments that are recommended by the National COVID-19 Clinical Evidence Taskforce for patients who have mild-moderate illness and who do not require oxygen.

The initiation of these medicines is time-critical. Lagevrio (molnupiravir) and Paxlovid (nirmatrelvir with ritonavir) must typically be commenced within five days of symptom onset, so early assessment and intervention are vital. This could be done in collaboration with the commissioned triaging health service, hospital or infectious disease specialists.

More information on Lagevrio (molnupiravir) and Paxlovid (nirmatrelvir with ritonavir) is available on the RACGP website.

An antipyretic is generally not required for mild COVID-19, but paracetamol or ibuprofen, as appropriate, can be considered for symptomatic relief. If a patient takes non-steroidal anti-inflammatory drugs for a chronic condition, they should continue taking these.⁵

When appropriate, consider simple interventions for mild symptoms according to clinical judgement:
- intranasal decongestants, isotonic nasal/sinus rinse or intranasal ipratropium for rhinosinusitis
- keep air warm and humid
- manage hydration carefully through small regular sips of fluid, and consider oral rehydration salts

Do not prescribe treatments that are not recommended by the National COVID-19 Clinical Evidence Taskforce, including ivermectin.
Do not routinely use dexamethasone (or other systemic corticosteroids) to treat COVID-19 in adults who do not require oxygen. However, patients can be discharged from hospital on these, and the GP might need to manage the weaning of such medications, as per the discharge instructions/summary.

Patients with asthma or COPD should refer to their action plan to guide the use of relievers and when to escalate.¹⁶
Patients with diabetes should follow their sick day plans (or have a sick day plan developed), check blood glucose levels (BGLs) more frequently and call for medical advice if BGLs are unstable (noting some patients might be discharged from hospital on oral steroids post-admission for COVID-19).
Consider pharmacological management of drug or alcohol dependencies if withdrawal is likely during isolation.

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