Therapeutics in hospitalised adult patients with COVID-19

The proportion of patients with COVID-19 requiring hospitalisation has decreased dramatically since the start of the pandemic, while the population has been gaining immunity. In parallel, variants have also evolved. Most patients included in large-scale RCTs were recruited during the 2 first years of the pandemic, and the extent to which the corresponding evidence is still applicable is not fully clear. The pharmacological treatment for severe COVID-19 currently includes systemic corticosteroids (dexamethasone), associated with anti-IL-6 agents and/or the JAK inhibitor baricitinib, and with prophylactic or therapeutic heparin regimen. Remdesivir can be administered. Other agents are not recommended. When oxygen therapy is not sufficient to obtain adequate gas exchange, high-flow nasal therapy or NIV are indicated and can be used alternately. Resources need to be mobilised to provide adequate supportive measures, including palliative care and rehabilitation. Adequate protective measures are needed when providing nebulised therapy.