WHO updates COVID-19 guidelines on masks, treatments and patient care

WHO has updated its guidelines on mask use in community settings, COVID-19 treatments and clinical management. This is part of an ongoing process of reviewing these materials, working with guideline development groups composed of independent international experts who take into consideration the latest available evidence and evolving epidemiology.

Masks continue to be a key tool against COVID-19

WHO continues to recommend the use of masks by the public in specific situations and this update recommends their use regardless of the local epidemiological situation, given the current spread of COVID-19 globally. Masks are recommended following recent exposure to COVID-19, when someone has or suspects they have COVID-19, when someone is at high risk for severe COVID-19, and for anyone in a crowded, enclosed space or poorly ventilated. Previously, WHO recommendations were based on the epidemiological situation.

Similar to previous recommendations, WHO advises that there are other instances where a mask may be suggested, based on a risk assessment. Factors to consider include local epidemiological trends or increasing levels of hospitalization, levels of vaccination coverage and immunity in the community, and the context in which people are located.

Reduced isolation period for COVID-19 patients

WHO advises that a COVID-19 patient can be discharged from isolation early if he tests negative on a rapid antigen-based test.

Without testing, for patients with symptoms, the new guidelines suggest 10 days of isolation from the date of symptom onset. Previously, WHO advised patients to be discharged 10 days after symptom onset, plus at least three more days after their symptoms had resolved.

For those who test positive for COVID-19 but have no signs or symptoms, WHO is now suggesting 5 days of isolation without testing, up from 10 days previously.

Isolating people with COVID-19 is an important step in preventing others from becoming infected. This can be done at home or in a dedicated facility, such as a hospital or clinic.

Evidence considered by the guideline development group showed that people without symptoms are much less likely to transmit the virus than those with symptoms. Although with very low certainty, the trials also showed that people with symptoms discharged at day 5 after symptom onset were likely to infect three times as many people as those discharged at day 10.

Review of COVID-19 treatments

WHO has extended its strong recommendation for the use of nirmatrelvir-ritonavir (also known under the trade name ‘Paxlovid’).

Pregnant or nursing women with non-severe COVID-19 should consult their doctor to determine if they should take this drug, due to “likely benefits” and lack of reported adverse events.

Nirmatrelvir-ritonavir was first recommended by WHO in April 2022. WHO strongly recommends its use in mild to moderate COVID-19 patients at high risk of hospitalization. In December 2022, the drug’s first generic manufacturer was prequalified by WHO.

WHO has also reviewed the evidence on two other medicines, sotrovimab and casirivimab-imdevimab, and maintains strong recommendations against their use to treat COVID-19. These monoclonal antibody drugs lack or have reduced activity against current circulating viral variants.

There are currently 6 proven treatment options for patients with COVID-19, three that prevent hospitalization in high-risk people and three that save lives in those with severe or critical illness. Except for corticosteroids, access to other medicines remains unsatisfactory globally.

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