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This guide is for adult patients with confirmed COVID-19 disease based on:

  • PCR positive sample for SARS-CoV-2 (most commonly a naso-pharyngeal swab)

This guide now includes information for

  • people hospitalised with COVID-19 - where all treatments should be considered and
  • people with hospital-onset COVID 19 - where neutralising monoclonal antibodies +/- remdesivir may be used to prevent progression of disease


If the initial nasopharyngeal swab is PCR negative and COVID-19 remains the most likely diagnosis with no alternative diagnosis made, send a repeat nasopharyngeal swab.

  • Alternatively send sputum for testing by PCR.
  • Consider requesting a full respiratory virology panel by contacting virology to look for alternative cause of symptoms

Definition of probable case

Probable COVID19 disease is defined as:

Strong clinical suspicion including a compatible clinical syndrome
temperature >37.8oC
new continuous cough
loss of, or change in, normal sense of smell (anosmia) or taste (ageusia)INCLUDING
compatible radiology (CXR - bilateral infiltrates)
no alternative diagnosis
Before commencing patient on a COVID-19 pathway consider carefully whether the most likely diagnosis is COVID-19.



  • No trials in COVID-19 disease have shown that starting specific treatment is time critical.
  • In most patients it is safer to wait for a confirmed diagnosis than to start treatment empirically.
  • Inclusion in clinical trials should be encouraged and is of critical importance to ensure treatment strategies are clarified.

Risk stratification

The 4C Mortality Score is a risk stratification score that predicts in-hospital mortality for hospitalised COVID-19 patients, produced by the ISARIC 4C consortium . It is intended for use by clinicians. It can be accessed here.