Guidance

Update information

Update information

8 May 2024
We updated the guidance on remdesivir and added a new recommendation on tixagevimab plus cilgavimab in line with NICE's technology appraisal guidance on remdesivir and tixagevimab plus cilgavimab for treating COVID-19.

13 March 2024

We updated the recommendation on nirmatrelvir plus ritonavir to include additional groups eligible for treatment (people with diabetes, obesity or heart failure, or people aged 70 years or older). We have included a link to the funding variation as set out in NICE's technology appraisal guidance on nirmatrelvir plus ritonavir, sotrovimab and tocilizumab.

We removed the recommendation on casirivimab plus imdevimab because the conditional marketing authorisation for casirivimab plus imdevimab for treating COVID‑19 was withdrawn.

We clarified the wording of recommendation 1.1.4 by removing reference to isolation.

25 January 2024

We made editorial changes to ensure recommendations reflect the current context for COVID-19, including updating recommendation 1.1.4 to reflect that isolation is no longer mandatory. We transferred the guideline recommendations, evidence reviews and supporting information from the MAGICapp platform to the NICE website, changing the presentation.

30 November 2023

We replaced 2 recommendations on managing acute cough with a link to the NICE guideline on cough (acute): antimicrobial prescribing.

We removed the recommendation to consider benzodiazepine for managing anxiety or agitation because health system support for people with COVID-19 has changed significantly since the guideline was developed.

We removed the recommendations on medicines for end of life care because these are covered by the NICE guidelines on care of dying adults in the last days of life, end of life care for adults: service delivery and care and support of people growing older with learning disabilities, which are already linked from this guideline.

22 June 2023

We updated the recommendations on nirmatrelvir plus ritonavir and sotrovimab to link to section 5 of NICE's technology appraisal guidance on casirivimab plus imdevimab, nirmatrelvir plus ritonavir, sotrovimab and tocilizumab. The linked section provides supporting information on risk factors for progression to severe COVID-19 provided by the independent advisory group commissioned by the Department of Health and Social Care.

29 March 2023

We updated the recommendations on casirivimab plus imdevimab for people in hospital because of COVID-19, nirmatrelvir plus ritonavir and tocilizumab. We replaced the recommendations on neutralising monoclonal antibodies for people not in hospital with a recommendation on sotrovimab. The clinical and cost effectiveness of these therapeutics was reviewed through the NICE multiple technology process. For more information, see NICE's technology appraisal guidance on casirivimab plus imdevimab, nirmatrelvir plus ritonavir, sotrovimab and tocilizumab.

We replaced 2 recommendations on baricitinib with 1 updated recommendation to clarify how it should be used. We updated recommendations on remdesivir to account for an extension to the marketing authorisation to include the paediatric population.

We removed the recommendation on sarilumab, which was for off-label use of sarilumab because it is not licensed for use in COVID-19. This recommendation has been superseded by NICE's technology appraisal guidance on casirivimab plus imdevimab, nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for people with COVID-19, which recommends tocilizumab.

14 July 2022

We updated recommendations on using remdesivir in hospital, and added a recommendation on vitamin D for treating COVID-19.

15 June 2022

We updated the recommendation on ivermectin.

19 May 2022

We replaced 2 recommendations about advice to give to people with COVID-19 with a single recommendation linking to the UK Health Security Agency's guidance for people with symptoms of a respiratory infection including COVID-19, which now provides this information. We deleted the recommendation for people with pre-existing advanced comorbidities because finding out if whether they have advance care plans or advance decisions to refuse treatment, is part of routine care. We also added a link to the UK Government's information on the COVID-19 vaccination programme to the section on discharge, follow‑up and rehabilitation.

6 May 2022

We added new recommendations on baricitinib.

13 April 2022

We added a new recommendation on nirmatrelvir and ritonavir (Paxlovid) for people at high risk of progression to severe COVID-19.

30 March 2022

We updated existing recommendations on casirivimab and imdevimab – for people hospitalised because of COVID-19.

10 March 2022

We added a new recommendation on awake prone positioning and updated existing recommendations on non-invasive respiratory support.

23 February 2022

We added recommendations on molnupiravir and remdesivir for people with COVID‑19 who do not need supplemental oxygen.

27 January 2022

We added recommendations on neutralising monoclonal antibodies for people with COVID-19 who are not in hospital.

16 December 2021

We added new recommendations on COVID-19-associated pulmonary aspergillosis. We revised our statement about the Omicron variant in the recommendation on casirivimab and imdevimab.

14 December 2021

We added a statement to the recommendation on casirivimab and imdevimab about the Omicron variant.

1 December 2021

We updated existing recommendations on colchicine.

22 November 2021

We added a new recommendation on ivermectin.

3 November 2021

We added a new recommendation on inhaled budesonide and updated the recommendations on casirivimab and imdevimab, clarifying that these recommendations apply to people who are hospitalised because of COVID-19.

27 October 2021

We updated existing recommendations on tocilizumab and sarilumab.

4 October 2021

We added new recommendations on casirivimab and imdevimab. We have also updated our supporting evidence on the use of heparins with the peer-reviewed REMAP-CAP trial results. This update does not change our current recommendations.

2 September 2021

We added new recommendations on non-invasive respiratory support and doxycycline, and updated existing recommendations on heparins.

10 August 2021

We corrected an error in the dosage information on corticosteroids. The dose of prednisolone for children with a greater than 44-week corrected gestational age is 1 mg/kg.

We made minor changes to:

  • clarify that NHS England's Interim Clinical Commissioning Policy on remdesivir for patients hospitalised with COVID-19 was updated in June 2021 to include eligibility criteria for people who are significantly immunocompromised

  • update hyperlinks in the recommendations on communication and shared decision making.

3 June 2021

We added new recommendations on azithromycin to treat COVID-19.

27 May 2021

We added new recommendations on colchicine to treat COVID-19 and updated existing recommendations on remdesivir for COVID-19 pneumonia.

We made a minor change to our recommendation on using pulse oximetry to identify people with severe COVID-19 in primary and community care settings to clarify that the NHS England guide should be followed for adults.

8 April 2021

We added recommendations for using corticosteroids, tocilizumab and sarilumab to treat COVID-19 (including the evidence and rationale for making the recommendations).

This updates and replaces our COVID-19 rapid evidence summaries on:

  • remdesivir for treating hospitalised patients with suspected or confirmed COVID-19 (ES27, published 5 June 2020)

  • tocilizumab for COVID-19 (ES33, published 15 January 2021, last updated 24 February 2021)

  • sarilumab for COVID-19 (ES34, published 20 January 2021).

23 March 2021

This guideline updates and replaces our COVID-19 rapid guidelines on:

  • critical care in adults (NG159, published 20 March 2020, last updated 12 February 2021)

  • managing symptoms (including at the end of life) in the community (NG163, published 03 April 2020, last updated 13 October 2020)

  • managing suspected or confirmed pneumonia in adults in the community (NG165, published 03 April 2020, last updated 23 April 2020)

  • acute myocardial injury (NG171, published 23 April 2020)

  • antibiotics for pneumonia in adults in hospital (NG173, published 01 May 2020, last updated 09 October 2020)

  • acute kidney injury in hospital (NG175, published 06 May 2020)

  • reducing the risk of venous thromboembolism in over 16s with COVID-19 (NG186, published 20 November 2020).

The guideline includes new recommendations on the use of therapeutics for people with COVID-19.

Minor changes since publication

11 July 2023: We updated links to the new NHS interim policy in the recommendations on remdesivir and molnupiravir.

22 June 2023: We updated hyperlinks to other sources in the recommendations on nirmatrelvir and ritonavir, and sotrovimab.

06 April 2023: We updated hyperlinks to other sources in the recommendations on nirmatrelvir and ritonavir, and sotrovimab.

27 July 2022: We amended section 6.2 to clarify that it covers tests for identifying other causes of pneumonia as well as bacterial.

22 July 2021: We added a cross-reference to the Renal Association's guidelines on renal replacement therapy for critically unwell adults for information on managing renal replacement therapy for adults who are critically unwell with COVID-19.

ISBN: 978-1-4731-6130-6