Principles of symptom control in patients with COVID-19 infection.
| Symptom | Intervention (first-line) | Comments |
| All symptoms | Exclude other conditions (Treat other conditions) | Non-pharmacological interventions may not be practical at the end of life (especially in patients in isolation) |
| Fever | Cooling measures (not fan) Paracetamol – usual routes, usual doses | Fans are not recommended (infection control) Concerns have been raised about the use of non-steroidal anti-inflammatory drugs, but at present the evidence is lacking to support these concerns8 |
| Cough (dry) | Simple linctus9 Opioids9 – usual routes, small doses (cf pain) | Opioids are not indicated in a productive cough9 |
| Shortness of breath | Opioids10 – usual routes, small doses (cf pain) | Fans are not recommended (infection control) Oxygen may not improve shortness of breath (even in patients with severe hypoxia) Benzodiazepines do not improve shortness of breath, although they can be used to manage related anxiety11 |
| Delirium / terminal restlessness | Exclude reversible causes [Non-pharmacological interventions – see above] Haloperidol12 – usual routes, usual doses | Second-line (sedating) pharmacological interventions include levomepromazine and midazolam |
| Audible upper airway secretions (‘death rattle’) | No evidence to support any pharmacological intervention (or non-pharmacological intervention)13 [Anticholinergics are generally prescribed] | Patients are usually not distressed by these upper airway secretions Explanation/reassurance is needed for family members (and others) |
| Pain | Manage in usual way | Not a major feature of COVID-19 infection |
| Nausea and vomiting | Manage in usual way | Not a major feature of COVID-19 infection |