Table 2.

Principles of symptom control in patients with COVID-19 infection.

SymptomIntervention (first-line)Comments
All symptomsExclude other conditions
(Treat other conditions)
Non-pharmacological interventions may not be practical at the end of life (especially in patients in isolation)
FeverCooling 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 breathOpioids10 – 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 restlessnessExclude 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)
PainManage in usual wayNot a major feature of COVID-19 infection
Nausea and vomitingManage in usual wayNot a major feature of COVID-19 infection