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

WHO has updated its guidance on community masking, treatment of COVID-19 and clinical management. This is part of an ongoing process of reviewing such materials, working with guideline development groups made up of independent, international experts who take into account the latest available evidence and changing epidemiology.

Masks are still a key tool against COVID-19

WHO continues to recommend the use of masks by the public in certain situations, and this update recommends their use regardless of the local epidemiological situation, given the current global spread of COVID-19. Masks are recommended after recent exposure to COVID-19, when someone has or is suspected of having COVID-19, when someone is at high risk of severe COVID-19 illness, and for anyone in a crowded, closed, or poorly ventilated space. Previously, WHO recommendations were based on the epidemiological situation.

Similar to previous recommendations, the WHO advises that there are other cases when a mask may be suggested, based on a risk assessment. Factors to consider include local epidemiological trends or rising levels of hospitalization, levels of vaccination coverage and immunity in the community, and the environment in which people find themselves.

Shortened period of isolation for patients with COVID-19

The WHO advises that a patient with COVID-19 can be released early from isolation if the rapid antigen test is negative.

Without testing, for symptomatic patients, the new guidelines suggest 10 days of isolation from the date of symptom onset. Previously, the WHO advised that patients be discharged 10 days after the onset of symptoms, plus at least three additional days after symptoms have resolved.

For those who test positive for COVID-19 but do not have any signs or symptoms, the WHO now recommends 5 days of isolation without testing, compared to 10 days previously.

Isolation of people with COVID-19 is an important step in preventing the infection of others. This can be done at home or in a dedicated facility, such as a hospital or clinic.

Evidence reviewed by the guideline development group showed that people without symptoms are much less likely to transmit the virus than those with symptoms. Although of very low certainty, the evidence also showed that people with symptoms discharged on the 5th day after the onset of symptoms risked infecting three times more people than those discharged on the 10th day.

Overview of treatment for COVID-19

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

Pregnant or breastfeeding women with a milder form of COVID-19 should consult their doctor to determine whether they should take this drug because of its ‘probable benefits’ and lack of reported side effects.

WHO first recommended nirmatrelvir-ritonavir in April 2022. WHO strongly recommends its use in patients with mild or moderate COVID-19 who are at high risk of hospitalization. In December 2022, the first generic drug manufacturer was pre-qualified from who.

The WHO has also reviewed the evidence on two other drugs, sotrovimab and casirivimab-imdevimab, and maintains strong recommendations against their use for the treatment of COVID-19. These monoclonal antibody drugs have no or reduced activity against currently circulating variants of the virus.

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