to increased risk of aerosol transmission. Remark 2 for pregnant patients: COVID-19 testing of symptomatic pregnant women may need to be prioritized to enable access to specialized care. Remark 3: Dual infections with other respiratory viral and bacterial infections have been found in SARS, MERS and COVID-19 patients (8). As a result, a positive test for a non-COVID-19 pathogen does not rule out COVID-19. At this stage, detailed microbiologic studies are needed in all suspected cases. Both URT and LRT specimens can be tested for other respiratory viruses, such as influenza A and B (including zoonotic influenza A), respiratory syncytial virus, parainfluenza viruses, rhinoviruses, adenoviruses, enteroviruses (e.g. EVD68), human metapneumovirus and endemic human coronaviruses (i.e. HKU1, OC43, NL63, and 229E). LRT specimens can also be tested for bacterial pathogens, including Legionella pneumophila. In malaria-endemic areas, patients with fever should be tested for the presence of malaria or other co-infections with validated rapid diagnostic tests (RDTs) or thick and thin blood films and treated as appropriate. In endemic settings arbovirus infection (dengue/chikungunya) should also be considered in the differential diagnosis of undifferentiated febrile illness, particularly when thrombocytopenia is present. Co-infection with COVID-19 virus may also occur and a positive diagnostic test for dengue (e.g. dengue RDTs) does not exclude the testing for COVID-19 (24). 4. Management of mild COVID-19: symptomatic treatment and monitoring Patients with mild disease do not require hospital interventions, but isolation is necessary to contain virus transmission and will depend on national strategy and resources. Remark: Although most patients with mild disease may not have indications for hospitalization, it is necessary to implement appropriate IPC to contain and mitigate transmission. This can be done either in hospital, if there are only sporadic cases or small clusters, or in repurposed, non-traditional settings; or at home. Provide patients with mild COVID-19 with symptomatic treatment such as antipyretics for fever. Counsel patients with mild COVID-19 about signs and symptoms of complicated disease. If they develop any of these symptoms, they should seek urgent care through national referral systems. 5. Management of severe COVID-19: oxygen therapy and monitoring Give supplemental oxygen therapy immediately to patients with SARI and respiratory distress, hypoxaemia or shock and target SpO2 > 94%. Remarks for adults: Adults with emergency signs (obstructed or absent breathing, severe respiratory distress, central cyanosis, shock, coma, or convulsions) should receive airway management and oxygen therapy during resuscitation to target SpO2 ≥ 94%. Initiate oxygen therapy at 5 L/min and titrate flow rates to reach target SpO2 ≥ 93% during resuscitation; or use face mask with reservoir bag (at 10–15 L/min) if patient in critical condition. Once patient is stable, the target is > 90% SpO2 in non-pregnant adults and ≥ 92–95% in pregnant patients (16, 25). Remarks for children: Children with emergency signs (obstructed or absent breathing, severe respiratory distress, central cyanosis, shock, coma or convulsions) should receive airway management and oxygen therapy during resuscitation to target SpO2 ≥ 94%; otherwise, the target SpO2 is ≥ 90% (25). Use of nasal prongs or nasal cannula is preferred in young children, as they may be better tolerated. Remark 3: All areas where patients with SARI are cared for should be equipped with pulse oximeters, functioning oxygen systems and disposable, single-use, oxygen-delivering interfaces (nasal cannula, nasal prongs, simple face mask, and mask with reservoir bag). See Appendix for details of resources. Closely monitor patients with COVID-19 for signs of clinical deterioration, such as rapidly progressive respiratory failure and sepsis and respond immediately with supportive care interventions. Remark 1: Patients hospitalized with COVID-19 require regular monitoring of vital signs and, where possible, utilization of medical early warning scores (e.g. NEWS2) that facilitate early recognition and escalation of treatment of the deteriorating patient (26). Remark 2: Haematology and biochemistry laboratory testing and ECG should be performed at admission and as clinically indicated to monitor for complications, such as acute liver injury, acute kidney injury, acute cardiac injury, or shock. Application 6 Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance of timely, effective, and safe supportive therapies is the cornerstone of therapy for patients who develop severe manifestations of COVID-19. Remarks 3: After resuscitation and stabilization of the pregnant patient, then fetal well-being should be monitored. Understand the patient’s co-morbid condition(s) to tailor the management of critical illness. Remark 1: Determine which chronic therapies should be continued and which therapies should be stopped temporarily. Monitor for drug-drug interactions. Use conservative fluid management in patients with SARI when there is no evidence of shock. Remarks: Patients with SARI should be treated cautiously with intravenous fluids, because aggressive fluid resuscitation may worsen oxygenation, especially in