Table 1

Suggested low-cost interventions with supporting evidence for the clinical management of COVID-19 pneumonia in resource-constrained settings

Intervention	Evidence	Clinical use	Clinical settings	LMIC availability
Non-invasive supplemental oxygen (via NC or NRB mask) guided by pulse-oximetry	Mainstay of therapy21 and recommended for use in COVID-19 based on expert consensus.22 25 Anecdotally beneficial in COVID-19 with improvement in hypoxia and work of breathing.	All patients with suspected or confirmed COVID-19 with respiratory distress, RR >20, or resting SpO₂ <92%.	Hospital	Variable; pulse oximeter frequently available; piped oxygen may be limited in severely resource-constrained settings.
Awake prone positioning	Inconsistent observational data; Some studies suggest improvement in hypoxia among patients with severe respiratory failure and COVID-19,26 27 while others found no benefit. Anecdotally shown to be effective in improving hypoxia in COVID-19 patients who are oriented.	All patients with suspected or confirmed COVID-19 with RR >20 or resting SpO₂ <92%	Hospital; Clinic; Home.	Unlimited.
Standing acetaminophen or paracetamol	Improves fevers and respiratory distress by reducing oxygen consumption and recommended for use in COVID-19.22 Anecdotally effective in treating myalgias and improving work of breathing in COVID-19 patients.	All patients with suspected or confirmed COVID-19 with respiratory distress, RR >20, or resting SpO₂ <92% irrespective of fever curve.	Hospital; Clinic; Home.	Widely available.
Glucocorticoids	Mortality benefit in in hypoxic patients hospitalised with COVID-19.34 35	All patients with suspected or confirmed COVID-19 pneumonia and resting SpO₂ <92%	Hospital/ICU; Clinic; Home.	Frequently available.
Heparin or LMWH	Improvement in 28-day mortality among select patients with COVID-19.47 Anecdotal observations of high rates of hemodynamically significant thromboembolic disease in COVID-19 requiring LMWH use.	Patients with suspected or confirmed COVID-19 with symptom duration >7 days, minimal bleeding risk, and one of the following: persistent temperature >39.4°C, respiratory failure, shock, kidney failure or clinically evident thromboembolic disease.	Hospital/ICU.	Variable drug availability; may be limited in more resource-constrained areas. Further limitations in laboratory testing limit safe administration in many LMICs.
Low-dose aspirin	Observational data demonstrated aspirin independently associated with lower risk of mechanical ventilation, ICU admission, and in-hospital mortality among hospitalised patients with COVID-19.51	Patients with suspected or confirmed COVID-19 with symptom duration >7 days, minimal bleeding risk, and one of the following: persistent temperature >39.4°C, respiratory failure, shock, kidney failure or clinically evident thromboembolic disease.	Hospital/ICU in which anticoagulation is not available.	Widely available.

ICU, intensive care unit; LMICs, low-income and middle-income countries; LMWH, low-molecular-weight heparin; NC, nasal cannula; NRB, non-rebreather; RR, respiratory rate; SpO₂, oxygen saturation.