• See Section 6.1 regarding approach to identify patients at highest risk f or hospitalization.
• Several therapeutic op tions are available: see decision support t ool that displays benefits and harms o f nirmatrelvir-ritonavir, molnupiravir and remdesivir.
• The GDG c oncluded that nirmatr elvir-ritonavir represents a superior choic e because it may hav e greater efficacy in preventing hospitalization than alt ernatives, has f ewer concerns with respect t o harms than does molnupir avir; and is easier t o administer than a 3-day c ourse of intravenous remdesivir.
• Remdesivir should be administ ered as soon as possible aft er onset o f symptoms, ideally within 7 day s.

Practical Info Route, dosage and duration: Additional considerations are available in three summaries of practical issues (remdesivir for COVID-19, administration of remdesivir for COVID-19, safety and monitoring in pa tients receiving remdesivir for COVID-19). Here follows a brief summary o f the key points:

• The recommended dose f or remdesivir is one dose daily f or 3 c onsecutive days as intravenous infusion, as per the r egimen evaluated in large trials informing the recommendation. Remdesivir is given as 200 mg in travenously on da y 1, f ollowed by 100 mg in travenously on da ys 2 and 3.
• Administration should be as early as possible in the time c ourse of the disease. I n the included studies, r emdesivir was administered within 7 da ys of disease onse t.
• It may be reasonable to monitor pa tients for a brief period f ollowing infusion. Any health care workers administering the infusions should f ollow recommended infection prevention and c ontrol recommendations in the outpa tient setting.
• One should use caution when administering r emdesivir to patients with significant liver or kidney disease.
• The GDG no ted that there is insufficient evidence to make a recommendation around the use o f remdesivir in children and further studies are needed.
• Additionally, the trials did no t enrol pregnant or breastfeeding women. T he decision regarding use o f this therapeutic should be made be tween the pregnant person and their health car e provider while discussing whe ther the potential benefit justifies the potential risk to the mo ther and fetus (see Research evidence and WHO in formation sheet).

Resources and other considerations Acceptability and feasibility Remdesivir is administered as one in travenous infusion daily over 3 consecutive days, representing a f easibility challenge in outpatients aiming to a void hospital admission. F urthermore, remdesivir is unlikely to be a vailable for all individuals who, given the op tion, would choose to r eceive the treatment. This reinforces that remdesivir should be reserved for those at highest risk. Obstacles to access in LMICs due to c ost, feasibility and availability are of concern (30). Challenges in shared decisionmaking and in c ommunicating the harms v ersus benefits of remdesivir may also be incr eased in LMICs. F or example, those with socioeconomic disadvantages tend to ha ve less ac cess to services, including diagnostic testing and tr eatments in the first 7 days of symptoms, and thus less ac cess to the in terventions. Therefore, if pa tients at highest risk receive the intervention, this may exacerbate health inequity. It is important that countries integrate the COVID-19 clinical care pathway in the parts o f the health s ystem that may provide care for patients with non-se vere COVID-19 (i.e. primary care, community care settings). The recommendations should provide a stimulus to engag e all possible mechanisms to impr ove global access to the intervention. As an e xample of this, on 17 D ecember 2021, WHO published the 8th invitation to M anufacturers of therapeutics against COVID-19 to submit an Expression of Interest (EOI) for Product Evaluation to the WHO P requalification Unit. If this e valuation demonstrates that a product and its c orresponding manufacturing (and clinical) site(s) meet WHO recommended standards, it will be included in the list o f medicinal products that are considered to be acceptable for procurement by UN or ganizations and o thers. Individual countries may formulate their guidelines considering available resources and prioritize treatment options accordingly. Access to SARS-CoV-2 diagnostics: Since this recommendation emphasizes the need to administer tr eatment with remdesivir within 7 days of symptom onset, increasing access and ensuring appropriate use o f diagnostic tests is essen tial. Thus, availability and use of reliable and timely S ARS-CoV-2 diagnostic tests (including the use o f nucleic acid amplifica tion tests (NAAT) and antigen-based rapid detection tests (Ag-RDTs)) are needed to impr ove access to drugs, especially those targeting the early phase o f disease. T he appropriate use o f Ag-RDTs by individuals and trained professionals can improve early diagnosis and earlier access to clinical care, particularly in the c ommunity and in primary health car e settings. National programmes should op timize their testing s ystems to reflect local epidemiology, response objectives, available resources and needs o f their populations.