Rizwana Khan MD

COVID-19 Guidelines: What to Do in 2026

In 2026, stay current with COVID-19 vaccination CDC — everyone aged 6 months and older should receive the updated COVID-19 vaccine Ann IM, with a second dose for adults 65+ or immunocompromised MM Weekly. If you have symptoms or exposure, test promptly Clin ID and isolate for at least 5 days if positive, masking through day 10. For high-risk outpatients with mild-to-moderate COVID-19, start nirmatrelvir/ritonavir within 5 days; in hospitalized patients, use remdesivir for high-risk mild-to-moderate disease Clin ID and add dexamethasone for severe or critical illness. Continue standard precautions and mask in high-risk settings. Monitor for severe disease and seek care if symptoms worsen.

Vaccination recommendations

Universal vaccination: Everyone aged 6 months and older should receive the 2025–2026 COVID-19 vaccine CDC +1.
Additional doses: Adults 65+ and those with moderate to severe immunocompromise should receive a second dose 6 months after the first MM Weekly +1.
Immunocompromised patients: May require 2–3 doses in the initial series and additional doses based on clinical judgment MM Weekly +1.

Testing and isolation guidelines

Testing: Use NAAT or antigen tests for suspected cases Clin ID +1; antigen tests are acceptable when NAAT is unavailable Clin ID.
Isolation: Isolate for at least 5 days if positive; end isolation only if fever-free for 24 hours without medication and symptoms improve, then mask through day 10 CDC.
High-risk settings: Isolate for 10 days if severe illness, hospitalized, or immunocompromised; consult a clinician before ending isolation CDC.

Treatment recommendations

Outpatient management

For mild-to-moderate COVID-19, use nirmatrelvir/ritonavir within 5 days of symptom onset for high-risk patients IDSA +1. For remdesivir, administer as a 3-day IV course within 7 days of symptom onset for high-risk outpatients IDSA +1. Molnupiravir is a conditional alternative when preferred agents are unavailable or contraindicated Clin ID.

Hospitalized patients

For severe or critical COVID-19, give dexamethasone 6 mg IV or PO daily for 10 days or until discharge IDSA. Add remdesivir for hospitalized patients with high-risk mild-to-moderate disease Clin ID +1. For tocilizumab, use in hospitalized patients with severe or critical disease when appropriate Clin ID.

Infection prevention and control

Maintain standard precautions — hand hygiene, respiratory etiquette, and environmental cleaning Geneva: World Health Organization +1. Use source control — masks in high-risk settings or when symptomatic CDC +1. Ensure ventilation — improve indoor air quality to reduce transmission MM Weekly.

Special populations

Immunocompromised: Prioritize vaccination, early antivirals, and close monitoring IDSA +1.
Pregnant patients: Vaccinate and treat based on risk; nirmatrelvir/ritonavir is generally acceptable when indicated.
Pediatrics: Vaccinate per age-appropriate schedules; antivirals for high-risk children Pediatrics.

Monitoring and follow-up

Monitor for severe disease — watch for hypoxia, persistent fever, or worsening symptoms, and escalate care if needed MM Weekly. For long COVID, provide supportive care and refer to specialized clinics when available. Keep documentation — record vaccination, testing, and treatment to guide future care.

Summary of key actions

ActionRecommendationVaccination2025–2026 vaccine for all ≥ 6 months; second dose for 65+ or immunocompromised CDC +1TestingNAAT or antigen for suspected cases; isolate if positive Clin ID +1Outpatient treatmentNirmatrelvir/ritonavir within 5 days for high-risk patients IDSA +1Hospitalized treatmentDexamethasone for severe/critical; remdesivir for high-risk mild-to-moderate IDSA +1Infection controlStandard precautions, masks in high-risk settings, ventilation CDC +1Special populationsTailor vaccination, antivirals, and monitoring IDSA +1HelpfulNot HelpfulReferences

1Staying up to date with COVID-19 vaccines-CDC (...)CDC, 2025Recent
2COVID-19 vaccines for 2025-2026 in adults who are not pregnant or immunocompromised: rapid practice points from the American College of PhysiciansAnnals of Internal Medicine, 2026GuidelineRecent
3Use of an additional updated 2023-2024 COVID-19 vaccine dose for adults aged ≥ 65 years: recommendations of the advisory committee on immunization practices-United States, 2024MMWR: Morbidity and Mortality Weekly Report, 2024Free PDF via Doximity

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COVID-19 Guidelines: What to Do in 2026

Vaccination recommendations

Universal vaccination: Everyone aged 6 months and older should receive the updated COVID-19 vaccine CDC +1.
Additional doses: Adults 65+ and those with moderate to severe immunocompromise should receive a second dose 6 months after the first MM Weekly.
Immunocompromised patients: May require 2–3 doses in the initial series and additional doses based on clinical judgment MM Weekly.

Testing and isolation guidelines

Testing: Use NAAT or antigen tests for suspected cases Clin ID; antigen tests are acceptable when NAAT is unavailable.
Isolation: Isolate for at least 5 days if positive; end isolation only if fever-free for 24 hours without medication and symptoms improve, then mask through day 10.
High-risk settings: Isolate for 10 days if severe illness, hospitalized, or immunocompromised; consult a clinician before ending isolation.

Treatment recommendations

Outpatient management

For mild-to-moderate COVID-19, use nirmatrelvir/ritonavir within 5 days of symptom onset for high-risk patients Clin ID. For remdesivir, administer as a 3-day IV course within 7 days of symptom onset for high-risk outpatients Clin ID. Molnupiravir is a conditional alternative when preferred agents are unavailable or contraindicated Clin ID.

Hospitalized patients

For severe or critical COVID-19, give dexamethasone 6 mg IV or PO daily for 10 days or until discharge. Add remdesivir for hospitalized patients with high-risk mild-to-moderate disease Clin ID +1. For tocilizumab, use in hospitalized patients with severe or critical disease when appropriate.

Infection prevention and control

Maintain standard precautions — hand hygiene, respiratory etiquette, and environmental cleaning BMJ. Use source control — masks in high-risk settings or when symptomatic CDC. Ensure ventilation — improve indoor air quality to reduce transmission.

Special populations

Immunocompromised: Prioritize vaccination, early antivirals, and close monitoring IDSA.
Pregnant patients: Vaccinate and treat based on risk; nirmatrelvir/ritonavir is generally acceptable when indicated.
Pediatrics: Vaccinate per age-appropriate schedules; antivirals for high-risk children Pediatrics.

Monitoring and follow-up

Monitor for severe disease — watch for hypoxia, persistent fever, or worsening symptoms, and escalate care if needed. For long COVID, provide supportive care and refer to specialized clinics when available. Keep documentation — record vaccination, testing, and treatment to guide future care.

Summary of key actions

ActionRecommendationVaccinationUpdated COVID-19 vaccine for all ≥ 6 months; second dose for 65+ or immunocompromised CDC +1TestingNAAT or antigen for suspected cases; isolate if positive Clin IDOutpatient treatmentNirmatrelvir/ritonavir within 5 days for high-risk patients Clin IDHospitalized treatmentDexamethasone for severe/critical; remdesivir for high-risk mild-to-moderate Clin IDInfection controlStandard precautions, masks in high-risk settings, ventilationSpecial populationsTailor vaccination, antivirals, and monitoring IDSAHelpfulNot HelpfulReferences