From the Guidelines
Elderly patients with mild COVID-19 should be treated with supportive care, including rest, adequate hydration, and over-the-counter medications for symptom relief, and may be considered for early treatment with high-titer convalescent plasma, as recommended by recent guidelines 1. The primary focus of treatment for mild COVID-19 in elderly patients is on supportive care, which includes:
- Rest
- Adequate hydration
- Over-the-counter medications for symptom relief, such as acetaminophen (Tylenol) for fever and pain at 500-1000mg every 6 hours, not exceeding 3000mg daily for elderly patients Most elderly patients with mild COVID-19 can recover at home with careful monitoring. According to recent studies, early treatment with high-titer convalescent plasma can be considered for elderly patients with mild COVID-19, as it has been shown to reduce the severe conversion rate of COVID-19 1. It is essential to note that some treatments may have more impairments than benefits in reducing the severe COVID-19 conversion rate, such as hydroxychloroquine (HCQ) and corticosteroid treatment, which may increase the risk of adverse events and mortality 1. Regular communication with healthcare providers is crucial, as elderly patients may deteriorate rapidly due to age-related immune system changes and comorbidities. Elderly patients should monitor for worsening symptoms like difficulty breathing, persistent chest pain, confusion, or bluish lips, which require immediate medical attention. In terms of antiviral medications, options like nirmatrelvir/ritonavir (Paxlovid), remdesivir, and molnupiravir may be considered, but the decision to use these medications should be made on a case-by-case basis, taking into account the patient's individual needs and medical history.
From the FDA Drug Label
VEKLURY is indicated for the treatment of coronavirus disease 2019 (COVID-19) in adults and pediatric patients (birth to less than 18 years of age weighing at least 1. 5 kg) who are [see Clinical Studies (14)]: Hospitalized, or Not hospitalized and have mild-to-moderate COVID-19, and are at high risk for progression to severe COVID-19, including hospitalization or death.
The treatment for mild COVID-19 in elderly patients is remdesivir (IV), but only if they are at high risk for progression to severe COVID-19.
- The recommended dosage for adults is a single loading dose of VEKLURY 200 mg on Day 1 via intravenous infusion followed by once-daily maintenance doses of VEKLURY 100 mg from Day 2 via intravenous infusion.
- Treatment should be initiated as soon as possible after diagnosis of symptomatic COVID-19 has been made.
- The recommended total treatment duration is 5 days for non-hospitalized patients or hospitalized patients not requiring invasive mechanical ventilation and/or ECMO, and can be extended up to 10 days if necessary 2.
From the Research
Current Treatment Options for Mild COVID-19 in Elderly Patients
- The current treatment for mild COVID-19 in elderly patients involves the use of antiviral agents, corticosteroids, and monoclonal antibody combinations 3, 4, 5, 6, 7.
- Remdesivir is an antiviral agent that has been shown to reduce recovery time and mortality in patients with COVID-19 3, 4.
- Corticosteroids, such as dexamethasone, have been found to reduce mortality in hospitalized patients with severe or critical COVID-19 3, 4.
- Monoclonal antibody combinations, such as bamlanivimab/etesevimab and casirivimab/imdevimab, have been authorized for emergency use in non-hospitalized patients with mild-to-moderate COVID-19 at high risk of disease progression 3.
- Other treatment options, such as molnupiravir, have been found to reduce the risk of hospitalization or death in at-risk, unvaccinated adults with COVID-19 6.
Considerations for Elderly Patients
- Elderly patients with COVID-19 are at higher risk of severe illness and mortality, and may require more aggressive treatment 7.
- Antiviral therapy, immune regulation, and auxiliary respiratory therapy may be given to elderly patients with COVID-19 after a comprehensive evaluation of the disease 7.
- The use of COVID-19 vaccines has been found to be effective in preventing severe illness and mortality in elderly patients 7.
- Elderly patients with COVID-19 may also require additional support, such as psychological counseling, to manage the emotional and social impacts of the disease 7.
Pharmacological Treatment Options
- Bamlanivimab and nitazoxanide have been found to reduce viral load in patients with mild to moderate COVID-19 5.
- Ivermectin may have shortened time to viral clearance in patients with mild to moderate COVID-19 5.
- Inhaled budesonide has been found to reduce the number of hospitalizations and visits to emergency departments in patients with mild to moderate COVID-19 5.
- Colchicine has been found to reduce the number of deaths and hospitalizations in patients with mild to moderate COVID-19 5.