From the Guidelines
COVID-19 treatment should prioritize supportive care and specific medications, with a focus on reducing morbidity, mortality, and improving quality of life, as evidenced by the most recent and highest quality study 1.
Treatment Approach
The treatment approach for COVID-19 varies based on severity, with mild cases typically managed with rest, hydration, and over-the-counter fever reducers like acetaminophen (500-1000mg every 6 hours as needed).
- For moderate to severe cases requiring hospitalization, treatment may include:
- Remdesivir (200mg IV on day 1, then 100mg daily for 5-10 days)
- Dexamethasone (6mg daily for up to 10 days)
- Baricitinib (4mg daily for up to 14 days)
- Monoclonal antibody treatments like bebtelovimab may be given to high-risk outpatients.
- Paxlovid (nirmatrelvir 300mg with ritonavir 100mg twice daily for 5 days) is effective for non-hospitalized patients at high risk for progression when started within 5 days of symptom onset.
- Molnupiravir (800mg twice daily for 5 days) is an alternative when Paxlovid isn't suitable.
Rationale
These treatments work by either reducing viral replication or modulating the inflammatory response that causes severe disease, as supported by studies such as 1 and 1.
- Oxygen therapy and ventilatory support are provided as needed for respiratory symptoms.
- Treatment plans should be individualized based on symptom severity, risk factors, and timing from symptom onset, with consideration of the latest guidelines and evidence-based recommendations 1.
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 COVID-19 is remdesivir (IV), which is indicated for:
- Hospitalized patients
- Not hospitalized patients with mild-to-moderate COVID-19 who are at high risk for progression to severe COVID-19, including hospitalization or death 2. The recommended dosage and treatment duration vary based on the patient's condition and weight, as outlined in the drug label 2.
From the Research
COVID-19 Treatment Overview
- COVID-19 treatment is a complex and multifaceted process, requiring a holistic approach to manage symptoms and prevent long-term complications 3.
- The treatment of COVID-19 can be divided into two main categories: supportive care and specific treatments, such as antiviral medications and corticosteroids 4, 5, 6, 7.
Supportive Care
- Supportive care is essential for managing COVID-19 symptoms, particularly for patients with mild to moderate disease 4, 7.
- This includes oxygen therapy, hydration, and nutritional support, as well as management of comorbidities and modifiable risk factors 3, 7.
- Early mobilization and prone positioning can also be beneficial for patients with severe respiratory symptoms 7.
Specific Treatments
- Remdesivir, an antiviral medication, has been shown to reduce the risk of hospitalization and improve clinical outcomes in hospitalized patients with COVID-19 5, 6.
- Dexamethasone, a corticosteroid, can be used in combination with remdesivir to improve clinical outcomes and reduce the need for mechanical ventilation 5, 6.
- However, the effectiveness of these treatments can vary depending on the patient's vaccination status, age, and underlying health conditions 5, 6.
Long COVID Management
- Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), can present with a wide range of symptoms, including fatigue, cognitive impairment, and dysautonomia 3.
- Management of Long COVID requires a multidisciplinary approach, including physiatrists, primary care physicians, and other healthcare professionals 3.
- Treatment strategies focus on symptom-based supportive care, energy conservation, and addressing comorbidities and modifiable risk factors 3.