What are the treatment options for Coronavirus disease (COVID-19)?

From the Guidelines

Treatment for COVID-19 should prioritize corticosteroids, such as dexamethasone, and anti-IL-6 receptor monoclonal antibody therapy, as these have been shown to decrease mortality in hospitalized patients 1. When managing COVID-19, it's essential to consider the severity of symptoms and tailor treatment accordingly. For mild cases, supportive care with rest, hydration, and over-the-counter medications like acetaminophen or ibuprofen can help manage fever and pain.

Key Considerations

• Antiviral medications, such as nirmatrelvir/ritonavir (Paxlovid), may be prescribed for high-risk patients within 5 days of symptom onset 1.
• Remdesivir may be given intravenously in hospital settings, although its effectiveness is supported by weaker evidence compared to corticosteroids and anti-IL-6 receptor monoclonal antibody therapy 1.
• For moderate to severe cases requiring hospitalization, oxygen therapy, corticosteroids like dexamethasone (typically 6mg daily for up to 10 days), and anticoagulants may be necessary 1.
• Monoclonal antibody treatments might be used for certain patients, particularly those at risk of severe COVID-19 course, with symptom onset <5 days, or still seronegative 1.

Monitoring and Prevention

• Throughout infection, isolation for at least 5 days after symptom onset is recommended to prevent spread.
• Patients should monitor for worsening symptoms like difficulty breathing, persistent chest pain, confusion, or bluish lips, which require immediate medical attention. The most recent and highest quality evidence supports the use of corticosteroids and anti-IL-6 receptor monoclonal antibody therapy as the cornerstone of treatment for COVID-19, particularly in hospitalized patients 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 recommended dosage for adults and pediatric patients weighing at least 40 kg 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.

The treatment for COVID-19 is Remdesivir (IV), also known as VEKLURY. The recommended dosage varies based on the patient's weight and age.

• For adults and pediatric patients weighing at least 40 kg, the recommended dosage is a single loading dose of 200 mg on Day 1, followed by once-daily maintenance doses of 100 mg from Day 2.
• For pediatric patients weighing 1.5 kg to less than 40 kg, the recommended dosage is presented in a table and varies based on the patient's age and weight. The treatment course should be initiated as soon as possible after diagnosis of symptomatic COVID-19 has been made, and the recommended total treatment duration varies from 5 to 10 days depending on the patient's condition 2 2.

From the Research

Treatment Options for COVID-19

• The treatment for COVID-19 typically involves a combination of antiviral agents, inflammation inhibitors, and supportive care 3.
• A study published in 2021 found that combination therapy with baricitinib, remdesivir, and dexamethasone was effective in treating severe COVID-19, with a low 28-day mortality rate of 2.3% 4.
• Another study published in 2022 found that the use of evidence-based treatments, such as remdesivir and corticosteroids, increased over time, and was associated with improved outcomes, including a decrease in median length of stay and mortality 5.

Management of Long COVID

• Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection, is a condition that can occur after COVID-19 infection, and is characterized by a wide range of symptoms, including fatigue, cognitive impairment, and pain 6.
• The management of Long COVID typically involves a holistic approach, including symptom-based supportive care, energy conservation strategies, and addressing comorbidities and modifiable risk factors 6.
• There is currently limited data to guide medication management specifically in the context of Long COVID, and treatment recommendations should be delivered with humility and caution 6.

Diagnostic Tools and Prevention

• The diagnosis of COVID-19 typically involves real-time PCR using nasal swab, tracheal aspirate, or bronchoalveolar lavage samples, as well as computed tomography findings 7.
• Hand hygiene and wearing personal protective equipment are recommended to prevent contamination and transmission of the virus 7.
• Quarantine is currently the only intervention that appears to be effective in decreasing the contagion rate, and specifically designed randomized clinical trials are needed to determine the most appropriate evidence-based treatment modality 7.