What is the treatment for COVID-19 (Coronavirus disease 2019)?

From the Guidelines

The treatment for COVID-19 should include remdesivir for 5 days as a treatment for patients with moderate to severe COVID-19, as it may reduce mortality slightly and result in slightly fewer serious adverse events compared with standard care 1. The treatment approach for COVID-19 depends on the severity of illness, with mild cases managed through supportive care, including rest, adequate hydration, and over-the-counter medications like acetaminophen or ibuprofen to manage fever and pain. For moderate to severe cases requiring hospitalization, treatment may include:

• Remdesivir, typically given intravenously for 5 days, as recommended by the American College of Physicians 1
• Dexamethasone, 6 mg daily for up to 10 days, which has been shown to support the use of corticosteroids, particularly dexamethasone, in reducing mortality 1
• Other corticosteroids, which may be used to manage the inflammatory response that can damage organs
• Oxygen therapy, provided for patients with low oxygen levels
• Antiviral medications like nirmatrelvir-ritonavir or molnupiravir, which may be prescribed within 5 days of symptom onset to prevent progression to severe disease These treatments work by either reducing viral replication (antivirals) or managing the inflammatory response (corticosteroids) that can damage organs. Treatment plans should be individualized based on symptom severity, risk factors, and timing since symptom onset, and patients should isolate to prevent transmission regardless of treatment approach. It is essential to consider the patient's condition and medical history before initiating treatment, as remdesivir is not recommended for patients with an alanine aminotransferase level ≥5 times the upper limit of normal or an estimated glomerular filtration rate <30 mL/min/1.73 m2 1. The European Respiratory Society Living Guidelines for the Management of Hospitalised Adults with COVID-19 provide recommendations on appropriate pharmacotherapy, emphasizing the importance of evidence-based guidelines in improving quality of care and patient outcomes 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: 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 includes remdesivir (IV), which is indicated for hospitalized patients and non-hospitalized patients with mild-to-moderate COVID-19 who are at high risk for progression to severe COVID-19.

• 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 recommended total treatment duration for hospitalized patients requiring invasive mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO) is 10 days.
• The recommended treatment duration for hospitalized patients not requiring invasive mechanical ventilation and/or ECMO is 5 days.
• The recommended total treatment duration for non-hospitalized patients diagnosed with mild-to-moderate COVID-19 who are at high risk for progression to severe COVID-19 is 3 days 2.

From the Research

Treatment Overview

• The treatment for COVID-19 primarily focuses on supportive care, as no specific antiviral agent has been proven effective in treating the disease 3, 4.
• Patients with mild cases can self-manage their symptoms, while those with severe and critical disease require hospital admission and full active treatment 3.

Supportive Care Measures

• Oxygen therapy for hypoxemia and ventilatory support are crucial for patients with severe respiratory compromise 3, 5.
• Optimal management of complications, such as superimposed bacterial infections and underlying co-morbidities, is essential 3.
• Symptomatic and supportive care, including oxygenation, anti-co-infection treatments, and ventilation, are the mainstay of treatment for critical patients 4.

Pharmacological Interventions

• Dexamethasone has been shown to decrease mortality among patients with severe or critical COVID-19 5, 6.
• Remdesivir, in combination with dexamethasone and other therapies, has been used to treat severe COVID-19 cases 6, 7.
• Baricitinib, a Janus kinase inhibitor, has been used in combination with remdesivir and dexamethasone to treat severe COVID-19, with promising results 7.

Hospital Admission and Intensive Care

• Determination of hospital admission should consider factors such as age, comorbidities, respiratory rate, and oxygen saturation 5.
• Patients with hypoxemic respiratory insufficiency may require high-flow oxygen, non-invasive ventilation, or intubation and invasive ventilation 5.
• Intensified prophylaxis against thromboembolism may be indicated in patients with additional risk factors 5.