What are the treatments for COVID-19?

Treatment Options for COVID-19

The treatment of COVID-19 should be stratified based on disease severity, with remdesivir as the primary antiviral therapy for hospitalized patients, while non-hospitalized high-risk patients should receive either remdesivir, monoclonal antibodies, or oral antivirals based on availability and clinical presentation. 1

Primary Therapies Based on Disease Severity

For Hospitalized Patients:

• Remdesivir: Recommended as primary therapy for patients with moderate COVID-19 requiring oxygen support with saturation >90% 1

  • Dosing: 200mg IV loading dose on Day 1, followed by 100mg IV daily from Day 2 2
  • Duration: 5 days for those not requiring mechanical ventilation; can be extended to 10 days if no clinical improvement 2

• Dexamethasone: 6mg daily for 10 days for patients requiring oxygen 1

  • Strongly recommended for patients with severe COVID-19 (oxygen saturation <90%, respiratory rate >30/min) or critical COVID-19 (ARDS, sepsis, shock, requiring mechanical ventilation) 1

• Anti-IL-6 agents: Tocilizumab or sarilumab recommended for patients with evidence of systemic inflammation 1

  • Consider adding when patient is worsening despite dexamethasone treatment with COVID-19-related inflammation

For Non-Hospitalized High-Risk Patients:

• Remdesivir: Can be administered to non-hospitalized patients with mild-to-moderate COVID-19 who are at high risk for progression to severe disease 2

• Monoclonal antibodies: Recommended for high-risk patients, especially those who are unvaccinated or vaccine non-responders 1

  • For seronegative patients, consider casirivimab/imdevimab or convalescent plasma 1

• Oral antivirals: Nirmatrelvir/ritonavir may be considered for patients with mild-to-moderate COVID-19 who are at high risk for progression 1

Special Considerations and Monitoring

• Liver function monitoring: Perform hepatic laboratory testing in all patients before starting remdesivir and during treatment 2

  • Abnormal LFTs are common in COVID-19 and may be associated with higher risk for severe disease 3

• Coagulation monitoring: Determine prothrombin time before starting remdesivir and monitor during treatment 2

  • COVID-19 is associated with a prothrombotic state requiring appropriate anticoagulation 1

• Timing of treatment: Treatment should be initiated as soon as possible after diagnosis of symptomatic COVID-19 2

Symptom Management

• For cough:

  • Avoid lying on back
  • Consider honey (for patients >1 year old), codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution for distressing cough 1

• For fever:

  • Regular fluid intake (≤2 liters/day)
  • Acetaminophen is most commonly used and perceived as highly effective 1

Supportive Care

• Psychological support: Should be integrated into care plans to address mental health concerns 1

• Non-drug treatments: Tai Chi, breathing relaxation training, and mindfulness training may be considered for anxiety and mental health symptoms 1

Important Cautions

• Avoid inappropriate antibiotic use: Unless bacterial infection is clinically suspected 1

• Remdesivir administration setting: Must only be administered in settings where healthcare providers have immediate access to medications to treat severe infusion or hypersensitivity reactions 2

• Discharge criteria: Avoid premature discharge; patients should meet appropriate criteria including resolution of fever for >3 days, improvement of respiratory symptoms, and significant absorption of pulmonary lesions on imaging 1

The treatment approach should be adjusted based on the patient's clinical status, risk factors, and response to therapy. Early intervention with appropriate therapies is crucial for improving outcomes in COVID-19 patients.