What is the treatment for COVID-19 pneumonia?

Treatment for COVID-19 Pneumonia

The treatment of COVID-19 pneumonia requires a structured approach focusing on supportive care, oxygen therapy, and specific medications depending on disease severity, with hospitalization in designated facilities for isolation and appropriate monitoring.

Core Treatment Components

Hospitalization and Monitoring

• Patients should be treated in designated hospitals with effective isolation protocols 1
• Suspected cases require single-room isolation; confirmed cases can be cohorted in the same ward 1
• Critical cases should be admitted to ICU as soon as possible 1
• Continuous monitoring of vital signs including heart rate, oxygen saturation, respiratory rate, and blood pressure 1

Supportive Care

• Bed rest with supportive treatment to ensure:
  • Sufficient energy intake
  • Water and electrolyte balance
  • Acid-base homeostasis 1
• Regular monitoring of:
  • Complete blood count, CRP, PCT
  • Organ function (liver enzymes, bilirubin, cardiac enzymes, renal function)
  • Coagulation profile
  • Arterial blood gas analysis
  • Serial chest imaging 1

Oxygen Therapy

• Oxygen therapy is the cornerstone of treatment for respiratory distress, hypoxemia, or shock 1
• Escalation pathway based on severity:
  1. Start with nasal cannula at 5 L/min, titrating to target oxygen saturation
  2. Progress to mask oxygen if needed
  3. High-flow nasal oxygen therapy (HFNO) for worsening hypoxemia
  4. Non-invasive ventilation (NIV) for appropriate candidates
  5. Invasive mechanical ventilation for severe cases 1, 2
• Consider extracorporeal membrane oxygenation (ECMO) for refractory hypoxemia not responding to protective lung ventilation 1

Positioning Therapy

• Prone positioning should be considered for patients with severe hypoxemia, particularly those requiring mechanical ventilation 3

Pharmacological Treatment

Antiviral Therapy

• No definitive RCT evidence supported specific antiviral drugs at the time of the guideline publication 1
• Weak recommendations for:
  • α-interferon atomization inhalation (5 million U twice daily) 1
  • Lopinavir/ritonavir (2 capsules twice daily) - most effective when started early 1

Antibiotics

• Avoid inappropriate use of broad-spectrum antibiotics 1
• For suspected bacterial co-infection:
  • Mild cases: Consider amoxicillin, azithromycin, or fluoroquinolones 1
  • Severe cases: Empiric coverage of all possible pathogens with de-escalation once culture results are available 1
• Enhanced bacteriological surveillance is essential 1

Corticosteroids

• Dexamethasone is beneficial for severe and critical COVID-19 4
• For rapid disease progression or severe illness: methylprednisolone 40-80 mg/day (not exceeding 2 mg/kg/day) 1
• Use cautiously as systemic glucocorticoids remain controversial for ARDS 1

Tocilizumab

• Indicated for hospitalized COVID-19 patients who are:
  • Receiving systemic corticosteroids AND
  • Require supplemental oxygen, non-invasive/invasive mechanical ventilation, or ECMO 5

Thromboprophylaxis

• Enhanced prophylaxis against thromboembolism is recommended, especially for patients with:
  • Obesity
  • Known thrombophilia
  • Intensive care treatment
  • Elevated D-dimers 4

Special Considerations

Disease Progression Monitoring

• Be vigilant for signs of deterioration requiring escalation of care 6
• Set appropriate ceilings of care early in the disease course 6
• COVID-19 pneumonia evolves over time - initial presentation may show severe hypoxemia with near-normal lung mechanics, progressing to more typical ARDS features 2

Common Pitfalls to Avoid

1. Delaying oxygen therapy escalation when hypoxemia worsens
2. Inappropriate use of broad-spectrum antibiotics without evidence of bacterial infection
3. Delayed initiation of corticosteroids in severe disease
4. Failure to recognize and address thromboembolic complications
5. Overlooking the need for early ICU transfer in rapidly deteriorating patients

Post-COVID Care

• COVID-19 survivors, especially those with ARDS, are at high risk for long-term physical and mental impairments 3
• Plan for interdisciplinary follow-up care after discharge

The management of COVID-19 pneumonia continues to evolve as new evidence emerges. This guidance represents the best available evidence at the time of publication, with emphasis on supportive care, appropriate respiratory support, and targeted pharmacological interventions based on disease severity.