What are the treatment options for COVID-19 symptoms?

Treatment Options for COVID-19 Symptoms

For patients with COVID-19, symptom management should focus on treating cough, fever, and breathlessness with specific medications and non-pharmacological approaches, while severe cases require corticosteroids, antivirals, and possibly immunomodulators based on disease severity. 1

Managing Cough

First-line approaches:

• Avoid lying on back as this makes coughing ineffective
• Use honey for patients over 1 year of age

For distressing cough:

• Consider short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution 1
• Start with lowest effective dose to minimize side effects
• Monitor for respiratory depression, especially in elderly or those with respiratory compromise

Managing Fever

• Fever typically peaks around day 5 after exposure 1
• Advise regular fluid intake (not exceeding 2 liters per day) to prevent dehydration
• Use paracetamol (acetaminophen) for fever and associated symptoms 1
• Continue only while symptoms persist
• Paracetamol is preferred over NSAIDs for COVID-19 patients
• Do not use antipyretics solely to reduce body temperature

Managing Breathlessness

Non-pharmacological techniques:

• Controlled breathing techniques including:
  • Pursed-lip breathing (inhale through nose for several seconds, exhale slowly through pursed lips for 4-6 seconds)
  • Relaxing shoulders to reduce hunched posture
  • Sitting upright to increase ventilation
  • Leaning forward with arms bracing a chair to improve ventilatory capacity
  • Breathing retraining with help from physiotherapists/clinical nurse specialists 1

For moderate-severe breathlessness at end of life:

• For opioid-naïve patients able to swallow: Morphine sulfate immediate-release 2.5-5mg every 2-4 hours as needed, or morphine sulfate modified-release 5mg twice daily (maximum 30mg daily) 1
• For patients already on opioids: Morphine sulfate immediate-release 5-10mg every 2-4 hours as needed
• For patients unable to swallow: Morphine sulfate 1-2mg subcutaneously every 2-4 hours as needed
• Consider antiemetics (e.g., haloperidol) and regular stimulant laxatives (e.g., senna) when using opioids
• For patients with eGFR <30 mL/min, use oxycodone instead of morphine sulfate

Pharmacological Interventions for Moderate-Severe Disease

Corticosteroids:

• Dexamethasone 6mg daily for 10 days for patients requiring oxygen support 2
• Avoid corticosteroids in patients not requiring oxygen

Antivirals:

• Remdesivir for moderate COVID-19 requiring oxygen with saturation >90% 2, 3
  • Adults and pediatric patients ≥40kg: 200mg IV on day 1, then 100mg IV daily
  • For hospitalized patients not on mechanical ventilation: 5-day course
  • For hospitalized patients on mechanical ventilation: 10-day course
  • Monitor hepatic function and prothrombin time before and during treatment 3

For high-risk patients with mild-moderate disease:

• Nirmatrelvir/ritonavir for non-hospitalized patients at high risk for progression 2
• Monoclonal antibodies for high-risk unvaccinated or vaccine non-responders 2

Traditional Chinese Medicine (TCM) Options

For regions where TCM is integrated with conventional care:

• HXZQ capsule/dropping pill combined with LHQW capsule/granule may help with fatigue, chest distress, shortness of breath, and loss of appetite 1
• For digestive symptoms, TCM decoctions based on syndrome differentiation may be more effective than Chinese patent medicines 1

Thromboprophylaxis

• All hospitalized COVID-19 patients should receive thromboprophylaxis with low molecular weight heparin (LMWH) 2
• Consider higher doses for patients with additional risk factors (high BMI, history of VTE, active cancer) 2

Special Considerations

Common pitfalls to avoid:

1. Delaying treatment initiation - Treatment should begin as soon as possible after diagnosis
2. Overuse of antibiotics - Only use when bacterial co-infection is suspected
3. Using NSAIDs as first-line for fever - Paracetamol is preferred
4. Neglecting non-pharmacological approaches - These can be highly effective for symptom management
5. Failing to monitor for drug interactions - Particularly important with antivirals and immunomodulators

For discharge planning:

• Resolution of fever for >3 days
• Improvement of respiratory symptoms
• Significant absorption of pulmonary lesions on imaging 2
• Avoid premature discharge before clinical improvement is established

By following this symptom management approach while considering disease severity and patient-specific factors, COVID-19 symptoms can be effectively managed to improve patient outcomes and quality of life.