What are the treatment options for Covid-19 symptoms?

Treatment Options for COVID-19 Symptoms

For COVID-19 symptom management, use paracetamol for fever, honey or codeine-based medications for cough, and controlled breathing techniques for breathlessness, while ensuring adequate hydration and considering morphine for severe breathlessness in end-of-life care. 1

Managing Fever

• Fever typically peaks around 5 days after exposure to COVID-19 1
• Recommended approach:
  • Maintain adequate hydration (no more than 2 liters per day) 1
  • Use paracetamol for fever and associated symptoms 1
  • Continue paracetamol only while symptoms persist
  • Paracetamol is preferred over NSAIDs for COVID-19 patients based on current evidence 1
  • Do not use antipyretics solely to reduce body temperature 1

Managing Cough

• High-risk patients for severe pneumonia include older adults, those with comorbidities, frailty, impaired immunity, or reduced ability to clear secretions 1
• Recommended interventions:
  • Avoid lying on back as this makes coughing ineffective 1
  • Try simple measures first, including honey for patients over 1 year of age 1
  • For distressing cough, consider short-term use of:
    • Codeine linctus
    • Codeine phosphate tablets
    • Morphine sulfate oral solution 1

Managing Breathlessness

Breathlessness often causes anxiety, which can further worsen breathing difficulties. Recommended techniques include:

1. Positioning techniques:

   • Sit upright to increase peak ventilation and reduce airway obstruction
   • Lean forward with arms bracing a chair to improve ventilatory capacity
   • Relax and drop shoulders to reduce hunched posture associated with anxiety 1

2. Breathing techniques:

   • Pursed-lip breathing: Inhale through nose for several seconds with mouth closed, then exhale slowly through pursed lips for 4-6 seconds
   • Coordinated breathing training
   • Breathing exercises 1

3. For end-of-life care with moderate to severe breathlessness:

   • Consider morphine sulfate (dosage based on whether patient is opioid-naive or already taking opioids)
   • For opioid-naive patients able to swallow: Morphine sulfate immediate-release 2.5-5 mg every 2-4 hours as needed
   • For patients already taking opioids: Morphine sulfate immediate-release 5-10 mg every 2-4 hours as needed
   • For patients unable to swallow: Morphine sulfate 1-2 mg subcutaneously every 2-4 hours as needed 1
   • Consider concomitant antiemetic and regular stimulant laxative 1
   • Note: For patients with eGFR <30 mL/minute, use equivalent doses of oxycodone instead of morphine sulfate 1

Managing Anxiety, Delirium, and Agitation

• Address reversible causes first:
  • Explore patient concerns and anxieties
  • Ensure effective communication and orientation 1

Antiviral Treatment Options

For patients at high risk of disease progression, consider:

• Remdesivir (Veklury): For hospitalized and non-hospitalized patients with COVID-19 2
  • For adults: 200 mg IV loading dose on day 1, followed by 100 mg IV daily
  • Treatment duration:
    • 10 days for hospitalized patients requiring mechanical ventilation/ECMO
    • 5 days for hospitalized patients not requiring mechanical ventilation
    • 3 days for non-hospitalized patients with mild-to-moderate COVID-19 at high risk for progression 2
  • Must be started within 7 days of symptom onset for non-hospitalized patients 2

Treatment Planning and Monitoring

• Put treatment escalation plans in place as patients may deteriorate rapidly 1
• Perform hepatic laboratory testing and assess prothrombin time before starting remdesivir and monitor during treatment 2
• Ensure patients know who to contact if symptoms worsen 1

Special Considerations

• For patients with pre-existing advanced comorbidities, determine if they have advance care plans or advance decisions to refuse treatment 1
• Remdesivir is contraindicated in patients with history of clinically significant hypersensitivity reactions to the medication 2
• Monitor for hypersensitivity reactions during and after remdesivir infusion 2

By following these evidence-based approaches to symptom management, healthcare providers can help alleviate the distressing symptoms of COVID-19 while reducing morbidity and mortality in affected patients.