What is the supportive treatment for COVID-19?

Supportive Treatment for COVID-19

Supportive treatment for COVID-19 should focus on symptom management including fever control with paracetamol, breathlessness management techniques, and appropriate oxygen therapy when needed, while avoiding routine corticosteroid use in mild cases. 1

General Supportive Measures

Managing Fever

• Advise patients to drink fluids regularly to avoid dehydration (no more than 2 liters per day)
• Use paracetamol for fever and associated symptoms, continuing only while symptoms persist
• Paracetamol is preferred over NSAIDs until more evidence is available 1
• Do not use antipyretics with the sole aim of reducing body temperature

Managing Breathlessness

Several techniques can help manage breathlessness:

• Positioning techniques:
  • Sitting upright to increase ventilation
  • Leaning forward with arms bracing a chair to improve ventilatory capacity
  • Relaxing and dropping shoulders to reduce anxiety-related hunched posture 1
• Breathing techniques:
  • Pursed-lip breathing (inhale through nose, exhale slowly through pursed lips)
  • Controlled breathing exercises
  • Breathing retraining to improve respiratory muscle strength 1

Severity-Based Management

Mild COVID-19 (Outpatient)

• Home isolation with regular monitoring of vital signs
• Adequate hydration and nutrition
• Paracetamol for fever and pain
• Consider codeine linctus or codeine phosphate tablets for distressing cough 1
• Avoid routine corticosteroid use 1

Moderate COVID-19 (Requiring Oxygen)

• Oxygen therapy to maintain saturation >90-94%
• Consider remdesivir for patients at high risk of progression 1, 2
• Dexamethasone 6mg daily for up to 10 days 1
• Consider anti-SARS-CoV-2 monoclonal antibodies in seronegative patients 1

Severe/Critical COVID-19

• Dexamethasone is strongly recommended 1
• Remdesivir may be considered 1, 2
• For severe breathlessness at end of life, consider:
  • Morphine sulfate immediate-release 2.5-5mg every 2-4 hours as needed (opioid-naïve patients)
  • Adjust dose for patients already on opioids (approximately 1/12 of 24-hour dose) 1
  • Consider concomitant antiemetic and regular stimulant laxative

Special Considerations

Anticoagulation

• Prophylactic anticoagulation against venous thromboembolism is recommended due to COVID-19's prothrombotic state 1
• In non-critically ill hospitalized patients, therapeutic-dose anticoagulation with heparin may increase survival 1
• In critically ill patients, standard thromboprophylaxis is recommended 1

Patients with Hematological Malignancies

• Consider growth factor support to maintain neutrophil count >1000 cells/μL
• Monitor for drug-drug interactions between COVID-19 therapies and cancer treatments 1
• In patients with active malignancy, consider early use of cytokine modulators if COVID-19 symptoms develop 1

Post-COVID Management

For persistent symptoms (Long COVID):

• Screen for post-exertional malaise and implement pacing strategies if present
• Implement cognitive rehabilitation for brain fog
• Provide psychological support
• Address sleep and gastrointestinal issues 3, 4

Common Pitfalls to Avoid

1. Overuse of antibiotics: Only use if bacterial superinfection is suspected
2. Routine use of corticosteroids in mild cases: This may worsen outcomes 1
3. Excessive fluid administration: Maintain euvolemia to avoid worsening respiratory status
4. Excessive physical activity: In patients with post-exertional malaise, this can worsen symptoms 3
5. Dismissing patient symptoms: Validate the patient's experience, especially with persistent symptoms 4

Supportive care remains the cornerstone of COVID-19 management, with specific therapies added based on disease severity, risk factors, and clinical presentation 5, 6.