What are the accepted treatments for Coronavirus Disease 2019 (COVID-19)?

Accepted Treatments for COVID-19

The standard treatment for COVID-19 includes remdesivir for antiviral therapy and dexamethasone for anti-inflammatory effects, with treatment decisions based on disease severity and risk factors for progression. 1, 2

Treatment Based on Disease Severity

Mild-to-Moderate COVID-19 (Outpatient)

• For high-risk patients:
  • Remdesivir: Loading dose of 200 mg IV on Day 1, followed by 100 mg IV daily from Day 2 for 3-5 days 1
  • Nirmatrelvir-ritonavir: 300 mg nirmatrelvir with 100 mg ritonavir twice daily for 5 days 2
  • Treatment should be initiated as soon as possible after diagnosis 2, 1

Hospitalized Patients Not Requiring Mechanical Ventilation

• Standard regimen:

  • Remdesivir: 200 mg IV on Day 1, followed by 100 mg IV daily for a total of 5 days 1
  • Dexamethasone: 6 mg daily for up to 10 days (for patients requiring oxygen) 2
  • Standard thromboprophylaxis 2

• For patients with elevated inflammatory markers:

  • Consider adding tocilizumab (IL-6 receptor antagonist) 2, 3

Severe COVID-19 (Requiring Mechanical Ventilation/ECMO)

• Intensive regimen:
  • Remdesivir: 200 mg IV on Day 1, followed by 100 mg IV daily for a total of 10 days 1
  • Dexamethasone: 6 mg daily for up to 10 days 2
  • Consider tocilizumab for cytokine storm management 2, 3
  • Appropriate anticoagulation 2

Respiratory Support Options

• Oxygen therapy targets: Maintain SpO2 ≥94% (or 90-96% in patients at risk of hypercapnic respiratory failure) 2
• Escalation pathway:
  1. Low-flow nasal cannula
  2. High-flow nasal cannula (HFNC)
  3. Continuous positive airway pressure (CPAP)
  4. Non-invasive ventilation (NIV)
  5. Invasive mechanical ventilation 2
• Adjunctive measures: Consider awake prone positioning for patients on HFNC or NIV 2

Important Considerations and Monitoring

Pre-treatment Assessment

• Perform hepatic laboratory testing before starting remdesivir 1
• Determine prothrombin time before starting remdesivir 1
• Assess for drug-drug interactions, particularly with nirmatrelvir-ritonavir 2

Monitoring During Treatment

• Continue hepatic laboratory testing while receiving remdesivir 1
• Monitor prothrombin time as clinically appropriate 1
• Watch for infusion or hypersensitivity reactions with remdesivir 1

Treatment Pitfalls to Avoid

• Do not use corticosteroids in patients not requiring oxygen as this may be harmful 2
• Do not use tocilizumab in patients not requiring supplementary oxygen 2
• Remdesivir should be administered only in settings where healthcare providers have immediate access to medications to treat severe reactions 1
• Avoid hydroxychloroquine with or without azithromycin as studies have shown no benefit and potential harm 4, 5

Special Populations

Pediatric Patients

• Remdesivir is approved for pediatric patients from birth to less than 18 years of age weighing at least 1.5 kg 1
• Dosing is weight-based:
  • For patients weighing 1.5 kg to less than 40 kg: 5 mg/kg loading dose on Day 1, followed by 2.5 mg/kg daily 1
  • For neonates less than 28 days old: 2.5 mg/kg loading dose on Day 1, followed by 1.25 mg/kg daily 1

Patients with Comorbidities

• Adjust medication doses according to age and comorbidities 2
• Use medications with lowest risk of drug-drug interactions 2
• For patients with abnormal liver function, use COVID-19 treatments with caution and close monitoring 2

Adjunctive Therapies

• Traditional Chinese Medicine approaches may be considered as adjunctive therapy in appropriate settings 6, 2
• Psychological support should be provided, including addressing anxiety and depression, which affect more than 60% of COVID-19 patients 2
• Early rehabilitation, including pulmonary rehabilitation and breathing exercises, is recommended to improve outcomes 2

The treatment landscape for COVID-19 continues to evolve, with ongoing research into new therapies. Current evidence strongly supports the use of remdesivir and dexamethasone as the backbone of treatment, with additional immunomodulatory agents for selected patients with more severe disease.