What are the treatment options for COVID-19?

Treatment Options for COVID-19

For most COVID-19 patients with mild to moderate symptoms, treatment should focus on symptom management with over-the-counter medications, adequate hydration, and rest, while severe cases require antiviral medications, corticosteroids, and possibly hospitalization.

Symptom Management for Mild to Moderate COVID-19

Cough Management

• Avoid lying on your back as this makes coughing ineffective 1
• First-line options:
  • Honey (for patients over 1 year old) 1
  • Maintain adequate hydration (no more than 2 liters per day) 1
• For distressing cough:
  • Consider short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution 1

Fever Management

• First-line options:
  • Acetaminophen/paracetamol
  • Adequate fluid intake to prevent dehydration 1
• Monitoring: Be aware that fever typically peaks around day 5 after exposure 1

Breathing Difficulties

• Non-pharmacological approaches:
  • Controlled breathing techniques
  • Proper positioning (sitting upright, leaning forward)
  • Pursed-lip breathing exercises 1

Treatment for Severe COVID-19

Antiviral Therapy

• Remdesivir: Recommended for hospitalized patients requiring oxygen 1, 2
• Paxlovid (nirmatrelvir-ritonavir): Recommended for high-risk patients, especially immunocompromised individuals 2, 3

Anti-inflammatory Therapy

• Dexamethasone: 6 mg daily for up to 10 days for patients requiring oxygen supplementation 2, 4
• Tocilizumab: Consider for patients with elevated inflammatory markers who are rapidly deteriorating despite corticosteroid treatment 2

Thromboprophylaxis

• For hospitalized non-ICU patients: Prophylactic-dose low-molecular-weight heparin (LMWH) 2
• For ICU patients with additional risk factors (BMI >30 kg/m², history of VTE, thrombophilia, active cancer): Consider intensified VTE prophylaxis 2
• For confirmed VTE: Therapeutic-dose LMWH 2

Traditional Chinese Medicine Options

For those with access to and preference for Traditional Chinese Medicine approaches:

• Lianhua Qingwen capsules/granules: May improve symptoms and reduce fever in mild to moderate cases 1
• Qingfei Paidu decoction: May shorten hospital stay duration and improve symptoms 1

Special Considerations

Oxygen Therapy

• Indications: SpO2 <90%, respiratory rate >30/min, or signs of severe disease 2, 4
• Progression: Start with nasal cannula or mask; if no improvement within 1-2 hours, consider high-flow nasal cannula (HFNC) or non-invasive ventilation (NIV) 1
• For patients on HFNC or NIV: Consider awake prone positioning for >12 hours if no contraindications 1

Post-Discharge Care

• Extended thromboprophylaxis: Consider for 14-30 days in high-risk patients 2
• Pulmonary rehabilitation: Implement as soon as possible for patients recovering from severe COVID-19 1

Common Pitfalls to Avoid

1. Delaying treatment in high-risk patients: Early intervention with antivirals is critical for immunocompromised patients 2
2. Inappropriate use of antibiotics: Only use if bacterial co-infection is suspected
3. Overlooking thromboprophylaxis: COVID-19 is associated with a prothrombotic state 1
4. Discontinuing necessary medications: Continue cardiovascular medications including ACE inhibitors and ARBs 1

When to Seek Emergency Care

• Oxygen saturation <90%
• Respiratory rate >30/min
• Severe shortness of breath
• Confusion or altered mental status
• Persistent chest pain or pressure

Remember to contact healthcare providers if symptoms worsen, particularly if you have underlying health conditions that increase your risk for severe disease.