What are the primary treatment options for Covid-19?

Primary Treatment Options for COVID-19

The primary treatment options for COVID-19 include remdesivir, dexamethasone, and supportive care, with treatment selection based on disease severity and patient risk factors. 1, 2

Treatment Based on Disease Severity

Non-Hospitalized Patients with Mild-to-Moderate COVID-19

• For high-risk patients:
  • Remdesivir: 200 mg IV on day 1, followed by 100 mg IV daily for 2 days (total 3-day course) 2
  • Treatment should be initiated as soon as possible after diagnosis 2
  • High-risk factors include: age ≥60 years, obesity (BMI ≥30), chronic lung disease, hypertension, cardiovascular disease, diabetes, immunocompromised state, chronic kidney/liver disease, cancer, and sickle cell disease 2

Hospitalized Patients Not Requiring Oxygen

• Supportive care (hydration, symptom management) 1
• Consider remdesivir in high-risk patients 2

Hospitalized Patients Requiring Oxygen

• Remdesivir: 200 mg IV on day 1, followed by 100 mg IV daily 2
• Dexamethasone: 6 mg daily for up to 10 days 1
• Duration: 5 days of remdesivir for those not requiring mechanical ventilation 2

Hospitalized Patients with Severe Disease (Requiring Mechanical Ventilation/ECMO)

• Remdesivir: 200 mg IV on day 1, followed by 100 mg IV daily for a total of 10 days 2
• Dexamethasone: 6 mg daily for up to 10 days 1
• Consider tocilizumab for patients with elevated inflammatory markers who are rapidly deteriorating despite corticosteroids 1

Supportive Care Measures

Respiratory Support

• For patients with cough: avoid lying on back, consider honey (for patients >1 year old) 3
• For distressing cough: consider short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution 3
• Oxygen therapy for patients with hypoxemia (SpO2 <90%) 1
• Consider high-flow oxygen or non-invasive ventilation for hypoxemic respiratory insufficiency 4
• Intubation and invasive ventilation for severe hypoxemia/high respiratory rate 4

Thromboprophylaxis

• Prophylactic-dose low-molecular-weight heparin (LMWH) for hospitalized non-ICU patients without contraindications 1
• Consider intensified VTE prophylaxis for ICU patients with additional risk factors (BMI >30 kg/m², history of VTE, thrombophilia, active cancer) 1
• For confirmed VTE, therapeutic-dose LMWH is standard of care 1
• Consider post-discharge prophylaxis for 14-30 days in high-risk patients 1

Important Considerations and Precautions

• Laboratory monitoring:

  • Perform hepatic laboratory testing before starting remdesivir and during treatment 2
  • Monitor prothrombin time before and during remdesivir treatment 2

• Contraindications and cautions:

  • Remdesivir should only be administered in settings with immediate access to medications for treating severe reactions 2
  • Corticosteroids are not recommended for viral pneumonia unless indicated for another condition 3

• Treatment escalation planning:

  • Put treatment escalation plans in place early as patients may deteriorate rapidly 3
  • Consider hospitalization for patients with oxygen saturation <90%, respiratory rate >30/min, or signs of severe disease 1

Special Populations

• Pediatric patients:

  • Remdesivir is approved for pediatric patients from birth (weighing at least 1.5 kg) 2
  • Dosing is weight-based for children <40 kg 2

• Immunocompromised patients:

  • Should receive antiviral treatment even if not currently on treatment for their underlying condition 1
  • Resume treatment for underlying conditions after clinical resolution and negative PCR test 1

The evidence strongly supports early intervention with antivirals for high-risk patients and a combination of remdesivir, dexamethasone, and supportive care for hospitalized patients based on disease severity. Timely implementation of these treatments has been shown to reduce mortality and improve outcomes in COVID-19 patients.