What is the treatment for Covid-19 (Coronavirus disease 2019) pneumonia?

Treatment for COVID-19 Pneumonia

The treatment for COVID-19 pneumonia requires a combination of supportive care, oxygen therapy, antiviral medications, and in severe cases, immunomodulators like tocilizumab for patients requiring supplemental oxygen or mechanical ventilation. 1, 2

Supportive Care

• Patients should be monitored for vital signs (heart rate, pulse oxygen saturation, respiratory rate, blood pressure) with regular assessment of blood routine, CRP, PCT, organ function, coagulation function, and chest imaging 1
• Nutritional support is essential - patients with nutrition risk scores <3 points should consume protein-rich foods with ideal energy intake of 25-30 kcal/(kg·d) and protein intake of 1.5 g/(kg·d) 1
• For patients with nutrition risk scores ≥3 points, increase protein intake through oral supplements 2-3 times daily (≥18g protein/time) 1
• Use H2 receptor antagonists or proton pump inhibitors in patients with gastrointestinal bleeding risk factors 1
• Evaluate risk of venous embolism and use low-molecular-weight heparin or heparin in high-risk patients without contraindications 1

Oxygen Therapy and Respiratory Support

• Effective oxygen therapy is crucial, with options including nasal catheter, mask oxygen, high flow nasal oxygen therapy (HFNO), non-invasive ventilation (NIV), or invasive mechanical ventilation based on severity 1
• When used appropriately, high flow nasal cannula may help patients avoid intubation without increasing disease transmission risk 3
• For patients requiring invasive mechanical ventilation, low tidal volume ventilation and positive end expiratory pressure (PEEP) titration are recommended 3
• Consider Extracorporeal Membrane Oxygenation (ECMO) for patients with refractory hypoxemia that is difficult to correct with protective lung ventilation 1

Antiviral Treatment

• Remdesivir is recommended for hospitalized patients with COVID-19 pneumonia, particularly when initiated early in the disease course 4
• The standard dosing regimen is 200 mg IV loading dose on day 1, followed by 100 mg IV daily for 4 additional days 4, 5
• Early initiation of remdesivir (within first 4 days of symptom onset) is most effective for preventing oxygen desaturation and disease progression 4
• Remdesivir may have modest benefit in time to recovery in patients with severe disease but shows no statistically significant mortality benefit 3

Immunomodulatory Therapy

• Tocilizumab (Actemra) is indicated for hospitalized COVID-19 patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or ECMO 2
• Dexamethasone treatment improves mortality for severe and critical COVID-19 3
• For patients with rapid disease progression or severe illness, methylprednisolone 40-80 mg per day can be considered, not exceeding 2 mg/kg daily 1
• Corticosteroids should be used cautiously and typically for short periods (3-5 days) according to the degree of dyspnea and progression on chest imaging 1

Management of Complications

• For patients with dyspnea, cough, wheeze, and respiratory distress due to increased respiratory secretions, selective (M1, M3) receptor anticholinergic drugs are recommended to reduce secretion and improve pulmonary ventilation 1
• For septic shock, recognize early and administer vasopressors when shock persists after fluid resuscitation, with norepinephrine as first choice 1
• Avoid blind or inappropriate use of antibacterial drugs; however, if bacterial infection cannot be ruled out, appropriate antibiotics should be administered 1
• For mild cases with suspected bacterial infection, consider antibiotics effective against community-acquired pneumonia (amoxicillin, azithromycin, or fluoroquinolones) 1

Special Considerations

• Patients with hypertension as a comorbidity may have longer hospital stays and worse outcomes 6
• Monitor for adverse events, particularly increases in transaminase and creatinine levels when using remdesivir 6
• Nosocomial infections may be more frequent when combining remdesivir with immunosuppressive drugs 6
• COVID-19 survivors, especially those with ARDS, are at high risk for long-term physical and mental impairments, requiring interdisciplinary follow-up care 3

Discharge Criteria

• Body temperature returned to normal for more than 3 days 1
• Respiratory symptoms significantly improved 1
• Lung inflammation showing obvious signs of absorption 1
• Respiratory nucleic acid negative for two consecutive tests (one-day sampling interval) 1