What are the treatment options for someone currently experiencing Covid-19 symptoms?

Treatment Options for COVID-19 Symptoms

For patients experiencing COVID-19 symptoms, treatment should focus on managing specific symptoms with medications like paracetamol for fever, honey or codeine for cough, and breathing techniques for breathlessness, while considering antiviral therapy with remdesivir for those at high risk of disease progression. 1

Managing Common Symptoms

Cough Management

• Encourage patients to avoid lying on their back as this makes coughing ineffective 1
• Start with simple measures such as honey for patients over 1 year of age 1
• For distressing cough, consider short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution 1

Fever Management

• Be aware that fever typically peaks around 5 days after exposure to infection 1
• Advise regular fluid intake to avoid dehydration (no more than 2 liters per day) 1
• Do not use antipyretics solely to reduce body temperature 1
• Recommend paracetamol for fever and associated symptoms; continue only while symptoms persist 1
• Paracetamol is preferred over NSAIDs for COVID-19 patients until more evidence is available 1

Breathlessness Management

• Implement controlled breathing techniques including:

  • Proper positioning (sitting upright or leaning forward with arms bracing a chair) 1
  • Pursed-lip breathing (inhale through nose, exhale slowly through pursed lips) 1
  • Relaxing shoulders to reduce hunched posture associated with anxiety 1
  • Breathing exercises to improve respiratory muscle strength 1

• For end-of-life care with moderate to severe breathlessness:

  • Consider morphine sulfate (dosage based on whether patient is opioid-naive or already taking opioids) 1
  • Use concomitant antiemetics and regular stimulant laxatives 1

Antiviral Treatment with Remdesivir

Indications

• Remdesivir (VEKLURY) is indicated for COVID-19 treatment in:
  • Hospitalized patients 2
  • Non-hospitalized patients with mild-to-moderate COVID-19 who are at high risk for progression to severe disease 2

Dosing

• For adults: 200mg IV loading dose on Day 1, followed by 100mg IV daily 2
• For non-hospitalized high-risk patients: 3-day treatment course, initiated within 7 days of symptom onset 2
• For hospitalized patients not requiring mechanical ventilation: 5-day course (may extend to 10 days if no improvement) 2
• For hospitalized patients requiring mechanical ventilation/ECMO: 10-day course 2

Monitoring

• Perform hepatic laboratory testing before starting and during treatment 2
• Assess prothrombin time before starting and monitor as clinically appropriate 2
• Monitor for hypersensitivity reactions during and for at least one hour after infusion 2

Special Considerations

Risk Assessment and Care Planning

• Put treatment escalation plans in place as patients may deteriorate rapidly 1
• Discuss risks, benefits, and likely outcomes with patients and their families 1
• Document any advance care plans or decisions to refuse treatment 1

High-Risk Patients

• Older patients and those with comorbidities, frailty, or impaired immunity are at higher risk of developing severe pneumonia 1
• Consider early intervention for patients at risk of cytokine storm, which is characterized by elevated inflammatory markers (CRP, ESR, D-dimer) 1

Pitfalls to Avoid

• Do not delay treatment initiation in high-risk patients; early intervention is crucial 1
• Avoid using antibiotics indiscriminately, but consider them if bacterial superinfection cannot be ruled out 1
• Be aware that some patients with mild symptoms may have severe radiologic findings and can deteriorate rapidly 1
• Do not use hydroxychloroquine with remdesivir as it may reduce antiviral activity 2

By following these evidence-based approaches to symptom management and considering appropriate antiviral therapy, healthcare providers can effectively treat patients with COVID-19 symptoms while reducing the risk of disease progression and complications.