What are the management and treatment options for Covid-19 symptoms?

Management and Treatment Options for COVID-19 Symptoms

The management of COVID-19 symptoms should focus on supportive care with specific treatments for cough, fever, and breathlessness, while considering treatment escalation plans for patients who may deteriorate rapidly. 1

General Management Approach

• Put treatment escalation plans in place for COVID-19 patients as they may deteriorate rapidly and require urgent hospital admission 1
• Discuss risks, benefits, and likely outcomes of treatment options with patients and their families to allow them to express preferences about treatment and escalation plans 1
• For patients with pre-existing advanced comorbidities, identify if they have advance care plans or advance decisions to refuse treatment, including do not attempt resuscitation decisions 1

Managing Specific Symptoms

Cough Management

• Encourage patients with cough to avoid lying on their back as this makes coughing ineffective 1
• Use simple measures first, including honey for patients aged over 1 year 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 is most commonly observed around five days after exposure to infection 1
• Advise patients to drink fluids regularly to avoid dehydration (no more than 2 liters per day) 1
• Do not use antipyretics with the sole aim of reducing body temperature 1
• Recommend paracetamol for fever and other symptoms that antipyretics would help treat, continuing 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: 1

  • Proper positioning (sitting upright to increase ventilation)
  • Pursed-lip breathing (inhaling through nose, exhaling slowly through pursed lips)
  • Relaxing and dropping shoulders to reduce hunched posture from anxiety
  • Leaning forward with arms bracing a chair to improve ventilatory capacity
  • Breathing retraining to improve respiratory muscle strength

• For end-of-life patients with moderate to severe breathlessness: 1

  • For opioid-naive patients who can swallow: morphine sulfate immediate-release 2.5-5 mg every 2-4 hours as required, or morphine sulfate modified-release 5 mg twice daily (maximum 30 mg daily)
  • For patients already taking regular opioids: morphine sulfate immediate-release 5-10 mg every 2-4 hours as required
  • For patients unable to swallow: morphine sulfate 1-2 mg subcutaneously every 2-4 hours as required
  • Consider concomitant use of an antiemetic and a regular stimulant laxative

Pharmacological Interventions

• Remdesivir is indicated for treatment of COVID-19 in adults and pediatric patients who are: 2
  • Hospitalized, or
  • Not hospitalized with mild-to-moderate COVID-19 but at high risk for progression to severe disease
  • Recommended dosage for adults: 200 mg loading dose on Day 1, followed by 100 mg daily maintenance doses

Special Considerations

• Patients with comorbidities, frailty, impaired immunity, or reduced ability to cough are at higher risk for developing severe pneumonia 1
• For immunocompromised patients or those with autoimmune liver disease, consider maintaining immunosuppressants rather than discontinuing them 1
• If pneumonia worsens with lymphopenia and persisting fever, dose reduction of certain immunosuppressants may be considered 1

Non-Pharmacological Interventions

• Implement social distancing measures to reduce transmission 1, 3
• Delay non-emergency procedures for COVID-19 patients (e.g., elective endoscopy, liver biopsy) 1
• Ensure healthcare workers comply with standard precautionary guidelines during all medical procedures 1

Self-Management Support

• Provide advice on self-management strategies including setting realistic goals 1
• Direct patients to reliable sources of information and support groups 1
• Consider symptom diaries and tracking apps to help with self-monitoring 1
• Discuss phased return to work or education 1

Follow-up and Monitoring

• Agree with patients how often follow-up and monitoring are needed 1
• Monitor for symptom changes, including new or worsening symptoms 1
• Consider both in-person and remote monitoring options based on availability and patient preference 1

Common Pitfalls to Avoid

• Do not routinely administer corticosteroids for viral pneumonia unless indicated for another condition or in a clinical trial 1
• Avoid rapid reduction or discontinuation of immunosuppressants in patients with autoimmune liver disease as this may exacerbate their condition 1
• Do not delay treatment escalation for patients showing signs of deterioration 1
• Avoid using opioid patches in opioid-naive patients due to the time needed to reach steady state and high morphine equivalence 1