What are the treatment options for COVID-19 (Coronavirus Disease 2019) and influenza in a community setting?

Treatment Options for COVID-19 and Influenza in Community Settings

For COVID-19 in non-hospitalized patients at high risk for progression, remdesivir (3-day course) is the FDA-approved treatment that should be initiated within 7 days of symptom onset, while for influenza, oseltamivir or baloxavir should be started within 48 hours of symptom onset. 1, 2

COVID-19 Treatment in Community Settings

Non-Hospitalized Patients at High Risk

Remdesivir is the only FDA-approved antiviral for non-hospitalized COVID-19 patients who are at high risk for progression to severe disease. 1

• Initiate treatment within 7 days of symptom onset for maximum benefit 1
• Dosing for adults and pediatric patients ≥40 kg: 200 mg IV loading dose on Day 1, followed by 100 mg IV daily on Days 2-3 (total 3-day course) 1
• Administer via IV infusion over 30-120 minutes 1
• Monitor hepatic function before starting and during treatment; assess prothrombin time as clinically appropriate 1

Supportive Care for Mild Cases

For the majority (>80%) of COVID-19 cases that are mild, supportive care with symptom management is appropriate and can be self-managed at home. 3

• Rest, hydration, and fever management with acetaminophen (preferred over NSAIDs until more evidence available) 2
• Monitor for signs requiring escalation: respiratory distress, oxygen saturation <92%, altered mental status 4
• Isolation from household members when feasible to prevent transmission 4

What NOT to Use

Favipiravir, chloroquine, and hydroxychloroquine are not recommended despite early investigational interest, as they lack definitive efficacy data and may have antagonistic effects with other treatments. 5, 1

Influenza Treatment in Community Settings

Antiviral Therapy

Oseltamivir or baloxavir should be administered according to standard influenza treatment guidelines, particularly for high-risk patients. 2

• Initiate within 48 hours of symptom onset for optimal effectiveness 2
• High-risk groups include elderly, pregnant women, immunocompromised, and those with chronic medical conditions 6
• Healthcare workers should be prioritized for both treatment and prophylaxis 6

Diagnostic Considerations

Test for influenza using PCR or rapid testing of nasopharyngeal secretions when clinically suspected, especially during co-circulation with COVID-19. 2

• Coinfection rates of 0.5-2% have been documented 2
• Similar presentations (fever, cough, fatigue, myalgias) make clinical diagnosis unreliable without testing 7
• If coinfection confirmed, continue both COVID-19 and influenza-specific therapies concurrently without modification 2

Prevention Strategies

Vaccination

Influenza vaccination is strongly recommended for all patients and reduces both influenza burden and potentially COVID-19 severity. 2, 6

• COVID-19-positive patients who received influenza vaccination had 2.44 times lower odds of hospitalization and 3.29 times lower odds of ICU admission compared to unvaccinated patients 8
• This protective effect persists regardless of comorbidities 8
• Vaccination reduces healthcare system burden during concurrent circulation of both viruses 6, 7

Critical Pitfalls to Avoid

Do not delay antiviral treatment while awaiting test results if clinical suspicion is high and the patient is within the treatment window. 1, 2

Do not use empiric antibiotics unless bacterial superinfection is strongly suspected (occurs in approximately 40% of viral respiratory infections requiring hospitalization). 2

Do not assume single infection—test for both pathogens when presentations overlap during co-circulation periods. 2, 7

Monitor for hypersensitivity reactions during remdesivir infusion and observe patients for at least one hour after completion; slower infusion rates up to 120 minutes can prevent reactions. 1