From the Guidelines
The current NHS COVID-19 guidelines recommend that patients with COVID-19 symptoms, including cough, fever, and breathlessness, should be managed in the community with treatment escalation plans in place, and encouraged to use controlled breathing techniques and seek help if their symptoms worsen. According to the National Institute for Health and Care Excellence (NICE) COVID-19 rapid guideline on managing symptoms in the community 1, patients with distressing cough can consider short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution. Key points to note include:
- Putting treatment escalation plans in place for patients with COVID-19 because they may deteriorate rapidly and need urgent hospital admission
- Encouraging patients with cough to avoid lying on their back and considering short-term use of medications for distressing cough
- Using controlled breathing techniques, such as positioning, pursed-lip breathing, breathing exercises, and coordinated breathing training
- Knowing who to contact if symptoms get worse, such as NHS 111 online 1. These guidelines prioritize symptom management and provide a framework for community-based clinicians to care for patients with COVID-19, while also considering advance care plans and decisions to refuse treatment.
From the Research
Current NHS COVID Guidelines
The current NHS COVID guidelines are based on various studies and research papers.
- The use of corticosteroids, such as dexamethasone, has become the standard of care for hospitalized patients with severe or critical COVID-19, as it has demonstrated mortality benefits in large, randomized controlled trials 2.
- Remdesivir is an antiviral agent approved for the treatment of COVID-19, and it has shown reduction in recovery time, faster clinical improvement, and decrease in time to discharge 2, 3.
- Tocilizumab is recommended for use in combination with a corticosteroid in certain hospitalized patients, as it has demonstrated mortality benefits in large, randomized controlled trials 2.
- Monoclonal antibody combinations, such as bamlanivimab/etesevimab and casirivimab/imdevimab, have received emergency use authorizations for use in non-hospitalized patients with mild-to-moderate COVID-19 at high risk of disease progression 2.
- Baricitinib, in combination with remdesivir and dexamethasone, has shown efficacy in hypoxic adults with COVID-19, with faster recovery and reduced mortality 4.
- The combination of remdesivir, dexamethasone, and baricitinib has been shown to be effective and tolerable in hypoxic patients with COVID-19, with a faster recovery rate and reduced incidence of new onset bacterial infection 4.
Treatment Options
- Hydroxychloroquine, Remdesivir, and Lopinavir/Ritonavir are treatment options for the pulmonary phase of COVID-19 5.
- Tocilizumab, Anakinra, Baricitinib, Eculizumab, Emapalumab, and Heparin are therapeutic options for the inflammatory phase of COVID-19 5.
- Molnupiravir and paxlovid are available for oral use, while remdesivir is only for hospitalized patients 6.
- Paxlovid is a combination of nirmatrelvir and ritonavir, and its dose adjustment is required for mild to moderate renal or hepatic impaired patients 6.
Authorized Drugs
- The US FDA has approved four monoclonal antibodies for COVID-19 treatment, which have shown to reduce the risk of hospitalization or severity of symptoms 6.
- The World Health Organization strongly recommends the use of corticosteroids along with other antiviral drugs for severe or critically hospitalized patients 6.
- All authorized drugs are effective in inhibiting viral replication for most SARS-CoV-2 variants 6.