What is the best treatment plan for supportive care, including over-the-counter (OTC) medicine, for a patient with mild to moderate Coronavirus Disease 2019 (COVID-19) symptoms?

Supportive Care and Over-the-Counter Treatment for COVID-19

For mild to moderate COVID-19, use paracetamol (acetaminophen) for fever and symptom relief, ensure adequate hydration, and employ non-pharmacological breathing techniques for symptom management. 1

Fever Management

Paracetamol is the preferred antipyretic for COVID-19 patients over NSAIDs until further evidence emerges. 1

• Take paracetamol only when fever and other symptoms are present that would benefit from antipyretic treatment 1
• Continue use only while symptoms persist 1
• Do not use antipyretics solely to reduce body temperature 1
• Advise regular fluid intake to prevent dehydration, but limit to no more than 2 liters per day 1
• Be aware that fever typically peaks around 5 days after exposure 1

Cough Management

For distressing cough that significantly impacts quality of life, consider:

• Codeine linctus 1
• Codeine phosphate tablets 1
• Morphine sulfate oral solution 1

These are recommended specifically for cough suppression when the symptom is causing significant distress 1.

Breathlessness Management

Non-pharmacological breathing techniques should be the first-line approach for managing breathlessness. 1

Specific Techniques to Implement:

• Pursed-lip breathing: Inhale through the nose for several seconds with mouth closed, then exhale slowly through pursed lips for 4-6 seconds 1
• Postural adjustments: Sit upright to increase peak ventilation and reduce airway obstruction 1
• Forward-leaning position: Lean forward with arms bracing a chair or knees and upper body supported to improve ventilatory capacity 1
• Shoulder relaxation: Consciously relax and drop shoulders to reduce the hunched posture associated with anxiety 1
• Breathing retraining: Work with physiotherapists or clinical nurse specialists (potentially remotely) to regain control and improve respiratory muscle strength 1

Psychological Support

More than 60% of COVID-19 patients experience anxiety and depression, requiring proactive mental health support. 1

For Mild Psychological Symptoms:

• Breath relaxation training 1
• Mindfulness training 1
• Tai Chi exercises 1

For Moderate to Severe Symptoms:

• Combine medication with psychotherapy 1
• Implement cognitive behavioral therapy 1
• Consider psychological first aid and stress management 1
• For severe anxiety, use medications with short half-life and low drug-drug interaction risk at the lowest effective dose for the shortest duration 1

Important Caveats

Severe breathlessness often triggers anxiety, which further worsens breathlessness—address both components simultaneously. 1

• Monitor for signs of clinical deterioration requiring medical attention 1
• If symptoms worsen or persist beyond expected timeframes (fever >3 days, pain >10 days), seek medical evaluation 2
• New symptoms, redness, or swelling warrant immediate medical assessment 2

What NOT to Use

Based on high-quality evidence, do not use the following for outpatient COVID-19 treatment: 3

• Azithromycin 3
• Chloroquine or hydroxychloroquine 3
• Ivermectin 3
• Nitazoxanide 3
• Lopinavir-ritonavir 3
• Fluvoxamine 3

These agents have been shown ineffective or potentially harmful in multiple trials 3.

Hydration and Rest

• Maintain adequate fluid intake with regular drinking 1
• Rest appropriately while maintaining some activity to prevent deconditioning 1
• Continue non-pharmacological strategies even if pharmacological interventions become necessary 1