Treatment for COVID-19 with Sinus Pressure and Congestion
For mild COVID-19 presenting primarily with sinus pressure and congestion, symptomatic treatment is the appropriate management approach, with intranasal corticosteroids remaining safe and effective for symptom relief. 1, 2
Symptomatic Management
Rest, hydration, and supportive care form the foundation of treatment for mild COVID-19 symptoms including sinus congestion and pressure. 1
Intranasal corticosteroids can be continued or initiated for sinus symptoms, as they remain the standard treatment even in patients with SARS-CoV-2 infection. 2
Acetaminophen (paracetamol) is preferred over NSAIDs for fever or discomfort management until more evidence is available regarding NSAID safety in COVID-19. 3
Avoid nebulized therapies; use metered-dose inhalers if bronchodilators are needed for any respiratory symptoms. 4
Monitoring and When to Escalate Care
Monitor for worsening symptoms including fever ≥38°C (100.4°F), subjective shortness of breath, respiratory rate >20/min, hypoxia, or cyanosis—these indicate progression beyond mild disease. 1
Seek immediate medical attention if you develop difficulty breathing, persistent chest pain or pressure, new confusion, inability to wake or stay awake, or bluish lips/face. 1
Daily temperature monitoring and symptom tracking should be performed throughout the illness course. 1
Antiviral Therapy Consideration
Nirmatrelvir-ritonavir (Paxlovid) should be initiated within 5 days of symptom onset if you are at high risk for progression to severe COVID-19 (age ≥65, obesity, diabetes, immunocompromised, chronic lung/heart/kidney disease). 5
The standard dose is 300 mg nirmatrelvir with 100 mg ritonavir taken together twice daily for 5 days, adjusted for renal impairment. 5
Review all current medications before starting Paxlovid due to significant drug-drug interactions with ritonavir, a strong CYP3A inhibitor. 5
What NOT to Do
Do not use antibiotics unless bacterial superinfection is suspected based on clinical deterioration, purulent nasal discharge with facial pain/pressure worsening after initial improvement, or high fever with systemic symptoms. 1
Avoid hydroxychloroquine, azithromycin, and chloroquine—these are not recommended for COVID-19 treatment based on current evidence. 1, 6
Do not use systemic corticosteroids for mild COVID-19; reserve these for hospitalized patients requiring supplemental oxygen. 1, 2
Infection Control at Home
Isolate in a well-ventilated single room and maintain at least 1 meter distance from household members. 1
Wear a mask when in the same room with others and ensure caregivers wear N95 or surgical masks. 1
Clean and disinfect frequently touched surfaces daily using 500 mg/L chlorine-containing disinfectant. 1
Practice hand hygiene by washing with soap and water for at least 20 seconds, especially after coughing or sneezing. 1