COVID-19 Treatment Depends Upon Disease Severity
Mild Cases (Home)
COVID-19almost always startswith relativelymild, flu-likesymptoms thatcan be treated at home.People who have these symptoms usually do not need to be tested to confirm the infection.
With limited opportunities for many suspected patients to get tested,“we assume that many respiratory infections now are COVID-19,” said Dr. FredPelzman, associate professor of clinical medicine at سԹ and associate attending physician atNewYork-Presbyterian/Weill Cornell Medical Center.“Most can be managed at home by treating the symptoms and watching for a worsening of illness.”
How the illness presents itself will vary from patient to patient, but typical symptoms include fever, cough, and fatigue, as well impaired taste and smell, and lack of appetite. Patients may also experience chills, headaches, body aches, shortness of breath, abdominal pains, nausea, and diarrhea.
Treatmentof COVID-19 at homeis supportive, much like home care for flu, and may includeacetaminophento reduce fever, aches and malaise.Many physicians nowinformallyrefrain fromprescribingibuprofenand other non-steroidal anti-inflammatory drugs(NSAIDs)for COVID-19 patients, at least in partbecause these drugs canstress the kidneys, which are among the organsthat can be harmedbythe infection.
No formal studies on NSAIDs and COVID-19have yet been published. The U.S. Food and Drug Administration recently issued anoting that it is looking into the possibility that NSAIDs worsen the vulnerability to severe COVID-19 and “will communicate publicly when more information is available.”
Dr.Pelzmanadded that for patients and their caregivers,one ofthe most important aspectsof care for mild COVID-19 cases is to prevent the spread of infection to others, for example by keeping the patient isolatedin one room and bathroom, havingthe patientwear a mask, andsterilizingroom surfaces.
Moderate and Severe Cases (Hospital)
Initial mild symptoms often progress so that patients feel that they are in the grip of a serious malady—yet doctors emphasize that with the current crush of cases, hospitalization should be reserved only for those who need urgent medical attention.
“The people now being hospitalized are usually very, very sick—we’re sending people home who normally would remain as inpatients,” Dr.Pelzmansaid.
Signs ofadvanced COVID-19 pneumonia, such asshortness of breathwhile at rest,persistent chest pain, bluish lips or face,or sudden changes in mental status,should prompta visit to adoctor’s officeoremergency room. So should any other sign of badly deteriorating health.
“We’ve had a lot of situations in which someone is watching their mom at home and they notice she’s stopped eating,or urinating less,or seems confused, and those have been the triggers for a visit to a clinic or hospital,” Dr.Pelzmansaid.
Hecautioned, though, that patients themselves often do not know how sick they are—manyreportno shortness of breath, for example,despite extensive evidence of pneumonia on X-rays.
(The U.S. Centers for Disease Control and Prevention has published instructions on “” on its website.)
When COVID-19 patients are hospitalized,they will typically be givenoxygen, as well asintravenous fluids to prevent dehydration and maintain electrolyte levels. Medical staff may also start blood tests formarkers of inflammation,to track the severity of disease.
In manycases, with patient consent, physicians will administer experimental treatments thatmayattack the virus orreducethe harmful inflammationthat istriggered byCOVID-19infection.Treatmentsthat have been used so far include the antimalarial drug hydroxychloroquine; the antiviral drugremdesivir;infusions of antibody-ladenbloodserum from recovered patients; and anti-inflammatorytreatmentscalled IL-6 inhibitors.
Many of the patients who are hospitalized with COVID-19 are very sick even before doctors assign them to the Intensive Care Unit (ICU), Dr.Pelzmansaid. Thishigh degree of illnesshas meant that alargeproportion—abouta fourth toa third—of COVID-19 patientswho are admitted to the hospitaleventuallyrequire ICU care.
COVID-19 patients in an ICU usuallycontinue to get treatments they hadreceivedbefore, andmay also getantibiotics to prevent secondary lung infections, as well asmedications to support the heart and kidneys, which canbeharmedby the disease.
Patients who areunable to get enough oxygen from breathing through non-invasive meansmay have a breathingtubeput in place sothat a machine called a ventilator can force oxygen into theirlungs.These patients are sedated. Even when patients in this situationshow signs that their infectionand inflammation areabating, they often require ventilator support for weeks.
“When they’re on a ventilator,it’s just a question of supporting them while they get through thatperiod ofrespiratory damage and the inflammatory storm that occurs as the disease progresses,” Dr.Pelzmansaid.
After infection
Patients may face abeforefeeling “100 percent” again, depending on the severityand durationoftheir COVID-19 infection. Lung functionin particular maytake weeks to return to normal, leaving patientstiredand easily out of breath. There may also be short- or medium-term cognitive symptoms if the patient experienced an extended period oflow oxygen levels in the brain.Patients who have spentweeksinanICU, fearingdeath,may also later suffer from.
Recovered patients, unless they have significant immune deficiencies, will have mounted an immune response to the coronavirus. This should include “memory cells” that provide someT-cell andprotection against COVID-19 reinfection, though scientistsare actively investigatingwhether that immunity is for a short time or long-lasting.Many hospital systems as well as the Americannow urge recovered patients to donate blood so that it may be usedfor research or to treat new COVID-19 patients.