Although several medications have been approved in different countries as of April 2022, not all countries have these medications. Patients with mild to moderate symptoms who are in the risk groups can take
nirmatrelvir/ritonavir
Nirmatrelvir/ritonavir, sold under the brand name Paxlovid, is a co-packaged oral medication, developed by Pfizer and used as a treatment for COVID-19. It contains the antiviral medications nirmatrelvir and ritonavir.
Side effects of nirmat ...
(marketed as Paxlovid) or
remdesivir
Remdesivir, sold under the brand name Veklury, Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged. is a broad-spectrum antiviral medication developed by the ...
, either of which reduces the risk of serious illness or hospitalization. In the US, the
Biden Administration COVID-19 action plan includes the Test to Treat initiative, where people can go to a pharmacy, take a COVID test, and immediately receive free Paxlovid if they test positive.
Highly effective vaccines have reduced mortality related to SARS-CoV-2; however, for those awaiting vaccination, as well as for the estimated millions of immunocompromised persons who are unlikely to respond robustly to vaccination, treatment remains important. The cornerstone of management of COVID-19 has been
supportive care
Symptomatic treatment, supportive care, supportive therapy, or palliative treatment is any medical therapy of a disease that only affects its symptoms, not the underlying cause. It is usually aimed at reducing the signs and symptoms for the comfor ...
, which includes treatment to
relieve symptoms,
fluid therapy,
oxygen support and
prone positioning as needed, and medications or devices to support other affected vital organs.
Most cases of COVID-19 are mild. In these, supportive care includes medication such as
paracetamol
Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol.
At a standard dose, paracetamol only slightly decreases body temperature; it is inferior ...
or
NSAID
Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...
s to relieve symptoms (fever, body aches, cough), proper intake of fluids, rest, and
nasal breathing.
Good personal hygiene and a
healthy diet
A healthy diet is a diet that maintains or improves overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients such as protein, micronutrients such as vitamins, and adequate fibre and food energy.
A health ...
are also recommended. As of April 2020 the U.S.
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georg ...
(CDC) recommended that those who suspect they are carrying the virus isolate themselves at home and wear a face mask.
As of November 2020 use of the
glucocorticoid
Glucocorticoids (or, less commonly, glucocorticosteroids) are a class of corticosteroids, which are a class of steroid hormones. Glucocorticoids are corticosteroids that bind to the glucocorticoid receptor that is present in almost every vertebr ...
dexamethasone
Dexamethasone is a glucocorticoid medication used to treat rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, superior vena cava s ...
had been strongly recommended in those severe cases treated in hospital with low oxygen levels, to reduce the risk of death.
Noninvasive ventilation
Non-invasive ventilation (NIV) is the use of breathing support administered through a face mask, nasal mask, or a helmet. Air, usually with added oxygen, is given through the mask under positive pressure; generally the amount of pressure is alter ...
and, ultimately, admission to an
intensive care unit
220px, Intensive care unit
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensiv ...
for
mechanical ventilation
Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move ai ...
may be required to support breathing.
Extracorporeal membrane oxygenation
Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate ...
(ECMO) has been used to address respiratory failure, but its benefits are still under consideration.
Some of the cases of severe disease course are caused by systemic hyper-inflammation, the so-called ''cytokine storm''.
Several
experimental treatments are being actively studied in
clinical trial
Clinical trials are prospective biomedical or behavioral research studies on human subject research, human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel v ...
s.
These include the antivirals
molnupiravir
Molnupiravir, sold under the brand name Lagevrio, is an antiviral medication that inhibits the replication of certain RNA viruses. It is used to treat COVID-19 in those infected by SARS-CoV-2. It is taken by mouth.
Molnupiravir is a prodrug of ...
(developed by
Merck), and
nirmatrelvir/ritonavir
Nirmatrelvir/ritonavir, sold under the brand name Paxlovid, is a co-packaged oral medication, developed by Pfizer and used as a treatment for COVID-19. It contains the antiviral medications nirmatrelvir and ritonavir.
Side effects of nirmat ...
(developed by
Pfizer). Others were thought to be promising early in the pandemic, such as
hydroxychloroquine
Hydroxychloroquine, sold under the brand name Plaquenil among others, is a medication used to prevent and treat malaria in areas where malaria remains sensitive to chloroquine. Other uses include treatment of rheumatoid arthritis, lupus, an ...
and
lopinavir/ritonavir
Lopinavir/ritonavir (LPV/r), sold under the brand name Kaletra among others, is a fixed-dose combination antiretroviral medication for the treatment and prevention of HIV/AIDS. It combines lopinavir with a low dose of ritonavir. It is generally ...
, but later research found them to be ineffective or even harmful,
like
fluvoxamine
Fluvoxamine, sold under the brand name Luvox and Faverin among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is primarily used to treat major depressive disorder and obsessive–compulsive disorde ...
, a cheap and widely available
antidepressant
Antidepressants are a class of medication used to treat major depressive disorder, anxiety disorders, chronic pain conditions, and to help manage addictions. Common side-effects of antidepressants include dry mouth, weight gain, dizziness, heada ...
; As of December 2020 , there was not enough high-quality evidence to recommend so-called early treatment.
In January 2021, two
monoclonal antibody-based therapies were available in the United States, for early use in cases thought to be at high risk of progression to severe disease.
[/] The antiviral
remdesivir
Remdesivir, sold under the brand name Veklury, Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged. is a broad-spectrum antiviral medication developed by the ...
has been available in the U.S., Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for people needing mechanical ventilation, and has been discouraged altogether by the
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(WHO),
due to limited evidence of its efficacy.
In November 2021, the UK approved the use of
molnupiravir
Molnupiravir, sold under the brand name Lagevrio, is an antiviral medication that inhibits the replication of certain RNA viruses. It is used to treat COVID-19 in those infected by SARS-CoV-2. It is taken by mouth.
Molnupiravir is a prodrug of ...
as a COVID treatment for vulnerable patients recently diagnosed with the disease.
Some people may experience persistent symptoms or disability after recovery from the infection, known as
long COVID
Long COVID or long-haul COVID (also known as post-COVID-19 syndrome, post-COVID-19 condition, post-acute sequelae of COVID-19 (PASC), or chronic COVID syndrome (CCS)) is a condition characterized by long-term health problems persisting or appe ...
, but there is still limited information on the best management and rehabilitation for this condition.
The WHO, the
Chinese National Health Commission, the UK
National Institute for Health and Care Excellence
The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health and Social Care in England that publishes guidelines in four areas:
* the use of health technologies wit ...
, and the United States'
National Institutes of Health
The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late 1 ...
, among other bodies and agencies worldwide, have all published recommendations and
guidelines
A guideline is a statement by which to determine a course of action. A guideline aims to streamline particular processes according to a set routine or sound practice. Guidelines may be issued by and used by any organization (governmental or pri ...
for taking care of people with COVID-19.
As of 2020
Intensivists and
pulmonologists in the U.S. have compiled treatment recommendations from various agencies into a free resource, the
IBCC.
General support
Taking
over-the-counter drug
Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescr ...
s such as
paracetamol
Paracetamol, also known as acetaminophen, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol.
At a standard dose, paracetamol only slightly decreases body temperature; it is inferior ...
or
ibuprofen
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used for treating pain, fever, and inflammation. This includes painful menstrual periods, migraines, and rheumatoid arthritis. It may also be used to close a patent ductus arte ...
, drinking fluids, taking
honey
Honey is a sweet and viscous substance made by several bees, the best-known of which are honey bees. Honey is made and stored to nourish bee colonies. Bees produce honey by gathering and then refining the sugary secretions of plants (primaril ...
to ease a cough, and resting may help alleviate symptoms.
[ ]
Medications
In the early months of the pandemic, many ICU doctors faced with the virus ventured to prescribe conjectured treatments because of the unprecedented circumstances.
However, the standard of care for most intractable illnesses is that, as it develops over years, doctors build a body of research that tests various theories, compares and contrasts dosages, and measures one drug's power against another.
Antiviral development for SARS-CoV-2 has been disappointing. In January 2020, research into potential treatments started, and several
antiviral drug
Antiviral drugs are a class of medication used for treating viral infections. Most antivirals target specific viruses, while a broad-spectrum antiviral is effective against a wide range of viruses. Unlike most antibiotics, antiviral drugs do ...
s were in clinical trials.
In February 2020 with 'no known effective' treatments, the WHO recommended volunteers take part in trials of the effectiveness and safety of potential treatments.
Antiviral medications were tried in people with severe disease.
As of March 2020 several medications were already approved for other uses or were already in advanced testing.
As of April 2020 trials were investigating whether existing medications could be used effectively against the body's immune reaction to SARS-CoV-2 infection.
As of May 2020 several
antiviral drug
Antiviral drugs are a class of medication used for treating viral infections. Most antivirals target specific viruses, while a broad-spectrum antiviral is effective against a wide range of viruses. Unlike most antibiotics, antiviral drugs do ...
s were under investigation for COVID-19, though none had been shown to be clearly effective on mortality in published randomized controlled trials.
As of February 2021, in the European Union, the use of
dexamethasone
Dexamethasone is a glucocorticoid medication used to treat rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, superior vena cava s ...
and
remdesivir
Remdesivir, sold under the brand name Veklury, Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged. is a broad-spectrum antiviral medication developed by the ...
were authorized. Despite being controversial at the beginning of the pandemic in 2020, corticosteroids like dexamethasone showed clinical benefit in treating COVID-19, once randomized controlled trials were performed in 2020.
As of February 2021, the
monoclonal antibody therapies
bamlanivimab/etesevimab and
casirivimab/imdevimab were found to reduce the number of hospitalizations, emergency room visits, and deaths.
[ ][ ] and both
combination drug
A combination drug or a fixed-dose combination (FDC) is a medicine that includes two or more active ingredients combined in a single dosage form. Terms like "combination drug" or "combination drug product" can be common shorthand for a FDC prod ...
s received
emergency use authorization
An Emergency Use Authorization (EUA) in the United States is an authorization granted to the Food and Drug Administration (FDA) under sections of the Federal Food, Drug, and Cosmetic Act as added to and amended by various Acts of Congress, includ ...
by the US
Food and Drug Administration
The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food s ...
(FDA).
As of February 2021 there were
Emergency Use Authorization
An Emergency Use Authorization (EUA) in the United States is an authorization granted to the Food and Drug Administration (FDA) under sections of the Federal Food, Drug, and Cosmetic Act as added to and amended by various Acts of Congress, includ ...
s for
baricitinib
Baricitinib, sold under the brand name Olumiant among others, is a medication used for the treatment of rheumatoid arthritis, alopecia areata, and COVID-19. It acts as an inhibitor of janus kinase (JAK), blocking the subtypes JAK1 and JAK2. ...
,
bamlanivimab,
bamlanivimab/etesevimab, and
casirivimab/imdevimab.
As of July 2021, outpatient drugs
budesonide
Budesonide, sold under the brand name Pulmicort among others, is a medication of the corticosteroid type. It is available as an inhaler, nebulization solution, pill, nasal spray, and rectal forms. The inhaled form is used in the long-term mana ...
and
tocilizumab
Tocilizumab, sold under the brand name Actemra among others, is an immunosuppressive drug, used for the treatment of rheumatoid arthritis, systemic juvenile idiopathic arthritis, a severe form of arthritis in children, and COVID19. It is a hu ...
showed promising results in some patients but remained under investigation.
As of July 2021, a large number of drugs had been considered for treating COVID-19 patients.
As of August 2021, there was moderate-certainty evidence suggesting that dexamethasone, and systemic corticosteroids in general, probably cause a slight reduction in all-cause mortality in hospitalised patients with COVID‐19.
In March 2022, the ''
BBC #REDIRECT BBC
Here i going to introduce about the best teacher of my life b BALAJI sir. He is the precious gift that I got befor 2yrs . How has helped and thought all the concept and made my success in the 10th board exam. ...
'' wrote, "There are now many drugs that target the virus or our body in different ways:
anti-inflammatory
Anti-inflammatory is the property of a substance or treatment that reduces inflammation or swelling. Anti-inflammatory drugs, also called anti-inflammatories, make up about half of analgesics. These drugs remedy pain by reducing inflammation as op ...
drugs that stop our immune system overreacting with deadly consequences,
anti-viral drug
Antiviral drugs are a class of medication used for treating viral infections. Most antivirals target specific viruses, while a broad-spectrum antiviral is effective against a wide range of viruses. Unlike most antibiotics, antiviral drugs do no ...
s that make it harder for the coronavirus to replicate inside the body and
antibody therapies that mimic our own immune system to attack the virus"
The WHO recommendations on which medications should or should not be used to treat Covid-19 are continuously updated. As of July 2022, WHO strongly recommended for non-severe cases
nirmatrelvir and
ritonavir
Ritonavir, sold under the brand name Norvir, is an antiretroviral drug used along with other medications to treat HIV/AIDS. This combination treatment is known as highly active antiretroviral therapy (HAART). Ritonavir is a protease inhibitor ...
, and recommended conditionally
Molnupiravir
Molnupiravir, sold under the brand name Lagevrio, is an antiviral medication that inhibits the replication of certain RNA viruses. It is used to treat COVID-19 in those infected by SARS-CoV-2. It is taken by mouth.
Molnupiravir is a prodrug of ...
,
Sotrovimab
Sotrovimab, sold under the brand name Xevudy, is a human neutralizing monoclonal antibody with activity against severe acute respiratory syndrome coronavirus 2, known as SARS-CoV-2. Text was copied from this source which is copyright European ...
and
Remdesivir
Remdesivir, sold under the brand name Veklury, Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged. is a broad-spectrum antiviral medication developed by the ...
. For severe cases WHO strongly recommended corticosteroids,
IL-6 receptor blockers or
Baricitinib
Baricitinib, sold under the brand name Olumiant among others, is a medication used for the treatment of rheumatoid arthritis, alopecia areata, and COVID-19. It acts as an inhibitor of janus kinase (JAK), blocking the subtypes JAK1 and JAK2. ...
and conditionally recommended
casirivimab and
imdevimab.
For patients in a life-threatening stage of the illness and in the presence of poor prognostic predictors, early antiviral treatment is essential.
Ineffective
As of 2020, several treatments had been investigated and found to be ineffective or unsafe, and are thus were not recommended for use; these include
baloxavir marboxil,
lopinavir/ritonavir
Lopinavir/ritonavir (LPV/r), sold under the brand name Kaletra among others, is a fixed-dose combination antiretroviral medication for the treatment and prevention of HIV/AIDS. It combines lopinavir with a low dose of ritonavir. It is generally ...
,
ruxolitinib
Ruxolitinib, sold under the brand names Jakafi and Jakavi, is a medication used for the treatment of intermediate or high-risk myelofibrosis, a type of myeloproliferative disorder that affects the bone marrow; polycythemia vera (PCV), when there ...
,
chloroquine
Chloroquine is a medication primarily used to prevent and treat malaria in areas where malaria remains sensitive to its effects. Certain types of malaria, resistant strains, and complicated cases typically require different or additional medi ...
,
hydroxychloroquine
Hydroxychloroquine, sold under the brand name Plaquenil among others, is a medication used to prevent and treat malaria in areas where malaria remains sensitive to chloroquine. Other uses include treatment of rheumatoid arthritis, lupus, an ...
,
interferon β-1a, and
colchicine.
As of 2021,
Favipiravir
Favipiravir, sold under the brand name Avigan among others, is an antiviral medication used to treat influenza in Japan. It is also being studied to treat a number of other viral infections, including SARS-CoV-2. Like the experimental antiviral ...
and
nafamostat
Nafamostat mesylate ( INN), a synthetic serine protease inhibitor, it is a short-acting anticoagulant, and is also used for the treatment of pancreatitis. It also has some potential antiviral and anti-cancer properties. Nafamostat is a fast-acting ...
had shown mixed results but were still in clinical trials in some countries.
During the early part of 2020
convalescent plasma, plasma from persons who recovered from SARS-CoV-2 infection, was frequently used with anecdotal successes in reports and small case series. However subsequent trials found no consistent evidence of benefit. However, conflicting outcomes from trials could be understood by noting that they transfused insufficient therapeutic doses of CCP.
As of February 2021, in the United States, only
remdesivir
Remdesivir, sold under the brand name Veklury, Text was copied from this source which is © European Medicines Agency. Reproduction is authorized provided the source is acknowledged. is a broad-spectrum antiviral medication developed by the ...
had FDA approval for certain COVID-19 patients, and while early research had suggested a benefit in preventing death and shortening illness duration, this was not borne out by subsequent trials.
On 16 April 2021, the FDA revoked the emergency use authorization (EUA) for the investigational monoclonal antibody therapy
bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID-19 in adults and certain pediatric patients.
[ ]
As of July 2022, WHO strongly recommended against treating non-severe cases with convalescent plasma, hydroxychloroquine, lopinavir-ritonavir or colchicine and recommended conditionally against corticosteroids or ivermectin or fluvoxamine or nirmatrelvir and ritonavir
WHO also strongly recommended against treating severe cases with hydroxychloroquine or lopinavir-ritonavir or
Baricitinib
Baricitinib, sold under the brand name Olumiant among others, is a medication used for the treatment of rheumatoid arthritis, alopecia areata, and COVID-19. It acts as an inhibitor of janus kinase (JAK), blocking the subtypes JAK1 and JAK2. ...
and conditionally recommended against
ruxolitinib
Ruxolitinib, sold under the brand names Jakafi and Jakavi, is a medication used for the treatment of intermediate or high-risk myelofibrosis, a type of myeloproliferative disorder that affects the bone marrow; polycythemia vera (PCV), when there ...
or
tofacitinib
Tofacitinib, sold under the brand Xeljanz among others, is a medication used to treat rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis.
Common side effects include diarrhea, headache, and high blood pressure. Serious side eff ...
, ivermectin or convalescent plasma.
As of September 2022, oral treatment of outpatients with
metformin
Metformin, sold under the brand name Glucophage, among others, is the main first-line medication for the treatment of type 2 diabetes, particularly in people who are overweight. It is also used in the treatment of polycystic ovary syndrome. ...
,
ivermectin
Ivermectin (, '' EYE-vər-MEK-tin'') is an antiparasitic drug. After its discovery in 1975, its first uses were in veterinary medicine to prevent and treat heartworm and acariasis. Approved for human use in 1987, today it is used to treat inf ...
, and
fluvoxamine
Fluvoxamine, sold under the brand name Luvox and Faverin among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is primarily used to treat major depressive disorder and obsessive–compulsive disorde ...
were found to be ineffective in a large randomized, controlled trial.
Adjuvant anticoagulation
In 2022, the Cochrane Database of Systematic Reviews suggested anticoagulants for people who are hospitalized with COVID-19 to prevent and treat venous or arterial thromboembolism.
Anticoagulants such as
heparinoids (including
heparin
Heparin, also known as unfractionated heparin (UFH), is a medication and naturally occurring glycosaminoglycan. Since heparins depend on the activity of antithrombin, they are considered anticoagulants. Specifically it is also used in the treatm ...
s), direct anticoagulants, and
vitamin K antagonist
Vitamin K antagonists (VKA) are a group of substances that reduce blood clotting by reducing the action of vitamin K. The term "vitamin K antagonist" is technically a misnomer, as the drugs do not directly antagonise the action of vitamin K in t ...
s and may reduce all-cause mortality in people who are hospitalized (very low certainty evidence), however there may also be an increased risk of major bleeding.
Respiratory support
Depending on the severity,
oxygen therapy
Oxygen therapy, also known as supplemental oxygen, is the use of oxygen as medical treatment. Acute indications for therapy include hypoxemia (low blood oxygen levels), carbon monoxide toxicity and cluster headache. It may also be prophylacti ...
and
intravenous fluids
Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
may be required.
Mechanical ventilation
Most cases of COVID-19 are not severe enough to require
mechanical ventilation
Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move ai ...
or alternatives, but a percentage of cases are.
The type of respiratory support for individuals with COVID-19 related
respiratory failure
Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide, or both cannot be kept at normal levels. A drop in the oxygen carried in the blood is known as hypoxemia; a rise ...
is being actively studied for people in the hospital, with some evidence that
intubation
Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Patients are generally anesthetized beforehand. Examples include tracheal intubation, and the balloon tamponade with a Sengstaken-Blakem ...
can be avoided with a
high flow nasal cannula or
bi-level positive airway pressure. Whether either of these two leads to the same benefit for people who are critically ill is not known. Some doctors prefer staying with invasive mechanical ventilation when available because this technique limits the spread of
aerosol
An aerosol is a suspension of fine solid particles or liquid droplets in air or another gas. Aerosols can be natural or anthropogenic. Examples of natural aerosols are fog or mist, dust, forest exudates, and geyser steam. Examples of anthropo ...
particles compared to a high flow nasal cannula.
Mechanical ventilation had been performed in 79% of critically ill people in hospital including 62% who previously received other treatment. Of these 41% died, according to one study in the United States.
Severe cases are most common in older adults (those older than 60 years,
and especially those older than 80 years).
Many developed countries do not have enough
hospital beds per capita, which limits a
health system
Health, according to the World Health Organization, is "a state of complete physical, Mental health, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World H ...
's capacity to handle a sudden spike in the number of COVID-19 cases severe enough to require hospitalisation.
This limited capacity is a significant driver behind calls to flatten the curve.
One study in China found 5% were admitted to
intensive care unit
220px, Intensive care unit
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensiv ...
s, 2.3% needed mechanical support of ventilation, and 1.4% died.
In China, approximately 30% of people in hospital with COVID-19 are eventually admitted to ICU.
The administration of inhaled
nitric oxide
Nitric oxide (nitrogen oxide or nitrogen monoxide) is a colorless gas with the formula . It is one of the principal oxides of nitrogen. Nitric oxide is a free radical: it has an unpaired electron, which is sometimes denoted by a dot in its ch ...
to people being ventilated is not recommended, and evidence around this practice is weak.
Mechanical ventilation
Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move ai ...
becomes more complex as
acute respiratory distress syndrome
Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin colo ...
(ARDS) develops in COVID-19 and oxygenation becomes increasingly difficult.
Ventilators capable of
pressure control modes and high
PEEP
Peep, Peeps, or PEEP may refer to:
People
*Peep (given name), Estonian masculine given name
* Lil Peep (1996–2017), American singer and rapper
* Helend Peep (1910–2007), Estonian actor
* Viljar Peep (born 1969), Estonian historian and civil s ...
are needed to maximise oxygen delivery while minimising the risk of
ventilator-associated lung injury
Ventilator-associated lung injury (VALI) is an acute lung injury that develops during mechanical ventilation and is termed ventilator-induced lung injury (VILI) if it can be proven that the mechanical ventilation caused the acute lung injury. In c ...
and
pneumothorax
A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve i ...
.
Extracorporeal membrane oxygenation
Extracorporeal membrane oxygenation (ECMO) is an artificial lung technology that has been used since the 1980s to treat respiratory failure and
acute respiratory distress syndrome
Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin colo ...
when conventional mechanical ventilation fails. In this complex procedure, blood is removed from the body via large cannulae, moved through a membrane
oxygenator
An oxygenator is a medical device that is capable of exchanging oxygen and carbon dioxide in the blood of human patient during surgical procedures that may necessitate the interruption or cessation of blood flow in the body, a critical organ or ...
that performs the lung functions of oxygen delivery and carbon dioxide removal, and then returned to the body. The
Extracorporeal Life Support Organization (ELSO) maintains a registry of outcomes for this technology, and as of September 2020 it has been used in less than 120,000 patients over 435 ECMO centers worldwide with 40% mortality for adult respiratory patients.
Initial use of ECMO in COVID-19 patients from China early in the pandemic suggested poor outcomes, with less than 90% mortality. In March 2020, the ELSO registry began collecting data on the worldwide use of ECMO for patients with COVID-19 and reporting this data on th
ELSO websitein real time. In September 2020, the outcomes of 1,035 COVID-19 patients supported with ECMO from 213 experienced centers in 36 different countries were published in
The Lancet
''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823.
The journal publishes original research articles, ...
, and demonstrated 38% mortality, which is similar to many other respiratory diseases treated with ECMO. The mortality is also similar to the 35% mortality seen in the EOLIA trial, the largest randomized controlled trial for ECMO in ARDS. This registry based, multi-center, multi-country data provide provisional support for the use of ECMO for COVID-19 associated acute hypoxemic respiratory failure. Given that this is a complex technology that can be resource intense, guidelines exist for the use of ECMO during the COVID-19 pandemic.
Psychological support
Individuals may experience distress from quarantine, travel restrictions, side effects of treatment, or fear of the infection itself. To address these concerns, the
National Health Commission of China published a national guideline for psychological crisis intervention on 27 January 2020.
In April 2020 ''The Lancet'' published a 14-page call for action focusing on the UK and stated conditions were such that a range of mental health issues was likely to become more common. BBC quoted Rory O'Connor in saying, "Increased social isolation, loneliness, health anxiety, stress, and an economic downturn are a perfect storm to harm people's mental health and wellbeing."
[Coronavirus: 'Profound' mental health impact prompts calls for urgent research](_blank)
, BBC, Philippa Roxby, 16 April 2020.
Special populations
Concurrent treatment of other conditions
Early in the pandemic, theoretical concerns were raised about
ACE inhibitors
Angiotensin-converting-enzyme inhibitors (ACE inhibitors) are a class of medication used primarily for the treatment of high blood pressure and heart failure. They work by causing relaxation of blood vessels as well as a decrease in blood volum ...
and
angiotensin receptor blocker
Angiotensin II receptor blockers (ARBs), formally angiotensin II receptor type 1 (AT1) antagonists, also known as angiotensin receptor blockers, angiotensin II receptor antagonists, or AT1 receptor antagonists, are a group of pharmaceuticals tha ...
s. However, later research in March 2020 found no evidence to justify stopping these medications in people who take them for conditions such as
high blood pressure
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high b ...
.
One study from April 2020 found that people with COVID-19 and hypertension had ''lower'' all-cause mortality when on these medications. Similar concerns were raised about
non-steroidal anti-inflammatory drugs
Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...
(NSAIDs) such as ibuprofen; these were likewise not borne out, and NSAIDs may both be used to relieve symptoms of COVID-19 and continue to be used by people who take them for other conditions.
People who use topical or systemic corticosteroids for respiratory conditions such as
asthma
Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, co ...
or
chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce m ...
should continue taking them as prescribed even if they contract COVID-19.
The principal for obstetric management of COVID-19 include rapid detection, isolation, and testing, profound preventive measures, regular monitoring of fetus as well as of uterine contractions, peculiar case-to-case delivery planning based on severity of symptoms, and appropriate post-natal measures for preventing infection.
Patients with simultaneous Influenza infection
Patients with simultaneous SARS CoV2 and
Influenza
Influenza, commonly known as "the flu", is an infectious disease caused by influenza viruses. Symptoms range from mild to severe and often include fever, runny nose, sore throat, muscle pain, headache, coughing, and fatigue. These symptoms ...
infection are more than twice as likely to die and more than four times as likely to need ventilation as patients with only COVID. It is recommended that patients admitted to hospital with COVID should be routinely tested to see if they also have Influenza. The public are advised to get vaccinated against both Influenza and COVID.
Patients with Covid and flu double the risk of dying, say scientists
''The Guardian
''The Guardian'' is a British daily newspaper. It was founded in 1821 as ''The Manchester Guardian'', and changed its name in 1959. Along with its sister papers ''The Observer'' and '' The Guardian Weekly'', ''The Guardian'' is part of the G ...
''
References
External links
Treatment guidelines
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{{Portal bar, COVID-19, Medicine, Viruses
Medical responses to the COVID-19 pandemic