COVID-19 Treatment Depends Upon Disease Severity
Mild Cases (Home)听
COVID-19听almost always starts听with relatively听mild, flu-like听symptoms that听can be treated at home.听People who have these symptoms usually do not need to be tested to confirm the infection.听
With limited opportunities for many suspected patients to get tested,听鈥we assume that many respiratory infections now are COVID-19,鈥 said Dr. Fred听Pelzman, associate professor of clinical medicine at 麻豆传媒高清版 and associate attending physician at听NewYork-Presbyterian/Weill Cornell Medical Center.听鈥淢ost can be managed at home by treating the symptoms and watching for a worsening of illness.鈥听
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.听听
Treatment听of COVID-19 at home听is supportive, much like home care for flu, and may include听acetaminophen听to reduce fever, aches and malaise.听Many physicians now听informally听refrain from听prescribing听ibuprofen听and other non-steroidal anti-inflammatory drugs听(NSAIDs)听for COVID-19 patients, at least in part听because these drugs can听stress the kidneys, which are among the organs听that can be harmed听by听the infection.听
No formal studies on NSAIDs and COVID-19听have yet been published. The U.S. Food and Drug Administration recently issued a听听noting that it is looking into the possibility that NSAIDs worsen the vulnerability to severe COVID-19 and 鈥will communicate publicly when more information is available.鈥听
Dr.听Pelzman听added that for patients and their caregivers,听one of听the most important aspects听of care for mild COVID-19 cases is to prevent the spread of infection to others, for example by keeping the patient isolated听in one room and bathroom, having听the patient听wear a mask, and听sterilizing听room surfaces.听
Moderate and Severe Cases (Hospital)听
Initial mild symptoms often progress so that patients feel that they are in the grip of a serious malady鈥攜et doctors emphasize that with the current crush of cases, hospitalization should be reserved only for those who need urgent medical attention.听
鈥淭he people now being hospitalized are usually very, very sick鈥攚e鈥檙e sending people home who normally would remain as inpatients,鈥 Dr.听Pelzman听said.听
Signs of听advanced COVID-19 pneumonia, such as听shortness of breath听while at rest,听persistent chest pain, bluish lips or face,听or sudden changes in mental status,听should prompt听a visit to a听doctor鈥檚 office听or听emergency room. So should any other sign of badly deteriorating health.听
鈥淲e鈥檝e had a lot of situations in which someone is watching their mom at home and they notice she鈥檚 stopped eating,听or urinating less,听or seems confused, and those have been the triggers for a visit to a clinic or hospital,鈥 Dr.听Pelzman听said.听
He听cautioned, though, that patients themselves often do not know how sick they are鈥攎any听report听no shortness of breath, for example,听despite extensive evidence of pneumonia on X-rays.听
(The U.S. Centers for Disease Control and Prevention has published instructions on 鈥鈥 on its website.)听
When COVID-19 patients are hospitalized,听they will typically be given听oxygen, as well as听intravenous fluids to prevent dehydration and maintain electrolyte levels. Medical staff may also start blood tests for听markers of inflammation,听to track the severity of disease.听
In many听cases, with patient consent, physicians will administer experimental treatments that听may听attack the virus or听reduce听the harmful inflammation听that is听triggered by听COVID-19听infection.听Treatments听that have been used so far include the antimalarial drug hydroxychloroquine; the antiviral drug听remdesivir;听infusions of antibody-laden听blood听serum from recovered patients; and anti-inflammatory听treatments听called IL-6 inhibitors.听
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.听Pelzman听said. This听high degree of illness听has meant that a听large听proportion鈥听about听a fourth to听a third鈥of COVID-19 patients听who are admitted to the hospital听eventually听require ICU care.听
COVID-19 patients in an ICU usually听continue to get treatments they had听received听before, and听may also get听antibiotics to prevent secondary lung infections, as well as听medications to support the heart and kidneys, which can听be听harmed听by the disease.听
Patients who are听unable to get enough oxygen from breathing through non-invasive means听may have a breathing听tube听put in place so听that a machine called a ventilator can force oxygen into their听lungs.听These patients are sedated. Even when patients in this situation听show signs that their infection听and inflammation are听abating, they often require ventilator support for weeks.听
鈥淲hen they鈥檙e on a ventilator,听it鈥檚 just a question of supporting them while they get through that听period of听respiratory damage and the inflammatory storm that occurs as the disease progresses,鈥 Dr.听Pelzman听said.听
After infection听
Patients may face a听听before听feeling 鈥100 percent鈥 again, depending on the severity听and duration听of听their COVID-19 infection. Lung function听in particular may听take weeks to return to normal, leaving patients听tired听and easily out of breath. There may also be short- or medium-term cognitive symptoms if the patient experienced an extended period of听low oxygen levels in the brain.听Patients who have spent听weeks听in听an听ICU, fearing听death,听may also later suffer from听.听听
Recovered patients, unless they have significant immune deficiencies, will have mounted an immune response to the coronavirus. This should include 鈥渕emory cells鈥 that provide some听T-cell and听听protection against COVID-19 reinfection, though scientists听are actively investigating听whether that immunity is for a short time or long-lasting.听Many hospital systems as well as the American听听now urge recovered patients to donate blood so that it may be used听for research or to treat new COVID-19 patients.听