TREATMENT

 Treatment for covid-19

Most people who become ill with COVID-19 will be able to recover at home. Some of the same things you do to feel better if you have the flu — getting enough rest, staying well hydrated, and taking medications to relieve fever and aches and pains — also help with COVID-19.

Beyond that, the FDA has also authorized treatments that may be used for people who have been hospitalized with COVID-19 and other medications to curb the progression of COVID-19 in people who are not hospitalized but who are at risk for developing severe illness. Scientists continue working hard to develop other effective treatments.

What therapies might help people with severe COVID-19 prior to hospitalization?

In November 2020, the FDA granted emergency use authorization to two monoclonal antibody treatments (bamlanivimab, made by Eli Lilly; and a combination of casirivimab and imdevimab, made by Regeneron). Both treatments have been approved for non-hospitalized adults and children over age 12 with mild to moderate COVID-19 symptoms who are at risk for developing severe COVID-19 or being hospitalized for it. In these patients, the approved treatments can reduce the risk of hospitalization and emergency room visits. These therapies must be given intravenously (by IV) soon after developing symptoms.

If you are recovering at home, these measures can help reduce symptoms:

•  While you don't need to stay in bed, you should get plenty of rest.

•  Stay well hydrated.

•  To reduce fever and ease aches and pains, take acetaminophen. Be sure to follow directions. If you are taking any combination cold or flu medicine, keep track of all the ingredients and the doses. For acetaminophen, the total daily dose from all products should not exceed 3,000 milligrams.

What medications can doctors use for people hospitalized with COVID-19?

Dexamethasone

Many doctors, including those in the United States, have been treating very ill COVID-19 patients with corticosteroids since the pandemic began. It makes biologic sense for those patients who have developed a hyper-immune response (a cytokine storm) to the viral infection. In these cases, it is the immune system's overreaction that is damaging the lungs and other organs, and too often leading to death.

Dexamethasone and other corticosteroids (prednisone, methylprednisolone) are potent anti-inflammatory drugs. They are readily available and inexpensive.

The NIH COVID-19 treatment guidelines recommend the use of dexamethasone in certain people hospitalized with severe COVID-19. The recommendation was based on results from the RECOVERY trial. In the study, more than 6000 patients hospitalized with COVID-19 randomly received either dexamethasone or standard treatment. Patients who required supplemental oxygen or ventilators and who received dexamethasone were less likely to die within 28 days than those who received standard care. Dexamethasone did not have a benefit in patients who did not need respiratory support.

Remdesivir

In October 2020, the FDA approved the antiviral drug remdesivir to treat COVID-19. The drug may be used to treat adults and children ages 12 and older and weighing at least 88 pounds, who have been hospitalized for COVID-19. Clinical trials suggest that in these patients, remdesivir may modestly speed up recovery time.

Baricitinib in combination with remdesivir

In November 2020, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the use of baricitinib in combination with remdesivir in hospitalized adults and children two years and older who require respiratory support. However, there is not yet enough evidence to support the use of this therapy instead of dexamethasone with or without remdesivir.

Anticoagulation drugs ("blood thinners")

Almost all people admitted to the hospital with COVID receive medications to help prevent blood clots. Doctors usually prescribe low dose heparin or enoxaparin. However, some patients require full doses of anticoagulants if they already have developed blood clots or have a high risk of doing so. Doctors always need to balance the risk of dangerous bleeding when prescribing full doses.