Standards of care for COVID-19 patients

Significant progress has been made on how to care for COVID-19 patients, and treatment recommendations continue to evolve.

In this video we present the current guidelines and recommendations from the United States National Institute of Health, or NIH, COVID-19 Treatment Guidelines Panel as of January 2021.

An individual’s treatment heavily depends on the patient’s health condition as well as the resources available to the health care team, so health care professionals should follow local policies and use their clinical judgement on a case-by-case basis.

Patients with mild symptoms from COVID-19 should be advised to treat the disease like any other bad cold.

Patients should rest, drink fluids, and can take over the counter medications to manage symptoms like fever and congestion.

Healthcare providers should encourage patients to isolate themselves, including isolating within a specific part of their home to avoid contact with other household residents.

In November 2020, the United States Food and Drug Administration or FDA, issued Emergency Use Authorization to allow bamlanivimab or casirivimab plus imdevimab to be given to outpatients who are at high-risk for serious infection, such as people with cancer, type 2 diabetes, and pre-existing heart conditions like heart failure.

Bamlanivimab and casirivimab plus imdevimab are laboratory manufactured monoclonal antibodies designed to fight COVID-19 by preventing the virus from entering the host cells.

To date, the NIH panel does not have enough information to make a recommendation for or against using these drugs for COVID-19 patients with mild symptoms, and these drugs can only be given through emergency use authorization or as part of a clinical trial.

Drug supply may also be limited depending on a provider’s location and administration should be prioritized for those with the highest risk.

Bamlanivimab and casirivimab plus imdevimab are not recommended for patients who are hospitalized as studies have suggested this could cause harm.

Patients who require hospitalization for COVID-19 infection, but do not require supplemental oxygen should primarily be given supportive treatment, focusing on reducing symptoms and promoting comfort.

Healthcare providers should also consider seeking permission to enroll patients into clinical trials as soon as a COVID-19 diagnosis is confirmed.

Patients who are at high-risk of developing severe COVID-19 symptoms may receive Remdesivir.

Remdesivir is an IV antiviral drug that inhibits viruses from replicating in the body, by interfering with a critical enzyme during RNA replication.

Clinical trials with hospitalized patients showed remdesivir treatment reduced the median recovery time from 15 days to 10 days, and reduced the number of individuals requiring mechanical ventilation.

Initial clinical trials also suggest remdesivir is safe for use in people who are pregnant, and has been given Emergency Use Authorization from the United States Food and Drug Administration, for use in children 12 years of age and younger as long as they are over 3.5 kilograms.

Patients who are unable to maintain appropriate oxygen saturations should receive supplemental oxygen.

Patients who need minimal oxygen, such as with low-flow nasal prongs, are good candidates to receive remdesivir as its benefits are greatest for patients on supplemental oxygen.

Remdesivir reduced recovery times as well as mortality rates for patients on supplemental oxygen.

Patients on supplemental oxygen with high-flow non-invasive devices may also benefit from the corticosteroid dexamethasone.

The immune response of the body in patients with severe COVID-19 symptoms can cause lung injury and significant damage to other organs.

Corticosteroids help reduce the intensity of the immune response.

One clinical trial with patients with severe COVID-19 symptoms showed that corticosteroids reduced mortality from 40% to 32%.

Other clinical trials showed similar mortality rate reductions and reduced need for invasive mechanical ventilation in severe COVID-19 cases.

The NIH panel recommends patients in need of high-flow oxygen or non-invasive mechanical ventilation receive dexamethasone or other similar corticosteroids, such as prednisone, preferably in combination with remdesivir.