A Centers for Disease Control and Prevention (CDC) report shows that COVID-19 illness severity can range from mild to critical, with 81% of cases having mild to moderate symptoms, 14% exhibiting severe symptoms and 5% experiencing a critical response, which includes respiratory failure or multi-organ system dysfunction.
“The number of COVID-19 cases continues to grow and our hospitals are becoming increasingly filled with people experiencing severe symptoms of the disease,” says Dr. Stephen Munday, medical director of epidemiology and provider safety with Sharp Rees-Stealy Medical Group. “The good news is that we now know more about the novel coronavirus — how it is transmitted and how it affects the human body — than when we first began to see people with COVID-19 in our hospitals, and we have more therapeutics to work with.”
How a mild case of COVID-19 is treated
According to the CDC, the majority of people with COVID-19 are able to recover at home while monitoring their symptoms in case they become more severe. Common symptoms include fever, cough, fatigue, loss of smell and difficulty breathing.
The most important guidance on managing asymptomatic or mild cases is to stay home and separate from others. If a person must come into contact with others in their household or when seeking medical care, they should always wear a face covering over their nose and mouth.
Additional at-home tips:
- Stay hydrated
- Use OTC medications such as acetaminophen to reduce fever and discomfort
- Stay in touch with their doctor and the local health department
How a mild to moderate case of COVID-19 in an at-risk person is treated
If a person is at risk for severe symptoms of the disease, the FDA has given emergency authorization for two antibody treatments for mild to moderate cases of COVID-19 in people age 12 and older. The “antibody cocktail” treatments, produced by drugmakers Regeneron and Eli Lily, are synthetic antibodies that mimic the immune system's ability to neutralize the novel coronavirus that causes COVID-19.
Neither antibody treatment is for those hospitalized with COVID-19 or requiring oxygen therapy. The treatments are meant to be given as soon as possible after COVID-19 has been diagnosed in high-risk people, such as individuals over 65 or with chronic health conditions. However, there is a limited supply of both medications; states will be given amounts based on area COVID-19 case rates.
If you are unable to safely recover at home, the National Institutes of Health (NIH) has developed standardized guidelines for the optimal management of severe COVID-19 and related complications, which can include pneumonia, sepsis, and heart concerns, as well as trouble with breathing, circulation, the kidneys and more.
These guidelines are based on both scientific evidence as well as expert knowledge and experience.
Currently, remdesivir is the only COVID-19 drug approved by the Food and Drug Administration (FDA). Remdesivir is an antiviral medication that can help certain patients with severe COVID-19 illness to recover approximately 31% more quickly than those not given the drug. It is given to hospitalized patients through an IV once a day for five to 10 days, depending on how ill they are.
Emergency use for baricitinib, in combination with remdesivir, has also been granted by the FDA for the treatment of COVID-19 in certain hospitalized patients requiring supplemental oxygen or ventilation. Currently approved for the treatment of rheumatoid arthritis, baricitinib is a Janus kinase (JAK) inhibitor, which influences immune cell function and can decrease an overactive, and potentially devastating, immune response to the virus.
The World Health Organization (WHO) also recommends dexamethasone, a corticosteroid used for its anti-inflammatory and immunosuppressant effects, for use with hospitalized patients with COVID-19. According to the WHO, the treatment has been shown to reduce mortality by approximately 33% for patients on ventilators and about 20% for patients requiring only oxygen.
Treatment for circulation complications
Patients with COVID-19 are at risk for sepsis, the body’s extreme and life-threatening response to an infection. Norepinephrine can be used to increase a patient’s heart rate and blood pressure to maintain blood flow to organs. According to the CDC, without timely treatment, sepsis can rapidly lead to tissue damage; failure of the heart, lungs and kidneys; and death.
Treatment for breathing complications
Adults with COVID-19 and acute respiratory failure due to low levels of oxygen in the blood, known as hypoxemia, may be given high-flow nasal cannula (HFNC) oxygen — delivered through a lightweight tube split into two prongs and placed in the nostrils — if traditional nasal cannula oxygen does not supply enough supplemental oxygen. Proning, or placing patients face down, also allows for better oxygenation of the lungs.
If a patient’s respiratory status worsens, endotracheal intubation may be necessary. Intubation requires a flexible tube to be inserted through the mouth and down the trachea to the lungs to open the upper airway and ventilate the lungs. The tubes can be connected to a ventilator machine to provide artificial ventilation and support the patient’s breathing. Proning can also be used in combination with mechanical ventilation.
Evidence also mounts for the use of extracorporeal membrane oxygenation (ECMO) for patients with severe COVID-19 and hypoxemia. An ECMO machine functions as an artificial heart and lungs by removing blood from the body, circulating it through the device and returning it to the body, oxygenated.
It is important to note that oxygen, ventilation and ECMO won’t help cure COVID-19, but can help support a patient while their immune system fights the infection. However, long-term ventilation can lead to additional complications, including continued difficulty breathing, lung injury, infections and mental health disorders, such as post-traumatic stress disorder (PTSD).
Treatment for kidney complications
For critically ill patients with COVID-19 who develop acute kidney complications, continuous renal replacement therapy (CRRT) is recommended. CRRT is a nonstop dialysis therapy that replaces the normal blood-filtering function of the kidneys in patients with kidney failure.
“There continues to be research, trials and discoveries of different medications and treatments for COVID-19, and, at this rate, we could have new options at any time,” Dr. Munday says.
“Until a vaccine is approved and widely distributed, health care providers across the country will use their combined knowledge and expertise to continue to treat the thousands with COVID-19 with compassionate care. All we ask is that everyone does their part to slow the spread of the virus by staying home when sick, practicing social distancing, wearing face coverings and frequently washing their hands.”