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Evaluate and Treat COVID-19

Evaluate and Treat COVID-19

    As COVID-19 cases rise with the country's reopening, many people find themselves with mild or moderate symptoms of cold or pneumonia. With limited testing and crowded hospitals, it can be hard to differentiate a common cold from COVID-19 symptoms. How should these people be evaluated? If these people do have COVID-19, how should they be treated? A clinical practice paper recently published in the New England Journal of Medicine studies how to evaluate and treat Mild/Moderate COVID-19.

Evaluation

      COVID-19 can reveal itself through a variety of symptoms including cough, fever, malaise or discomfort, muscle pain, gastrointestinal symptoms, and loss of smell. Evaluation and management of COVID-19 is based on the severity of the illness. According to data from Wuhan, China, 81% of people infected with COVID-19 had a mild/moderate disease, 14% had a severe disease, and 5% had a critical illness. The paper explains that people with mild symptoms generally don't need any additional evaluation. If these people aren't at risk (See Who's at Risk), they don't even need to be tested for COVID-19 as the infection will usually resolve. However, some patients with mild symptoms may experience a dramatic worsening condition approximately 1 week after the initial symptoms. Patients who have risk factors should be closely monitored but will unlikely need additional evaluation. If new or worsening symptoms develop after mild illness, patients should undergo a physical examination testing for abnormal respiratory findings or other respiratory viruses. If these findings suggest severe illness, hospitalization is highly recommended. Indications of severe illness include:

  • Dyspnea (labored breathing)
  • Tachypnea (rapid breathing) at a rate > 30 breaths per minute
  • Hypoxemia (low concentration of oxygen in blood) with oxygen concentration < 93%
  • Lung infiltrates involving >50% of the lung within 24-48 hours

Risk Factors for Severe COVID-19

Management/Treatment

    Patients with mild illness tend to recover at home in isolation with supportive care. For those with underlying risks, it is useful to have a pulse oximeter, or a device to monitor oxygen saturation. Patients with severe illness should be treated and monitored in a hospital. While there are no approved treatments for COVID-19, patients may enroll in clinical trials where new drugs that show potential to treat COVID-19 can be tested. The EUA, Emergency Use Authorization issued by the FDA, encourages participation in trials to provide evidence for effectiveness of the following drugs:

  • Hydroxychloroquine and chloroquine: recommended treatment for COVID-19 in China, shown to be effective in a nonrandomized trial in France

  • Lopinavir-Ritonavir: HIV-1 inhibitor, no sufficient data shown to be effective in treatment of COVID-19, not recommended for people with HIV-1

  • Remdesivir: See Remdesivir, majority of patients had decreased need for oxygen support after use of Remdesivir

  • Immunomodulation: type of therapy currently under investigation, largely in patients with severe disease

Conclusion

    Patients showing mild symptoms of COVID-19 such as a cough or fever typically recover at home within the following week. For patients who show mild symptoms but are at high risk for COVID-19, it is recommended that they be closely monitored for the next week. Patients with severe COVID-19 or new/worsening symptoms should seek hospitalization and observation where they will be tested for abnormal respiratory findings. As there are currently no approved treatments for COVID-19, participation in clinical trials are the only way for patients to gain access to promising drugs. If you are showing symptoms of COVID-19 or suspect you carry the virus, it is critical that you wear a mask, preferably a respirator, and isolate yourself for up to 2 weeks to prevent spreading the virus.

Sources

  1. Gandhi, Rajesh T., et al. “Mild or Moderate Covid-19: NEJM.” New England Journal of Medicine, 25 June 2020, www.nejm.org/doi/full/10.1056/NEJMcp2009249.


    

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