COVID-19 Treatment

ABSTRACT:

As the number of positive cases for SARS-CoV2 increases, many of us would like to understand what can be done if we develop symptoms of COVID-19 after exposure, and what are the current best medical practices to preserve our health.  

 

What medical treatments could your doctor offer if your infection progresses?

Although a cure has not been discovered yet, there are some advances in the intervention of the patients that we can implement if a COVID-19 diagnosis is determined. Like any other medical condition, decisions for the management of the viral infection are implemented on a case-by-case basis, and you should consult your physician for the treatment that suits you best.

NIH experts have delivered a series of recommendations with the current evidence. We went over the published scientific articles to explain what all of this means for you. So please, get comfy and put on your nerdy hat because you are going to need it for this one!

The infection timeline presents an early and late phase. The early phase of the disease is driven by the viral invasion of the respiratory tract, and although it can affect other systems such as the nervous, and gastrointestinal, it’s respiratory system complications that are the main contributor to the rapid deterioration of the majority of patients. In some cases, this is then followed by a severe inflammatory response, which puts the patient’s life on the line and affects their ability to breathe on their own. These different stages explain why some treatment regimens are beneficial at a given point in the disease course but useless or even harmful at other disease stages. 

To estimate where you are in the infection, we use the disease severity scale, which is based on how much help you require to breathe.[1] 

With this approach, we can divide the patient presentation by
1) no oxygen required
2) low flow oxygen delivery
3) high flow oxygen delivery
4) advanced life support measures.[2]

 

-There are three main groups of pharmacologic therapies that we will discuss based on recommendations from current evidence:

Immune-based therapies that modulate the hyperactive inflammatory effects from the virus.

Antivirals that directly disrupt part of the viral cycle. 

Adjuvant therapies, which are substances that may play a significant role in the treatment or even prevent the infection or its complications.

-Several medications have been studied but only one has shown a definitive benefit on patient mortality: Dexamethasone. [9]  

Dexamethasone is a corticosteroid drug that is very similar to hormones produced in your body. It works by decreasing the activation of several functions of the immune system, which in turn decreases inflammation. A large study from the UK showed the benefits of this medication on the treatment of COVID19 patients that require oxygen. 

This benefit was most evident in patients that required advanced means of life support, such as mechanical ventilation or extracorporeal oxygenation. Researchers’ findings determined a reduction in mortality risk of death of 11.7% and estimated that for every 9 patients one will benefit from this therapy. There was also a minor decrease in mortality from those requiring oxygen delivery by other modalities. In this group of patients, the reduction in the absolute risk of death was 3.5%, estimating that from every 29 patients one will benefit from this therapy. [12]  On the other hand, dexamethasone was not beneficial in patients who didn’t require oxygen.NIH recommendation for this medication is that only for use in patients that are hospitalized and require oxygen.  Although this is far away from even being considered a cure, it’s the greatest benefit from any medication so far.  

Nonetheless, other medications are being tested… like Bamlanivimab. Bamlanivimab is a monoclonal antibody that provides antibodies that neutralize the virus. The clinical trial that justified emergency use authorization by the FDA showed a reduction in hospitalization in 72% of the patients with early diagnosis by PCR. In fact, if Bamlanivimab was infused within 72 hours after a positive result, only 1.6% of the patients went on to require hospitalization compared to 6% of patients that received placebo. A cocktail similar to this medication was in the news in October as it was one of the medications the former president Trump received during his hospital stay. 

Another medication is the famous Remdesivir, which works by decreasing viral replication. This makes the medication more beneficial at the early stages of the disease as shown by the adaptive COVID-19 treatment trial. This study concluded that this drug decreased the time to recovery from 15 days on average to 10 days when patients required supplemental oxygen during hospitalization. This benefit was not present when patients had progressed to required advanced life support measures. The WHO contradicts the use of this medication based on a large observational study that showed no benefit of the treatment in hospitalized patients.  

Ivermectin on the other hand is a medication that has shown a correlational decrease in reported cases in some populations. The retrospective analysis put this anti-parasite medication as a potential prophylactic alternative for the virus if clinical trials are able to determine that Ivermectin is responsible for this correlation. In laboratory experiments, it decreased viral replication. Therefore, more studies are needed to determine this drug’s potential preventive benefits.  

Honorable mentions for COVID-19 treatment methods go to prone positioning. This involves placing mechanically ventilated patients face-down, allowing for better lung function. Despite its physical limitations, this technique has also shown some potential benefit even before the patient requires ventilation.

Amongst the adjuvant therapies are vitamin C, vitamin D, and Zinc. Although they lack strong randomized clinical trials for the treatment of COVID-19, their use has been proven to be safe for most patients. The control of chronic medical conditions such as diabetes and hypertension decreases the risk for complications from the infection as well.

 

CONCLUSION

In conclusion, Bamlanivimab could prevent progression to hospitalization when given early in the disease. Remdesivir may decrease the duration of hospitalizations of patients requiring oxygen who are not intubated. Dexamethasone can be used to decrease mortality for patients who receive oxygen, especially those who are on mechanical ventilation. Given the limited treatment options, patients at risk should maintain good control of their chronic conditions. 

As vaccines become available, the consequences of the infection are dependent upon the prevention of the disease spread. Your role is critical to protect your loved ones as much as yourself. This is the importance of physical distancing, hand hygiene, and mask-wearing. 

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