Zulfiqar Rana, MD, MPH, FACP

Board Certified in Internal Medicine

COVID 19 Treatments

This article is for providers.

Guidelines


Treatment strategy for COVID-19


  • Step 1 risk stratification
  • Treatment based on risk
  • Special considerations

Risk Stratification


Criteria for clinical severity of confirmed cases of COVID 19:
  • Mild  (Hx, PE, Imaging)
    • MILD clinical symptoms: – fever less than 38°C, whether without cough, – no dyspnea, no gasping, – no chronic disease;
    • no imaging findings of pneumonia
  • Moderate (Hx, PE, Imaging)
    • fever,
    • respiratory symptoms,
    • imaging findings suggestive of pneumonia
  • Severe – any of the following:
    • respiratory distress, RR greater than 30 minute;
    • SPO to less than 93% at rest
    • PaO2/FiO2 < 300 mmHg
    • the rapid progression (greater than 50%) on CT imaging within 24 – 48 hours
  • Critical – any of the following:
    • respiratory failure
    • needs mechanical assistance
    • shock
    • extra pulmonary organ failure
    • ICU is needed

Treatment


Mild – outpatient

    • Symptoms +
    • Infiltrates –
    • NO Hypoxia (oxygen saturation ≤94 percent on room air) OR Need for oxygenation or ventilatory support
– No treatment
– Monoclonal antibody The US Food and Drug Administration (FDA) issued EUAs for bamlanivimab and for the combination casirivimab-imdevimab for non-hospitalized COVID-19 patients with mild to moderate illness (eg, not requiring supplemental oxygen or, if on chronic supplemental oxygen, without an increased oxygen requirement) who have certain risk factors for severe disease [73,74]. These risk factors for adults (≥18 years) include any of the following:
  • Body mass index (BMI) ≥35 kg/m²
  •  Chronic kidney disease
  •  Diabetes mellitus
  •  Immunosuppression (immunosuppressive disease or treatment)
  •  ≥65 years of age
  •  ≥55 years of age and who have cardiovascular disease, and/or hypertension, and/or chronic obstructive pulmonary disease (or other chronic respiratory disease)
If either of these monoclonal antibodies are used, they are to be given as a single intravenous dose as soon as possible after a positive SARS-CoV-2 test, within 10 days of symptom onset.

Moderate

  • Symptoms +
  • Infiltrates +
  • NO Hypoxia (oxygen saturation > 94 percent on room air) OR Need for oxygenation or ventilatory support

Severe

  • Symptoms +
  • Infiltrates +
  • Hypoxia PRESENT (oxygen saturation ≤94 percent on room air) OR Need for oxygenation or ventilatory support
– Patients with severe disease but NOT on Oxygen
Remdesivir but NO dexamethasone
– Patients with severe disease but REQUIRING Oxygen
Remdesivir PLUS dexamethasone

Critical: ICU/ARDS/Ventilator/ shock/ organ failure

  • Ventilator settings
  • Management of shock
  • Management of organ failure
  • Specific therapies

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