COVID-19: How patients are treated

Persons admitted to isolation centers get symptoms resolved as their immune systems fight virus off

COVID-19: How patients are treated

By Sola Ogundipe

There is currently no cure for the novel Coronavirus disease (COVID-19) but researchers are working on creating a suitable vaccine as well as coming up with potential treatments and a number of potential vaccines and curative drugs are under trial

As the world desperately seeks to find an effective treatment and a probable cure, more and more new vaccine trials and treatment options are being conducted even as the global case count continues to increase.

While there may be some evidence that certain medications may have the potential to be effective with regard to preventing illness or treating the symptoms of COVID-19, the World Health Organisation, WHO says there is no proof of any cure yet and people are advised against self-medicating.

There are no specific drugs or other therapeutics presently approved by health authorities to prevent or treat COVID-19. Current clinical management includes infection prevention and control measures and supportive care, including supplemental oxygen and mechanical ventilatory support when indicated.

Treatment guidelines

Screening is done at the first point of contact at the emergency department or outpatient department/clinic and all patients are given a face mask and kept apart. All persons with COVID-19   are prioritised according to the severity of their cases at the first point of contact with the health care system.

The recommendation by the World Health Organisation, WHO, for laboratory-confirmed cases is that they should be isolated and cared for in a designated health care facility.

The purpose of hospital admission is to treat the symptoms while their immune systems battle the virus until they clear the virus and test negative. Hospitalisation is also to isolate patients and stop the virus spreading, therefore, health workers must utilise standard treatment protocols as recommended by the WHO.

Standard precautions are always applied in all areas and these include hand hygiene and the use of personal protective equipment, PPE, when in indirect and direct contact with patients’ blood, body fluids, secretions (including respiratory secretions), and non-intact skin.

Patients with mild disease are provided with symptomatic treatment such as an antipyretic (medication to lower body temperature when a fever is present).

They are counselled about the mild signs and symptoms of the complicated disease and if they develop any of these symptoms, they obtain urgent care.

The COVID-19 is more likely to cause symptoms in older adults and those with underlying health conditions. Most people who develop symptoms experience fever, cough, shortness of breath, fatigue, chills, with or without repeated shaking, headache, loss of taste or smell, sore throat, muscle aches, and pains.  Antibiotics are ineffective because COVID-19 is a viral infection and not bacterial.

For patients with severe cases,  oxygen therapy and monitoring are commenced immediately.  If symptoms are more severe, supportive treatments may be given including fluids to reduce the risk of dehydration, medication to reduce a fever, and supplemental oxygen in more severe cases. People with breathing problems are put on the respirator.

The COVID-19 poses a particular risk for elderly people and those with pre-existing illnesses, hence, patients in the open wards or in the Intensive Care Unit, ICU,  are cared for with critical care equipment to monitor their health and support their bodily functions.

In severe cases, the coronavirus causes pneumonia (inflammation of the lungs) and breathing may need to be supported. The patients are given oxygen and critical cases may be put on a ventilator.

If all mild cases cannot be isolated in health facilities, then those with mild illness and no risk factors may need to be isolated in non-traditional facilities, such as repurposed hotels, stadiums, or gymnasiums where they can remain until their symptoms resolve and laboratory tests for coronavirus are negative.

Alternatively, patients with mild disease are placed on admission if they are at risk for poor outcome, especially persons aged above 60 years,  and those with underlying conditions such as chronic cardiovascular disease, chronic respiratory disease, diabetes, and cancer.

Home care

Patients with mild symptoms and without underlying chronic conditions that could place them at increased risk of developing complications may be cared for at home according to the WHO.

In such cases, where feasible, a trained healthcare worker conducts an assessment to verify whether the residential setting is suitable for providing care.

The patient and the family must be capable of adhering to recommended precautions as part of home care isolation. among these are hand hygiene, respiratory hygiene, environmental cleaning, and other safety concerns. Where feasible, a communication link with health care providers or public health personnel, or both, should be established.

For a confirmed positive patient at home, immediate implementation of appropriate infection prevention and control (IPC)  measures must commence.

Infection prevention and control is a critical and integral part of the clinical management of patients.

If symptoms are more severe, supportive treatments may be given including fluids to reduce the risk of dehydration, medication to reduce a fever, and supplemental oxygen in more severe cases. People with breathing problems are put on the respirator.

Drugs under test

The drugs being tested range from established flu treatments, Ebola drugs, and old malaria treatments.

EIDD-2801

Among treatments that doctors hope will help fight COVID-19  include an oral drug called EIDD-2801 that is showing promise in test-tube experiments with human lung and airway cells according to reports in the  Science Translational Medicine, a journal.

EIDD-2801 is a multipurpose antiviral drug, that introduces genetic mutations into the virus’s RNA and makes it no longer able to infect cells.

Researchers are following standard protocol and carrying out randomly controlled human trials before potential vaccines and other treatments become available. All these take time.

Here are some treatment options that are currently being investigated for protection against and treatment of COVID-19 symptoms.

Remdesivir

Remdesivir is an experimental broad-spectrum antiviral drug originally designed to target Ebola.

The drug is highly effective at fighting the novel coronavirus in isolated cells. Remdesivir actually stops the coronavirus from multiplying, however, the treatment is not yet approved in humans, but two clinical trials for this drug have been implemented in China. One clinical trial has been approved by the United States.

Chloroquine

Chloroquine is effective against malaria and autoimmune diseases and is considered safe. Researchers say the drug is effective at fighting the coronavirus in studies done in test tubes and many clinical trials are ongoing to investigate the potential use of chloroquine as an option for combating the coronavirus.

Lopinavir and ritonavir

Lopinavir and ritonavir are sold under the name Kaletra and are designed to treat HIV. According to the WHO, there could be benefits to using Kaletra in combination with other drugs.

APN01

A clinical trial is set to start soon in China to examine the potential of a drug called APN01 to fight the novel coronavirus.

The scientists who first developed APN01 in the early 2000s discovered that a certain protein called ACE2 is involved in SARS infections. This protein also helped protect the lungs from injury due to respiratory distress.

Favilavir

China approved the use of the antiviral drug Favilavir to treat symptoms of COVID-19. The drug was initially developed to treat inflammation in the nose and throat.

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