Is there a treatment for COVID-19?
Anika H. Ahmed, MD
The biggest challenge for a physician is to explain to a patient that there is no curative treatment available for the present coronavirus infection. As a physician whose main focus is on the primary prevention of infectious communicable diseases, I myself understand fully how hard it is to digest that there is no specific treatment plan. Over the years, I have had the experience of focusing on both the physical as well as the mental health of my patients. It is surely an established fact that Coronavirus is a highly infectious virus and the present pandemic of COVID-19 has killed hundreds of thousands across the globe. So far, the World Health Organization and the Food and Drug Administration in the United States have not approved any medication for COVID-19 treatment. A lot of research is being conducted at the National Institutes of Health through randomized clinical trials, and it may take several months, and potentially years, before a specific treatment and vaccine can be introduced.
Most who feel the onset of COVID-19 initial symptoms in the form of a fever, a cough, body aches, breathlessness, or sensory loss of taste or smell would understandably get anxious or apprehensive. Every physician needs to address the physical, as well as the mental, well-being of the patient. Management and treatment of COVID-19 patients presently is mainly through supportive therapy. Every doctor’s decision to keep a patient at home or in the hospital (outpatient vs. inpatient) is made on a case-by-case basis, as in this case one size does not fit all. This decision depends on the clinical symptoms, potential underlying risk factors for severe disease, the need for supportive care, and the ability of the patient to self-isolate at home. Patients with underlying risk factors are closely monitored at home, especially in the second week of illness when symptoms can become more severe.
Patients with mild or moderate symptoms do not require hospitalization and can be managed at home with supportive therapy by the doctor. Supportive therapy includes both physical and mental therapy. For physical well-being at home, every doctor will advise self-quarantine and isolation from everyone in the house for at least three days after no further symptoms are present. Antipyretic drugs, mainly Acetaminophen, will control fever and body aches and decongestants will help the patient remain comfortable. Other keys to combatting the virus are good hydration and rest, balanced nutritional diet with more fresh fruits and green vegetables to boost the immune system, highest standards of personal hygiene, staying active with regular exercise and mobility, frequent cleaning of all surfaces with disinfectants, and keeping all personal items separate. For mental well-being, it is important that every patient stays in touch with friends and family regularly through audio and visual calls. It will help to keep the spirits of everyone high, particularly the patient. Staying in touch can help reduce the stress of being in isolation and away from everyone. Many depressive and anxious mental states can be avoided by staying connected with family, friends, and colleagues. With the supportive therapy of analgesics and decongestants, many can continue with teleworking too.
For the more severely affected patients, inpatient management with hospitalization is advised by doctors. Severe symptoms indicating pneumonia, sepsis and septic shock, hypoxic respiratory failure, adult respiratory distress syndrome (ARDS), acute kidney disease, cardiomyopathy, and arrythmia need immediate hospitalization with intensive care. One should keep in mind that this does not come without risks. Prolonged hospitalization in turn can lead to further complications of secondary bacterial infections, thrombocytosis, and gastrointestinal bleeding.
Many patients expect the use of corticosteroids as the main course of action in the management of COVID-19. Corticosteroids are mainly used in inpatient supportive management of severe COVID-19 patients with complications. There has been documentation in the use of corticosteroids in China for some patients with COVID-19. However, benefits based upon controlled, observational data have not been established by the Centers for Disease Control (CDC).