Treatment

Treatment is essentially supportive and symptomatic.

The first step is to ensure adequate isolation to prevent transmission to other contacts, patients, and healthcare workers. Mild illness should be managed at home with counseling about danger signs. The usual principles are maintaining hydration and nutrition and controlling fever and cough. Routine use of antibiotics and antivirals such as oseltamivir should be avoided in confirmed cases. In hypoxic patients, provision of oxygen through nasal prongs, face mask, high flow nasal cannula (HFNC) or non-invasive ventilation and even extra corporeal membrane oxygen support may be needed. Renal replacement therapy may be needed in some cases too. Antibiotics and antifungals are required if co-infections are suspected or proven. The role of corticosteroids is unproven; while current international consensus and WHO advocate against their use, Chinese guidelines do recommend short term therapy with low-to-moderate dose corticosteroids in COVID-19 ARDS. Detailed guidelines for critical care management for COVID-19 have been published by the WHO. There is, as of now, no approved treatment for COVID-19. Antiviral drugs such as ribavirin, lopinavir-ritonavir have been used based on the experience with SARS and MERS. In a historical control study in patients with SARS, patients treated with lopinavir-ritonavir with ribavirin had better outcomes as compared to those given ribavirin alone.

In the case series of 99 hospitalized patients with COVID-19 infection from Wuhan, oxygen was given to 76% non-invasive ventilation in 13%, mechanical ventilation in 4%, extracorporeal membrane oxygenation (ECMO) in 3%, continuous renal replacement therapy (CRRT) in 9%, antibiotics in 71%, antifungals in 15%, glucocorticoids in 19% and intravenous immunoglobulin therapy in 27%. Antiviral therapy consisting of oseltamivir, ganciclovir and lopinavir-ritonavir was given to 75% of the patients. The duration of non-invasive ventilation was 4-22 days [median 9 days]. In the case series of children, all children recovered with basic treatment and did not need intensive care.

There is anecdotal experience with use of remdeswir, a broad spectrum anti RNA drug developed foe Ebola in management of COVID-19. More evidence is needed before these drugs are recommended. Other drugs proposed for therapy are arbidol (an antiviral drug available in Russia and China), intravenous immunoglobulin, interferons, chloroquine and plasma of patients recovered from COVID-19. Additionally, recommendations about using traditional Chinese herbs find place in the Chinese guidelines.