Let’s face it, COVID, with all its myriad variants we know and are yet to appear, is not going away any time soon.
Last year we thought the pandemic would wane with vaccination and prevention strategies. These have certainly helped but thanks to a highly transmissible Omicron variant, COVID-19 is reaching record highs as we enter 2022. More than 800,000 people have died in the United States, including more than 3,100 in Pima County, since we started counting. Treatment options vary according to the severity of disease, risk factors, while research continues into what is the best treatment and for whom. Medications and supportive care continue to be our mainstays and prevention should always be at the forefront.
Mild symptoms usually appear within two weeks of contracting the virus and can usually be treated at home. Cough, fever, shortness of breath, muscle aches, headache, sore throat and a loss of the senses of taste or smell are all symptoms (except for taste and smell loss) that can be attributed to influenza, so it is important to be tested. Rest, adequate fluids, cough suppressants, and fever reducers such as acetaminophen and ibuprofen should help to control symptoms. These symptoms may last up to three weeks but could resolve more quickly for some or worsen for others.
If you find it harder to breathe or experience pale skin, a higher fever or chest pains, or just become very sleepy, then an emergency is brewing and hospital care is warranted. These symptoms can worsen in a very short time so timely treatment is essential.
There are several medications that can treat COVID 19. Some viral infections (such as shingles and influenza) can be treated with drugs. Antivirals are not antibiotics, which treat bacterial infections and are not useful against viruses. Remdesivir is an intravenous medication that helps people hospitalized with COVID to recover faster. Dexamethasone is a steroid that reduces inflammation and suppresses parts of the immune system. It is used in patients on oxygen or on a ventilator. Inflammatory pathway inhibitors, also called immunomodulators, treat severe systemic inflammation. Inflammatory markers can get very high in people with severe COVID. Baricitinib and Sarilumab are examples of such medications and are used when a hospitalized patient needs high flow oxygen or a ventilator for breathing.
Monoclonal antibodies are “biologics,” manmade antibodies which inhibit the progression of some inflammatory diseases (such as rheumatoid arthritis) and cancer. Monoclonal antibodies can target the SARS-COV-2 virus and prevent a serious infection in people who have been exposed and would be likely to developing severe illness. This medication is considered “post exposure prophylaxis.” Those at risk include people with chronic medical conditions, the elderly, and the disabled.
This is an intravenous medication given in hospitals. With the demand for this therapy increasing, there will likely be a shortage so health care professionals will determine greatest need. Just last week, Banner Health announced a pause in monoclonal antibody treatment statewide and warned that when it resumed this week, it would be in limited supply.
Antibodies produced by people who have had COVID and recovered are called convalescent plasma. They are donated after recovery and these antibodies are then infused into hospitalized patients with impaired immunity in an effort to help the ill person’s immune system fight the virus.
Various pharmaceutical companies including Pfizer, Merck, and Roche are currently developing and testing oral medications that might reduce the risk of severe disease in people with mild or moderate COVID illness. These are antivirals that will target proteins specific to SARS-CoV-2. The most promising thus far is Paxlovid, by Pfizer and Roche together. It’s in clinical trials now and is showing an 89% reduction in the risk of hospitalization or death due to COVID.
Oxygen therapy is of critical importance in hospitalized COVID patients. Reduced lung function is a hallmark symptom and can lead to death since the body cannot get enough oxygen to maintain healthy tissues and organs. Supplemental oxygen can reduce shortness of breath, increase oxygen saturation and help recovery. In acute respiratory distress, patients may receive high flow or positive pressure oxygen. If that’s not enough, patients can be placed on ventilators. Supplemental oxygen is sometimes needed upon hospital discharge and this can be easily arranged and managed.
COVID-19 can be managed but there are no guarantees of an easy recovery. “Long COVID” symptoms such as fatigue, sensory loss, headaches, shortness of breath, cognitive impairment and muscle pain can persist for months upon initial symptom resolution.
As always, maintaining a healthy lifestyle helps to protect against many illnesses. Vaccination, masking in crowded places and reasonable physical distancing will help protect not only you but others from getting sick with COVID-19.