What do we know about treatment for people with COVID-19 infections who need to be hospitalized?


A: We are learning more and more as the pandemic continues, but there are still lots of questions.

For now, remdesivir appears to help you feel better faster (but maybe doesn’t help people live longer), corticosteroids for really sick people definitely help people live longer but aren’t useful for people with mild symptoms, tocilizumab is promising but not always available, and convalescent plasma needs to go back to the drawing board for more study.

The Infectious Diseases Society of America (IDSA) and the US National Institutes of Health (NIH) both have guidelines on treatment of #COVID-19 and weighed in. There is a lot of info on the websites, including evidence tables, summaries of relevant studies, and remaining questions. If you have some free time and love reading through treatment guidelines, check out the links below and live the nerdy dream!

➡️Remdesivir: This is an intravenous (IV) antiviral drug that works by keeping the virus from copying itself. It is the only drug approved by the US Food and Drug Administration (FDA) for the treatment of COVID-19 in hospitalized folks. Both the NIH and the IDSA currently recommend the use of #remdesivir for individuals who require oxygen treatment in the hospital. It appears to be less beneficial for people need a lot more help breathing. Remdesivir has been shown to shorten how long people in the hospital who need oxygen are sick, but not so much for other groups. It might also reduce the risk of needing to be intubated (a breathing tube inserted to help someone breathe). It probably doesn’t reduce the risk of death, but the trials did not have enough participants or deaths to know for sure. The treatment is 5 to 10 days, depending on how sick someone is.

➡️Corticosteroids: These types of steroid medicines help reduce inflammation and might prevent damage to lungs or other organs from a systemic inflammatory response to COVID-19 infection. Steroids are recommended by the IDSA and NIH for people who are hospitalized with severe or critical COVID-19. This includes people who need oxygen, intubation, intensive care stays, organ damage, or have sepsis. The most used steroid in the hospital is dexamethasone, but other steroids might be given. Corticosteroids reduce the risk of death for these patients (definitely something we would consider a patient-oriented outcome). Corticosteroids are not recommended for people who don’t need to be hospitalized or have mild illness. There is no evidence of any improvement for important outcomes for these folks.

➡️Tocilizumab: This is the new kid on the block. This is not approved or authorized by the FDA for treatment of COVID-19, but may be used “off-label.” Off label use is when a drug is given for a condition other than one it is approved for. #Tocilizumab is a monoclonal antibody treatment that is used for some autoimmune diseases. Interleuken-6 (IL-6) is a pro-inflammatory substance in the blood that is involved in the immune response. Tocilizumab inhibits IL-6 from binding its receptor and could potentially reduce the systemic inflammatory response. Some individuals with COVID-19 have a way too robust immune response that can damage organs like the lungs and kidneys, and the thought is that tocilizumab might lessen that response and limit organ damage. Based on two clinical trials, the IDSA and NIH both recommend tocilizumab in combination with corticosteroids for people who have severe COVID-19 and have high blood markers of inflammation. The two studies show a trend towards reduced mortality and a lower risk of getting even sicker. There are some important caveats to this one. It has been associated with developing holes in the intestines and liver damage. It cannot be given to people who have other infections or weakened immune systems. This is also not readily available everywhere.

➡️Convalescent plasma: This is plasma donated from people who have recovered from COVID-19 and may contain antibodies against the SARS-CoV-2 virus. Both IDSA and NIH feel there is not enough evidence to give this regularly and recommend using it only as a part of clinical trials. Despite lots of people already having received convalescent plasma through an Expanded Access Program (EAP), there are not well-designed trials to determine the safety or efficacy of this treatment. The EAP data suggests that plasma with higher amounts of antibodies might be more useful than plasma with lower antibody amounts, but there are no widely available or even agreed upon tests to measure for neutralizing antibodies in plasma. Several randomized clinical trials are underway, and we should have more answers soon.

➡️What about some things that don’t help? This includes hydroxychloroquine, antibiotics (if there are no bacterial infections complicating things), and famotidine (a medication commonly used to treat heartburn and ulcers). Vitamin or mineral supplements (like Vitamin C, D, or zinc) likely do not help but there is not enough evidence to be certain yet. These are not routinely given.

Don’t worry! We will have even more to come on treatment! Hold on to those hats and stay tuned!


NIH COVID-19 Treatment Guidelines

IDSA Guidelines on Treatment of COVID-19

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