How Hospitals Treat COVID-19 Patients
COVID-19 is the disease caused by the novel coronavirus, SARS-CoV-2. Symptoms include fever, cough, fatigue, shortness of breath, lack of appetite, loss of taste or smell, and diarrhea. Most people who develop COVID-19 have mild symptoms that can (and should) be managed at home. However, some people with COVID-19 develop serious illness and require hospital care. About 25 to 33% of those who are hospitalized need intensive care, but most people who are hospitalized for COVID-19 recover.
Unfortunately, there is no known cure for COVID-19. Scientists and physicians are still searching for effective treatments, but there are some promising therapies currently in use for severely ill COVID-19 patients.
A person who is persistently short of breath may need hospital care. Shortness of breath indicates the lungs are not delivering enough oxygen to the rest of the body; without treatment, oxygen levels may fall and cause organ failure.
Because there is no cure for COVID-19 at this time, hospital care for coronavirus focuses on what’s called supportive care, or treatment to support the body’s vital organs. Doctors, nurses and others will monitor oxygen levels and provide treatment to maintain a healthy supply of oxygen to the rest of the body. Some patients need only a nasal cannula, a tube that’s placed in the nostrils to deliver oxygen. Other patients require an oxygen mask, which can deliver high concentrations of oxygen.
Hospital staff monitor patients’ vital signs (heart rate, blood pressure, number of breaths per minute) to watch for any developing problems. A patient whose heart rate increases as their blood pressure decreases could be experiencing heart trouble; staff will likely run tests and administer IV (intravenous) fluids and medicine to support the heart’s function.
Some patients will be able to eat and drink normally; others are too sick to do so. If needed, hospital staff can deliver nutrition directly into patients’ veins via an IV.
Up until November 2020, there were no FDA-approved treatments specifically for COVID-19. Since then, the FDA has authorized monoclonal antibody drugs—bamlanivimab; combination bamlanivimab and etesevimab; and combination casirivimab and imdevimab—that target the virus's spike protein. Clinical studies show the antibodies can reduce emergency room visits and hospitalizations in patients with mild to moderate COVID-19. Emergency use authorization (EUA) of the antibodies is for patients with mild-to-moderate COVID-19 who are at high risk for developing severe COVID-19.
Some existing drugs may help hospitalized patients with COVID-19, so doctors are using a variety of treatments. Patients may receive the following drugs:
- Antibiotics. COVID-19 is caused by a virus, so antibiotics—which kill bacteria, not viruses—cannot cure the disease. Interestingly, some antibiotics like azithromycin (Zithromax) exhibit antiviral properties. Equally important, some patients with COVID-19 also develop bacteria-caused infections. Treating these infections with antibiotics can ease the overall strain on the body.
- Antiviral drugs. Remdesivir (Veklury), an antiviral drug that can kill SARS-CoV-2 in a petri dish under experimental conditions, was given EUA by the FDA in May and normal FDA approval in October. It is approved for hospitalized patients 12 and older, even if they are not enrolled in clinical trials. A clinical trial of another antiviral drug, EIDD-2801, began in late April 2020.
- Steroids. Oxford University found that treating patients on ventilators with the steroid dexamethasone improved outcomes—reducing deaths by up to a third. Dexamethasone—an inexpensive and readily available drug—also reduced the death rate for patients receiving supplemental oxygen (one-fifth fewer deaths), but had no effect on hospitalized patients who did not need either of these therapies. The World Health Organization's guideline is to administer a 7 to 10 course of dexamethasone to patients with severe or critical COVID-19.
- Convalescent plasma. In 2020, the FDA began allowing doctors to collect “convalescent plasma” from the blood of recovered patients; this plasma was then administered to sick patients via IV infusion. U.S. clinical trials have thus far not provided conclusive evidence that convalescent therapy is more effective than the standard of care for patients with moderate, severe or critical COVID-19. Under its EUA, doctors can administer antibody-rich convalescent plasma to hospitalized patients early in the course of the disease, in an attempt to prevent progression of the disease and the need for mechanical ventilation.
- DMARDS (disease-modifying antirheumatic drugs). Clinical trials are underway to test the effect of drugs currently prescribed to suppress the immune system, in the hopes of tamping down widespread inflammation that occurs in severely ill patients. Guidelines include administering a combination of tocilizumab (Actemra) with dexamethasone to patients whose oxygen levels are rapidly declining.
For information about all COVID-19 clinical trials, visit clinicaltrials.gov and enter 'COVID' in the condition field.
Caution About Drugs Not Approved or Authorized by the FDA
Early research from China suggested the malaria drugs, hydroxychloroquine (HCQ) and chloroquine (CQ), might be effective in treating COVID-19. In some cases, they seemed to help; in others, there was no positive effect. Early in the pandemic, the FDA granted emergency use authorized (EUA) for HCQ, but later withdrew it because mounting evidence showed the drugs "are unlikely to be effective in treating COVID-19 for the authorized uses in the EUA." HCQ and CQ have serious side effects, including irregular heart rhythms and death.
The FDA has received reports of people taking ivermectin for COVID-19. This drug is not authorized or approved for use in people for treating COVID-19. It's most common use in the U.S. is to treat and prevent parasitic worm infections in animals. In humans, ivermectin tablets are approved for treating the parasitic worm infections strongyloidiasis and onchocerciasis; topical forms treat head lice and rosacea. Ivermectin for horses is not the same as ivermectin for humans. People who have taken ivermectin meant for horses have become very ill. If you have an ivermectin prescription for an FDA-approved use, get it from a reputable source and take it as prescribed. The FDA has not reviewed the data to support the use of ivermectin for COVID-19, but the FDA website states that "initial research is underway."
If a patient’s condition worsens despite supportive hospital care, the patient may be transferred to the intensive care unit (ICU). Patients in the ICU are monitored even more closely than other hospitalized patients; usually, an ICU nurse only cares for 1 to 2 patients per shift.
If the patient cannot breathe effectively, doctors may recommend intubation—placing a breathing tube in the patient’s airway—and ventilator treatment. A ventilator forces air and oxygen into the lungs. Critical care providers administer drugs so the patient remains sleepy and comfortable. If the patient’s condition improves, the healthcare team will gradually wean the patient off the ventilator.
Hospitalization for coronavirus may be a week or longer. According to the CDC (U.S. Centers for Disease Control and Prevention), the average length of hospitalization for survivors is 10 to 13 days. It is difficult to predict what will happen during coronavirus hospitalization. The healthcare team will do their best to keep you informed at all times.