Although the potentially deadly nature of the novel coronavirus SARS-CoV-2, commonly known as COVID-19, is no secret, the unknowns that surround the disease are many. Because of its novel nature, there are a lot of blanks left to fill in -- What are the long term effects of the virus? Can one re-contract the disease if they’ve already been infected? Is there a second wave coming? What do I do if I, or someone I’ve been in contact with, tests positive? While we’ve tackled some of these questions in previous posts, one we haven’t taken a look at yet is what hospitalization and treatment looks like for those suffering from severe cases of the virus.
For many who are infected, the symptoms of COVID-19 are rather mild, resembling those of the flu. They include a fever, headaches, nausea, loss of smell or taste, congestion, sore throat, and a cough. Most people who experience these symptoms will be able to recover at home by isolating, hydrating, resting, and weathering out the storm of the illness in solitude. But the disease manifests in differing levels of severity, especially for those who have underlying conditions or are older than 65. Symptoms such as fever, cough, and shortness of breath are more often reported in serious cases, while achy joints and muscles, fatigue, sore throat, and congestion are the most often reported symptoms for milder cases of the disease, as well as gastrointestinal symptoms such as nausea, vomiting, and diarrhea. In nearly all cases, children present symptoms with much milder symptoms than adults. Some studies also indicate a delayed display of symptoms, or that some of those infected are entirely asymptomatic, meaning that they never develop symptoms. Most transmissions of the disease take place while the infected persons are pre-symptomatic or asymptomatic.
Symptoms are classified into three categories: mild to moderate, which makes up 81% of cases; severe, presented in 14% of infected persons and characterized as lung involvement being >50%; and critical, making up 5% of cases, which means respiratory system and multi organ system failure. Clinical cases are the ones that are most often fatal. It is important to note that while age and underlying conditions do seem to have some correlation with the severity of the symptoms presented in infected persons,that does NOT mean that a healthy person cannot have a critical case of COVID-19. Many aspects of the disease are not yet understood, and youth and health do NOT guarantee invincibility.
Those infected should be in contact with their doctor as soon as they present symptoms of the virus, and should follow medical advice. However, one should seek urgent care or go to the emergency room if they begin experiencing a serious shortness or shallowness of breath and increased difficulty breathing. 911 should be called if this becomes increasingly serious and the infected person is unable to take in oxygen, is turning blue or suffocating, or is unable to be woken.
If hospitalization occurs, the most common course of treatment for severe cases is to first take chest radiographs and use other imaging techniques to determine the physiological severity of the case. Then, the investigational antiviral agent remdesivir is recommended for treatment for
patients whose symptoms are severe enough that additional oxygen must be administered. Remdesivir is also recommended for those who are on mechanical ventilation or extracorporeal membrane oxygenation (ECMO). Those who are not intubated are treated with 5 days of the drug. The use of chloroquine or hydroxychloroquine is strongly advised against, unless used in the cases of clinical trials. For clinical cases, intubation and ventilation will likely be required in addition to the administration of remdesivir.
Since severe to critical cases of SARS-CoV-2 involve a typically total respiratory tract infection (meaning it infects the throat, sinuses, and lungs), which means that the respiratory tract becomes inflamed and the lungs may fill with fluid, causing extreme chest pain, difficulty breathing, and lack of oxygen. Remdesivir, an antiviral drug created to fight the Ebola virus, has been approved for use on hospitalized patients and in clinical trials. The drug is shown to have inhibitory effects on the virus, and may help those hospitalized recover up to 31% faster. However, so much is unknown about the drug that it is not yet safe to administer to all cases of COVID-19, and its use should be preserved for severe cases. Other treatment options being explored experimentally include the use of the drug tocilizumab, a medication used to treat some autoimmune disorders, and plasma transplants to promote the building of immunity. This procedure is called, “convalescent plasma.” While chloroquine or hydroxychloroquine have also been explored as viable treatment options since they’re used to treat malaria, as well as other autoimmune conditions like rheumatoid arthritis and lupus, they are no longer part of the recommended course of treatment, as they were shown to be ineffective in clinical trials and the risks outweigh the benefits of their use.
The overall recovery rate of the virus is estimated to be between 97-99%, but the varying degrees of severity and overall number of unknowns we are as of yet unable to account for makes these numbers no more than mere estimates. Such variation also precludes a discussion of average success rates of treatments, or time spent in hospitals.
As always, the greatest way to protect yourself and your loved ones is via the use of masks, especially N95 masks with filters, and other PPE, as well as adhering to social distancing protocols in your area.