Treatment

NIH Updates COVID-19 Treatment Guidelines

The National Institutes of Health (NIH) has updated its COVID-19 treatment guidelines.

Specific areas of modification include new sections on recommendations for treatment based on the severity of disease and considerations for patients with human immunodeficiency virus (HIV). Research on presentations of symptoms after recovery from COVID-19 infection and guidance to critical care workers for treating critically ill patients with COVID-19 are among the key updates noted in this revision.

Among the October 2020 updates made by the COVID-19 Treatment Guidelines Panel:

  • For patients with COVID-19 who are not hospitalized or hospitalized without the use of supplemental oxygen, no particular antiviral or immunomodulatory therapy treatment is recommended. However, dexamethasone should not be used in these patients.
  • In patients who are hospitalized and who require supplemental oxygen, remdesivir is recommended for use alone or in addition to dexamethasone.
  • Dexamethasone is recommended in patients who are hospitalized and require oxygen delivery through high-flow devices or noninvasive ventilation, as well as in patients requiring invasive mechanical ventilation.  
  • While triage, management, and treatment of COVID-19 for people with HIV is encouraged to be the same as for the general population, the Panel recommends continuing antiretroviral therapy and prophylaxis for opportunistic infections in patients with HIV, when possible.
  • Despite the severity of the initial COVID-19 infection, persistent symptoms following recovery may occur. These symptoms include fatigue, joint pain, chest pain, palpitations, shortness of breath, and worsened quality of life. For up to 3 months following a COVID-19 diagnosis, patients may continue to experience headaches, vision changes, hearing loss, loss of taste or smell, memory loss, and cognitive impairment. The Panel calls for further research to understand the relationship and identify management strategies.
  • The guidelines note that there is limited knowledge on how treatment should differ between critically ill patients, and critically ill patients with COVID-19. Healthcare providers should make considerations for Post-Intensive Care Syndrome, which is a spectrum of cognitive, psychiatric, and/or physical disability that affects survivors of critical illness and persists after a patient leaves the ICU.

 

“The COVID-19 Treatment Guidelines have been developed to inform clinicians how to care for patients with COVID-19. Because clinical information about the optimal management of COVID-19 is evolving quickly, these Guidelines will be updated frequently as published data and other authoritative information becomes available,” the authors note. 

 

—Leigh Precopio

 

Reference:

National Institutes of Health. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. Updated October 9, 2020. Accessed October 13, 2020. http://www.covid19treatmentguidelines.nih.gov/