Jordan Ellis
The SARS-CoV-2 virus causes COVID-19, which can cause a range of symptoms, from mild and cold-like to severe and life-threatening. While scientists have developed treatments and vaccines that have reduced hospitalizations, COVID-19 can still cause severe illness, long-term symptoms, and even death. Approximately 10% of infected individuals will require hospital admission due to COVID-19 pneumonia, and about 10% of those hospitalized will require intensive care, including mechanical ventilation. Treatments such as Paxlovid, remdesivir, and molnupiravir can help reduce the risk of hospitalization, while other interventions, such as JAK inhibitors, show little benefit. People experiencing long COVID are encouraged to seek care from medical providers, and several hospitals and research centers have set up special clinics and rehabilitation services for survivors.
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Antiviral medications
While COVID-19 vaccines are the primary method of preventing severe health outcomes, antiviral medications are also available to treat the illness. Antivirals can help patients feel better and reduce their risk of severe illness and long COVID when taken within the first five days of experiencing symptoms. The available antiviral treatments for COVID-19 include nirmatrelvir/ritonavir (Paxlovid®), remdesivir (Veklury®), and molnupiravir (Lagevrio™).
It is important to note that antiviral medications are not a replacement for vaccinations. Vaccines effectively protect people from getting seriously ill, being hospitalized, and even dying. However, people with weakened immune systems may require additional vaccine doses as they are at higher risk for severe COVID-19 and might have a decreased response to vaccination.
For those experiencing COVID-19 symptoms, it is recommended to seek testing and treatment right away, even if the symptoms are mild. This is because treatments are most effective when started within 5-7 days of developing symptoms. If symptoms persist for longer than four weeks and do not improve, it is advised to consult a healthcare provider.
While COVID-19 can cause mild, cold-like symptoms for some, it can also lead to severe illness, long-term symptoms, and even death. The risk of severe illness and hospitalization is significantly higher for older adults, especially those aged 65 and above, and individuals with underlying health conditions or comorbidities. Therefore, it is crucial to stay informed about the latest developments, practice preventive measures, and seek medical care when necessary to manage the impact of COVID-19 effectively.
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Vaccines
The CDC recommends that you stay up to date with your COVID-19 vaccinations. People with weakened immune systems who are at higher risk of severe COVID-19 and might have a decreased response to vaccination may require additional doses of the COVID-19 vaccine.
Medicare covers the updated (2024–2025 formula) Moderna, Pfizer-BioNTech, or Novavax COVID-19 vaccine for anyone who has Medicare. The updated 2024–2025 Pfizer-BioNTech or Moderna vaccine is available for people 5 and older. If you recently had COVID-19, the CDC recommends waiting at least 3 months before getting the updated COVID-19 vaccine.
OHSU, a healthcare provider, strongly recommends mask-wearing throughout its health care system, including at its hospitals and clinics. OHSU also highly recommends that all hospital patients wear masks when outside their rooms. Studies show that people are contagious starting two to three days before they have symptoms of COVID-19. On average, people are no longer contagious about a week after symptoms start.
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Intensive care
Patients in intensive care units (ICUs) for COVID-19 typically present with respiratory tract illness, which may include symptoms such as cough, fever, difficulty breathing, fatigue, and myalgia. In severe cases, viral pneumonia can develop, leading to acute respiratory distress and, in some cases, respiratory failure. Other complications that may arise include myocarditis, acute kidney injury, secondary infections, and sepsis/septic shock.
The management of critically ill COVID-19 patients in ICUs involves providing respiratory support and addressing any complications that arise. Oxygen therapy is often required, with target oxygen saturation between 92% and 96% in patients without chronic lung diseases. High-flow nasal cannula (HFNC) and long-term Continuous Positive Airway Pressure (CPAP) are recommended for patients who do not respond to conventional oxygen therapy.
In addition to respiratory support, experimental therapies and repurposed drugs have been used in intensive care settings for COVID-19. For example, the use of therapeutic plasma exchange and blood purification therapy have been explored as potential treatments. Steroids are also used to reduce inflammation, and antiviral medications, such as Remdesivir, are administered to stop the virus from multiplying.
Despite advancements in treatment protocols and the availability of novel therapeutics, the high mortality rate persists in unvaccinated critical COVID-19 patients. However, the overall COVID-19-related mortality has declined due to vaccination campaigns and a reduced incidence of critical cases.
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Invasive ventilation
In response to these concerns, the German Respiratory Society (DGP) has developed detailed recommendations advocating for the use of non-invasive ventilation (NIV) as a potential alternative to invasive ventilation. NIV methods such as Continuous Positive Airway Pressure (CPAP) and High Flow Nasal Oxygen (HFNO) have been shown to be effective in treating acute respiratory failure, reducing the need for invasive ventilation, and relieving pressure on intensive care services.
However, it is important to recognise that in certain cases, invasive ventilation can be lifesaving. The decision to utilise invasive ventilation should be made by medical professionals based on the patient's condition, with a stepwise treatment strategy that may include nasal high flow, non-invasive ventilation, and invasive ventilation under intensive care monitoring.
While the understanding of COVID-19 treatment has evolved, ongoing research and clinical trials continue to shape the approach to invasive ventilation. The RECOVERY-RS trial, for instance, has provided valuable insights into the effectiveness of CPAP in reducing the need for invasive ventilation in hospitalised COVID-19 patients with acute respiratory failure.
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Risk factors
Age: Older adults, especially those aged 50 and above, are at a higher risk of developing severe COVID-19. The risk increases substantially for individuals older than 65, with more than 81% of COVID-19 deaths occurring in this age group.
Underlying Medical Conditions: People with certain underlying medical conditions are more susceptible to severe COVID-19. These conditions include lung disease, heart disease, neurological disorders, genetic disorders, metabolic disorders, congenital heart disease, and a weakened immune system. Residents of long-term care facilities are also at increased risk.
Obesity: Individuals who are overweight or obese, particularly those with a high body mass index (BMI), are at a higher risk of severe illness from COVID-19.
Ethnicity and Race: Data from the CDC suggests that people from racial and ethnic minority groups, including American Indian, Alaska Native, Asian, Black, African-American, and Hispanic/Latino populations, are disproportionately affected by COVID-19. They are more likely to be hospitalized and die from COVID-19 at younger ages compared to non-Hispanic white individuals.
Vaccination Status: Unvaccinated individuals or those who are not up to date with COVID-19 vaccines, including recommended boosters, are at an increased risk of severe illness. Staying current with vaccinations can significantly reduce this risk.
Other factors such as smoking status, radiologic characteristics, and the presence of other comorbidities can also influence an individual's risk of severe COVID-19. It is important to note that the presence of multiple risk factors further increases the likelihood of severe outcomes.
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Frequently asked questions
Hospital treatment for COVID-19 depends on the severity of the illness and the patient's health condition. Medications can be used to treat the virus, reduce an overactive immune response, or treat complications. In some cases, patients may require intensive care, including invasive ventilation due to acute respiratory distress syndrome (ARDS).
Some antiviral medications used to treat COVID-19 include nirmatrelvir/ritonavir (Paxlovid), remdesivir (Veklury), and molnupiravir (Lagevrio). These medications can help reduce the risk of severe illness and long COVID if taken within the first five days of symptom onset.
The risk of severe COVID-19 requiring hospitalisation is higher for people who are unvaccinated, have certain medical conditions, are immunocompromised, or are over the age of 50. Getting vaccinated and staying up to date with recommended COVID-19 vaccinations can significantly reduce the risk of severe illness and hospitalisation. Additionally, practicing good hygiene, ensuring good ventilation indoors, and avoiding crowds can help prevent the spread of the virus and lower your chances of developing severe COVID-19.
