Risk-adapted Treatment Strategy For COVID-19 Patients

[Md. Sumon-ul Islam]

Risk-adapted treatment
Risk-adapted treatment approaches were adopted for these patients. For mild COVID-19 patients, intermitted low-flow oxygen therapy (≤3 L/min) and antiviral treatment with one of the oral antiviral regimens (such as arbidol tablets, 200 mg three times daily) are given. For moderate COVID-19 patients, continuous middle-flow oxygen therapy (3∼ 5 L/min), triple antiviral treatment of an oral antiviral regimen, ribavirin (500 mg every 12 h, intravenously) and recombinant interferon-α2b (5 million units twice daily, aerosol) are given. Traditional Chinese medicine (TCM) is also recommended for mild or moderate COVID-19 patients. For severe COVID-19 patients, the treatment approach is comprised of oxygen support including mask oxygen(＞5 L/min), high flow nasal oxygen therapy (HFNO), or non-invasive ventilation (NIV); triple antiviral treatment including an oral antiviral regimen, ribavirin and recombinant interferon-α2b (usage and dosage same as above). The recommended duration of antiviral treatment is 10 days. For severe patients, corticosteroid (methylprednisolone 0.5mg∼1 mg/kg.d×5 days) should be given immediately on admission or within the first three days of hospitalization. Empirical antibiotic treatment is considered for all types if bacteria infection was suspected. Treatment-failure patients should be prepared early for intubation and invasive mechanical ventilation, and even considered with extracorporeal membrane oxygenation (ECMO) (MacLaren et al., 2020).
Statistical methods
Variables of clinical characteristics, laboratory parameters, treatment approaches, and clinical outcomes, such as categorical variables were measured using the χ2 test, and continuous variables were measured using the Mann-Whitney U test between non-severe group (including mild and moderate patients ) and severe group. Statistical analyses were conducted using R statistical software (R Foundation for Statistical Computing, Version 3.4.3). Differences with р< 0.05 were considered significant.
Results
This study includes 55 hospitalized patients with confirmed COVID-19 including 12 patients in mild group and 22 in the moderate group (non-severe group, n = 34), and 21 patients were in severe group (table1). The median age was 59(29-77) years in the non-severe group and 62(29-91) years in severe group (p = 0.37). There are 47.1%(n = 16) male patients in the non-severe group and 38.1% (n =  in a severe group (p = 0.58). The most common symptoms at the onset of illness were fever (26[76.5%] in the non-severe group and 19[90.5%] in severe group) and cough (13[38.2%] in a non-severe group and 11[52.4%] in severe group). The median Days from onset of symptoms to hospital presentation were 11(3-40) in the non-severe group and 10(1-30) in a severe group (p = 0.89).

Source: https://www.ijidonline.com/article/S1201-9712(20)30179-X/fulltext#tbl0005