From August 1, 2020:
A patient who is admitted to the hospital due to COVID-19 (not addressing admission of COVID-19+ patient admitted for an unrelated reason), is typically admitted due to a new supplemental oxygen requirement or increased work of breathing at rest. They are also typically given dexamethasone 6mg oral tablet daily due to the significant role that inflammation plays in the course of COVID-19. They receive albuterol inhaler treatments. Nebulizer treatments are avoided in an attempt to decrease the awrosolization of COVID-19. If a patient is requiring between 4 and 8 liters of supplemental oxygen via nasal cannula, then remdesivir or convalescent plasma should be considered. There are other criteria for consideration of remdesivir, such as number of days since onset of symptoms, renal function, and hepatic function. Convalescent plasma may be a good option if renal function is a limiting factor when it comes to using remdesivir.
What about when the patient still is not improving? I have been adding Dulera. Dulera is an inhaled corticosteroid, so based on what was previously mentioned in regards to dexamethasone, it makes sense. I have had some patients who cannot tolerate the dexamethasone, but make fairly rapid improvement once taken off the dexamethasone and started on Dulera.
Addendum: The above was written August 1, 2020. Since that time, Remdesivir is now more readily available and there are less restrictive requirements for use. It is now also easier to obtain convalescent plasma, although supply is still limited.
Skewed-Up 