Managing the supportive care needs of those affected by COVID-19

Bajwah, Sabrina; Wilcock, Andrew; Towers, Richard P; Costantini, Massimo; Bausewein, Claudia; Simon, Steffen T.; Bendstrup, Elisabeth; Prentice, Wendy; Johnson, Miriam J.; Currow, David C.; Kreuter, Michael; Wells, Adrian; Birring, Surinder S.; Edmonds, Polly; Higginson, Irene J

doi:10.1183/13993003.00815-2020

Cited by 113 publications

(139 citation statements)

References 26 publications

(18 reference statements)

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“…A report of 6801 patients who died with covid-19 in Italy found that the median time from onset of symptoms to hospitalisation was five days, and from onset of symptoms to death was nine days 7. Therefore, an anticipatory approach to symptom management for people with severe covid-19 is key 8…”

Section: Symptoms In Patients With Severe Covid-19mentioning

confidence: 99%

Palliative care for patients with severe covid-19

Ting

Edmonds

Higginson

et al. 2020

BMJ

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Section: Symptoms In Patients With Severe Covid-19mentioning

confidence: 99%

Palliative care for patients with severe covid-19

Ting

Edmonds

Higginson

et al. 2020

BMJ

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“…Mildly symptomatic Covid-19 is a self-limiting illness and management consists of supportive care with rest, fluids, and antipyretics combined with close monitoring for clinical deterioration [ 83 ]. There is no safe, effective and proven treatment at this time.…”

Section: Managementmentioning

confidence: 99%

A Telemedicine Approach to Covid-19 Assessment and Triage

et al. 2020

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Covid-19 is a new highly contagious RNA viral disease that has caused a global pandemic. Human-to-human transmission occurs primarily through oral and nasal droplets and possibly through the airborne route. The disease may be asymptomatic or the course may be mild with upper respiratory symptoms, moderate with non-life-threatening pneumonia, or severe with pneumonia and acute respiratory distress syndrome. The severe form is associated with significant morbidity and mortality. While patients who are unstable and in acute distress need immediate in-person attention, many patients can be evaluated at home by telemedicine or videoconferencing. The more benign manifestations of Covid-19 may be managed from home to maintain quarantine, thus avoiding spread to other patients and health care workers. This document provides an overview of the clinical presentation of Covid-19, emphasizing telemedicine strategies for assessment and triage of patients. Advantages of the virtual visit during this time of social distancing are highlighted.

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“…While > 80% of infected patients experience only mild illness [ 1 ], mortality rates of Coronavirus Disease 2019 (COVID-19) have been estimated to be 5–27% [ 2 , 3 ] in vulnerable populations, including older adults and patients with multiple co-morbidities [ 4 , 5 ]. For patients with mild disease, supportive care has been the preferred management strategy [ 6 ]; pharmacological treatments with possible anti-viral effects have been primarily used for patients with moderate-to-severe disease [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Pharmacotherapy for Hospitalized Patients with COVID-19: Treatment Patterns by Disease Severity

Lin

Schneeweiß

Tesfaye

et al. 2020

Drugs

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Background Treatment decisions for Coronavirus Disease 2019 (COVID-19) depend on disease severity, but the prescribing pattern by severity and drivers of therapeutic choices remain unclear. Objectives The objectives of the study were to evaluate pharmacological treatment patterns by COVID-19 severity and identify the determinants of prescribing for COVID-19. Methods Using electronic health record data from a large Massachusetts-based healthcare system, we identified all patients aged ≥ 18 years hospitalized with laboratory-confirmed COVID-19 from 1 March to 24 May, 2020. We defined five levels of COVID-19 severity at hospital admission: (1) hospitalized but not requiring supplemental oxygen; (2–4) hospitalized and requiring oxygen ≤ 2, 3–4, and ≥ 5 L per minute, respectively; and (5) intubated or admitted to an intensive care unit. We assessed the medications used to treat COVID-19 or as supportive care during hospitalization. Results Among 2821 patients hospitalized for COVID-19, we found inpatient mortality increased by severity from 5% for level 1 to 23% for level 5. As compared to patients with severity level 1, those with severity level 5 were 3.53 times (95% confidence interval 2.73–4.57) more likely to receive a medication used to treat COVID-19. Other predictors of treatment were fever, low oxygen saturation, presence of co-morbidities, and elevated inflammatory biomarkers. The use of most COVID-19 relevant medications has dropped substantially while the use of remdesivir and therapeutic anticoagulants has increased over the study period. Conclusions Careful consideration of disease severity and other determinants of COVID-19 drug use is necessary for appropriate conduct and interpretation of non-randomized studies evaluating outcomes of COVID-19 treatments. Electronic supplementary material The online version of this article (10.1007/s40265-020-01424-7) contains supplementary material, which is available to authorized users.

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Managing the supportive care needs of those affected by COVID-19

Cited by 113 publications

References 26 publications

Palliative care for patients with severe covid-19

Palliative care for patients with severe covid-19

A Telemedicine Approach to Covid-19 Assessment and Triage

Pharmacotherapy for Hospitalized Patients with COVID-19: Treatment Patterns by Disease Severity

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