The COVID-19 Textbook

CHAPTER 15

Treatment of COVID-19 in Adults

Nikolaus Jilg • Adil Yunis • Christopher Newton-Cheh • Rajesh T. Gandhi

Introduction Therapeutic Research During a Pandemic Clinical Management of COVID-19 Initial Considerations Management of Acute COVID-19 Supportive Care

COVID-19 Pathogenesis and Therapeutic Options Pharmacologic Treatment Options for Nonhospitalized Patients With COVID-19 Pharmacologic Treatment Options for Hospitalized Patients With COVID-19 Management of Cardiac Complications Because of COVID-19 Management of Acute Kidney Failure Thromboembolism Prophylaxis Postacute Sequelae of SARS-CoV-2 Infection or Long COVID-19

INTRODUCTION COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in late 2019 and rapidly evolved into a global pandemic. Basic, translational, and clinical research have informed the development of novel drugs for the treatment of COVID-19. In addition, agents already in clinical use for other indications were studied for their potential role in treating COVID-19. In this chapter, we provide an overview of the evolving pharmacologic management of COVID-19. As therapeutic recommendations for COVID-19 change frequently, it is import ant to consult the latest guidelines when caring for patients. Here, we provide a framework for understanding the role of different therapeutic options and summarize the development of current management strategies. THERAPEUTIC RESEARCH DURING A PANDEMIC Development of successful therapies for COVID-19 happened at an unprecedented speed and re quired herculean efforts by clinical scientists, study participants, research organizations, foundations, the pharmaceutical industry, and governments. In the early months of the pandemic, there were massive obstacles to conducting clinical trials, including supply chain disruptions that hindered or prevented SARS-CoV-2 testing and led to shortages of personal protective equipment for healthcare workers and researchers; limitations on movement of study participants and investigators; and im mense clinical needs requiring academic medical centers and clinicians (including clinical scientists) to focus on clinical care in overcrowded hospitals. Conversely, there was a single-minded focus on

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