Since the beginning of the pandemic with covid-19, We have learned a lot regarding prevention and treatment. However, the knowledge Gap exists. Recent JAMA editorial summarized this for severe covid-19.
Social distancing, frequent hand washing and mask wearing by the general public reduces the transmission of covid 19. Contact tracing and isolation are the next public implemented successfully in various countries.
So far no effective therapy in preventing progression from mild to severe disease.
- Non invasive ventilation for patients with COVID-19, including high-flow nasal cannula oxygen therapy works well as with any other ARDS.
- Low tidal volumes of 4- to 8-cc/kg predicted body weight and limiting plateau pressure to 30 cm H2O or less.
- Sedation and analgesia should be provided at the minimum level required to promote patient comfort and ventilator synchrony. Neuromuscular blockade (with deeper sedation) can be used
- Conservative strategy for the administration of fluids, including aggressive diuresis, if needed, once patients are out of shock (ie, off vasopressors).
- Prone positioning for P/F ratio less than 150 unless contraindicated by severe
hemodynamic instability, pregnancy, open abdomen, or other reasons.
- Venovenous extracorporeal membrane oxygenation should be considered if severe gas exchange abnormalities (eg, profound hypoxemia, severe respiratory acidosis) persist despite standard
interventions, including prone positioning.
- Remdesivir has shown to reduce the duration of illness.
- Dexamethasone showed survival benefit in patients with COVID- 19 who require oxygen or mechanical ventilation. Other corticosteroids have also shown benefit in patients with severe COVID.
- Distinct pathways of injury due to SARS COV 2
- Ongoing trials are testing a variety of therapies, including aggressive anticoagulation, convalescentplasma, monoclonalantibodies, and additional immunomodulatory agents.
- Long-term sequelae of the disease
More recent data shows outcomes more typical for patients with ARDS, with hospital mortality of 30% to 40%.
For COVID-19, scientists believe between 60% and 70% of the population may need to become immune before herd immunity is reached. That means, around 3 million deaths in USA.
For patients with severe Covid, british researchers have developed a calculator called 4C. Can be assessed here-