What is proper treatment for mild case of COVID-19?

DEAR DR. ROACH »

With cases rising and all the information about COVID-19 out there,

I have yet to read what should we be doing for people who have only a mild case. I know of three people in their late to mid20s who all tested positive and only had sinus issues and one had a sore throat. Could you please share what treatment they should be receiving, if any?

— M.W.

DEAR READER » Fortunately, most cases of COVID-19 are mild and will not require hospitalization. The range of symptoms is broad, including a large number of people who have no discernable symptoms at all, to the nasal and throat symptoms you describe, to gastrointestinal symptoms. However, the most common symptoms among those who will ever develop them are fever and cough, often with muscle aches or headaches. Shortness of breath is sometimes present; fatigue is sometimes overwhelming.

In people with newly diagnosed COVID-19 infection, it’s critical for the treating provider to assess risk for severe disease. This includes a review of underlying medical conditions that put a person at risk, especially being over age 65, obesity, chronic kidney disease, diabetes and immunosuppression due to disease or treatment. Any heart or lung disease should be considered a risk factor as well.

Oxygen level has proven to be a very useful tool for assessing risk. Many hospitals provide an oxygen meter for those diagnosed with COVID-19, and a level below 95% is an indication that the person needs a face-to-face evaluation. A high degree of shortness of breath is a powerful indicator of more severe disease, as is confusion or lethargy.

While there are established and emerging treatments for people hospitalized with COVID-19, there are few options for treatment beyond support for people with milder disease managed at home. One new treatment that was approved is called bamlanivimab. It is reserved for people with the risk conditions above and has been shown to reduce the risk of hospitalization. However, there is just not a lot of the drug available at the time of this writing, and most people with milder disease will not receive specific treatment. New treatments are being made available quickly, and it is possible something new will be available even before this is published.