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 we should be doing for people who have only a mild case. I know of three people in their late to mid-20s 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. ANSWER: 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 COVID19 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 COVID19, 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.

DEAR DR. ROACH: I’m 85 and had been taking my blood pressure medicine in the morning for probably 25 years. I take metoprolol, losartan and a water pill. Lately I’ve been reading that I should take this medicine at night, so that we will be better protected against heart attacks and strokes when we wake up in the morning, when most of them occur. Since I started taking my medicine at night, my readings have been wonderful — for example, 117/70 at the doc’s office! To my surprise, my heart doctor told me to return to taking my meds in the morning because she doesn’t agree with the new suggestions. What is your opinion?

— Anon.

ANSWER: A study from Spain in 2019 showed a surprisingly large benefit to taking blood pressure medications at night. People who did had a lower risk of heart attack and stroke. The difference was so large that some experts have difficulty believing how important the time of day was. While waiting for confirmation, however, I have told my patients to take all blood pressure medication at night; however, some people find taking a diuretic (“water pill”) at nighttime problematic.