What Should You Do For A Mild Case of COVID-19?
So, you, or someone in your household, has a flu-like or pneumonia-like illness that you suspect is COVID-19. What can you do to increase your chances of getting well, and decrease your chances of getting sick enough to need a hospital?
This document doesn’t actually have a lot of answers.
For respiratory infections not severe enough to need hospitalization, most medical guidelines advise identifying the pathogen, prescribing antivirals or antibiotics effective against that pathogen (we don’t know that much yet about which ones work for COVID-19), and otherwise practicing “supportive care” – rest, fluids, treating symptoms, avoiding infecting others.
Supportive care often isn’t specified in studies, which is annoying, because it means we don’t have data on the effectiveness or potential disadvantages of over-the-counter medications to treat symptoms like fever and cough.
For the purposes of this document, I am restricting attention to studies and reports of human subjects – no animal or in-vitro evidence – but I am including correlational evidence or even case reports, and I am including evidence from other diseases than COVID-19 where it seems that the result could translate.
(For instance, I’m not including all the evidence about oseltamivir (Tamiflu) being effective against influenza, because it doesn’t seem to help with COVID-19; but I am including evidence about N-acetylcysteine preventing and reducing the severity of influenza, because NAC seems to work by generic immune-stimulatory effects rather than an effect specific to a particular virus.)
It’s important to get tested by a doctor if you have a respiratory illness you think is COVID-19. Even if you can’t get access to a COVID-19 test, you might also have a different bacterial or viral infection (either instead of or in addition to COVID-19) which is treatable by antivirals or antibiotics. It’s very common for viral pneumonia to be complicated by an opportunistic bacterial infection, and killing the bacteria can help improve outcomes.
Symptoms of Mild COVID-19
The most common symptoms of mild COVID-19 are fever, cough, fatigue and muscle pain, and headache. Other symptoms include sore throat, difficulty breathing, diarrhea, chest tightness, fear of cold, and sputum production. Rash on the limbs is also possible.
Rest and Fluids
Just like with any mild illness, public health departments are advising patients who have mild COVID-19 to get rest and drink fluids.
I couldn’t find experimental evidence for this but it makes sense and can’t hurt.
The WHO’s recommendations for home care for mild COVID-19 cases are primarily about avoiding infection for caregivers; patients should be in their own, well-ventilated room if possible, caregivers should wear masks and clean & disinfect surfaces daily, etc. There is no mention of how to optimize for recovery of the patient.
France’s health minister has counseled patients with mild COVID-19 not to use ibuprofen or other NSAIDs to treat symptoms, after four young patients with the disease developed severe symptoms after using NSAIDs. Patients were advised to take paracetamol instead.
Corticosteroids were associated with increased mortality and viral shedding in H1N1 viral pneumonia. Corticosteroids increased viral load in SARS.
In an open-label study, COVID-19 patients who took favipiravir had on average a shorter course of disease (4 days vs 12 days, p < 0.001) than those who took a combination of lopinavir and ritonavir. All patients in the study also received interferon-alpha1b by aerosol inhalation, rehydration, electrolytes, antipyretics, analgesics, and antiemetics.
Hydroxychloroquine and Azithromycin
In a non-randomized study of 36 patients with COVID-19 treated with placebo, hydroxychloroquine, or hydroxychloroquine + azithromycin, hydroxychloroquine had a significantly higher rate of virological cure (p < 0.001) than placebo. By day 6, 70% of hydroxychloroquine patients were cured, compared to 20% with placebo. With azithromycin + hydroxychloroquine, 100% of patients were cured by day 5.
However, a Chinese study (reported by Bloomberg  because it’s in Chinese) of 30 patients given hydroxychloroquine or placebo found no difference in the rate of cure between the two groups.
In a randomized trial of 262 elderly patients, assigned to N-acetylcysteine or placebo for 6 months, NAC significantly (p<0.01) reduced the incidence of influenza-like episodes, and significantly (p < 0.001) reduced the incidence of headache, muscle soreness, sore throat, and cough. In the NAC group, 25% of serologically confirmed H1N1 influenza cases were symptomatic, compared to 79% in the placebo group.
In a retrospective study in Utah hospitals, high concentrations of particulate matter in the air were associated with slightly but significantly higher (OR = 1.004) rates of admission to the emergency room for pneumonia, and slightly (OR = 1.02) but significantly higher rates of pneumonia mortality.
Having air filters in the home may be slightly protective.
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