Supportive and symptomatic therapy in the treatment of Covid-19, in addition to the use of anti-viral.

Coronavirus is a microorganism that causes Covid-19 cases. The corona virus is a single, encapsulated, non-segmented RNA virus. Coronaviruses are classified as the order of nidovirales from the coronaviridae family.

4 genus corona virus :

• Alphacoronavirus.
• Betacoronavirus.
• Gammacoronavirus.
• Deltacoronavirus.

There are 7 types of coronavirus that can infect humans today :

• 2 types of Alphacoronavirus (229E and NL63).
• 4 types of Betacoronavirus (OC43, HKU1, MERS-Cov, SARS-Cov).
• Novel Coronavirus 2019 (2019-nCov).

Clinical manifestations :

• Uncomplicated illness ➡ Patients infected with Covid-19 have non-specific symptoms (fever, cough, sore throat, malaise, headache, muscle aches) but need to be aware of elderly patients > 60 years old or elderly patients with multiple diseases or disorders of organ function.
• Mild pneumonia.
• Severe pneumonia.
• Acute Respiratory Distress Syndrome (ARDS).
• Sepsis.
• Septic shock.

There are currently no specific treatment recommendations for Covid-19 patients and there is no specific treatment for anti-Covid-19.

➡ Supportive therapy in the form of oxygen supplementation therapy.

Indications for oxygen administration :

• Respiratory distress.
• Shock accompanied by desaturation.

Targeted oxygen supplementation therapy : oxygen levels greater than 94%.

• Giving oxygen can be started from 5 liters / minute, then slowly increased until the therapeutic target is reached.
• Conservative fluid therapy.
• Fluid resuscitation with crystalloids.

Close monitoring of patients with worsening clinical symptoms, such as:

• Breathing is failing.
• Sepsis. 

➡ Symptomatic therapy can be given antipyretic therapy.

Choice of fever medication for Covid-19 patients :

• Acetaminophen.

Theraphy empirical antibiotic :

• Azithromycin.
• Levofloxacin.

Although the patient is suspected of being infected with Covid-19, theraphy of appropriate empirical antibiotics must still be done within 1 hour after identification of the patient's sepsis. Empirical therapy is certainly based on microbiological data and clinical suspected data.

Empirical antibiotics must be based on clinical diagnosis, local microbial profiles, local epidemiology, resistance data and guidelines.

Pathogenic bacteria that cause :

• streptococcus pneumoniae.
• haemophilus influenzae.
• mycoplasma pneumoniae.
• staphylococcus aureus.
• chlamydia pneumoniae.

Theraphy of corticosteroids is still controversial for the treatment of Covid-19 patients, there are studies that show a decrease in mortality and treatment time in patients with critical SARS and the dose given to patients : methylprednisolone, 1 mg/kg, for 7 days.

Italy recommends giving dexamethasone to critical Covid-19 patients : a dose of 20 mg/day, for 5 days, followed by 10 mg/day, for the next 5 days.

But there are studies that do not recommend giving corticosteroids to Covid-19 patients because observational studies show no relationship with corticosteroids (virus incubation time, patient care time and duration of symptoms of Covid-19 patients).

A systematic study also states that corticosteroids cannot yet be of benefit or harm, but in patients who have experienced sepsis shock, steroids are indicated if :

• Giving of fluids, the administration of vasopressors, for example norepinephrine, fails to achieve stable himodynamics.
• The MAP target has not been reached. MAP recommendation limit of 65 mmHg.

The Indonesian Lung Doctors Association (PDPI) does not recommend systemic corticosteroids because the risks are greater than the benefits.

If a Covid-19 patient has been treated with Acute Respiratory Distress Syndrome (ARDS), corticosteroids are needed. ARDS Stage, namely :

• The lungs are filled with fluid.
• The patient has difficulty breathing.

Covid-19 therapy for patients treated in isolation rooms (only for doctors treating patients).

1. Oseltamivir 2 × 75 mg (5-10 days) and other antivirals for corona.
2. High doses of vitamin C for 14 days.
3. Antibiotics Azithromycin 1 × 500 mg (5-7 days) or Levofloxacin 1 × 750 mg (7 days).
4. Symptomatic therapy.
5. Hepatoprotector if SGOT / SGPT increases.
6. Corticosteroid therapy is not recommended.
7. Chloroquine phosphate 2 × 500 mg (5 days) can be added in severe cases.
8. Other drugs according to comorbidities.