Patients who are hospitalized and require invasive mechanical ventilation (IMV) and extracorporeal membrane oxygenation (ECMO) will need immune modulation with dexamethasone. Dr. Ostrosky-Zeichner acknowledged that other glucocorticoids would also likely be effective, but he noted that dexamethasone has demonstrated efficacy in clinical trials of COVID-19 patients.
According to Dr. Ostrosky-Zeichner, “thrombosis is part of the pathogenesis of this disease.” Patients should therefore be screened for venous thromboembolism. In addition, clinical trials are currently underway to examine the role of anticoagulation in non-hospitalized patients.
Pharmaceutical companies are also in the process of developing additional antivirals. For example, molnupiravir, developed by Merck would, if approved, be the first oral agent with an indication for the treatment of COVID-19. Pfizer also announced that it’s seeking emergency use authorization for an antiviral.
Long COVID
Dr. Ostrosky-Zeichner introduced the long-term effects of COVID-19, noting, “This is going to be a new branch of medicine.” These long-term effects include fatigue, neurological problems, gastrointestinal problems and brain fog, the last of which, he says, is present in 80% of patients with long COVID.4
In addition, many individuals are diagnosed with diabetes or vascular disease following SARS-CoV2 infection, suggesting these diagnoses may also be aspects of long COVID.
A multidisciplinary approach, such as they have at UTHealth, benefits patients with long COVID, said Dr. Ostrosky-Zeichner, because it includes a team of specialists and focuses on the whole patient. He emphasized the importance of having rheumatologists on the treatment team especially because patients may be diagnosed with reactive arthritis, fibromyalgia and connective tissue disease. He has also seen patients present with inflammatory arthritis flares after COVID-19.
Although the medical community still knows very little about long COVID, there is a bright spot: “Some early data indicate that people with long COVID symptoms tend to improve when they are vaccinated,” he said. “There appears to be a beneficial effect.”
Dr. Ostrosky-Zeichner concluded his presentation by calling for continued masking.
Lara C. Pullen, PhD, is a medical writer based in the Chicago area.
References
- Datta SD, Talwar A, Lee JT. A proposed framework and timeline of the spectrum of disease due to SARS-CoV-2 infection: Illness beyond acute infection and public health implications. JAMA. 2020 Nov 18;324(22):2251–2252.
- Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: A clinical–therapeutic staging proposal. J Heart Lung Transplant. 2020 May;39(5):405–407.
- COVID-19 Treatment Guidelines Panel. Coronavirus disease 2019 (COVID-19) treatment guidelines. National Institutes of Health. 2021 Oct 27.
- Lopez-Leon S, Wegman-Ostrosky T, Perlman C, et al. More than 50 long-term effects of COVID-19: A systematic review and meta-analysis. Sci Rep. 2021 Aug 9;11(1):16144.
