Currently only a few treatments available help mildly ill patients – people who have COVID-19 who do not require admission to hospital. Drugs like azithromycin, bamlanivimab, colchicine, hydroxychloroquine, ivermectin, lopinavir-ritonavir, and vitamin D do not help patients with COVID-19, and may cause harm.
Dexamethasone, a steroid that can be given in pill form, may benefit patients who are at home but need supplemental oxygen, but does not help patients who are mildly ill who do not need supplemental oxygen.
Budesonide, a steroid that can be inhaled (from a “puffer”), has no effect on whether patients with mild COVID-19 get sicker, are hospitalized, or die. But there is weak evidence that inhaled budesonide 800 mcg twice daily for 14 days may make patients feel better a few days earlier, so doctors may consider prescribing it.
These consolidated guidelines for the prevention, control and management COVID-19 in Kenya provide updated recommendations for comprehensive prevention and case management strategies in Kenya. They cover infection prevention and control measures including the use of vaccines. They also target the diagnosis and case management of COVID-19.
Patients who are assessed by a Health Care Worker and meet all the criteria below will be considered for home-based isolation and care:
- Laboratory confirmed COVID-19
- Asymptomatic patients or patients with mild symptoms of COVID-19
- Absence of comorbidities
- Access to a suitable space for home-based isolation and care
As the COVID‐19 pandemic continues to unfold here in Kenya, more and more patients are requiring oxygen. To increase the capacity of healthcare facilities to provide oxygen to more patients, we have installed Oxygen Gas Manifolds in the emergency departments at the county referral hospitals in Machakos, Kiambu (COVID-19 isolation centre) and Kajiado counties and at the Alupe Sub-County Hospital COVID-19 isolation centre in Busia county. These are the hardest hit counties at the moment and we continue to seek additional support to support more facilities.
The findings of this well done randomized controlled trial indicate that in patients with COVID-19 pneumonia, that dexamethasone improves 28d mortality compared to placebo in patients requiring invasive mechanical ventilation (IMV) (NNT = 8.5) and those patients requiring oxygen therapy (NNT = 29). There was no benefit to patients not requiring oxygenation support and even a signal for harm. It is important to remember this is a preprint, preliminary report, which is better than a press release. At this time, in patients requiring any oxygen therapy, HFNC, NIV, IMV, or ECMO I would recommend dexamethasone until further evidence disproves this benefit.