Часто задаваемые вопросы о методах лечения COVID-19
<strong>Программа лечения COVID-19 и гриппа с антивирусными средствами для домашнего тестирования</strong>
Провал медицинской системы: что произошло с тем, что вводило панический режим в штаты
В начале февраля Министерство здравоохранения и социальных услуг США объявило о продлении режима чрезвычайной ситуации (РЧС) последний раз и сказало, что после этого разрешит ему истечь 11 мая. Это означает немедленное завершение некоторых программ и действий; другие будут постепенно закрываться, а некоторые останутся.
Другое изменение: Центры по контролю и профилактике заболеваний США потеряют доступ к части данных, которые они использовали для оценки тяжести пандемии и направления своих рекомендаций по общественному здравоохранению.
Но Валенски, которая уходит в отставку в конце июня, подчеркнула, что Центр по контролю и профилактике заболеваний не меняет темп, с которым мы работаем над разрешением этой чрезвычайной ситуации в области общественного здравоохранения.
Агенство, сказала она, будет внимательно следить за этим вирусом по всей стране, используя более новые подходы, такие как генетическое секвенирование и анализ водных стоков.
Осторожность остается важным фактором
Нам необходимо оставаться бдительными. Никто не хочет видеть пациента, который снова попадает в больницу.
Если смотреть только на абсолютные цифры, решение о завершении РЧС может вызвать у вас недоумение. Ведь до недели 1 мая в США было почти 9900 новых госпитализаций по поводу Covid, а в конце апреля было примерно 1050 смертей в неделю. В сравнении, когда первое объявление о РЧС было подписано в конце января 2020 года, в Соединенных Штатах не было зарегистрировано смертей (первая смерть в США была зафиксирована только 29 февраля). Фактически, только 10 февраля число смертей в мире превысило 1000.
Однако в медицине цифры и данные важны, но тенденции рассказывают более богатые и полные истории.
Представьте моего пациента, Америку, приходящего в больницу, когда у них только начали болеть. Может быть, у них была температура 101 градус, быстрый пульс и они чувствовали себя слегка нездоровыми. Я заметил их витальные показатели — случаи, госпитализации и смерти, но что я действительно следил за тем, как менялись их показатели. Улучшались ли эти цифры или ухудшались? Наблюдалось ли нарастание заболевания или это только начиналось? В начале 2020 года все эти цифры развивались в неправильном направлении.
Но сейчас тенденции — в случаях, госпитализациях и смертях — до сих пор высоки, но, слава богу, движутся в правильном направлении для моего пациента, нашей страны.
Для ясности, у нас есть возможность сделать гораздо лучше и довести цифры до более низкого уровня перед выпиской пациента, но это поднимает философский вопрос, даже более чем медицинский: что мы готовы терпеть как общество, чтобы предотвратить заболевание и смерть?
За последние три года я часто разговаривал с экспертами в области общественного здравоохранения и другими, чтобы попытаться точно определить, когда мы выйдем из фазы пандемии и перейдем в эндемическую стадию этой медицинской чрезвычайной ситуации. Было всего несколько жестких ответов. Вместо этого многие говорили мне, что все сводится к тому, сколько смертей от Covid мы можем пережить как общество в обмен на конец нашей нарушенной жизни.
Пандемия COVID-19: достижения и вызовы для нашего здоровья
В свое время я написал: На каком этапе мы, как общество, поднимаем руки вверх и говорим: Мы не можем сделать лучше, чем сейчас, поэтому давайте назовем этот уровень болезни и смертности эндемичным, примем цифры и двигаемся дальше с нашей жизнью?
Похоже, что мы коллективно эмоционально достигли этой точки. Если еженедельная смертность в США в конце апреля останется стабильной в течение 52 недель (или представляет среднюю еженедельную смертность), мы получим около 54 700 смертей в год. Это ставит Covid наравне с плохим сезоном гриппа. И помните, когда речь идет о гриппе, менее половины взрослого населения в Соединенных Штатах каждый год делает прививку.
Крепкая медицинская наука в виде вакцин и эффективных стратегий общественного здравоохранения, таких как качественные маски и проветривание в помещениях, могут помочь нам только до определенной степени, если нет коллективной воли их использовать.
Многие из нас готовы, чтобы эта глава в истории завершилась, и, честно говоря, я хорошо осведомлен о том, что многие люди уже двигались дальше недели, если не месяцы назад. Но мы также должны помнить, что есть значительная группа американцев, которые все еще очень беспокоятся о заражении Covid, в частности пожилые и больные.
В этом кроется один из величайших уроков пандемии для моего пациента, Соединенных Штатов. Хотя у нас были огромные ресурсы для борьбы с этой пандемией, наше коллективное плохое здоровье поставило нас в огромное несчастье. Мы должны сделать все возможное, чтобы сосредоточиться на основах, потому что ни одно количество богатства не может купить хорошее здоровье.
В настоящее время, однако, мой пациент делает решающие шаги из больницы и возвращается в мир. Я вне себя от радости.
Получайте еженедельную рассылку здоровья CNN
И, да, пожалуйста, используйте формальное окончание пандемии как новое начало для себя лично. Инвестируйте в себя, чтобы быть в наилучшем здоровье, чувствовать себя лучше, счастливее и сильнее сейчас, а также переносить любую медицинскую бурю в будущем.
Но, прежде всего, наслаждайтесь всем, чего крупная чрезвычайная ситуация или угроза серьезного заболевания не позволяли вам делать. Звоните, если у вас возникнут проблемы.
Я желаю моему пациенту всего самого лучшего. Я желаю всем нам всего самого лучшего.
Андреа Кейн из CNN внесла свой вклад в этот отчет.
COVID-19 был впервые идентифицирован в декабре 2019 года и был объявлен глобальной пандемией в течение нескольких месяцев. Хотя исследования о болезни и ее последствиях все еще находятся на относительно ранних этапах, пандемия вызвала невиданное количество научного сотрудничества и открытий.
смертей от COVID-19 оставались незарегистрированными.
ежедневно отмечались в пик пандемии в январе 2021 года.
мира было полностью вакцинировано от COVID-19 к концу 2021 года.
из тех, кто столкнулся с долговременными последствиями COVID в течение первых двух лет пандемии, были женщинами.
На этой странице
Мы начали прогнозировать траекторию пандемии COVID-19 в начале 2020 года, чтобы помочь больницам и политикам планировать, как распределять ресурсы. Сейчас мы прогнозируем случаи, смертность и инвалидность из-за COVID-19 в рамках Глобального исследования бремени болезни.
Иммунитет от прошлого заражения COVID-19 с течением времени ослабевает.
Our research supports the need for annual vaccines. While immunity after an infection is initially strong, it begins to drop after about 6 months and can provide as little as a third of its previous protection after a year.
Women are twice as likely as men to develop long COVID.
On average, long COVID lasts nine months for someone who was hospitalized for their illness and four months for someone who was not.
15% of those with long COVID symptoms three months after becoming infected with COVID continued to experience symptoms even at 12 months.
Read the article on long COVID
US states that imposed more vaccine and mask mandates had lower infection rates.
However, there were trade-offs that came with those decisions. While states with more restrictions did not experience worse economic outcomes, they did have lower rates of employment and lower student test scores.
Interactive data visual
Million people died from COVID-19 in 2022.
In December 2022, we paused our regular COVID-19 updates. Past estimates remain publicly available in our interactive data visual.
News and events
Didier Raoult gained global celebrity for touting the effectiveness of hydroxychloroquine to treat Covid-19. He is being criticized by many experts for questionable studies conducted at a research hospital in Marseille.
Lire en français
The study in question is in fact a continuation of a line of publications by the Marseille IHU characterized by debatable methodology. It should be remembered that Raoult expressed his enthusiasm for chloroquine and then hydroxychloroquine very early on. The former is used against malaria, the latter against lupus and various rheumatological conditions. Chloroquine "repositionings" had already been attempted, unsuccessfully, against Ebola, Dengue and Chikungunya viruses. On February 25, 2020, in a video entitled "Coronavirus: fin de parties" ("Coronavirus: game over"), he estimated, on the basis of a very incomplete Chinese study, that, thanks to this molecule, Covid-19 was "probably the easiest respiratory infection to treat."
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Coronavirus disease (COVID-19)
Note: Information in this article was accurate at the time of original publication. Because information about COVID-19 changes rapidly, we encourage you to visit the websites of the Centers for Disease Control & Prevention (CDC), World Health Organization (WHO), and your state and local government for the latest information.
Paxlovid is an oral antiviral pill that can be taken at home to help keep high-risk patients from getting so sick that they need to be hospitalized. So, if you are eligible to take the pills, you can take them at home and lower your risk of going to the hospital.
The drug, developed by Pfizer, had an 89% reduction in the risk of hospitalization and death in unvaccinated people in the clinical trial that supported the EUA, a number that was high enough to prompt the National Institutes of Health (NIH) to prioritize it over other COVID-19 treatments. Studies outside of the laboratory have since confirmed Paxlovid’s effectiveness among people who have been vaccinated. It’s cheaper than many other COVID-19 drugs (at this time, U.S. residents eligible for Paxlovid will continue to receive the medicine at no charge), and it is expected to work against the latest Omicron subvariants.
“It’s really our first efficacious oral antiviral pill for this virus,” says Scott Roberts, MD, a Yale Medicine infectious diseases specialist. “It shows clear benefit, and it really can prevent hospitalization and death in people who are at high risk.”
FDA approval will allow Paxlovid to remain available for adults indefinitely. Meanwhile, Pfizer continues to gather pediatric data to submit for FDA approval in children at a future date.
We asked Yale Medicine infectious diseases experts common questions about Paxlovid. Below are their responses.
How does Paxlovid work?
Paxlovid is an antiviral therapy that consists of two separate medications packaged together. When you take your three-pill dose, two of those pills will be nirmatrelvir, which inhibits a key enzyme that the COVID virus requires in order to make functional virus particles. After nirmatrelvir treatment, the COVID virus that is released from the cells is no longer able to enter uninfected cells in the body, which, in turn, stops the infection. The other is ritonavir, a drug that was once used to treat HIV/AIDS but is now used to boost levels of antiviral medicines.
As a COVID-19 treatment, ritonavir essentially shuts down nirmatrelvir’s metabolism in the liver, so that it doesn’t move out of your body as quickly, which means it can work longer—giving it a boost to help fight the infection.
When should I take Paxlovid?
You have to take Paxlovid within five days of developing symptoms.
Like all antivirals, Paxlovid works best early in the course of an illness—in this case, within the first five days of symptom onset, says Jeffrey Topal, MD, a Yale Medicine infectious diseases specialist who is involved in determining COVID-19 treatment protocols for Yale New Haven Hospital patients.
How often do I take Paxlovid?
The standard dose is three Paxlovid pills twice daily for five days for a full course that adds up to 30 pills. It helps that the pills are packaged in a “dose card,” basically a medication blister pack that allows you to punch out the pills as needed. There is also a reduced dose (two pills instead of three) for people with moderate renal impairment.
Is Paxlovid similar to Tamiflu?
“I think it’s a good comparison,” says Dr. Roberts. Tamiflu is an antiviral drug that reduces flu symptoms. Both are prescription-only oral antiviral pills given early in illness.
Tamiflu is taken twice a day for five days, and it must be started within 48 hours of flu onset. “When you give a patient Tamiflu beyond that, it doesn’t really change the course of their flu,” Dr. Roberts says.
But there are also differences between the two, starting with the way they were studied, Dr. Topal adds. Researchers showed that Paxlovid can prevent hospitalization and death. But since influenza causes fewer severe cases, clinical trials focused on whether Tamiflu could shorten the length of flu illness—which it did, he says.
Can anyone get a Paxlovid prescription?
In order to qualify for a prescription, you must be at high risk for developing severe COVID-19. That means you must either be 50 or older (age remains the strongest factor for severe COVID-19 outcomes, according to the FDA), although, the agency still authorizes Paxlovid for adolescents and teenagers ages 12 and older who weigh at least 88 pounds. You also qualify if you have certain underlying conditions (including cancer, diabetes, obesity, or others). The more underlying medical conditions a person has, the higher their risk for developing a severe case of COVID-19, according to the CDC.
Determining whether a patient is at high risk for progression to severe COVID-19, including hospitalization or death, is based on the provider’s assessment of the individual patient and that patient’s medical history, according to the FDA. If you are pregnant or breastfeeding, the FDA recommends discussing your options and specific situation with your health care provider, since there is no experience using the drug in these populations. If you could become pregnant, it’s recommended that you use effective barrier contraception or do not have sexual activity while taking Paxlovid.
How well does Paxlovid work?
The FDA’s approval of Paxlovid for adults in 2023 was based on the totality of scientific evidence submitted by Pfizer, including efficacy data from a Phase 2/3 study showing an 86% reduction in risk of COVID-19-related hospitalization or death from any cause in patients who took Paxlovid within five days of symptom onset.
When it applied for FDA authorization in 2021, Pfizer presented data from a clinical trial conducted between mid-July and early December 2021. That data showed that participants, who were given Paxlovid were 89% less likely to develop severe illness and death compared to trial participants who received a placebo. All of the trial participants were unvaccinated and they took the drug within three days of symptom onset.
In November 2022, the CDC reported on a real-world study that showed adults who took Paxlovid within five days of a COVID-19 diagnosis had a 51% lower hospitalization rate within the next 30 days than those who were not given the drug. The study included people who had been vaccinated or had a previous infection, which the CDC said implied the drug should be offered to people who are eligible regardless of their vaccination status.
What do we know about how Paxlovid works in kids?
Pfizer launched a clinical trial in March 2022 to study the safety and efficacy of Paxlovid in children and teenagers ages 6 to 17 who have COVID-19 symptoms and test positive for the virus, and who are neither hospitalized nor at risk for severe disease.
While Paxlovid is authorized for use in adolescents and teenagers ages 12 and up, and weighing at least 88 pounds, that age group wasn’t tested in the original clinical trial. But because many children reach 88 pounds—considered to be an adult weight—the FDA has allowed extensions of EUAs for medications such as monoclonal antibodies and remdesivir in younger age groups, adds Dr. Topal.
“Based on the pharmacokinetics of the drugs in Paxlovid, the differences in metabolism and excretion—liver and kidney function specifically—of these drugs in this age group are thought to be similar to that of adults,” Dr. Topal says.
Do antiviral treatments such as Paxlovid work against Omicron subvariant JN.1?
The CDC says antiviral treatments work well against JN.1, which is currently the dominant strain in the U.S..
What are the side effects from Paxlovid?
The most common side effects of taking Paxlovid include impaired sense of taste (for example, a metallic taste in the mouth) and diarrhea, according to the FDA. Most people who take Paxlovid should not experience serious side effects, explains Dr. Roberts. “Paxlovid is usually very well-tolerated,” he says.
Other possible side effects include:
Since Paxlovid is cleared by the kidneys, dose adjustments may be required for patients with mild-to-moderate kidney disease, explains Dr. Topal. “For patients with severe kidney disease—or who are on dialysis—or those with severe liver disease, Paxlovid is not recommended; the levels of the drug can become too high and could cause increased side effects,” he says.
The FDA says that anyone who takes Paxlovid should contact their health provider right away if they have any signs and symptoms of liver problems: loss of appetite, yellowing of the skin and whites of the eyes (jaundice), dark-colored urine, pale-colored stools and itchy skin, or stomach-area (abdominal) pain.
It’s worth noting that because Paxlovid is still being monitored in the real world, it is possible that all of the risks are not yet known. (The FDA has provided a fact sheet on Paxlovid with a full list of known side effects.)
Can I take Paxlovid if I’m taking other medications?
There is a long list of medications Paxlovid may interact with, and in some cases, doctors may not prescribe Paxlovid because these interactions may cause serious complications.
The list of drugs that Paxlovid interacts with includes some organ anti-rejection drugs that transplant patients take, as well as more common drugs like some used to treat heart arrhythmias. Paxlovid also decreases the metabolism of anticoagulants, or blood thinners, that many older adults depend on, driving up levels of those medications in the body to a point where they are unsafe, Dr. Topal explains.
Anyone who has Human Immunodeficiency Virus 1 (HIV-1) infection should talk to their health care provider before taking Paxlovid, since it may lead to some HIV-1 medicines not working as well in the future.
What is the rebound effect of Paxlovid?
There have been reports of a “rebound” of COVID-19 symptoms in some people within 2 to 8 days after completing the five-day course of Paxlovid; in those cases, some have tested positive again but have no symptoms; others have a recurrence of symptoms. Pfizer had said that in the clinical trial for Paxlovid, several participants appeared to have a rebound in virus levels, although this also occurred in some people who were given a placebo.
When it approved Paxlovid in May, the FDA said there not a clear association between Paxlovid treatment and COVID-19 rebound based on available data, and rebound rates in clinical trials were similar among participants who took Paxlovid and those who took a placebo.
However, scientists are still studying the Paxlovid rebound. The CDC says a rebound does not mean a person was resistant to Paxlovid, nor does it mean they were reinfected with the virus. In June, the CDC released guidance for clinicians, saying a brief return of symptoms may be part of the natural history of SARS-CoV-2 infection in some people, independent of treatment with Paxlovid, adding that there is no evidence additional treatment is needed. A CDC study reported that rebound symptoms tended to be unlikely to require hospitalization and milder than symptoms experienced during the primary infection.
“The hypothesis is that the immune system didn’t have a chance to see the full extent of the virus, since Paxlovid suppressed replication early in disease,” Dr. Roberts says. Scientists are studying the effects of longer treatment durations, longer periods of isolation, and other ways of managing the problem, he adds.
For anyone who experiences a rebound, Pfizer recommends reporting it to them on its portal for adverse events associated with Paxlovid.
If I’m not eligible for Paxlovid, is there something else I can take?
There are other therapies for COVID-19, and anyone who cannot take Paxlovid—perhaps because it would interact with another medication—should talk to their doctor about the best approach for their situation.
Do I still need to be ‘up to date’ on vaccination if Paxlovid is available?
Vaccination, testing, and mitigation efforts such as masking, remain a key part of prevention, even as more drugs become available, says Dr. Topal.
“Early testing is key to making these drugs work,” he says. “It’s always been the Achilles’ heel of these antiviral drugs that most people don’t get tested—or they don’t have access to testing.”
He encourages taking a test even if you think you only have a cold or allergies—and if you can get one. “Home testing is a huge part of the way to really ‘operationalize’ these medications,” he says, adding that while home tests may not be as highly sensitive as the laboratory-based polymerase chain reaction (PCR) tests, they are still very helpful in making a diagnosis.
Dr. Topal says people also should remember that Paxlovid, even with its high efficacy, is not perfect, and even if it were, viruses can mutate and develop resistance to antiviral medications. “Will some people still be hospitalized? Yes—no medication is perfect,” he says. “But for many high-risk patients, this medication can really reduce that risk.”
If you are experiencing symptoms of COVID-19 and think you are eligible for a treatment, you can visit the government Test-to-Treat Locater. You can use the site to search for the places near you where you can fill a COVID-19 prescription, or identify sites that provide testing, medical care, and COVID-19 medications.
For answers to more Paxlovid-related questions, read the Paxlovid FAQ provided by the FDA.
Information provided in Yale Medicine articles is for general informational purposes only. No content in the articles should ever be used as a substitute for medical advice from your doctor or other qualified clinician. Always seek the individual advice of your health care provider with any questions you have regarding a medical condition.
Diagnosis
If you have symptoms of coronavirus disease 2019, known as COVID-19, or you’ve been exposed to the COVID-19 virus, contact your healthcare team. Let them know if you’ve had close contact with anyone diagnosed with COVID-19.
COVID-19 tests also are available from healthcare professionals, some pharmacies and clinics, or at community testing sites.
Here are some guidelines for when to take a COVID-19 test:
Also, testing before an event or contact with people at high risk of serious illness helps prevent the spread of the virus that causes COVID-19.
COVID-19 tests use a sample taken from your nose or throat, or a sample of saliva.
Two types of tests can help diagnose COVID-19.
Understanding test results
If you have a positive COVID-19 PCR or antigen test, you almost certainly have COVID-19. Another test isn’t needed.
If you get a negative PCR test, you most likely do not have COVID-19.
If you have a negative antigen test, the FDA recommends that you repeat an antigen test two days after the first test. With or without symptoms, repeating the test helps get the correct diagnosis.
If you test positive, call a healthcare professional immediately to find out what options are available.
Preventing the spread of the COVID-19 virus while sick
To prevent the spread of the COVID-19 virus to others, stay home and apart from anyone you live with for at least five days. If you have a weakened immune system, you will likely need to isolate for longer. How long depends on your symptoms and personal health history. Your healthcare professional can advise you on what’s best in your situation.
After five days of isolation, many people can go back to being physically with others. But listen to the advice of your healthcare professional. Wearing a mask for five days after isolation can help prevent the spread of the COVID-19 virus.
More Information
Many people with COVID-19 recover with rest, plenty of fluids and care that manages symptoms. Medicine you can get without a prescription can help, such as:
If you are at high risk of serious COVID-19 illness, your healthcare professional may suggest medicine to prevent mild illness from getting worse. These medicines can include nirmatrelvir and ritonavir (Paxlovid), remdesivir (Veklury) or molnupiravir (Lagevrio).
Paxlovid and Lagevrio are taken by mouth as pills. Veklury is given through a needle in a vein.
If you’re very ill, you may need to be treated in the hospital.
Treatment for serious COVID-19 illness
For people who are in the hospital for COVID-19 care, care is given based on a person’s immune system response and the need for oxygen support.
Added oxygen may be given through a tube in the nose. Some people may need to have a tube placed in their airway to push air into the lungs. That’s called mechanical ventilation. In very severe situations, a machine called extracorporeal membrane oxygenation, also known as ECMO, can be used to mimic the function of the heart and lungs.
Medicines for severe COVID-19 may be remdesivir, baricitinib (Olumiant) and tocilizumab (Actemra), or a corticosteroid such as dexamethasone.
Baricitinib is a pill. Tocilizumab is an injection. Dexamethasone may be either a pill or given through a needle in a vein.
Another option may be blood donated by people who have recovered from COVID-19, called convalescent plasma. The blood is processed to remove blood cells, leaving behind a liquid called plasma that has immune system proteins called antibodies. Convalescent plasma with high antibody levels may be used to help people with a weakened immune system recover from COVID-19.
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Clinical trials
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
Lifestyle and home remedies
If you have COVID-19, it’s important to get plenty of rest, drink fluids and keep an eye on your symptoms. Medicines you can get without a prescription can help manage pain, fever or cough.
If you have COVID-19 and are staying separate from others, try to keep busy and help your body clear out the infection. Some things that might help are:
People who have COVID-19 or care for someone with the illness may feel new or worse symptoms of stress, depression and anxiety. If you or a loved one need help with managing the stress of illness, isolation or caregiving, contact your healthcare professional. Consider asking for a referral to a mental health professional.
Related information
To be treated for COVID-19, you may start by seeing your healthcare professional. Or you may be referred immediately to a specialist trained in treating infectious diseases.
Here’s some information to help you get ready for your appointment.
What you can do
When you make the appointment, ask if there’s anything you need to do in advance. Make a list of:
Take a family member or friend along, if possible, to help you remember the information you’re given. Bring only one or two people. Check before you go to the appointment, as your hospital or clinic may have visitor restrictions.
Some basic questions to ask your health care team include:
What to expect from your doctor
Your health care professional is likely to ask you several questions, such as:
Feb. 21, 2024