Key Insights on Novel Coronavirus Pneumonia (COVID-19)

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Key Insights on Novel Coronavirus Pneumonia (COVID-19): Symptoms, Treatment, and Critical Care

Did you know some people infected with the novel coronavirus (2019-nCoV) might feel perfectly fine while spreading the virus? Or that severe COVID-19 cases can progress without high fever? These are just a few of the critical insights from respiratory specialists studying how the virus behaves—and how best to treat it.

These findings come from Han-Yu-Jie Kang, Yi-Shan Wang, and Zhao-Hui Tong, experts in respiratory and critical care medicine at Beijing Chao-Yang Hospital, Capital Medical University—a leading institution in China’s response to COVID-19. Their work sheds light on the virus’s tricky nature and the challenges of saving lives during outbreaks.

The Virus’s Silent Threat: Symptoms and Contagion

One of the biggest hurdles with COVID-19 is its unpredictability. The virus’s incubation period (time from infection to symptoms) can last up to 2 weeks—or longer. Even during this “latent” phase (when someone feels healthy), they might still pass the virus to others. Symptoms also vary wildly:

  • Some people get mild upper respiratory issues (like a cold).
  • Others develop severe pneumonia.
  • Many have no fever at all—instead, they might have headaches, stomach pain, or no symptoms.

This “silent” progression means many cases go unnoticed until it’s too late, especially in older adults (50+) with underlying conditions like hypertension, diabetes, or heart disease.

Corticosteroids for COVID-19: What We Know (and Don’t)

For severe COVID-19 cases—especially those with acute respiratory distress syndrome (ARDS, a life-threatening lung condition)—doctors have debated using corticosteroids (anti-inflammatory drugs). Here’s the science:
Corticosteroids work by reducing harmful inflammation, excessive cell growth, and scarring in the lungs. But research on their use in viral illnesses is conflicting:

  • SARS: A study found patients on corticosteroids had higher ICU admission rates and mortality—even though they were younger and healthier.
  • MERS: Corticosteroids didn’t improve survival and slowed the body’s ability to clear the virus.
  • H1N1 Flu: A meta-analysis linked corticosteroids to higher death rates.

But there’s nuance:

  • Short-term corticosteroid use might lower ARDS risk in severe community-acquired pneumonia.
  • They’re standard for ARDS caused by Pneumocystis carinii pneumonia (a fungal infection) to improve oxygen levels.

So where does that leave COVID-19? The World Health Organization (WHO) doesn’t recommend routine corticosteroids for viral pneumonia or ARDS outside clinical trials. However, China’s Novel Coronavirus Pneumonia Diagnosis and Treatment Protocol (5th edition, trial) suggests short-term use (3–5 days) for severe/critical cases—if patients have worsening shortness of breath or chest imaging changes—at a dose no higher than 1–2 mg/kg/day of methylprednisolone (a common corticosteroid).

The bottom line: We need more high-quality randomized controlled trials (RCTs) to confirm if corticosteroids help—or harm—COVID-19 patients.

Respiratory Support: The Difference Between Life and Death

For critical COVID-19 cases, breathing support is non-negotiable. The virus causes more severe ARDS than usual, and older patients with multiple health issues are hit hardest. Our team’s clinical experience shows:
Many severe patients on high-flow nasal cannula (HFNC) or non-invasive ventilation (NIV)—breathing 100% oxygen—still have low oxygenation indexes (a measure of lung function, calculated as arterial oxygen pressure [PaO₂] divided by the oxygen breathed in [FiO₂]). If this index falls below 150 mmHg (or even 100 mmHg), prolonged low oxygen (hypoxia) damages organs irreversibly. Even with invasive ventilation (a breathing tube) or ECMO (a machine that takes over breathing/heart function), few patients recover fully.

Here’s our urgent advice:

  1. If NIV fails: If a patient’s oxygenation index stays below 150 mmHg after 2 hours on NIV with high oxygen, intubate (place a breathing tube) for invasive ventilation immediately.
  2. Watch for deterioration: The WHO warns HFNC/NIV should only be used for select patients—and they must be closely monitored for worsening.
  3. ECMO as a last resort: If invasive ventilation (including prone positioning—lying on the stomach to open lungs) doesn’t help within 24 hours (and oxygenation stays below 100 mmHg), start ECMO right away.

This aligns with guidance from the Chinese Society of Extracorporeal Life Support and China’s national COVID-19 protocol, which also urges intubation within 1–2 hours if HFNC/NIV fails.

The Gold Standard: Supportive Care

There’s no “magic bullet” for COVID-19. The best treatment is supportive care—keeping patients oxygenated to protect their organs. Key rules:

  • No proven antivirals: There are no drugs that reliably kill the virus.
  • Antibiotics only for bacteria: Use them only if there’s a bacterial infection (not for the virus itself).
  • Herbal remedies need research: Traditional Chinese medicines like Shuanghuanglian block the virus in lab tests—but we don’t know if they work in people. More studies are needed.

This article is based on a 2020 viewpoint by Han-Yu-Jie Kang, Yi-Shan Wang, and Zhao-Hui Tong, published in the Chinese Medical Journal. For the full study, visit doi.org/10.1097/CM9.0000000000000757

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