"My Voice"

Order a paperback or Kindle Edition or e-book of "My Voice: A Physician's Personal Experience with Throat Cancer," the complete 282 page story of Dr. Brook's diagnosis, treatment, and recovery from throat cancer.

Order a paperback or Kindle Edition or e-book of "The Laryngectomee Guide," the 170 page practical guide for laryngectomees.

Obtain and/or view a video presentation, instructive manual and a slide presentation how to ventilate laryngectomees and neck breathers (free).

To obtain suggestions for laryngectomees how to cope with COVID-19 pandemic click the Laryngectomee Newsletter link.

Preventing & coping with COVID-19 in laryngectomees

The global COVID-19 pandemic is particularly stressful for laryngectomees as well as those undergoing treatment for head and neck cancer, their caretakers, and cancer survivors.
This chapter presents guidelines and suggestions how these individuals can cope with the medical, psychological and social challenges created by the COVID-19 pandemic.

Suggestions in Spanish: Laringectomíay Total y el nuevo virus corona: Sugerencias para la protección.

Watch the video "How laryngectomees can cope with the COVID-19 pandemic"

Child's view of corona virus

Prevention of Corona virus (COVID-19) infection in neck breathers (including laryngectomees)

Most individuals experience less “colds” after laryngectomy. This is believed to be because respiratory viruses generally first infect the nose before spreading to other body sites (including the lungs). Because laryngectomees do not inhale through their noses this mode of transmission is rare.

However, all respiratory viruses (including COVID-19) can also access the body through the nose, mouth, conjunctiva and stoma (in neck breathers) after they are inhaled or introduced by a contaminated object or hand. It is therefore prudent that laryngectomees are extra vigilant in protecting themselves.

Laryngectomees have several risk factors of developing a serious infection.
Once laryngectomees become infected they may be more likely to develop severe pneumonia because their airway are compromised.  Many have chronically dry and irritated trachea and bronchi, and they often have reduced lung capacity because of partial collapse of their lower lobes (athelectasis).

This is why it is prudent that all neck breathers as well as those who are in close contact with them are careful and follow the Health Departments instructions. If someone in close contact with laryngectomee is exposed or infected with COVID-19, he/she should self-quarantine themselves  and avoid any contact with the neck breather.

  • Wearing heat and moisture exchanger (HME) 24/7 especially when being around other people. HME with greater filtering ability would work better in reducing the risk of inhaling the virus ( e.g., Provox Micron TM). (picture below) Provox Micron, has an electrostatic filter and over 99.9% filtration rate and it’s cover prevents direct finger contact with the stoma when speaking. Wearing it also protects other individuals when the laryngectomee is infected. It has maximal activity during the first 24 hours of use. Provox HME Cassette Adaptor enables the use of a Provox HME Cassette to any tracheostomy tube with a 15 mm ISO connector. Those with tracheostomy can protect themselves by using ProTrach XtraCare HME.

Provox micron

  • Wearing hands free tracheostoma valve (because it does not require touching when speaking) in those using trachea esophageal speech. Those who use a regular HME should wash their hands before touching their HME. 
  • Wearing a surgical mask (see pictures below), 100% cotton turtleneck, bib, or scarf over the stoma (in addition to the HME). Tie the upper strings of the mask around neck, use additional extension string to connect the two lower mask strings together under the arms and behind the back.
  • Wearing an additional surgical mask or respirator over the nose and mouth, and protective glasses or face shield. This can prevent the virus from entering the body through these sites or spread to other people when infected. Men should shave their facial hair prior to wearing surgical mask or respirator. If worn properly, a surgical mask can help block large-particle droplets, splashes, sprays or splatter that may contain germs (viruses and bacteria). While a surgical mask may be effective in blocking splashes and large-particle droplets, it does not filter or block very small particles in the air that may be transmitted by coughs, and sneezes. Wearing the mask on the stoma and face also serves in preventing laryngectomees from touching these locations with unclean hands.

Wearing surgical mask and protective glasses

Wearing a face shield and surgical mask

  • Washing hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available. This especially important before managing their stoma, and touching their HME when speaking using tracheoesophageal speech.
  • Avoiding touching the stoma, HME, eyes, nose, and mouth with unwashed hands.A useful routine is to use the non dominant hand to touch the stoma and the dominant hand for other activities (e.g., touching a door handle).
  • Avoiding close contact with sick people and avoid public and crowded places.
  • Staying at least 6 feet from other who don't live with you.
  • Cleaning and disinfecting frequently touched objects and surfaces.

              Provox micron

Those in close contact with neck breathers can expose them to the virus when they become asymptomatic carrier or infected with COVID-19. These individuals as well as the neck breathers should observe meticulous hand hygiene and wear face masks, gloves, eye shields, and other protective items whenever they are in contact with each other.

Wearing a facemask and protecting glasses

Modified face mask by lengthening one of the strings

 Wearing a modified face mask over the stoma (view from the front)

 Wearing a modified face mask over the stoma (view from the back)

The information and knowledge about the prevention and management of COCID-19 is growing and constantly evolving. Because the recommendations for COVID-19 prevention and treatment may change, it is important to follow the local health department and Center of Disease Control and Prevention updates and consulting with medical professionals.

Click for further reading about protection of laryngectomees (Oral Oncology editorial April 

Click for further reading about protection of laryngectomees (International Achieves of Otorhinolaryngology)  

COVID-19 Vaccines

COVID-19 vaccines are effective at keeping people from getting COVID-19. Getting a COVID-19 vaccine will also help keep one from getting seriously ill even if one do get COVID-19. It typically takes 2 weeks after vaccination for the body to build protection against the virus that causes COVID-19. That means it is possible a person could still get COVID-19 before or just after vaccination and then get sick because the vaccine did not have enough time to build protection. People are considered fully vaccinated 2 weeks after their second dose of the Pfizer-BioNTech or Moderna COVID-19 vaccines, or 2 weeks after the single-dose Johnson & Johnson’s Janssen COVID-19 vaccine. A booster dose should be administered after six months following the initial vaccination, and may be periodically needed in the future.

Individuals with medical conditions or those taking medicines that weaken their immune system, should talk to their healthcare provider. They may need to keep taking all precautions to prevent COVID-19 disease.

More information about the vaccines is available at the CDC website.

Going outside during the COVID-19 pandemic. What should laryngectomees do?

Laryngectomee may experience social and medical challenges when they leave their home during the COVID-19 pandemics. Most non-neck breathers do not understand or recognize their medical condition and may react in a negative way toward them. They may be alarmed when the laryngectomee coughs or sneezes, or take care of their stoma in public.c.

Included are some of the steps that laryngectomees can take when in public:

  • Cleaning the stoma and trachea including inserting saline into the trachea and coughing out the secretions before going out
  • Taking care of the stoma and it’s secretion at a private location away from others (e.g., bathroom, separate room)
  • Covering the stoma (with napkin, cloth or elbow) whenever coughing or sneezing. Preferably this is done away from other people. When coughing forcefully the stoma can produce large amount of droplets that can spread and infect others when the laryngectomee carries a respiratory virus such as COVID-19
  • Keeping a distance of at least 6 feet (2 meters) from others
  • A useful routine is to use the non-dominant hand to touch the stoma and the dominant hand for other activities (e.g., touching a door handle).
  • Wearing a surgical mask or garment over the mouth and nose (in addition another one over the stoma). This is done to protect the laryngectomee from becoming infected, as well as otherwhen the laryngectomee is infected. Wearing a mask over the mouth and nose in public prevent the laryngectomee from standing out from others. Wearing the mask on the stoma and face also serves in preventing laryngectomees from touching these locations with unclean hands
Hopefully these measures can assist laryngectomees in public locations.
As home confinement and other restrictions are being slowly lifted, it would be prudent for laryngectomees to continue to observe these precautionary measures. As more clinical experience in managing COVID-19 infection is gained and new medications and  vaccines are available the consequences of becoming infected may become less dangerous.

COVID-19 testing in laryngectomees

Two kinds of tests are available for COVID-19: viral tests and antibody tests.

  • A viral test tells if someone has a current infection. It is obtained by collecting a nasopharyngeal specimen (e.g., nasal, oropharyngeal) with a swab.  Neck breathers should be tested in two locations: by collecting a nasopharyngeal specimen as well as a stomal specimen.
  • An antibody test is obtained by getting a blood sample. It tells if a person had a previous infection.

Those whose viral test is positive and are sick or take care of someone need to take protective steps.

A negative viral test result only means that the person tested did not have COVID-19 at the time of testing. If the viral test is positive or negative for COVID-19, the person tested still should take preventive measures to protect themselves and others.

An antibody test may not be able to show if a person has a current infection, because it can take 1-3 weeks after infection to make antibodies. Currently it is not know if having antibodies to the virus can protect someone from getting infected with the virus again, or how long that protection might last. 

CDC has guidance for who should be tested, but decisions about testing are made by state and local health departments or healthcare providers.

                                                            Diagnostic swabbing for COVID-19

Coping with voice prosthesis leakage during the corona (COVID- 19) pandemic

The COVID-19 pandemic presents many challenges for laryngectomees and their medical providers. Because of the reduction or decrease in outpatient services and voice prosthesis availability, those using tracheoesophageal speech may have trouble in having their clinician-changed (indwelling) prosthesis replaced.

Enclosed are suggestions how to cope with these challenges: 
  • If possible, switching to using patient-changed voice prosthesis (non indwelling)
  • Extend the life span of the current voice prosthesis by keeping it clean using a cleaning brush and flushing bulb and preventing buildup of candida biofilm.

If voice prosthesis leakage occurs:
  • Attempting to stop the leak by cleaning and brushing it as suggested in this link
  • Stopping the leak by inserting an adequate plug (see picture below) into the prosthesis whenever consuming fluids or leaving it permanently and switching to alternate speaking method (e.g., esophageal speech, electrolarynx)
  • Consuming viscous fluids that generally do not leak (i.e., yogurt, jelly, soup, oatmeal, etc) 

If the prosthesis has been accidentally removed, a 12 Fr/ 16’’red rubber catheter (see picture below) can be inserted into the trachea-esophageal puncture to prevent its closure until the voice prosthesis is replaced.

The laryngectomee should seek immediate medical care if aspiration of the dislodged voice prosthesis has occurred as this may requires urgent intervention to remove it.

One’s speech and language pathologist and/or physician should be contacted for guidance when leakage occurs. The prosthesis should be replaced when consuming liquids becomes difficult, or recurrent aspiration occurs. The speech and language pathologist and other medical providers may wear personal protective equipment (PPE) when they change the voice prosthesis and may perform the procedure in a negatively pressurized room. 

More information how to prevent and deal with voice prosthesis leakage can be found in this link.  Click to watch a video that explains what to do if the voice prosthesis leaks.

 Voice prosthesis plugs

 Red Catheter

How laryngectomees can cope with the COVID -19 quarantine

The forced quarantine imposed by COVID -19 can be difficult for laryngectomees. Their communication difficulties may increase their social isolation, leading to medical and psychological problems.

In addition to taking steps to improve psychological vulnerability (e.g., developing a routine, reading, watching movies, taking walks, exercising, and learning a new skill)  laryngectomees may want to consider the following: 
  •       Communicating with family, friends and support groups by speaking over the phone; and e-mailing and texting using computer, tablet and smartphone. There are several applications that allow video communication (e.g., Skype, FaceTime, Zoom) to keep in touch. The volume and quality of the voice when using telecommunication methods  can be improved by using a hand held microphone and placing it near the laptop,iPad or iPhone. It would be helpful for support groups to continue meeting using some of these methods. 
  •      Those using tracheo-esophageal speech can learn how to communicate through other methods of speaking (e.g., esophageal speech, electrolarynx, sign language) in case they need to plug their leaking voice prosthesis. 
  •      It is important not ignore medical, dental and psychological issues and continue to receive care from physicians, dentists, mental health providers, and speech and language pathologists. If physical access to them is limited, one can contact them using telemedicine.
  •      Having adequate supplies needed to speak and care for one’s airways (e.g., baseplate, HME, saline bullets).
Hopefully, following these suggestion may help laryngectomees cope with their quarantine.

As home confinement and other restrictions are being slowly lifted, it would be prudent for laryngectomees to continue to observe precautionary measures. As more clinical experience in managing COVID-19 infection is gained and new medications and vaccines are available the consequences of becoming infected may become less dangerous.

How can patients, survivors and caregivers of head and neck cancer cope with COVID-19 pandemic?

The global COVID-19 pandemic is particularly stressful for those undergoing treatment for head and neck cancer, their caretakers, and cancer survivors.

Because of the increasing numbers of patients with COVID-19 infections, many health systems adopted strategies to provide sound care for non COVID-19 patients while reducing the risk of infection transmission to patients and medical personal. Additional considerations include the limited availability of operating rooms and inpatient beds, and the scarcity of personal protective equipment needed to provide safe and hygienic conditions.
Below is a brief outline of some of the changes in near future.

People undergoing active treatment (especially chemotherapy) are at increased risk of getting an infection. It is very important that they and those in close contact with them, follow the CDC and local government instruction:
  •       Washing hands with soap and water frequently, for 20 seconds, including wrists.
  •         If unable to wash hands, using hand sanitizer and rubbing them for 20 seconds.
  •         Disinfecting commonly used surfaces such as tabletops, doorknobs, and phones.
  •         Avoiding direct contact with others such as hugging or shaking hands. Ideally, and staying at least 6 feet away from other people.
  •         Avoiding being in large groups of 6 or more people, especially when in an enclosed space.
  •         Avoiding sharing cups or utensils with others.
  •         Covering the mouth or stoma during a cough or sneeze.
  •         Wearing a face mask and protective glasses when at risk of exposure to the virus
  •         Avoiding contact with anyone with a known COVID-19 infection or individuals with a cough and/or fever.
  •         Avoiding air travel or other public transportation.
  •        Notifying their doctor immediately when feeling sick (develop a cough, fever, muscle aches, or other symptoms) or if after having contact with anyone with a known or suspected COVID-19 infection. It may be necessary to be evaluated and potentially tested for the virus.

Patients who have finished therapy are seen regularly to monitor for cancer recurrence and also to address any of their treatments side effects. In the current crisis, these visits are typically not urgent and may increase the risk of exposure to COVID-19 to both survivors and physicians. As a result, many hospitals are postponing non-urgent surgeries, routine follow-up visits and imaging tests (such as CT and PET/CT scans) to minimize the risk of transmission and to conserve health care resources that may be in limited supply. However, if a patient experiences concerning new signs or symptoms for cancer ( e.g., worsening mouth or throat pain, changes in one’s voice or swallowing, a spot in the mouth that has not healed in 2 weeks, unexplained ear pain, new lump in your neck) he/she should inform their doctor as they may still need to be seen.

While social distancing, isolation, and quarantine at home are effective in reducing the incidence of COVID-19, they do increase health risks from other causes. Social isolation among older adults is associated with heightened risk of cardiovascular, autoimmune, neurocognitive, and mental health problems.

A model created by the National Cancer Institute predicts that tens of thousands of excess cancer deaths will occur over the next decade as a result of missed screening, delays in diagnosis, and reductions in oncology treatment caused by the COVID-19 pandemic. It is important that patients continue to be screened and treated.

Some institutions are offering virtual clinic visits (Telemedicine) interactions with your provider by way of a video conference call) in an effort to reduce exposure of both patients and health care staff. While virtual visits and telemedicine will never completely replace in-person interactions, in times of crisis, they can provide an effective means to maintain a patient-doctor relationship, allowing them to engage in a directed conversation about disease-specific symptoms and concerns, and to discuss future plans of care. Virtual visits can be very important for head and neck cancer survivors, as they reduce individual patient exposure in clinics and hospitals, and minimize the risk to other cancer patients with compromised immune systems, as well as health care providers and staff. Survivors and caregivers should be reassured that these encounters are a sound approach to cancer surveillance and can allow providers to identify patients who may require an in-person visit.

Other general considerations:
  •          Maintaining close communication with family/loved ones and health care team
  •          Having a sufficient supply (at least a 2-week supply) of: easy to preserve food items, prescriptions and cleaning supplies and other essentials.
  •          Contacting one’s physician to ensure one has adequate access to prescription medications, and necessary supplies (e.g., tube feedings, tracheostomy supplies and personal protective equipment)

Neck breathers ( Laryngectomees and those with tracheostomy) are likely at higher risk of becoming infected with COVID-19 due to the increased exposure of their airway. These individuals should observe special precautions (See above).

Ensuring adequate care during hospitalization for neck breathers including laryngectomees during the COVID-19 pandemic

It is helpful to have a plan in place in case one becomes sick. Identifying a caregiver and staying in touch with family, friends, neighbors, and healthcare professionals during the pandemic through email or phone, especially if some lives alone is important. If one is aware of an exposure or are experiencing symptoms such as a sore throat, dry cough, fever, and/or shortness of breath, seek medical help as soon as possible. Trying to contact one’s care team over the phone before coming into a medical center can facilitate their care.

Neck breathers are at a high risk of receiving inadequate care when hospitalized. The medical staff is often not aware of their condition, do not know how to care for their airways, and may not know how to communicate with them. 

The COVID-19 pandemic created greater workload for hospital staff and may make it difficult to pay attention to laryngectomee’s special needs. Because most hospital limit or prohibit the presence of patients’ companions, making it more difficult for laryngectomees to communicate with the staff. It is therefore important to take certain steps to ensure that the care is adequate:

1. Inform the ward’s head nurse and attending physician about the laryngectomee’s general and specific needs. In case of elective admission, this can be done prior to the admission to allow the staff time to get ready and to get adequate supplies and equipment.

2. Inform the dietitian about the food requirements of the laryngectomee.

3. Inform and, when possible, meet with the hospital’s speech and language pathologist to ensure adequate care and availability of adequate supplies.

4. Laryngectomees who experience swallowing difficulties should request that the orally administered medications be given in liquid or easy to swallow form.

5. Request specific supplies and equipment to ensure adequate respiratory care, such as saline bullets, humidifier, and suction machine.

6. Keep reminding every staff member caring for the laryngectomee about his or her condition. This can be done by the patient and/or advocate.

7. Inform the head nurse; attending physician, and/or patient’s hospital advocate if medical care is not adequate or if errors are made.

8. Request that signs informing the staff about the laryngectomee are placed in the patient’s room.

9. Wear the hospital patient ID wristband on the same hand that identifies them as neck breathers. Because staff is required to continuously check the patient ID wristband, they will be reminded of the condition.

10. Make sure that the laryngectomee is able to communicate with staff. Those using tracheoesophageal speech may need to use alternative speech methods such as an electrolarynx and/or communicate through writing and speech generating devices, i.e., laptop, smartphone, etc.

11. Preparing a kit with essential information and material when going to the hospital

  • The kit should contain the following:
  • An updated and current summary of the medical and surgical history, allergies and diagnoses
  • An updated list of the medications taken and the results of all procedures, radiological examinations, scans and laboratory tests. These may be placed on a disc or USB flash drive
  • Contact information and proof of medical insurance
  • Information (phone, email, address) of the laryngectomee’s physician(s), speech and language pathologist, family members and friend(s)
  • A figure or drawing of a side view of the neck that explains the anatomy of the laryngectomee's upper airways and if relevant where the voice prosthesis is located
  • A paper pad and pen
  •  An electrolarynx with extra batteries (even for those using a voice prosthesis)
  •  A box of paper tissues
  • A supply of saline bullets, HME filters, HME housing, and supplies needed to apply and remove them (e.g., alcohol, Remove, Skin Tag, glue) and to clean the voice prosthesis (brush, flushing bulb)
  • Tweezers, mirror, flash light (with extra batteries)

Protecting immunocompromised cancer patients from COVID-19

Older adults, people who have severe underlying medical conditions like heart or lung disease or diabetes, and immunocompromised individuals seem to be at higher risk for developing serious complications from COVID-19 illness.

Examples of persons with weakened immune systems include those with HIV/AIDS; cancer and transplant patients who are taking certain immunosuppressive drugs; and those with inherited diseases that affect the immune system.

Individuals with cancer including those with the head and neck who are at higher risk of suffering from a serious and life threatening COVID -19 infection include:

  •         Age > 55 years
  •         Pre-existing pulmonary disease
  •         Chronic kidney and or kidney disease
  •         Hypertension and/or cardiovascular disease
  •         Diabetes
  •         Immunosuppression to include: chronic prednisone treatment (>20mg/day), biologics, transplant, chemotherapy, and HIV. The risk of developing severe disease may depend on the degree of immune suppression.

These persons as well as those who are in close contact with them should be extra vigilant in following the CDC and local government instructions. It is recommended that they isolating themselves by staying home and avoiding any contact.   https://www.cdc.gov/coronavirus/2019-ncov/index.html 

It is advisable to contact one’s physicians for guidance and when becoming ill.
Click this link to get information how to make your home corona proof.

Mental health issues in head and neck patients (including laryngectomees) caused by the COVID-19 pandemic

The current COVID-19 outbreak is spurring depression, fear, anxiety, and stress on a societal level. An increase in deaths by suicide during this quarantine period was also noted. On an individual level, it may exacerbate anxiety and psychosis-like symptoms as well as lead to non-specific mental issues (e.g., mood problems, sleep issues, phobia-like behaviors, panic-like symptoms). Head and neck cancer patients (HNCP) (including laryngectomees) are more vulnerable to these psychological issues as well as  the viral infection. Laryngectomees may experience increased social isolation and loneliness. Contributing to these are the difficulties in get medical and diagnostic care, prescription drugs, and medical supplies, and the economic situation.

HNCP with mental health issues such as obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), anxiety and depressive disorders, and paranoia may experience exacerbation of their symptoms.

HNCP can be proactive and alleviate some of their psychological vulnerability by:

  •         Reaching out and seeking support from mental health professionals (i.e., psychiatrists, psychologists, social workers)
  •         Getting medical and other supplies delivered to one’s residence
  •         Engaging in healthy distractions such as reading, watching movies, taking walks, exercising, and learning a new skill
  •         Developing a routine
  •         Obtaining information from reliable sources
  •         Curbing media exposure to certain times in the day
  •         Being aware of what is anxiety and what is reality in one’s thoughts and conversations
  •         Following guidelines (i.e., using prescribed handwashing methods, avoiding touching the face, avoiding hugging and shaking hands, staying at home and contacting one’s medical provider when experiencing medical problems)
  •          Connecting with family and friends through the internet, social media, video calls and phone 

Following these suggestions can assist HNCP navigate through the corona virus pandemic.

Individuals who experience suicidal thoughts are encourage to seek help from mental health professionals such as social workers, psychologist and psychiatrist. They can call the National Suicide Prevention Lifeline at 1-800-273-8255 to get immediate assistance.

How to cope with neopharyngeal or esophageal narrowing during the COVID-19 pandemic

The corona (COVID-19) pandemic presents many challenges for head and neck cancer patients and their medical providers. Because of the reduction or decrease in outpatient services, the availability of neopharyngeal and /or esophageal dilation for esophageal narrowing may not be available.

Enclosed are suggestions how to cope with these challenges:

  • Performing dilation at-home using self-dilation device
  • Considering treatment that resolve the narrowing (i.e., stent, laser treatment)
  • Temporarily altering the diet to soft or liquid one
  • Using a gastric tube for feeding
It is helpful to contact one’s speech and language pathologist and/or physician for guidance. Many institutions perform dilation to those who are unable to consume sufficient calories and liquids.

Hopefully these temporary measures will be helpful.

Keeping fit and eating adequate nutrition during the COVID-19 pandemic

Keeping up with fitness and exercise during the COVID-19 pandemic can be difficult. As people self-isolate and practice social distancing, many gyms are closed.  At the same time, it’s more important than ever that laryngectomees keep exercising and staying as active as possible – for both our mental and physical health. Performing fitness exercises and riding stationary bikes can be can be done at home and provide an excellent mode of keeping fit. Taking walks outside home while keeping social distance and wearing protective mask and HME can also be helpful.

People who eat a well-balanced diet tend to be healthier with stronger immune systems and lower risk of chronic illnesses and infectious diseases. Eating adequate diet is very important and may be challenging for laryngectomees with swallowing difficulties.  (click to read more ) Proper nutrition and hydration are vital according to the World Health Organization (WHO).  Their nutrition advice for adults during the COVID-19 outbreak is to eat a variety of fresh and unprocessed foods every day to get the vitamins, minerals, dietary fiber, protein and antioxidants the body needs. Drinking enough water is also important. The WHO recommends avoiding sugar, fat and salt to significantly lower the risk of overweight, obesity, heart disease, stroke, diabetes and certain types of cancer.

Indoor bikes

Potential agents and vaccines for the treatment and prevention of COVID-19

There are currently no US Food and Drug Administration (FDA) - approved drugs specifically for the treatment of patients with COVID-19.  At present clinical management includes infection prevention and control measures and supportive care, including supplementary oxygen and mechanical ventilatory support when indicated. 

Several of drugs approved for other indications as well as several investigational drugs are being studied in several hundred clinical trials that are underway across the world. There are two approved drugs (chloroquine and hydroxychloroquine) and one investigational agents (remdesivir) that are currently in use in the United States for the treatment of COVID-19 on a compassionate basis as well as in clinical trials. 

Hydroxychloroquine (HCQ) and chloroquine are oral prescription drugs that have been used for treatment of malaria and certain inflammatory conditions. There are no currently available data from Randomized Clinical Trials to inform clinical guidance on the use, dosing, or duration of HCQ for prophylaxis or treatment of SARS-CoV-2 infection. 

A randomized controlled trial of 150 hospitalized adults in China suggests the hydroxychloroquine does not help clear the virus or relieve symptoms for COVID-19 patients more than standard care alone and has more side effects, . However, experts caution that because of confounding issues, the trial is unable to answer convincingly the question of whether the drug can benefit COVID-19 patients. FDA cautions against use of HCQ or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems.

systematical review of the existing clinical evidence of HCQ use for the prevention and treatment of COVID-19 that there is no evidence supporting HCQ for prophylaxis or treatment of COVID-19. 

Hydroxychloroquine tablets

Remdesivir is a broad-spectrum antiviral medication developed by the biopharmaceutical company Gilead Sciences. Remdesivir inhibits viral replication through premature termination of RNA transcription and has in-vitro activity against SARS-CoV-2 and in-vitro and in-vivo activity against related betacoronaviruses. It is being tested as a specific treatment for COVID-19, and has been issued an Emergency Use Authorization (EUA) in the U.S. for those hospitalized with severe disease. It may shorten the time it takes to recover from the infection. 


The use of these agents have potential significant risk. They have a narrow therapeutic window (the toxic dose is not much greater than the therapeutic dose). Side effects include ocular, neurological , and cardiac toxicities. It is therefore critical not to take these medications without physician evaluation and prescription. 

The list of additional preparations being tried that have demonstrated efficacy in diseases with similar pathophysiology, as well as anecdotally against COVID-19, includes several monoclonal antibodies (47D11, tocilizumab, sarilumab, others), famotidine (better known as Pepcid), favipiravir (shortens time for viral clearance), stem cells, convalescent plasma, and, to make thing interesting, thalidomide and sildenafil, better known by its trade name Viagra. (Seriously. It is known to be a vasodilator in certain other organs, and perhaps will help fight lung inflammation in COVID-19.)

NOTE: DO NOT TAKE ANY OF THESE except by individual physician prescription.

A novel treatment involving immunotherapy with NK ("natural killer") cells, which are a type of lymphocyte and a component of the innate immune system, is being tried. NK cells attack virally infected cells and reduce the inflammation around them.

A "cytokine storm", or overproduction of immune cells and their activating compounds, or cytokines, is responsible for the rapid decline (high blood pressure, lung damage, organ failure, and often rapid death) that sometimes occurs in patients who appear to be doing well or recovering well. Overreaction of the immune system is thought by some to be the reason that otherwise healthy young people died during the 1918-1919 influenza pandemic. Also the use of plasma from convalescent patients in a few critically ill patients has shown rapid improvement in several cases; these results will of course require evaluation and confirmation in formal clinical trials.

Although there is currently no vaccine against COVID-19, there are multiple attempts develop such a vaccine, and clinical trials to develop such vaccines. Since COVID-19 is an RNA virus, it may be possible to develop a vaccine that will provide long-term immunity. 

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