Preparing Yourself and Your Practice for a Surge of COVID-19 Patients this Winter

Treating Patients

Treating most COVID-19 nasal symptoms is similar to treatment for symptoms from other causes, although there have been some new advances. Dr. Lee and colleagues are currently investigating the use of a 1% betadine nasal spray and oropharyngeal gargle for COVID-19 patients to mitigate infection and potentially shorten illness duration and severity. Patients self-administer the spray into each side of their nose and then gargle with the medication in the oropharyngeal cavity. “If proven effective in mitigating viral load in infected patients, topical betadine as an outpatient treatment method early in a patient’s disease course may help decrease transmission of COVID-19,” he said.

In a study of 100 COVID-19 patients, Dr. Doty found that two-thirds of those who received an objective smell test fully regained their smell function in six to eight weeks, although a few recovered spontaneously in a few weeks (Int Forum Allergy Rhinol. 2020;10:1127-1135). “Recovery likely depends upon the severity of the viral impact,” he said. All patients were tested after treatments for COVID-19 and were in the process of leaving the hospital to go home.

Although fatigue can set in when wearing masks and face shields, and practicing within these new restrictions can feel tedious, it’s important to ensure that practices aren’t the source of infection.  —Zara M. Patel, MD

While sense of smell returned completely in approximately 70% of Dr. Sedaghat’s patients, with most of the remainder having at least some recovery, some took weeks or months to achieve this result. With continued follow-up, he expects the number of patients with complete recovery to increase.

No literature has been published to date that supports any methodology for treating patients with anosmia caused by COVID-19. However, some otolaryngologists are conducting clinical trials to evaluate certain methodologies. Another option is to recommend treatment based on one’s experience with other complications from viral infections, Dr. Jones said.

For example, Dr. Jones advises patients take 2,000 mg of omega-3 per day, in addition to olfactory training, to aid in the recovery process after having COVID-19. A current study is investigating the use of 1,000 mg of omega-3 fatty acid twice daily to treat the effects of anosmia and parosmia associated with COVID-19 (https://clinicaltrials.gov/ct2/show/NCT04495816). In addition, she encourages patients to take zinc, as well as vitamins D and C, all common natural treatments for upper respiratory infections.

Dr. Jones also recommends starting olfactory training—which should include citrus, mint, floral, and spicy smells—as soon as a patient can tolerate it. Dr. Jones’ patients sniff essential oils on a paper towel twice daily. If a smell is too noxious, she’ll advise them to stop for two to three weeks and then try to reintroduce it.

Dr. Lee is also a proponent of olfactory training to aid with recovery of smell loss after viral inflammation by spurring nerve regeneration. She advises patients to sniff four scents, including lemon, cloves, eucalyptus, and rose, as essential oils in glass vials. They should breathe normally and imagine what a lemon smells and tastes like, for example, to train themselves to recover that scent. Patients should switch odors every three months.

Steroids may be another treatment option; however, conflicting evidence surrounds their use. Therefore, it may be prudent to avoid using oral and/or topical corticosteroids to treat acute smell loss in a patient with active COVID-19, Dr. McLean said. Recommendations are less clear for patients with persistent smell loss who have completely recovered from COVID-19. “Use caution when prescribing corticosteroids until data is available about efficacy and risks specific to the COVID-19 population,” she said.

As the winter sets in, arm yourself with the best safety and treatment protocols as the COVID-19 pandemic rages onward. Although the medical community still has much to learn about this virus, give it your best by relying on what is known and staying abreast of new developments.