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Review
. 2021 May;30(5):505-518.
doi: 10.1080/13543784.2021.1901883. Epub 2021 Apr 23.

The time to offer treatments for COVID-19

Binh T Ngo  1   2 , Paul Marik  3 , Pierre Kory  4 , Leland Shapiro  5 , Raphael Thomadsen  6 , Jose Iglesias  7 , Stephen Ditmore  8 , Marc Rendell  2 , Joseph Varon  9 , Michael Dubé  1 , Neha Nanda  1 , Gino In  1 , Daniel Arkfeld  1 , Preet Chaudhary  1 , Vito M Campese  1 , Diana L Hanna  1 , David E Sawcer  1 , Glenn Ehresmann  1 , David Peng  1 , Miroslaw Smogorewski  1 , April Armstrong  1 , Rajkumar Dasgupta  1 , Fred Sattler  1 , Denise Brennan-Rieder  10 , Cristina Mussini  11 , Oriol Mitja  12 , Vicente Soriano  13 , Nicolas Peschanski  14 , Gilles Hayem  15 , Marco Confalonieri  16 , Maria Carmela Piccirillo  17 , Antonio Lobo-Ferreira  18 , Iraldo Bello Rivero  19 , Mika Turkia  20 , Eivind H Vinjevoll  21 , Daniel Griffin  5   22 , Ivan Fn Hung  5
Affiliations
Review

The time to offer treatments for COVID-19

Binh T Ngo et al. Expert Opin Investig Drugs. 2021 May.

Abstract

Background: COVID-19 has several overlapping phases. Treatments to date have focused on the late stage of disease in hospital. Yet, the pandemic is by propagated by the viral phase in out-patients. The current public health strategy relies solely on vaccines to prevent disease.Methods: We searched the major national registries, pubmed.org, and the preprint servers for all ongoing, completed and published trial results.Results: As of 2/15/2021, we found 111 publications reporting findings on 14 classes of agents, and 9 vaccines. There were 62 randomized controlled studies, the rest retrospective observational analyses. Only 21 publications dealt with outpatient care. Remdesivir and high titer convalescent plasma have emergency use authorization for hospitalized patients in the U.S.A. There is also support for glucocorticoid treatment of the COVID-19 respiratory distress syndrome. Monoclonal antibodies are authorized for outpatients, but supply is inadequate to treat all at time of diagnosis. Favipiravir, ivermectin, and interferons are approved in certain countries.Expert Opinion: Vaccines and antibodies are highly antigen specific, and new SARS-Cov-2 variants are appearing. We call on public health authorities to authorize treatments with known low-risk and possible benefit for outpatients in parallel with universal vaccination.

Keywords: SARS-Cov-2; convalescent plasma; covid-19; favipiravir; hcq; interferon-β-1; interferon-λ; ivermectin; remdesivir; synthetic anti-spike protein antibodies.

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Figures

Figure 1.
Figure 1.
The Phases of COVID-19. SARS-Cov-2 infection begins with an asymptomatic period of viral incubation. As viral replication accelerates, an influenza-like illness may appear. Lung involvement begins the early inflammatory phase which can proceed to a late inflammatory phase with accompanying secondary infections and a coagulopathy. The viral load is typically falling while the inflammatory state intensifies. This phase often includes disease of multi-organ systems. Elevated cytokine levels suggest an autoimmune process as the cause. The pneumonia may lead to acute respiratory distress with severe hypoxia. In those patients who recover, there can occur a prolonged period of symptoms and disability. This “tail phase” can continue for many months
Figure 2.
Figure 2.
Phase-specific treatment of COVID-19. The successive disease periods call for different treatments. Antiviral treatments, including convalescent plasma., monoclonal antibodies, and interferons are indicated during the period of viral replication, but are unlikely to be effective during the inflammatory process. Suppression of the immune response is indicated to combat the inflammatory events
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References

    1. WHO Coronavirus Disease (COVID-19) Dashboard 2021. Data last updated: 2021 February 15, 11 pm, Greenwich mean time
    1. Griffin DO, Brennan-Rieder D, Ngo B, et al. The importance of understanding the stages of COVID-19 in treatment and trials. AIDS Rev. 2021. DOI:10.24875/AIDSRev.200001261. - DOI - PubMed

    2. •• This article presents COVID-19 as a disease with specific phases and calls for research on distinctive treatments of different phases rather than to be viewed as a single process.

    1. Wu Z, McGoogan JM.. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China. Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–1242. - PubMed
    1. Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091. - PMC - PubMed
    1. Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. 2020;18(7):1559–1561. - PMC - PubMed

Grants and funding

This paper was funded by The Rose Salter Medical Research Foundation.