Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19), which has rapidly become epidemic in Italy and other European countries. The disease spectrum ranges from asymptomatic/mildly symptomatic presentations to acute respiratory failure. At the present time the absolute number of severe cases requiring ventilator support is reaching or even surpassing the intensive care unit bed capacity in the most affected regions and countries.
Objectives: To narratively summarize the available literature on the management of COVID-19 in order to combine current evidence and frontline opinions and to provide balanced answers to pressing clinical questions.
Sources: Inductive PubMed search for publications relevant to the topic.
Content: The available literature and the authors' frontline-based opinion are summarized in brief narrative answers to selected clinical questions, with a conclusive statement provided for each answer.
Implications: Many off-label antiviral and anti-inflammatory drugs are currently being administered to patients with COVID-19. Physicians must be aware that, as they are not supported by high-level evidence, these treatments may often be ethically justifiable only in those worsening patients unlikely to improve only with supportive care, and who cannot be enrolled onto randomized clinical trials. Access to well-designed randomized controlled trials should be expanded as much as possible because it is the most secure way to change for the better our approach to COVID-19 patients.
Keywords: COVID-19; Coronavirus; Pneumonia; SARS-CoV-2; Therapy.
Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.
Features, Evaluation and Treatment Coronavirus (COVID-19).2020 Apr 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. StatPearls. 2020 Jan–. PMID: 32150360 Free Books & Documents. Review.
Focus on Receptors for Coronaviruses with Special Reference to Angiotensin-converting Enzyme 2 as a Potential Drug Target - A Perspective.Endocr Metab Immune Disord Drug Targets. 2020 Apr 27. doi: 10.2174/1871530320666200427112902. Online ahead of print. Endocr Metab Immune Disord Drug Targets. 2020. PMID: 32338224
[Repurposing of chlorpromazine in COVID-19 treatment: the reCoVery study].Encephale. 2020 Apr 29:S0013-7006(20)30079-8. doi: 10.1016/j.encep.2020.04.010. Online ahead of print. Encephale. 2020. PMID: 32387014 Free PMC article. French.
Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review.Cochrane Database Syst Rev. 2020 Apr 8;4(4):CD013574. doi: 10.1002/14651858.CD013574. Cochrane Database Syst Rev. 2020. PMID: 32267544
The Coronavirus Pandemic: What Does the Evidence Show?J Nepal Health Res Counc. 2020 Apr 19;18(1):1-9. doi: 10.33314/jnhrc.v18i1.2596. J Nepal Health Res Counc. 2020. PMID: 32335585 Review.
- Bassetti M., Vena A., Giacobbe D.R. The novel Chinese coronavirus (2019-nCoV) infections: Challenges for fighting the storm. Eur J Clin Invest. 2020;50
- Kinross P., Suetens C., Gomes Dias J. Rapidly increasing cumulative incidence of coronavirus disease (COVID-19) in the European Union/European Economic Area and the United Kingdom, 1 January to 15 March 2020. Euro Surveill. 2020;25
- Olsen S.J., Chen M.Y., Liu Y.L. Early Introduction of Severe Acute Respiratory Syndrome Coronavirus 2 into Europe. Emerg Infect Dis. 2020;26
- Baud D., Qi X., Nielsen-Saines K. Real estimates of mortality following COVID-19 infection. Lancet Infect Dis. 2020
- Mizumoto K., Kagaya K., Zarebski A., Chowell G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill. 2020:25.