Treatment algorithm for COVID-19: a multidisciplinary point of view

Clin Rheumatol. 2020 Jul;39(7):2077-2084. doi: 10.1007/s10067-020-05179-0. Epub 2020 May 29.

Abstract

The novel coronavirus (Sars-CoV-2) pandemic has spread rapidly, from December to the end of March, to 185 countries, and there have been over 3,000,000 cases identified and over 200,000 deaths. For a proportion of hospitalized patients, death can occur within a few days, mainly for adult respiratory distress syndrome or multi-organ dysfunction syndrome. In these patients, clinical signs and symptoms, as well as laboratory abnormalities, suggest a cytokine storm syndrome in response to the viral infection. No current targeted treatment is yet available for COVID-19, an unknown disease up to 2 months ago, which challenges doctors and researchers to find new drugs or reallocate other treatments for these patients. Since the beginning of the COVID-19 outbreak, a growing body of information on diagnostic and therapeutic strategies has emerged, mainly based on preliminary experience on retrospective studies or small case series. Antivirals, antimalarials, corticosteroids, biotechnological and small molecules, convalescent plasma and anticoagulants are among the drugs proposed for the treatment or in tested for COVID-19. Given the complexity of this new condition, a multidisciplinary management seems to be the best approach. Sharing and integrating knowledge between specialists, to evaluate the correct timing and setting of every treatment, could greatly benefit our patients. We reviewed the literature, combining it with our experiences and our specialist knowledge, to propose a management algorithm, correlating the clinical features with laboratory and imaging findings to establish the right timing for each treatment.Key Points• Critically ill COVID-19 patients show signs of cytokine storm syndrome.• No current targeted therapy is available, but a lot of drugs are in tested.• A multidisciplinary approach is crucial to manage COVID-19.• Choosing the correct timing of treatment is of pivotal importance to avoid the most severe complications.

Keywords: Algorithm; COVID-19; Management; Sars-CoV-2.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Antiviral Agents* / immunology
  • Antiviral Agents* / pharmacology
  • Betacoronavirus / isolation & purification
  • Clinical Laboratory Techniques / methods*
  • Coronavirus Infections* / diagnosis
  • Coronavirus Infections* / drug therapy
  • Coronavirus Infections* / epidemiology
  • Coronavirus Infections* / immunology
  • Coronavirus Infections* / therapy
  • Critical Pathways
  • Cytokine Release Syndrome* / diagnosis
  • Cytokine Release Syndrome* / drug therapy
  • Cytokine Release Syndrome* / etiology
  • Humans
  • Pandemics*
  • Patient Care Team / organization & administration*
  • Pneumonia, Viral* / epidemiology
  • Pneumonia, Viral* / immunology
  • Pneumonia, Viral* / therapy

Substances

  • Antiviral Agents

Supplementary concepts

  • COVID-19
  • COVID-19 diagnostic testing
  • COVID-19 drug treatment
  • severe acute respiratory syndrome coronavirus 2