Treating COVID-19: are we missing out the window of opportunity?

J Antimicrob Chemother. 2021 Jan 19;76(2):283-285. doi: 10.1093/jac/dkaa442.


Severe COVID-19 is a biphasic illness, with an initial viral replication phase, followed by a cascade of inflammatory events. Progression to severe disease is predominantly a function of the inflammatory cascade, rather than viral replication per se. This understanding can be effectively translated to changing our approach in managing the disease. The natural course of disease offers us separate windows of specific time intervals to administer either antiviral or immunomodulatory therapy. Instituting the right attack at the right time would maximize the benefit of treatment. This concept must also be factored into studies that assess the efficacy of antivirals and immunomodulatory agents against COVID-19.

MeSH terms

  • Antiviral Agents / administration & dosage*
  • Antiviral Agents / therapeutic use
  • COVID-19 / drug therapy*
  • COVID-19 / immunology
  • COVID-19 / virology
  • Cytokines / blood
  • Disease Progression
  • Humans
  • Immunomodulation / drug effects*
  • Immunomodulation / immunology
  • Immunosuppressive Agents / administration & dosage*
  • Immunosuppressive Agents / therapeutic use
  • SARS-CoV-2 / drug effects
  • Time-to-Treatment*
  • Virus Replication / drug effects


  • Antiviral Agents
  • Cytokines
  • Immunosuppressive Agents

Supplementary concepts

  • COVID-19 drug treatment