Emerging Treatment and Prevention Strategies against COVID-19: A Brief Update

Abstract

Patients with novel coronavirus disease 2019 (COVID-19) are at significantly increased risk for mortality and morbidity. Current management remains supportive care, ranging from symptomatic outpatient management to full–intensive care support, including intravenous fluids, invasive, and non-invasive oxygen supplementation. In patients with septic shock, treatment with antibiotics and vasopressors are recommended to keep mean arterial pressure (MAP) ≥ 65 mm Hg and lactate < 2 mmol/L. Because of the lack of effectiveness and possible adverse effects, routine corticosteroids should be avoided unless they are indicated for another reason (exacerbation of asthma or chronic obstructive pulmonary disease [COPD], and septic shock in whom fluids and vasopressors do not restore hemodynamic stability). There is currently no sufficient evidence of efficacy of hydroxychloroquine/chloroquine, remdesivir, and other antivirals in the treatment or prevention of COVID-19. Limited evidence shows that COVID-19 convalescent plasma can be used as a treatment of COVID-19 without the occurrence of severe adverse events. Drug regulatory agencies granted an emergency-use authorization of chloroquine/hydroxychloroquine and remdesivir to treat patients when a clinical trial is not available or participation is not feasible. Chloroquine and hydroxychloroquine are associated with QT interval prolongation and life-threatening cardiac arrhythmia in patients with pre-existing cardiovascular disease. Guidelines are issued for use of convalescent plasma in patients with serious or immediately life-threatening COVID-19. Data from several ongoing randomized controlled trials will provide further evidence regarding the safety and efficacy of these drugs for the treatment of COVID-19.

An Overview of Vaccine Development for COVID-19

“…The design of a vaccine offering active protective immunity will be the most successful long-term strategy for preventing potential outbreaks of this virus. As of April 2020, 115 vaccine candidates were included in the international COVID-19 vaccine research and design landscape [ 63 ]. The most crucial candidate vaccines include viral vector vaccines, nucleic acid-based vaccines, aAPC vaccines, viral proteins and live vaccines [ 12 , 20 , 64 , 65 ].…”

A Comprehensive Study of SARS-CoV-2:From 2019-nCoV to COVID-19 Outbreak

“…A Chinese study involving more than 100 COVID-19 patients found chloroquine superior to the control group to minimize the length of the symptoms, worsen pneumonia including radiological improvement and encourage virus-negative seroconversion without significant side effects. This was the first human trial ever performed against COVID-19 with chloroquine; this early outcome has led China to use chloroquine in COVID-19 prevention and treatment [97]. In the absence of serious side effects, early findings from more than 100 patients participating in studies performed in China demonstrated the superiority of chloroquine relative to control in terms of reduction of pneumonia exacerbation, length of symptoms and delay in viral clearance [98].…”

Exploring COVID-19 Therapies: An Extraordinary Global Challenge

“…15 Although in the review by Kant Kumar et al, they have comprehensively covered most of the main pipeline drugs, a few more, we believe, are worthy of a mention here. 2 As we said earlier, in this unprecedented time, authors are relaying on the results of their studies through prepublication portal till the paper is peer-reviewed. One of such drug is favipravir which is a RNA polymerase inhibitor drug and it has shown its efficacy against influenza virus and Ebola virus infection.…”

“…That being said, the review by Kant Kumar et al published in this journal is a welcome manuscript which adequately summarizes the available therapeutic options as of now and briefly touches upon the status of vaccine development. 2 It is very reassuring that majority of patients with COVID-19 disease have a mild course and only approximately 10 to 15% of them require substantial health care facility and specific treatment. 3 Therefore, the mainstay of treatment of COVID-19 is supportive for all the stages of the disease and use of lung protective ventilation, Surviving Sepsis Guidelines for COVID, and investigational agents only in a few selected patients.…”

“…As highlighted by Kant Kumar et al, several vaccine are being explored with some starting early clinical trials, the availability of an effective vaccine is not close and it may take 9 to 12 months for mass production and mass use. 2 We will have to wait for results of ongoing trials before specific treatment and preventive strategies are established as a standard of care, and till then, prevention of the spread of the disease remains at the center stage.…”