Pathophysiological basis and rationale for early outpatient treatment of SARS-CoV-2 (COVID-19) Infection
Date
2020Author
McCullough, Peter A.
Kelly, Ronan J.
Ruocco, Gaetano
Lerma, Edgar
Tumlin, James
Wheelan, Kevin
Katz, Nevin
Lepor, Norman E.
Vijay, Kris
Carter, Harvey
Singh, Bhupinder
McCullough, Sean P.
Bhambi, Brijesh K.
Palazzuoli, Alberto
De Ferrar, Gaetano M
Milligan, Gregory
Safder, Taimur
Tecson, Kristen M.
Wang, Dee Dee
McKinnon
O’Neill, William W.
Zervos, Marcus
Risch, Harvey A.
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Abstract
Approximately 9 months of the SARS-CoV-2 virus spreading across the globe
has led to widespread COVID-19 acute hospitalizations and death. The rapidity and
highly communicable nature of the SARS-CoV-2 outbreak has hampered the design and
execution of definitive randomized, controlled trials of therapy outside of the clinic or
hospital. In the absence of clinical trial results, physicians must use what has been
learned about the pathophysiology of SARS-CoV-2 infection in determining early
outpatient treatment of the illness with the aim of preventing hospitalization or death.
This paper outlines key pathophysiological principles that relate to the patient with early
infection treated at home. Therapeutic approaches based on these principles include: 1)
reduction of reinoculation, 2) combination antiviral therapy, 3) immunomodulation, 4)
antiplatelet/antithrombotic therapy 5) administration of oxygen, monitoring, and
telemedicine. Future randomized trials testing the principles and agents discussed in
this paper will undoubtedly refine and clarify their individual roles, however we
emphasize the immediate need for management guidance in the setting of widespread
hospital resource consumption, morbidity, and mortality.
Palabras clave
SARS-CoV-2; COVID-19; Hospitalization; Critical care; Mortality; Epidemiology; Ambulatory treatment; Antiviral; Anti-inflammatory; AnticoagulantLink to resource
https://doi.org/10.1016/j.amjmed.2020.07.003Collections
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