Treatment
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It is hoped that at least some of the options given in this overview will show positive results over time. It is also important, though, that despite the immense pressure, the basic principles of drug development and research including repurposing are not abandoned. Time is needed. The aim of the COVID Reference textbook is to scan the literature, not to write guidelines. However, after reviewing the studies published until January 20, 2021, presented above, we would recommend reviewing the following treatment options, considering the severity of the disease:
Outpatient, mild-to-moderate (no risk factors) •
Do NOTHING, except down-talking the patient. And make sure that he or she (and their households) stays home
Outpatient, mild-to-moderate (with risk factors) •
Do NOT use dexamethasone (could be harmful) or remdesivir (daily infusions not feasible)
•
Do NOT use hydroxychloroquine, chloroquine, tocilizumab, convalescent plasma or lopinavir (not efficient, plus side effects)
•
Consider ASS, colchicine, vitamin D, famotidine (potential harm seems to be limited)
•
In high risk patients: consider monoclonal antibodies
•
Interferon may work, if given early (optimal usage and administration is unclear)
Hospital, severe •
Use dexamethasone (only a few days)
•
Use remdesivir (5 days) as soon as possible (no benefit in those requiring high-flow oxygen or mechanical ventilation)
•
Consider cytokine blocking agents and/or baricitinib if available
References Abbaspour Kasgari H, Moradi S, Shabani AM, et al. Evaluation of the efficacy of sofosbuvir plus daclatasvir in combination with ribavirin for hospitalized COVID-19 patients with moderate disease compared with standard care: a single-centre, randomized controlled trial. J Antimicrob Chemother. 2020 Nov 1;75(11):3373-3378. PubMed: https://pubmed.gov/32812025. Full-text: https://doi.org/10.1093/jac/dkaa332 Abella BS, Jolkovsky EL, Biney BT, et al. Efficacy and Safety of Hydroxychloroquine vs Placebo for Pre-exposure SARS-CoV-2 Prophylaxis Among Health Care Workers: A Random-
COVID Reference ENG 006.9