Treatment of coronavirus disease (COVID-19)

Abstract

Coronavirus disease (COVID-19) is caused by RNA virus of severe acute respiratory syndrome 2 (SARS-CoV-2) which is highly contagious to humans. The primary receptor for the virus is probably angiotensin-converting enzyme 2. COVID-19 is a respiratory infection, primarily transmitted by droplets and close contact with a diseased person. Estimated reproductive number (R0) is 2-2.5 and the mean incubation time is 5.2 days, ranging 1-14 days (95% confidence interval 4.1-7.0 days). The most common symptoms are: fever, dry cough, malaise, productive sputum and dyspnea, followed, sore throat, headache, myalgia, arthralgia, fever and dizziness and, occasionally, confusion, rhinorrhea, nasal congestion, gastrointestinal symptoms, hemoptysis and conjunctival injection. Initial atypical manifestations are also known. Real-time reverse transcriptase polymerase chain reaction (rRT-PCR) assay is the "gold" diagnostic standard, but its specificity and sensitivity have not been established. The most common complications are: acute respiratory distress syndrome, acute liver damage, acute heart damage and arrhythmia, followed by secondary infections, acute respiratory failure, acute renal impairment, sepsis and/or septic shock, pneumothorax, disseminated intravascular coagulation, acute heart failure and occasionally, rhabdomyolysis. Disease duration varies and in hospitalized patients it is estimated to be 16-26 days (interquartile range 12-29 days), while the global mortality rate is still unknown with certainty. Drugs against SARS-CoV-2 prescribed by empirical protocols (off-label use) are lopinavir/ritonavir, chloroquine and hydroxychloroquine, nitazoxanide, umifenovir, ribavirin, inhaled interferon Alpha while the new drugs of clinical trial stages are remdesivir, nafamostat i favipiravir. Proven drug prophylaxis of COVID-19 does not yet exist and vaccine against SARS-CoV-2 has not yet been developed.