COVID-19: An Update on the Epidemiological, Clinical, Preventive and Therapeutic Evidence and Guidelines of Integrative Chinese–Western Medicine for the Management of 2019 Novel Coronavirus Disease

Abstract

As of 22 February 2020, more than 77662 cases of confirmed COVID-19 have been documented globally with over 2360 deaths. Common presentations of confirmed cases include fever, fatigue, dry cough, upper airway congestion, sputum production, shortness of breath, myalgia/arthralgia with lymphopenia, prolonged prothrombin time, elevated C-reactive protein, and elevated lactate dehydrogenase. The reported severe/critical case ratio is approximately 7-10% and median time to intensive care admission is 9.5-10.5 days with mortality of around 1-2% varied geographically. Similar to outbreaks of other newly identified virus, there is no proven regimen from conventional medicine and most reports managed the patients with lopinavir/ritonavir, ribavirin, beta-interferon, glucocorticoid and supportive treatment with remdesivir undergoing clinical trial. In China, Chinese medicine is proposed as a treatment option by national and provincial guidelines with substantial utilization. We reviewed the latest national and provincial clinical guidelines, retrospective cohort studies, and case series regarding the treatment of COVID-19 by add-on Chinese medicine. We have also reviewed the clinical evidence generated from SARS and H1N1 management with hypothesized mechanisms and latest in silico findings to identify candidate Chinese medicines for the consideration of possible trials and management. Given the paucity of strongly evidence-based regimens, the available data suggest that Chinese

The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from China

“…At present, systemic glucocorticoids administration was empirically used for severe comp licat ions in order to suppress CS man ifestations in patients with COVID-19, such as ARDS, acute heart in juries, acute kidney complication, and patients with higher D-d imer levels, et al [3,23,24] However, there is no evidence from randomized clinical trials to support glucocorticoids treatment for COVID-19. Chen et al reported 19 (19%) patients were treated with glucocorticoids for 3-15 days (median 5 [3][4][5][6][7]), and methylprednisolone (1-2 mg/kg per day) are reco mmended for patients with ARDS, fo r as short a duration of treatment as possible [25].…”

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“…Mechanical ventilation may be necessary in cases of respiratory failure refractory to oxygen therapy, whereas hemodynamic support is essential for managing septic shock [37]. Different strategies can be used depending on the severity of the patient and local epidemiology [38,39]. Home management is appropriate for asymptomatic or paucisintomatic patients.…”

COVID-19 for the Cardiologist

“…Another nucleotide analog for the disruption of RdRp-dependent viral replication is favipiravir, which has investigational approval in several countries (128,129). Additional agents that are under study include emtricitabine/tenofovir and ribavirin (128,130).…”