Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection

Abstract

Approximately 9 months of the severe acute respiratory syndrome coronavius-2 (SARS-CoV-2 [COVID-19]) 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 article 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, and 5) administration of oxygen, monitoring, and telemedicine. Future randomized trials testing the principles and agents discussed 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.

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“…This is in line with the observations that the difference in the viral load decrease was largest between day 1 and day 2 and that the 50% logarithmic reduction in viral load by day 6 was numerically greater in the early treatment group, suggesting the presence of modest antiviral activity in this setting. It has been suggested that antiviral therapy may be more efficacious if given early in the course of COVID-19 on October 30, 2020 by guest http://aac.asm.org/ Downloaded from than that in the terminal stage of illness (7). Favipiravir, which is active in vitro against SARS-CoV-2 and can be administered orally, is an agent which may fit this paradigm.…”

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