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

• Type of Material: Article
• Authors: Peter A. McCullough, Baylor University; Ronan J. Kelly, Baylor University; Gaetano Ruocco, Regina Montis Regalis Hospital; Edgar Lerma, Christ Advocate Medical Center; James Tumlin, Emory University; Kevin R. Wheelan, Baylor University; Nevin Katz, Johns Hopkins University; Norman E. Lepor, Cedars Sinai Medical Center; Kris Vijay, Abrazo Arizona Heart Hospital; Harvey Carter, Carter Eye Center; Bhupinder Singh, Cardiorenal Society of America; Sean P. McCullough, University of Texas Houston; Brijesh K. Bhambi, Bakersfield Heart Hospital; Alberto Palazzuoli, University of Siena; Gaetano M. De Ferrari, University of Torino; Gregory P. Milligan, Baylor University; Taimur Safder, Baylor University; Kristen M. Tecson, Baylor University; Dee Dee Wang, Henry Ford Hospital; John E. McKinnon, Henry Ford Hospital; William W. O'Neill, Henry Ford Hospital; Marcus Zervos, Henry Ford Hospital; Harvey A. Risch, Yale University
• Language: English
• Date: 2021-01-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Authors
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjmed.2020.07.003
• Title of Journal or Parent Work: AMERICAN JOURNAL OF MEDICINE
• Volume: 134
• Issue: 1
• Start Page: 16
• End Page: 22
• Grant/Funding Information: None
• Keywords: Mortality; SARS-CoV-2; Anti-inflammatory; Ambulatory treatment; COVID-19; Antiviral; Hospitalization; Epidemiology; Critical care; Anticoagulant
• Research Categories: Health Sciences, Epidemiology; Biology, Virology; Health Sciences, Public Health

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.