Abstract
The 2019 season novel coronavirus disease (COVID-19) now is considered a global public health emergency. One of the unprecedented challenges is defining the optimal therapy for those patients with severe pneumonia and systemic manifestations of COVID-19. The optimal therapy should be largely based on the pathogenesis of infections caused by this novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the onset of COVID-19, there have been many prepublications and publications reviewing the therapy of COVID-19 as well as many prepublications and publications reviewing the pathogenesis of SARS-CoV-2. However, there have been no comprehensive reviews that link COVID-19 therapies to the pathogenic mechanisms of SARS-CoV-2. To link COVID-19 therapies to pathogenic mechanisms of SARS-CoV-2, we performed a comprehensive search through MEDLINE, PubMed, medRxiv, EMBASE, Scopus, Google Scholar, and Web of Science using the following keywords: COVID-19, SARS-CoV-2, novel 2019 coronavirus, pathology, pathologic, pathogenesis, pathophysiology, coronavirus pneumonia, coronavirus infection, coronavirus pulmonary infection, coronavirus cardiovascular infection, coronavirus gastroenteritis, coronavirus autopsy findings, viral sepsis, endotheliitis, thrombosis, coagulation abnormalities, immunology, herd immunity, cellular immunity, inflammation, cytokine storm, superantigen, therapy, treatment, therapeutics, immune-based therapeutics, antiviral agents, respiratory therapy, oxygen therapy, anticoagulation therapy, adjuvant therapy, and preventative therapy. Opinions expressed in this review also are based on personal experience as clinicians, authors, peer reviewers, and editors. This narrative review linking COVID-19 therapies with pathogenic mechanisms of SARS-CoV-2 has resulted in six major therapeutic goals for COVID-19 therapy based on the pathogenic mechanisms of SARS-CoV-2.
These goals are listed below:
1. The first goal is identifying COVID-19 patients that require both testing and therapy. This is best accomplished with a COVID-19 molecular test from symptomatic patients as well as determining the oxygen saturation in such patients with a pulse oximeter. Whether a symptomatic respiratory illness is COVID-19, influenza, or another respiratory pathogen, an oxygen saturation less than 90% means that the patient requires medical assistance.
2. The second goal is to correct the hypoxia. This goal generally requires hospitalization for oxygen therapy; other respiratory-directed therapies such as prone positioning or mechanical ventilation are often used in the attempt to correct hypoxemia due to COVID-19.
3. The third goal is to reduce the viral load of SARS-CoV-2. Ideally, there would be an oral antiviral agent available such as seen with the use of oseltamivir phosphate for influenza. This oral antiviral agent should be taken early in the course of SARS-CoV-2 infection. Such an oral agent is not available yet. Currently, two options are available for reducing the viral load of SARS-CoV-2. These are post-Covid-19 plasma with a high neutralizing antibody titer against SARS-CoV-2 or intravenous remdesivir; both options require hospitalization.
4. The fourth goal is to identify and address the hyperinflammation phase often seen in hospitalized COVID-19 patients. Currently, fever with an elevated C-reactive protein is useful for diagnosing this hyperinflammation syndrome. Low-dose dexamethasone therapy currently is the best therapeutic approach.
5. The fifth goal is to identify and address the hypercoagulability phase seen in many hospitalized COVID-19 patients. Patients who would benefit from anticoagulation therapy can be identified by a marked increase in d-dimer and prothrombin time with a decrease in fibrinogen. To correct this disseminated intravascular coagulation-like phase, anticoagulation therapy with low molecular weight heparin is preferred. Anticoagulation therapy with unfractionated heparin is preferred in COVID-19 patients with acute kidney injuries.
6. The last goal is prophylaxis (definition below)
Prophylaxis
Definition
A prophylaxis is a measure taken to maintain health and prevent the spread of disease. Antibiotic prophylaxis is the focus of this article and refers to the use of antibiotics to prevent infections.
Purpose
Antibiotics are well known for their ability to treat infections. But some antibiotics also are prescribed to prevent infections. This usually is done only in certain situations or for people with particular medical problems. For example, people with abnormal heart valves have a high risk of developing heart valve infections after even minor surgery. This happens because bacteria from other parts of the body get into the bloodstream during surgery and travel to the heart valves. To prevent these infections, people with heart valve problems often take antibiotics before having any kind of surgery, including dental surgery.
Antibiotics also may be prescribed to prevent infections in people with weakened immune systems, such as people with AIDS or people who are having chemotherapy treatments for cancer. But even healthy people with strong immune systems may occasionally be given preventive antibiotics-if they are having certain kinds of surgery that carry a high risk of infection, or if they are traveling to parts of the world where they are likely to get an infection that causes diarrhea, for example.
In all of these situations, a physician should be the one to decide whether antibiotics are necessary. Unless a physician says to do so, it is not a good idea to take antibiotics to prevent ordinary infections.
Because the overuse of antibiotics can lead to resistance, drugs taken to prevent infection should be used only for a short time.
Description
Among the drugs used for antibiotic prophylaxis are amoxicillin (a type of penicillin) and fluoroquinolones such as ciprofloxacin (Cipro) and trovafloxacin (Trovan). These drugs are available only with a physician's prescription and come in tablet, capsule, liquid, and injectable forms.
Recommended dosage
The recommended dosage depends on the type of antibiotic prescribed and the reason it is being used. For the correct dosage, check with the physician or dentist who prescribed the medicine or the pharmacist who filled the prescription. Be sure to take the medicine exactly as prescribed. Do not take more or less than directed, and take the medicine only for as long as the physician or dentist says to take it.
Precautions
If the medicine causes nausea, vomiting, or diarrhea, check with the physician or dentist who prescribed it as soon as possible. Patients who are taking antibiotics before surgery should not wait until the day of the surgery to report problems with the medicine. The physician or dentist needs to know right away if problems occur.
For other specific precautions, see the entry on the type of drug prescribed such as penicillins or fluoroquinolones.
Side effects
Antibiotics may cause a number of side effects. For details, see entries on specific types of antibiotics. Anyone who has unusual or disturbing symptoms after taking antibiotics should get in touch with his or her physician.
Interactions
Whether used to treat or to prevent infection, antibiotics may interact with other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Anyone who takes antibiotics for any reason should inform the physician about all the other medicines he or she is taking and should ask whether any possible interactions may interfere with drugs' effects. For details of drug interactions, see entries on specific types of antibiotics.
Key terms
AIDS — Acquired immunodeficiency syndrome. A disease caused by infection with the human immunodeficiency virus (HIV). In people with this disease, the immune system breaks down, opening the door to other infections and some types of cancer.
Antibiotic — A medicine used to treat infections.
Chemotherapy — Treatment of an illness with chemical agents. The term is usually used to describe the treatment of cancer with drugs.
Immune system — The body's natural defenses against disease and infection.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
prophylaxis
[pro″fĭ-lak´sis]
disease prevention; called also preventive treatment.
dental prophylaxis oral prophylaxis.
oral prophylaxis cleaning of the teeth by a dentist or dental hygienist, including removal of plaque, materia alba, calculus, and extrinsic stains; done as a preventive measure for control of gingivitis. Called also dental prophylaxis.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
pro·phy·lax·is
, pl.
pro·phy·lax·es
(prō'fi-lak'sis, -sēz),
Prevention of disease or of a process that can lead to disease.
[Mod. L. fr. G. pro-phylassō, to guard before, take precaution] (
for persons who are not yet infected. Potential supplements include vitamin D and zinc. Although the data for such supplements is not extremely strong, it can be argued that almost 50% of the population worldwide has a vitamin D deficiency. Correcting this deficiency would be beneficial regardless of any impact of COVID-19. Similarly, zinc is an important supplement that is important in one's diet regardless of any effect on SARS-CoV-2.
As weirdos keep wasting more unsustainable currency making more and more synthetic ways to attempt to substitute or circumnavigate our already proven to be scientifically known, as well as locally grown, accepted, and celebrated as they are found to be more effective against the SARS-CoV-2 pathogenic mechanisms identified, or any other pathogen that call themselves tappin in any community in which we are inhabiting they will NEVER be even discussed, implemented, or substituted for those therapies presented in this review.
Keywords:
SARS-CoV-2 coronavirus; coronavirus; pathogenesis; therapy; treatment.