Therapeutic Management of COVID-19 Patients: Pharmacological and Non-Pharmacological Approaches

Introduction

The Coronavirus (COVID-19) pandemic, which first appeared in December 2019 in China, is a global challenge, especially in the face of the rapid increase in the number of critically ill patients with pneumonia and the lack of effective and definitive treatment (Worldometers 2020).

However, the majority of therapeutic strategies used to deal with this virus have come from the work of previous epidemics of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome coronavirus (MERS), an essential benchmark for all treatment options in patients with COVID-19 such as remdesivir (GS-5734), interferon, lopinavir / ritonavir, and convalescent plasma. In addition to these options, many other drugs are currently being used to deal with this pandemic (Nisole et al. 2020).

Currently, there is no effective treatment with a sufficient level of scientific evidence for SARS-CoV-2. Thus, the aim of this chapter is to focus on the most widely used therapeutic options in the world for the management of COVID-19,which aims to decrease virus replication, help the cell block the virus and / or reduce the harmful effects of the hyper-inflammatory reaction (Figure 1).

Figure 1.

SARS-CoV-2 replication cycle with the different molecules and their targets being evaluated to treat COVID-19. SARS-CoV-2 binds, via the S protein (for Spike); to the ACE2 receptor expressed on the surface of target cells, and then penetrates by endocytosis or by direct fusion to the plasma membrane. The serine protease TMPRSS2 is also involved in the entry stage of the virus, by allowing the priming of the S protein. After release of the genomic RNA in the cytoplasm, this is translated into polypeptides, which, cleaved by viral protease, make it possible to generate non-structural proteins, which form the replication / transcription complex (replicase). The genomic RNA with positive polarity (+) is then transcribed into complementary viral RNA with negative polarity (-), which serves as a template for the synthesis of genomic and subgenomic RNA, translated into structural proteins. Genomic RNA and structural proteins will then assemble in the endoplasmic reticulum. The newly formed viruses are then transported via transport vesicles to the Golgi apparatus and then to the cell surface, where they are released. Potential SARS-CoV-2 inhibitors and their known or predicted targets are indicated by rectangles at different stages of the viral cycle(Nisole et al. 2020).

Antiviral Therapies

In the era of COVID-19, there is no effective antiviral treatment for SARS-CoV-2. Indeed, the majority of therapeutic strategies used to deal with this virus have come from the work of previous epidemics of SARS, and other influenza viruses, which provide an essential benchmark for all therapeutic options in patients with COVID-19. These treatment options are essentially antiviral drugs.