Natural history and therapeutic options for COVID-19

Introduction 28 COVID-19 presents benign forms in young patients who frequently present with anosmia. 29 Infants are rarely infected, while severe forms occur in patients over 65 years of age with 30 comorbidities, including hypertension and diabetes. Lymphopenia, eosinopenia, 31 thrombopenia, increased lactate dehydrogenase, troponin, C-reactive protein, D-dimers, and 32 low zinc levels are associated with severity. 33 Areas covered 34 The authors review the literature and provide an overview of the current state of knowledge 35 regarding the natural history of and therapeutic options for COVID-19. 36 Expert opinion 37 Diagnosis should rely on PCR and not on clinical presumption. Because of discrepancies 38 between clinical symptoms, oxygen saturation or radiological signs on CT scans, pulse 39 oximetry and radiological investigation should be systematic. The disease evolves in 40 successive phases: an acute virological phase, and, in some patients, a cytokine storm phase; 41 an uncontrolled coagulopathy; and an acute respiratory distress syndrome. Therapeutic 42 options include antivirals, oxygen therapy, immunomodulators, anticoagulants and prolonged 43 mechanical treatment. Early diagnosis, care, and implementation of an antiviral treatment; the 44 use of immunomodulators at a later stage; and the quality of intensive care are critical 45 regarding mortality rates. The higher mortality observed in Western countries remains 46 unexplained. Pulmonary fibrosis may occur in some patients. Its future is unpredictable.