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Natural history and therapeutic options for COVID-19

IHU, Expert Review of Clinical Immunology
Sep 2020  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments.
Review of the current state of knowledge regarding the natural history of and therapeutic options for COVID-19.
Treatment with an oral combination of hydroxychloroquine, azithromycin and zinc may represent the best current therapeutic option in relation to its antiviral and
immunomodulatory effects.
Reviews covering hydroxychloroquine for COVID-19 include1-17.
IHU et al., 7 Sep 2020, peer-reviewed, 1 author.
This PaperHCQAll
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.
pulmonary embolism in our day care hospital after systematic D-dimer assessment without 717 any clinical signs. In the presence of a clinical (NEWS score ≥ 5) or biological sign of 718 severity, or if the treatment became difficult, patients were systematically hospitalized. have been observed. In the 60+ age group, the mortality regardless of treatment was 5.0%, 723 which was similar to the mortality in the same age group reported in China (6.0%) but lower 724 than that reported in Italy (12.3%) [171] . On the other hand, among patients aged 60 years and 725 over who had at least three days of dual HCQ-AZ therapy in our center, the mortality was 726 3.1%, which was much lower than that reported in China and Italy for the same age group. Supportive care No evidence of drug efficacy Quality of ICU care (respiratory support) Anti-coagulant therapy
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