Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection
McCullough et al.
, Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection
, The American Journal of Medicine, doi:10.1016/j.amjmed.2020.07.003 (Review)
Review of pathophysiological principles related to early outpatient treatment and therapeutic approaches including reduction of reinoculation, combination antiviral therapy, immunomodulation, antiplatelet/antithrombotic therapy, and administration of oxygen, monitoring, and telemedicine.
Proposes an algorithm based on age and comorbidities that allows for a large proportion to be monitored and treated at home during self-isolation with the aim of reducing the risks of hospitalization and death.
McCullough et al., 6 Aug 2020, peer-reviewed, 23 authors.
Abstract: ARTICLE IN PRESS
Pathophysiological Basis and Rationale for Early
Outpatient Treatment of SARS-CoV-2 (COVID-19)
Peter A. McCullough, MD, MPH,a,b,c Ronan J. Kelly, MD,a Gaetano Ruocco, MD,d Edgar Lerma, MD,e James Tumlin, MD,f
Kevin R. Wheelan, MD,a,b,c Nevin Katz, MD,g Norman E. Lepor, MD,h Kris Vijay, MD,i Harvey Carter, MD,j
Bhupinder Singh, MD,k Sean P. McCullough, BS,l Brijesh K. Bhambi, MD,m Alberto Palazzuoli, MD, PhD,n
Gaetano M. De Ferrari, MD, PhD,o Gregory P. Milligan, MD, MPH,a Taimur Safder, MD, MPH,a Kristen M. Tecson, PhD,b
Dee Dee Wang, MD,p John E. McKinnon, MD,p William W. O’Neill, MD,p Marcus Zervos, MD,p Harvey A. Risch, MD, PhDq
Baylor University Medical Center, Dallas, Tex; bBaylor Heart and Vascular Institute, Dallas, Tex; cBaylor Jack and Jane Hamilton Heart
and Vascular Hospital, Dallas, Tex; dCardiology Division, Regina Montis Regalis Hospital, Mondovı, Cuneo, Italy; eChrist Advocate
Medical Center, Chicago, Ill; fEmory University School of Medicine, Atlanta, Ga; gJohns Hopkins School of Medicine, Baltimore, Md;
Cedars Sinai Medical Center, Los Angeles, Calif; iAbrazo Arizona Heart Hospital, Abrazo Health System, Phoenix, Ariz; jCarter Eye
Center, Dallas, Tex; kCardiorenal Society of America, Phoenix, Ariz; lUniversity of Texas McGovern Medical School, Houston, Tex;
Bakersfield Heart Hospital, Bakersfield, Calif; nUniversity of Siena, Le Scotte Hospital Viale Bracci, Siena, Italy; oUniversity of Torino,
Torino, Italy; pHenry Ford Hospital, Detroit, Mich; qYale University School of Public Health, New Haven, Conn.
Approximately 9 months of the severe acute respiratory syndrome coronavius-2 (SARS-CoV-2 [COVID19]) 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 SARSCoV-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.
Ó 2020 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND
license. (http://creativecommons.org/licenses/by-nc-nd/4.0/) The American Journal of Medicine (2020)
KEYWORDS: Ambulatory treatment; Anticoagulant; Anti-inflammatory; Antiviral; COVID-19; Critical care; Epidemiology; Hospitalization; Mortality; SARS-CoV-2
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing
Requests for reprints should be addressed to Peter A. McCullough,
MD, MPH, Baylor Heart and Vascular Institute, 621 N. Hall..
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