HCQ: Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection

BACKGROUND HEADLINES: Clinical Significance: COVID-19 hospitalizations and death can be reduced with outpatient treatment

Figure 1 Treatment algorithm for COVID-19-like and confirmed COVID-19 illness in ambulatory patients at home in self-quarantine. BMI = body mass index; CKD = chronic kidney disease; CVD = cardiovascular disease; DM = diabetes mellitus; Dz = disease; HCQ = hydroxychloroquine; Mgt = management; O2 = oxygen; Ox = oximetry; Yr = year.

ABSTRACT

Approximately 9 months of the severe acute respiratory syndrome coronavius-2 (SARS-CoV-2 [COVID-19]) 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 SARS-CoV-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.

Published: August 06, 2020

DOI: 10.1016/j.amjmed.2020.07.003

AMJMED.COM: https://www.amjmed.com/article/S0002-9343(20)30673-2/fulltext

AUTHORS:
Peter A. McCullough, MD, MPH; Ronan J. Kelly, MD; Gaetano Ruocco, MD; Edgar Lerma, MD; James Tumlin, MD; Kevin R. Wheelan, MD; Nevin Katz, MD; Norman E. Lepor, MD; Kris Vijay, MD; Harvey Carter, MD; Bhupinder Singh, MD; Sean P. McCullough, BS; Brijesh K. Bhambi, MD; Alberto Palazzuoli, MD, PhD; Gaetano M. De Ferrari, MD, PhD; Gregory P. Milligan, MD, MPH; Taimur Safder, MD, MPH; Kristen M. Tecson, PhD; Dee Dee Wang, MD; John E. McKinnon, MD; William W. O’Neill, MD; Marcus Zervos, MD; Harvey A. Risch, MD, PhD

ORIGINAL SOURCE: Date-stamped: 2021 JAN 01 - Author: Peter A. McCullough, MD, MPH; Ronan J. Kelly, MD; Gaetano Ruocco, MD; Edgar Lerma, MD; James Tumlin, MD; Kevin R. Wheelan, MD; Nevin Katz, MD; Norman E. Lepor, MD; Kris Vijay, MD; Harvey Carter, MD; Bhupinder Singh, MD; Sean P. McCullough, BS; Brijesh K. Bhambi, MD; Alberto Palazzuoli, MD, PhD; Gaetano M. De Ferrari, MD, PhD; Gregory P. Milligan, MD, MPH; Taimur Safder, MD, MPH; Kristen M. Tecson, PhD; Dee Dee Wang, MD; John E. McKinnon, MD; William W. O'Neill, MD; Marcus Zervos, MD; Harvey A. Risch, MD, PhD - Article Title: Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection - Article Link: amjmed.com

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