Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website https://www.jocmr.org

Review

Volume 12, Number 12, December 2020, pages 758-772

COVID-19 and Possible Pharmacological Preventive Options

Figures

Figure 1.
Figure 1. Mechanisms of action of different antiviral drugs. A schematically diagram of SARS-CoV-2 structure and different pathway used by SARS-CoV-2 for the replication in the host cells. Theoretical applicable inhibitory action of certain antiviral drugs used in the treatment of other viral infections, as well as specific SARS-CoV-2 neutralizing antibodies would in combination interfere with the SARS-CoV-2 life cycle exerting a possible inhibitory effect on the virus replication, which is shown in red color. ORF proteins: ORF1a, ORF1b, ORF3a, ORF8 and ORF10 [8, 19]. SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; ACE2: angiotensin-converting enzyme 2; ORF: open read frame.
Figure 2.
Figure 2. Schematic illustration of the immune response to a viral infection. Based on the previous knowledge of immune system, we proposed a comparing graphic image for the virally-induced pro-inflammatory and anti-inflammatory cytokine generation (with the obvious suppressive effect of SARS-CoV-2 on the anti-inflammatory cytokine production resulting in cytokine storm), as well as development of antibody against SARS-CoV-2 compared to other viral infections by the body [29, 32].

Tables

Table 1. Characteristics of COVID-19, SARS and MERS
 
CharacteristicCOVID-19SARSMERSReferences
General information on variables related to the onset and progression of COVID-19, SARS and MERS infection. COVID-19: coronavirus disease 2019; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; MERS: Middle East respiratory syndrome; WHO: the World Health Organization.
VirusSARS-CoV-2SARS-CoVMERS-CoV
First locationWuhan, ChinaGuangdong, ChinaJeddah, Saudi Arabia[1, 2, 4, 5]
First reported201920022012[1-5]
Natural hostBatBatBat[2, 4, 5]
Intermediate hostUnknownCivet cat or other animalDromedary camels[2, 4, 5]
Incubation time (days)1 - 142 - 102 - 14WHO
Global incidences24,587,513 (to date)8,4222,400WHO
Mode of transmissionRespiratory droplet, contactRespiratory droplet, contactRespiratory droplet, contact[2, 4, 5]
Transmission rate2 - 32 - 5< 1[2, 4, 5]
Deaths (to date)833,556916858WHO
Mortality rate4%10%34%[2, 4, 5]

 

Table 2. Medications/Treatments Against COVID-19
 
MedicationMode of actionReferences
Mode of action and targets of potential medical agents for the treatment of SARS-CoV-2 infection. COVID-19: coronavirus disease 2019; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; ACE2: angiotensin-converting enzyme 2; IL: interleukin; NAC: N-acetylcysteine; rhACE2: recombinant human ACE2; IFN: interferon.
RemdesivirRNA polymerase inhibitor[26, 27, 34]
Lopinavir, ritonavirProtease inhibitor[28]
Peramivir, oseltamivirNeuraminidase/hemagglutinin-esterase inhibitor[29]
Tocilizumab, anakinra, leronlimabCytokine receptor/cytokine release blocker[32]
Camostat mesylateACE2 inhibitor[33]
Canakinumabhuman anti-IL-1β monoclonal antibody[34]
rhACE2Recombinant ACE2[35]
Hydroxychloroquine and chloroquineBlock RNA replication/release[33, 36, 37]
AzithromycinAntibiotic/IFN production[38]
Ivermectinanti-parasitic action[39]
Convalescent plasmaAnti-SARS-CoV-2 neutralizing antibodies[40]
Monoclonal antibodiesblock virus entry[41]
ErythropoietinTreatment of anemia[42]
Enoxaparin, edoxabanAnticoagulants[43]
Vitamin C/DImmunomodulatory, antioxidant[45-51]
NACAntioxidant[44]
Dornase alphaDNase I[52]

 

Table 3. Combination Medications/Treatments Against COVID-19
 
MedicationStatusOutcomeReferences
Clinical trials comparing the effect of mono- vs. combination drug therapy of COVID-19 patients. COVID-19: coronavirus disease 2019.
Hydroxychloroquine and azithromycin on mortality in patients with COVID-19FinalizedReduced in-hospital mortality in patients treated with a combination treatment[78]
Hydroxychloroquine and azithromycinFinalizedReduction in COVID-19 associated mortality[79]
Interferon beta-1b, lopinavir/ritonavir, and ribavirinFinalizedEarly triple antiviral therapy was safe and superior to lopinavir/ritonavir alone in alleviating symptoms and shortening the duration[80]
Remdesivir and interferon beta-1aOngoingOngoing[81]
Remdesivir and tocilizumab in hospitalized participants with severe COVID-19 pneumonia (REMDACTA)OngoingOngoing[82]
Intravenous immunoglobulin and remdesivirOngoingOngoing[83]