National Institute for the Infectious Diseases "L. Spallanzani", IRCCS. Recommendations for COVID-19 clinical management

Emanuele Nicastri, Nicola Petrosillo, Tommaso Ascoli Bartoli, Luciana Lepore, Annalisa Mondi, Fabrizio Palmieri, Gianpiero D'Offizi, Luisa Marchioni, Silvia Murachelli, Giuseppe Ippolito, Andrea Antinori, Emanuele Nicastri, Nicola Petrosillo, Tommaso Ascoli Bartoli, Luciana Lepore, Annalisa Mondi, Fabrizio Palmieri, Gianpiero D'Offizi, Luisa Marchioni, Silvia Murachelli, Giuseppe Ippolito, Andrea Antinori

Abstract

On January 9 2020, the World Health Organization (WHO) declared the identification, by Chinese Health authorities, of a novel coronavirus, further classified as SARS-CoV-2 responsible of a disease (COVID-19) ranging from asymptomatic cases to severe respiratory involvement. On March 9 2020, WHO declared COVID-19 a global pandemic. Italy is the second most affected country by COVID-19 infection after China. The "L. Spallanzani" National Institute for the Infectious Diseases, IRCCS, Rome, Italy, has been the first Italian hospital to admit and manage patients affected by COVID-19. Hereby, we show our recommendations for the management of COVID-19 patients, based on very limited clinical evidences; they should be considered as expert opinions, which may be modified according to newly produced literature data.

Keywords: COVID-19; SARS-CoV-2; Treatment.

Conflict of interest statement

Conflict of interest: The authors declare no potential conflict of interest.

©Copyright: the Author(s), 2020.

References

    1. European Centre for Disease Prevention and Control. Rapid Risk Assessment: Novel coronavirus disease 2019 (COVID-2019) pandemic: increased transmission in the EU/EEA – sixth update. ECDC: Stockholm;. 2020, 12 March 2020 Available at:
    1. Ministero della Salute. Direzione Generale della Prevenzione Sanitaria. Ufficio 5: Prevenzione delle Malattie Trasmissibili e Profilassi Internazionale. Aggiornamento Circolare 09.03.2020. Allegato 1. Definizione di caso di COVID-19 per la segnalazione. Available at , visited on March 13 2020.
    1. WHO. Global Surveillance for human infection with coronavirus disease (COVID-2019). Revised guidance, 27 February 2020. Available at , visited on 28 February 2020.
    1. European Centre for Disease Prevention and Control. An agency of the European Union. Case definition for EU surveillance of COVID-19, as of 25 February 2020. Available at , visited on 28 February 2020.
    1. Centers for Disease Control and Prevention (CDC). Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings. Updated February 21, 2020. Available at , visited on February 28 2020.
    1. Wang Z, Chen X, Lu Y, et al. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci Trends 2020 Feb 9. doi: 10.5582/bst.2020.01030.
    1. Lu H. Drug treatment options for the 2019- new coronavirus (2019-nCoV). Biosci Trends 2020 Jan 28. doi:10.5582/bst.2020.01020.
    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
    1. Chu CM, Cheng VC, Hung IF, et al. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax 2004;59:252-6.
    1. Momattin H, Mohammed K, Zumla A, et al. Therapeutic options for Middle East respiratory syndrome coronavirus (MERS-CoV)—possible lessons from a systematic review of SARS-CoV therapy. Int J Infect Dis 2013;17:e792-8.
    1. Momattin H, Al-Ali AY, Al-Tawfiq JA. A Systematic Review of therapeutic agents for the treatment of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Travel Med Infect Dis 2019;30:9-18..
    1. Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 2020 Feb 4. doi: 10.1038/s41422-020-0282-0.
    1. Holshue ML, DeBolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med 2020. Jan 31. doi: 10.1056/NEJMoa2001191.
    1. Sheahan TP, Sims AC, Leist SR, et al. Comparative therapeutic efficacy of remdesivir and combination lopinavir, ritonavir, and interferon beta against MERS-CoV. Nat Commun 2020;11: 222.
    1. Lai CC, Shih TP, Ko WC, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease- 2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents 2020:105924. doi: 10.1016/j.ijantimicag.2020.105924.
    1. NIH National Institutes of Health. NIH clinical trial of remdesivir to treat COVID-19 begins. Study enrolling hospitalized adults with COVID-19 in Nebraska. Tuesday, February 25, 2020. Available at , visited on February 28 2020.
    1. Zhao JP, Hu Y, Du RH, et al. Expert consensus on the use of corticosteroid in patients with 2019-nCoV pneumonia. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43:E007.
    1. ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526-33.
    1. Riviello ED, Kiviri W, Twagirumugabe T, et al. Hospital Incidence and Outcomes of the Acute Respiratory Distress Syndrome Using the Kigali Modification of the Berlin Definition. Am J Respir Crit Care Med 2016;193: 52-9.
    1. Khemani RG, Smith LS, Zimmerman JJ, et al. Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015;16:S23-40.
    1. Vincent MJ, Bergeron E, Benjannet S, et al. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. J Virol 2005;2:69.
    1. Yan Y, Zou Z, Sun Y, et al. Anti-malaria drug chloroquine is highly effective in treating avian influenza A H5N1 virus infection in an animal model. Cell Res 2013;23:300-2.
    1. Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020.
    1. Yao X, Ye F, Zhang M, et al. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis 2020. Mar 9.
    1. Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends 2020. Feb 19. doi: 0.5582/bst.2020.01047. [Epub ahead of print]
    1. Multicenter collaboration group of Department of Science and Technology of Guangdong Province and Health Commission of Guangdong Province for chloroquine in the treatment of novel coronavirus pneumonia. [Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi. 2020. Feb 20;43:E019.
    1. Chu CM, Cheng VC, Hung IF, et al. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax 2004;59:252-6.
    1. Chan KS, Lai ST, Chu CM, et al. Treatment of severe acute respiratory syndrome with lopinavir/ritonavir: a multicentre retrospective matched cohort study. Hong Kong Med J 2003;9:399-406.
    1. Chan JF, Yao Y, Yeung ML, et al. Treatment With Lopinavir/Ritonavir or Interferon- β1b Improves Outcome of MERS-CoV Infection in a Nonhuman Primate Model of Common Marmoset. J Infect Dis 2015;212:1904-13.
    1. Han W, Quan B, Guo Y, et al. The course of clinical diagnosis and treatment of a case infected with coronavirus disease 2019. J Med Virol 2020. Feb 19.
    1. Lim J, Jeon S, Shin HY, et al. Case of the Index Patient Who Caused Tertiary Transmission of COVID-19 Infection in Korea: the Application of Lopinavir/Ritonavir for the treatment of COVID-19 Infected Pneumonia Monitored by Quantitative RT-PCR. J Korean Med Sci 2020;35:e79.
    1. Sheahan TP, Sims AC, Leist SR, et al. Comparative therapeutic efficacy of remdesivir and combination lopinavir, ritonavir, and interferon beta against MERS CoV. Nat Commun 2020;11: 222.
    1. de Wit E, Feldmann F, Cronin J, et al. Prophylactic and therapeutic remdesivir (GS-5734) treatment in the rhesus macaque model of MERS-CoV infection. Proc Natl Acad Sci USA 2020. Feb 13.pii:201922083
    1. Agostini ML, Andres EL, Sims AC, Graham RL, Sheahan TP, Lu X, Smith EC, et al. Coronavirus susceptibility to the antiviral remdesivir (GS-5734) is mediated by the viral polymerase and the proofreading exoribonuclease. mBio 2018;9:e00221-18.
    1. Holshue ML, DeBolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med 2020;382:929-36.
    1. European Medicine Agency. Available at: (Last Access 10th March 2020)
    1. Le RQ, Li L, Yuan W, et al. FDA approval summary: tocilizumab for treatment of chimeric antigen receptor T cell induced severe or life threatening cytokine release syndrome. The Oncologist 2018;23:943.
    1. Shang L, Zhao J, Hu Y, et al. On the use of corticosteroids for 2019-nCoV pneumonia. The Lancet 2020
    1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020. Feb 7.
    1. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Resp Med 2020.
    1. Xiaoling X, Mingfeng H, Tiantian L, et al. Effective Treatment of Severe COVID-19 Patients with Tocilizumab. 2020. chinaXiv:202003.00026v1
    1. Riegler LL, Jones GP, Lee DW. Current approaches in the grading and management of cytokine release syndrome after chimeric antigen receptor T-cell therapy. Therapeut Clin Risk Manag 2019; 15:323.
    1. European Medicine Agency. Assessment Report. RoActemra. Procedure No. EMEA/H/C/000955/II/0078. 28 June 2018.
    1. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM 2001;94:521-6.

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