Natural history of COVID-19 and therapeutic options
Philippe Gautret, Matthieu Million, Pierre‐André Jarrot, Laurence Camoin‐Jau, Philippe Colson, Florence Fenollar, Marc Léone, Bernard La Scola, Christian Devaux, Jean Gaubert, Jean‐Louis Mège, Joana Vitte, Cléa Melenotte, Jean‐Marc Rolain, Philippe Parola, Jean‐Christophe Lagier, Philippe Brouqui, Didier Raoult
Abstract
: Diagnosis should rely on PCR and not on clinical presumption. Because of discrepancies between clinical symptoms, oxygen saturation or radiological signs on CT scans, pulse oximetry, and radiological investigation should be systematic. The disease evolves in successive phases: an acute virological phase, and, in some patients, a cytokine storm phase; an uncontrolled coagulopathy; and an acute respiratory distress syndrome. Therapeutic options include antivirals, oxygen therapy, immunomodulators, anticoagulants and prolonged mechanical treatment. Early diagnosis, care, and implementation of an antiviral treatment; the use of immunomodulators at a later stage; and the quality of intensive care are critical regarding mortality rates. The higher mortality observed in Western countries remains unexplained. Pulmonary fibrosis may occur in some patients. Its future is unpredictable.