A treatment algorithm for COVID-19 that correlates the clinical features with laboratory and imaging findings to establish the right timing for treatment was described in a recent publication in Clinical Rheumatology (2020;39[7]:2077-2084. doi:10.1007/s10067-020-05179-0).
The novel coronavirus, SARS-CoV-2, has spread rapidly. Critically ill COVID-19 patients show clinical signs and symptoms along with laboratory abnormalities to suggest a cytokine storm syndrome in response to the viral infection.
Given the complexity of the new condition, a multidisciplinary approach for COVID-19 management is crucial. When knowledge is shared between specialists, the correct timing and setting of every treatment are thoroughly evaluated and the different phases of the disease are clearly understood.
“We reviewed the literature, combining it with our experiences and our specialist knowledge, to propose a management algorithm, correlating the clinical features with laboratory and imaging findings to establish the right timing for each treatment,” wrote Felice Galluccio, MD, Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence (Florence, Italy) and colleagues.
A comprehensive PubMed literature search using the terms “SARS-CoV-2” and “COVID-19” was performed. English-language articles published from January 2020 to April 2, 2020 were selected, and the references of the selected articles were manually searched.
A management algorithm was proposed based on the review of the literature and the experience of the team, which included 3 rheumatologists, 1 clinical immunologist, 2 infectious disease experts, and 4 anesthesiologists.
“The lesson we learned is that there are distinct phases of COVID-related disease that are dominated by infection, invasion and viral replication first and then by the host immune response, up to hyper-inflammation (CSS),” explained Dr Galluccio and colleagues.
Worsening COVID-19 symptoms usually occur a week after onset, especially in patients with an exaggerated immune response. “The experience, both from literature data and clinical practice, confirms as we could expect, the sooner the treatment, the better the outcomes.”—Lisa Kuhns
