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. 2023 Apr 19;22(6):449–475. doi: 10.1038/s41573-023-00672-y

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© Springer Nature Limited 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

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Fig. 8 — a, Therapeutic interventions at various stages of coronavirus disease 2019 (COVID-19). At the pre-infection stage, variant-proof vaccines, pre-exposure prophylaxis and nonpharmaceutical interventions can be considered. Once severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is diagnosed, anti-SARS-CoV-2 therapies are ideally administered to outpatients as soon as possible so that the viral load is significantly reduced at an early stage. SARS-CoV-2 viral load usually peaks within the first week after symptom onset (SO) and SARS-CoV-2 RNA shedding in the upper respiratory tract has a mean duration of approximately 17 days²⁸⁷. Levels of anti-SARS-CoV-2 immunoglobulin M (IgM), IgG and neutralizing antibodies peak at approximately 20, 25 and 31 days, respectively²⁸⁸. At the advanced stage of COVID-19 progression, immunomodulators, anticoagulants, anti-inflammatory drugs and/or critical care can be considered for severely or critically ill inpatients under certain conditions (Box 1). Post-infection interventions might be needed for some survivors experiencing persistent symptoms after COVID-19 infection²⁸⁹. COPD, chronic obstructive pulmonary disease; mAbs, monoclonal antibodies; M^pro, main protease; RdRp, RNA-dependent RNA polymerase.