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. 2020 Oct 11;889:173644. doi: 10.1016/j.ejphar.2020.173644

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© 2020 Elsevier B.V. All rights reserved.

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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Fig. 1 — A proposed potential therapeutic algorithm based on current studies and clinical trials

§ In the early stages of COVID-19, one or a combination of antiviral agents could be used as a prophylactic or early treatment option to decrease viral load, transmission and prevent progression to the later stage of the disease. The early treatment is under evaluation in some clinical trials (U. S. National Library of Medicine. ClinicalTrial.gov, 2020a; U. S. National Library of Medicine. ClinicalTrial.gov, 2020b)

*In the early stage, specific adjustment of glucocorticoid therapy could be needed based on specific reasons (i.e. in adrenal insufficient patients (Isidori et al., 2000)). WHO suggests not to use corticosteroids in the treatment of patients with non-severe COVID-19 as the treatment brought no benefits (World Health Organization, 2020 b).** Based on the clinical status, anticoagulants could be administered to prevent thrombotic phenomena starting from the pulmonary circulation as a consequence of hyperinflammation.

Several studies showed that inflammatory cytokines (Il-1, IL-6), c-reactive proteins (CPR), fibrinogen, D-Dimer, ferritin and other biomarkers are significantly elevated in patients with more advanced disease. Therefore, specific immunomodulators and corticosteroids are useful to counteract and prevent the cytokine storm and anticoagulants to prevent thrombotic events. The antiviral remdesivir appears to shorten recovery times for hospitalised patients.