After a steady decline in both the prevalence and incidence of coronavirus disease 2019 (COVID-19) infection in the United States, which was observed during the summer months of 2020, there was a resurgence of new clinical cases despite the lockdown, especially noted after the recent Thanksgiving and Christmas holidays.
However, during this current year, medical practitioners have now become more comfortable with new and effective treatments for COVID-19 infection, including the most severe clinical presentations. Recent emergency use authorization by the Food and Drug Administration have included the antiviral drug remdesivir (Gilead Sciences, Foster City, CA) for intravenous use,1 and 2 monoclonal antibody preparations. The first of these is the intravenous combination of casirivimab (REGN 10933) and imdevimab (REGN 10987), the second is the immunoglobulin G1 neutralizing agent, bamlanivimab (Ly-CoV555; Lilly, Indianapolis, IN), which can be used with etesevimab. Monoclonal antibody use may be associated with worse clinical outcomes in COVID-19 patients with ventilatory disorders who require oxygen.
Also released for use in COVID-19 patients through an Food and Drug Administration emergency approval is the orally active Janus kinase inhibitor, baricitinib (Olumiant: Lilly), which is available for the treatment of rheumatoid arthritis. It can be used in combination with remdesivir in COVID-19 patients requiring supplemental oxygen mechanical ventilation or extracorporeal membrane oxygenation. The anti-arthritis drug tocilizumab, an interleukin-6 inhibitor,2 has not been shown to be effective in severe COVID cases. Currently, the use of the corticosteroid intravenous dexamethasone3 has become the therapy of choice for severe COVID-19 respiratory illness with excellent outcomes being achieved.
Despite improvements in treatment, COVID-19 infection still remains a significant cause of morbidity and mortality especially in the frail elderly. More recently, cases of residual disease post-COVID infection are being described, with complaints of fatigue, muscle weakness, anxiety, and depression being reported by patients. Only a small number of patients with respiratory involvement during an active COVID-infection appear to have persistently abnormal x-rays.
A major clinical advance during the pandemic has been the synthesis, approval, and administration of effective vaccines (Pfizer, New York, NY and Moderna, Cambridge, MA). This approach may provide herd immunity against COVID-19 and at last bring an end to this clinical nightmare.
Included in this issue of Cardiology in Review is an updated article on the cardiovascular and cerebrovascular manifestations of COVID-19.4
Footnotes
Disclosure: The author has no conflicts of interest to report.
REFERENCES
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