Challenges in treating COVID-19 Coronavirus disease (COVID-19), which appeared in December 2019, presents a global challenge, particularly in the rapid increase of critically ill patients with pneumonia and absence of definitive treatment. To date, over 81,000 cases have been confirmed, with over 2700 deaths. The mortality appears to be around 2%; early published data indicate 25.9% with SARS-CoV-2 pneumonia required ICU admission and 20.1% developed acute respiratory distress syndrome [1]. There is presently no vaccine or specific anti-viral drug regime used to treat critically ill patients. The management of patients mainly focuses on the provision of supportive care, e.g., oxygenation, ventilation, and fluid management. Combination treatment of low-dose systematic corticosteroids and anti-virals and atomization inhalation of interferon have been encouraged as part of critical COVID-19 management [2]. Other reported therapeutic agents that are used for the treatment of seriously ill patients have been noted in Table 1. Convalescent plasma: one of the forgotten immunologically based strategies Passive immunization has been successfully used to treat infectious diseases. A meta-analysis demonstrated a significant reduction in mortality and viral load in studies using convalescent plasma for the treatment of severe acute viral respiratory infections, including those caused by related coronaviruses (SARS-CoV and MERS-CoV) [5]. Serious adverse events were not reported. Eighty SARS patients were treated with convalescent plasma during the last major outbreak. A significantly better outcome was obtained with earlier transfusion (before day 14), and no immediate adverse events were observed. A feasibility intervention study of convalescent plasma for MERS-CoV infection treatment failed to identify sufficient high-titer plasma from patients with confirmed/suspected MERS, their close family members, or healthcare workers exposed to MERS (n = 12 reactive ELISA/443 serum tested). Two fresh-frozen plasma units (250–350mL/unit) would be required for each enrolled MERS patient (NCT02190799).

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COVID-19 的治疗：应对新挑战的老方法

治疗 COVID-19 的挑战 冠状病毒病 (COVID-19) 于 2019 年 12 月出现，是一项全球性挑战，特别是在重症肺炎患者迅速增加和缺乏明确治疗的情况下。迄今为止，已确认超过 81,000 例病例，超过 2700 人死亡。死亡率似乎在 2% 左右；早期公布的数据表明，25.9% 的 SARS-CoV-2 肺炎患者需要入住 ICU，20.1% 的患者发展为急性呼吸窘迫综合征 [1]。目前没有用于治疗危重患者的疫苗或特定的抗病毒药物方案。患者的管理主要侧重于提供支持性护理，例如氧合、通气和液体管理。鼓励将低剂量全身性皮质类固醇和抗病毒药物以及干扰素雾化吸入作为关键 COVID-19 管理的一部分 [2]。其他报道的用于治疗重病患者的治疗剂已在表 1 中注明。 恢复期血浆：一种被遗忘的基于免疫学的策略 被动免疫已成功用于治疗传染病。一项荟萃分析表明，在使用恢复期血浆治疗严重急性病毒性呼吸道感染的研究中，死亡率和病毒载量显着降低，包括由相关冠状病毒（SARS-CoV 和 MERS-CoV）引起的感染 [5]。没有报告严重的不良事件。在上一次大爆发期间，80 名 SARS 患者接受了恢复期血浆治疗。较早输血（第 14 天之前）获得了显着更好的结果，并且没有立即观察到不良事件。用于治疗 MERS-CoV 感染的恢复期血浆的可行性干预研究未能从确诊/疑似 MERS 患者、其近亲或接触 MERS 的医护人员中鉴定出足够的高滴度血浆（n = 12 反应性 ELISA/443 血清检测）。每个登记的 MERS 患者需要两个新鲜冷冻血浆单位（250-350mL/单位）（NCT02190799）。他们的近亲或接触 MERS 的医护人员（n = 12 反应性 ELISA/443 血清测试）。每个登记的 MERS 患者需要两个新鲜冷冻血浆单位（250-350mL/单位）（NCT02190799）。他们的近亲，或暴露于 MERS 的医护人员（n = 12 反应性 ELISA/443 血清测试）。每个登记的 MERS 患者需要两个新鲜冷冻血浆单位（250-350mL/单位）（NCT02190799）。