Coronavirus disease 2019 (COVID-19) and it’s Management in adults

Coronaviruses are important human and animal pathogens. At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. It rapidly spread, resulting in a global pandemic. The disease is designated COVID-19, which stands for coronavirus disease 2019. The virus that causes COVID-19 is designated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-;- previously, it was referred to as 2019-nCoV.
Understanding of COVID-19 is evolving rapidly.

Many patients with known´-or-suspected COVID-19 have mild disease that does not warrant hospital-level care. Having such patients recover at home is preferred, as it prevents additional potential exposures in the health care setting and reduces burden on the health care system.
Indications — Home management is appropriate for patients with mild infection (eg, fever, cough, and/or myalgias without dyspnea)´-or-asymptomatic infection who can be adequately isolated in the outpatient setting. Risk factors for developing severe disease include older age (eg, >65 years), diabetes mellitus, cardiovascular disease, chronic lung disease, and obesity. Immunocompromising conditions, including HIV infection with CD4 count 5 times the upper-limit- of normal, chronic kidney disease (creatinine clearance 30 breaths per minute)´-or-respiratory distress
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More than 50 percent involvement of the lung parenchyma on chest imaging

These features were used in China to characterize severe disease in a large cohort of patients and are largely consistent with the WHO definition of severe infection.

We also treat patients who have certain laboratory abnormalities similar to patients who have severe disease, because these abnormalities have been associated with disease progression in several studies.
Nonsevere disease — For most patients with nonsevere disease, we suggest supportive care only, with close monitoring for clinical worsening. If they develop features of severe disease (eg, hypoxia, tachypnea,´-or-respiratory distress (see Defining disease severity above)),´-or-if they have any laboratory features associated with disease progression, we treat them as described below.
Some clinical trials may be available for patients with nonsevere disease. If so, we prioritize patients who have epidemiologic risk factors associated with development of severe illness.
We generally do not treat patients with nonsevere disease with experimental agents outside the context of a clinical trial.
Severe (including critical) disease — For hospitalized patients with documented´-or-suspected COVID-19 who have severe disease´-or-have laboratory risk factors for disease progression (table 2), we recommend referral to a clinical trial of remdesivir, convalescent plasma, hydroxychloroquine,´-or-other agents.
In the United States, convalescent plasma may also be available for patients with severe´-or-life-threatening COVID-19 through the FDA s.

Additionally, features similar to cytokine release syndrome (eg, persistent fevers, elevated IL-6 and other cytokines, and elevated ferritin, D-dimer, and other inflammatory markers) have been associated with severe and fatal disease in patients with COVID-19. In patients with such features, the use of IL-6 pathway inhibitors, such as tocilizumab, siltuximab, and sarilumab, has been proposed to disrupt this proinflammatory response and improve outcomes, but published data are-limit-ed. Clinicians should explore the availability of clinical trials of IL-6 inhibitors for such patients at their location.
The optimal timing for implementation of these therapies is unknown. Until more data are available, it remains uncertain which patients would benefit most (if at all) from any of them and how best to allocate potentially-limit-ed clinical trial slots.
There are insufficient data to know whether hydroxychloroquine´-or-chloroquine has a role in treatment of COVID-19-;- thus strongly recommend that patients be referred to a clinical trial whenever possible.

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