The Importance of Understanding the Stages of COVID-19 in Treatment and Trials
Daniel O. Griffin, Department of Medicine, Division of Infectious Diseases, Columbia University, College of Physicians and Surgeons, New York, USA; Research and Development at United Health Group Minnetonka, Minnesota, USA; ProHealth NY Lake Success, New York, USA Denise Brennan-Rieder, CoronaTracker Community Research Group, Binh Ngo, Keck School of Medicine, University of Southern California, California, USA Pierre Kory, Pulmonary and Critical Care Medicine, Aurora St. Luke?s Medical Center, Milwaukee, WI, USA Marco Confalonieri, Azienda Ospedaliero-Universitaria di Trieste, Trieste, Italy Leland Shapiro, Rocky Mountain Regional Veterans Affairs Medical Center in Aurora, CO and University of Colorado Anschutz Medical Campus in Aurora, CO, USA Jose Iglesias, Jersey Shore University Medical Center, Neptune NJ, Hackensack Meridian School of Medicine at Seton Hall, Hackensack University, NJ, USA Michael Dube, Keck School of Medicine, University of Southern California, California, USA Neha Nanda, Keck School of Medicine, University of Southern California, California, USA Gino K. In, Keck School of Medicine, University of Southern California, California, USA Daniel Arkfeld, Keck School of Medicine, University of Southern California, California, USA Preet Chaudhary, Keck School of Medicine, University of Southern California, California, USA Vito M. Campese, Keck School of Medicine, University of Southern California, California, USA Diana L. Hanna, Keck School of Medicine, University of Southern California, California, USA David Sawcer, Keck School of Medicine, University of Southern California, California, USA Glenn Ehresmann, Keck School of Medicine, University of Southern California, California, USA David Peng, Keck School of Medicine, University of Southern California, California, USA Miroslaw Smorgorzewski, Keck School of Medicine, University of Southern California, California, USA April Amstrong, Keck School of Medicine, University of Southern California, California, USA Eivind H. Vinjevoll, Volda Hospital HMR, Volda, Norway Rajkumar Dasgupta, Keck School of Medicine, University of Southern California, California, USA Fred R. Sattler, Keck School of Medicine, University of Southern California, California, USA Cristina Mussini, Oriol Mitjà, Hospital Universitari Germans Trias i Pujol, Badalona, Spain Vicente Soriano, UNIR Health Sciences School and Medical Center, La Paz ??? Carlos III University Hospital, Madrid, Spain Nicolas Peschanski, University Hospital of Rennes, Rennes, France Gilles Hayem, Hôpital Paris Saint-Joseph, Paris, France Maria Carmela Piccirillo, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy António Lobo-Ferreira, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Centro Hospitalar Universitário de São João, Porto, and Hospital Rainha Santa Isabel, Marco de Canaveses, Portugal Iraldo B. Rivero, Department of Clinical Investigations, Center for Genetic Engineering and Biotechnology, Havana, Cuba Ivan F. H. Hung, Ivan FN Hung, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Marc Rendell, The Rose Salter Medical Research Foundation, Newport Coast, CA, USA Stephen Ditmore, Parkchester Times Joseph Varon, United Memorial Medical Center and United General Hospital, UT Health Science Center at Houston, University of Texas School of Medicine, Houston, Texas, USA, Baylor College of Medicine, UAT, UDEM, UABC, UNE, USON, UPAEP ? Mexico, Caribbean Medical Unive Paul Marik, Eastern Virginia Medical School|, Department of Internal Medicine, Chief, Pulmonary and Critical Care Medicine, Norfolk, VA, USA |Full Article in PDF|
Abstract
COVID-19, caused by SARS-CoV-2, continues to be a major health problem since its first description in Wuhan, China, in December 2019. Multiple drugs have been tried to date in the treatment of COVID-19. Critical to treatment of COVID-19 and advancing therapeutics is an appreciation of the multiple stages of this disease and the importance of timing for investigation and use of various agents. We considered articles related to COVID-19 indexed on PubMed published January 1, 2020-November 15, 2020, and considered papers on the medRxiv preprint server. We identified relevant stages of COVID-19 including three periods: pre-exposure, incubation, and detectable viral replication; and five phases: the viral symptom phase, the early inflammatory phase, the secondary infection phase, the multisystem inflammatory phase, and the tail phase. This common terminology should serve as a framework to guide when COVID-19 therapeutics being studied or currently in use is likely to provide benefit rather than harm.
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