Dethroning the crown. From the kinetics and dynamics of COVID–19 diagnosis to promising treatments

The SARS–CoV–2 pandemic has become a great stressor for health systems worldwide, and the global scientific community is trying to effectively understand key aspects of this infection in order to halt its progression. National and local authorities have endorsed COVID–19 testing both for symptomatic and asymptomatic individuals who fulfill certain criteria and for public health or infection control purposes. Therefore understanding kinetics and dynamics of COVID–19 is crucial for diagnosis and potential treatments. Current diagnostic modalities include: (1) reverse-transcription polymerase chain reaction (RT–PCR) assay (currently the preferred initial diagnostic test for COVID–19); (2) antigen testing—tests that detect SARS–CoV–2 antigen can be performed rapidly and at the point of care; and (3) serologic detection of antibodies against SARS–CoV–2. As for the treatment, there are a few FDA-approved drugs for the treatment of COVID–19. However, definitive clinical trial data are needed to identify safety of COVID–19 treatments. In the meantime, current practice of SARS–CoV–2 treatment is based greatly on symptomatic care with critical care support applied when hemodynamic, respiratory, or renal insufficiency is needed. Antiviral therapies aim for the inhibition of viral entry (via the ACE2 receptor and TMPRSS2), viral membrane fusion, and endocytosis or the activity of the SARS–CoV–2 3CLprotease and the RNA-dependent RNA polymerase. Moreover, agents that modulate immune response, such as human blood-derived products and immunomodulatory therapies, are being explored as adjunctive treatments for the management of moderate to critical infection. In addition to the antiviral medications and the immune-based therapies administration of antithrombotic therapy, use of vitamins C and D and zinc is suggested.