Abstract:
The pandemic caused by SARS-CoV-2 has infected more than 94 million people
worldwide (as of 17 January 2020). Severe disease is believed to be secondary to
the cytokine release syndrome (CRS or “cytokine storm”) which causes local tissue
damage as well as multi-organ dysfunction and thrombotic complications. Due to the
high mortality rates in patients receiving invasive ventilation, practice has changed from
“early-intubation” for acute respiratory distress syndrome (ARDS) to a trial of non-invasive
ventilation (NIV) or high flow nasal cannula (HFNC) oxygen. Reports indicating the benefit
of NIV and HFNC have been encouraging and have led tomore than 20,000 such devices
being manufactured and ready for roll-out in South Africa (SA) as of July 2020. The need
to identify drugs with clear clinical benefits has led to an array of clinical trials, most of
which are repurposing drugs for COVID-19. The treatment landscape reflects the need
to target both the virus and its effects such as the CRS and thrombotic complications.
Conflicting results have the potential to confuse the implementation of coordinated
treatment strategies and guidelines. The purpose of this review is to address pertinent
areas in the current literature on the available medical treatment options for COVID-19.
Remdesivir, tocilizumab, and dexamethasone are some of the treatment options that
have shown the most promise, but further randomized trials are required to particularly
address timing and dosages to confidently create standardized protocols. For the SA
population, two healthcare sectors exist. In the private sector, patients with medical
insurance may have greater access to a wider range of treatment options than those
in the public sector. The latter serves >80% of the population, and resource constraints
require the identification of drugs with themost cost-effective use for the greatest number of affected patients.
