Posted on Authorea 6 May 2020 — CC BY 4.0 — https://doi.org/10.22541/au.158879190.06083691 — This a preprint and has not been peer reviewed. Data may be preliminary. enbCheraghi Zeinab A study patients: review COVID-19 for treatments pharmacologic Potential ae 1)admsl en smtmtco aigml om ftedsaes aigtecpct oact to capacity the having 0.9% so for disease the accounting of only forms through 10 mild transmitted under having be children or can with asymptomatic and adults being 11) mostly among 5, and mostly (3, which (12) seen days, reported cases asymptomatic. 14 are been or to symptomatic cases 1 has being of confirmed days whether period contact COVID-19 4 incubation Human-to-Human an of and has period objects, virus 10), contaminated The incubation (9, droplets, respiratory transmission an (11). acute zoonotic host cases, of reservoir severe most suspicion the like the for be raised epidemics to being which assumed of markets major were history wholesale bats a previous animal and had or in cases seafood first as with The touch (4) in (2). disease syndrome(MERS) respiratory lethal middle-eastern and and of syndrome(SARS) severe member for more 30 zoonotic an 11 concern(PHEIC) causing January positive-sense, with international March for On single-stranded, of well, on enveloped, emergency (6). as and an health most (4) (5), is Public the nations time of affected other state sixth being a and Italy the declared country and organization Spain the health States, of world United 23 parts the April other until with COVID- as to worldwide so 2019(COVID-19). spread (5) disease rate rapidly infection growth China, Coronavirus exponential to in changed starting later Hubei was 19 emerging the which 2(SARS-CoV- new 8 in (3) coronavirus a Wuhan February (NCP) syndrome by of Pneumonia caused On respiratory city be acute the to Severe (2). in out or 2) found origin coronavirus(2019-nCoV) later unknown novel was of which 2019 cases (1) called pneumonia detected was of China group in a Province 2019, 31th, December On anti- monoclonal remdesivir, hydroxy- Introduction Mpro, chloroquine, inhibitor, options, protease therapeutic umifenovir, bodies treatment, favipravir, azithromycin, pharmacology, chloroquine, ARDS, COVID-19, SARS-CoV-2, Keywords laboratory as and tested being clinical are on treatments other based favipiravir, azithromycin, and transmission diagnosed hydroxychloroquine, etc. antiviral Chloroquine, Ivermectin, zoonotic are different example, ribavirin, a and for from umifenovir, cases mechanisms, vaccine market, vary different and or with Symptoms animal treatment agents death Wuhan’s definitive therapeutic droplets. possible and to no and is cases syndrome coronavirus contact there first through of the distress Currently, transmission enters of discovery findings. respiratory human agent, the exposure acute causative to to to the human to Due led is suggested asymptomatic which which studies receptor. SARS-COV-2, Further 31th a involvement. December suspected. as of was on site ACE2 detected primary using was the cells are origin alveolar Lungs unknown of (COVID-19). 2019 cases disease pneumonia of cluster A Abstract 2020 6, May 1 hhdBhst nvriyo eia Sciences Medical of University Beheshti Shahid 1 uamdoenMoradi Muhammadhosein , th 00pemnacue yti gn a fewr ae oe Coronavirus Novel named afterward was agent this by caused pneumonia 2020 , th 00WOasse OI-9a admc() SARS-CoV-2 (7). pandemic a as COVID-19 assessed WHO 2020 , rd 00cuig25472cnre ae n 7,9 deaths 175,694 and cases confirmed 2,544,792 causing 2020 , 1 1 n ee l Ziai Ali Seyed and , β- ooaiue 4 )hc r known are 8)which (4, coronaviruses 1 β- coronavirus, th 00the 2020 , Posted on Authorea 6 May 2020 — CC BY 4.0 — https://doi.org/10.22541/au.158879190.06083691 — This a preprint and has not been peer reviewed. Data may be preliminary. edce aa ogsin hnrha(,1,1)adG ypossc snue,admnlpi and pain abdominal nausea, as such manifest fatigue, symptoms or malaise, GI fever, asymptomatic pain, and of chest are 17) symptoms breath, usually 10, of common Children (3, shortness 3 chills, rhinorrhea affects featuring (10). including congestion, which, symptomatic symptoms adults forms nasal are Other in severe headache, Adults myalgia. seen and and mostly moderate, 12). cough, mild, is dry (3, in it symptoms present but gastrointestinal is people mild It of disease. groups respiratory all acute child an to is mother COVID-19 vertical be suggesting should in evidence precautions transmission droplets no manifestation so airborne is thus Clinical transmission and There fluids of of transmission (10). body suspicion means human-to-human suspected in the Direct a (16). been transmission caused viruses be also 5). which have could of (1, closed-areas bats blood presence donation small with and the blood contact sputum suggested towards of including taken studies history fluids Further a body had and (11). coronavirus of measures cases zoonotic detected first formation The membrane hyaline and (15). desquamation Transmission (ARDS) pneumocytes syndrome in proinflammatory distress contributes in respiratory resulting which increase acute ultimately lymphocytes an indicating by to infiltration the dominated leads more as virus infiltration ACE2, the inflammatory to uses by interstitial and SARS-CoV-2 caused an II damage (14)causing functions. 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Data may be preliminary. nCia() nclrqieamnsrto,cuinms etknsnepoon ieeet uhas such effects side profound since taken be must conducted caution trials administration, clinical accomplished chloroquine to In according so treatment viruses, COVID-19 various (5). in for glycosylation China study and case in uncoating appropriate of inhibition an as is such it effects in-vitro shown has Chloroquine uncoating (13). coronavirus be could genome the not virus mAb of can and the The Inhibition coronavirus in protein 2- against al. mutations S vaccines considering et Peptide-based the epidemics Zhang expressing (8). subsequent to ACE2 cells in according receptor between utilized SARS-CoV binding formation 29). the virus syncytia (28, expressing with inhibit failure those interfere and renal therapeutic to SARS-CoV acute used neutralize same doses, efficiently be the monoclonal initial human could Recombinant have after (mAb) drug connection. drugs hypotension coronavirus-ACE2 antibodies adverse Severe with (ARBs) interfere shown to blockers example: converting mentioned angiotensin rarely was for receptor Both Chloroquine have effects; II This (13). adverse antagonists some patients angiotensin and AT1R SARS-CoV are and expression. effects the Although there (ACEI) of enzyme some receptor, inhibitors ACE2 option. in AT1R viral enzyme reporting decreased taking suitable is a findings, a that hypotension cells, these as But proved Considering be cardiac reactions role have angiotensin. the to the ACE2 produces Experiments of seems and on the binding activation antagonists (5). receptors enzyme to the ACE treatment on its Due in COVID-19 based results to action in are cells. coronavirus entrance (ARB) the the and antagonists on Fusion AT1R binding receptor use (8). ACE2 protein to attaches the (S) suggestions SARS-CoV-2 spike to surface (13). protein system its receptorS renin-angiotensin using the the receptor to dysregulates its and binding ACE2 to and the body virus. to the the body binds into on SARS-CoV-2 replication, entrance system coronavirus virus Immune the entrance, the of of coronavirus Inhibition effects of 1- diagnostic the stages promising and different virus, a on the also to based are reactions assorted studies are Imaging treatments Various (27). diagnosis of management RNA-based means an- Pharmacologic with anti-SARS-CoV-2 a reverse IgM/IgG along Real-time as Besides cause used genome. this 26). be tool. viral 5, for also of (1, used can presence technique mostly tibodies the CRISPR-based diagnos- is on and serologic (rRT-PCR) definitive sequencing based reaction no as metagenomic established is chain used is there were polymerase Currently Diagnosis 17) laboratory transcription (10, up. on deter- finding. follow feces based tool and procedure laboratory established screening treatment urine is tic primitive and blood, diagnosis diagnosis a definitive swabs, for as A oropharyngeal samples swabs, used centers. nasopharyngeal medical being Sputum, to are referral myalgia reports. of and necessity fever the cough, mining pleural as bilateral such small manifestation as Clinical such findings uncommon some (21). cases (24) detected some Diagnosis opacities also In glass was Grand (25). lymphadenopathy peripheral images mediastinal Bilateral CT and increased 23). in with effusions engagement (3, seen consolidations pulmonary seen be patchy bilateral were studies also irregular and septa These may unilateral ill-defined interlobular to (21). and or cases symptoms infiltration reticular few the of hilar a of thickening para in onset bilateral findings after no Increased days complementary from 10 a of (22). findings seen, as criteria of used usually a range been are is has a findings which (CT) revealed and tomography lymphopenia well computed and as with specific neutropenia tool studies (AST), Imaging no diagnostic of (19, aminotransferase consisting lactate 15). been Aspartate leukopenia (10, and has prognosis a of (CRP), poor alongside There protein levels found C-reactive elevated been (LDH), fever. have tests, dehydrogenase 20) and the lactate findings, tachycardia, (ALT), various among have aminotransferase distress, disease but Alanine the respiratory findings of to severity laboratory the within findings discovered diagnostic on been normal based week. have patients a pneumonia from than examination of less physical ranging signs within On infection, reported symptomatic patients. been has of of weeks (4), 75% progression third disease and of second sign the a During is which dyspnea and (18) diarrhea 3 Posted on Authorea 6 May 2020 — CC BY 4.0 — https://doi.org/10.22541/au.158879190.06083691 — This a preprint and has not been peer reviewed. Data may be preliminary. ffcieteayfrteCVD1 neto.As,flvnislk:Hraei,rofln n pectolinarin and rhoifolin, Herbacetin, Nelfinavir like: an flavonoids be (8). may Also, inhibit inhibitors Cinanserin could protease Therefore, infection. and 3C-like COVID-19 SARS-CoV2. protease are in chymotrypsin-like the encoded 3 for is the therapy protease inhibit 3C-L effective could The It (45). considered. replication be SARS-CoV to option possible another in pregnancy(44). and Cinanserin in interactions contraindicated drug-drug is Favipiravir potential inhibitors Protease attention(43). has Favipiravir pay f) to load. have viral diseases basic decreased with and patients treated rate Oseltamivir survival been of the have benefits creased patients The the (17). (42). of Favipiravir observed unknown been most e) have was therapy. China, 4.3% treatment Wuhan, glucocorticoid of of ganciclovir received rate in course g mortality them series the the 0.25 of on case and Some of 34.1% a of administration azithromycin. In rate intravenous and Discharge (11). ceftriaxone, the moxifloxacin, day and oseltamivir, a lopinavir, by twice efficacy mg days its 500 3–14 assessing ritonavir, for for mg trials 500 clinical several oseltamivir, under investigation. currently under Oseltamivir is are d) It effects adverse 41). and Toxicity (8, COVID-19. study against animal in for MERS developed combination against A primarily IFN- was and models. interferon- animal Lopinavir/ritonavir It in and of MERS (38-40). (RDV) and SARS remdesivir transcription. against of RNA effectiveness demonstrated terminates and and treatment Ebola respira- polymerase RNA upper viral in affects 37). result (28, can infarction Remdesivir it myocardial c) since (34). in transaminase increase Kaletra, SARS syndrome, possible of taking stevens-Johnson than a treatment when manifestation neutropenia, and the clinical taken thrombocytopenia, increase, in better be vasodilation, had have results infection, LPV/RTV should al and better tract et Caution arbidol showed tory Chu received ribavirin who (35). too. with patients patients, is only RTV 16 COVID-19 LPV/RTV LPV that in LPV/ found useful identity. of inhibits al be sequence use et LPV may Deng 79.5% the it a so that con- remarkably(36). patients, share out serum MERS loads SARS-CoV found and the viral and SARS increasing treating coronavirus SARS-CoV2 thereby for reduces useful CoV(34). 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Hydroxychloroquine is replication Pruritus viral of Inhibition (30). agranulocytosis, 3- death persons, QT sudden (G6PD)-deficient changes(28). dehydrogenase in prolonged electrocardiographic 6-phosphate and result causes glucose- hypotension, may in lopinavir/ritonavir hemolysis and with include pointes, effects co-administration de Chloroquine torsades interval, proceed. may retinopathy sa I- rtaeihbtrpeiul sdi I ramn htat hog niiinof inhibition through acts that treatment HIV in used previously inhibitor protease HIV-1 an is nw eooi naoit hc losoe oeu ASCVihbtr etrs is features, inhibitory SARS-CoV hopeful showed also which antagonist, serotonin known a , sabodsetu niia rgta niisvrlrpiain aiiai ramn in- treatment Favipiravir replication. viral inhibits that drug antiviral broad-spectrum a is edsvri naeoietihsht nlgeadabodsetu niia which antiviral broad-spectrum a and analogue triphosphate adenosine an is Remdesivir : h taeyta a entids a hwdta 5ptet eeamnsrtd7 mg 75 administrated were patients 75 that showed far so tried been has that strategy The : , r iu elcto niiosi nml n ua ellns des effects Adverse lines. cell human and animals in inhibitors replication virus are β. oiai/ioai LVRV sacmiaino oiai n ri- and lopinavir of combination a is (LPV/RTV) Lopinavir/ritonavir : lo edsvrulk LPV/RTV-IFN- unlike remdesivir Also, β aesonsrne niia ciiyaantMR-o othat to MERS-CoV against activity antiviral stronger shown have 4 β, ol eueln ia loads viral lung reduce could Posted on Authorea 6 May 2020 — CC BY 4.0 — https://doi.org/10.22541/au.158879190.06083691 — This a preprint and has not been peer reviewed. Data may be preliminary. Shikonin Baicalin replication. SARS on effects inhibitory Glycyrrhizin Ebselen: Selenium Selenium: (8). strongly replication virus this of treatment omega-3 the (55). for COVID-19 option to effective infect an to be could D3 C Vitamin vitamin so disease, COVID-19 (8). of infection against result a body be the could strengthening for C: important is Vitamin deficiencies vitamin B resolving coronavirus(8). 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SARS of spread the control could ecec ffcsteimn ytmrsos n h iu lmnto (56). elimination virus the and response system immune the affects deficiency α tteeryiles eoeAD happens(52). ARDS before illness, early the at 1 α- SApoenihbtr fHVhv enpooe o ute investigation further for proposed been have HCV of inhibitors protein NS5A , eomd rg httre h anpoes fcrnvrssad3 protease 3C and coronaviruses of protease main the target that drugs ketoamide UA-eie ii mediator lipid PUFA)-derived 5 hslpdmdao niie influenza inhibited mediator lipid This : sofosbuvir aebe used been have Telaprevir Posted on Authorea 6 May 2020 — CC BY 4.0 — https://doi.org/10.22541/au.158879190.06083691 — This a preprint and has not been peer reviewed. Data may be preliminary. eue ln ri obnto ihohratmcoilaet,dpnigo h itr n severity and history the can on It depending agents, pneumonia. antimicrobial community-acquired other for with options combination treatment the in of or part alone a used been be the has including reduce half-life, combination, effectively prolonged a could administer It to enhancement. Azithromycin (72). is immune and patients. way and electrolyte COVID-19 effective balance water, in ecological rate An of mortality micro maintenance and (8). and inhibiting balance, anti-hypoxemia, RNA and airways acid-base infection, and the are anti-secondary of protein breathing function antivirus, in the viral anti-shock, regulating difficulty of in and help ARDS synthesis could Resolving and oxide therapeutics. the and Antimicrobial nitric main prebiotics Also, which the of in hypoxemia. Application alongside symptoms and used COVID-19 course. shock be illness could causes elongated deficiencies it for nutritional administered body, be the could through agents develops antifungal storm cytokine the replication studies. As virus recent by on mediated complications based investigations of Treatment further 4- for nominated be to options therapeutic and drugs(65); toxicity chemotherapy used widely antagonist(70); most are (69). which potential virus exhibited Nile had West also as and Moexipril such studies infections laboratory in similar potential in promising control shown infection has it studies, to According Ivermectin 67). (45, TDZD-8 cancer lung and gastric, colorectal, (PX-12) with disulfide 2-imidazolyl 1-methylpropyl 66). 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Data may be preliminary. hsrsac i o eev n pcfi rn rmfnigaece ntepbi,cmeca,o not-for- or commercial, public, the in agencies funding from grant specific any sectors. receive profit not did research This article. this to relevant interest Funding of and conflicts efficacy no have determine with authors to along The conducted therapy; of be choice to interest the of need Conflict be homology, studies to period. sequence more seem therapy high and Antivirals and SARS-CoV-2 Trials dosage therapy. could and Clinical appropriate choosing suppression SARS-CoV disorders. system’s in on antibodies. underlying immunity utilized Depending with monoclonal otherwise be must patients cases disease. can contraindications in specific the data and reported to relevant of effects limited are with exacerbation Side be rates patients to peptide must of purpose. mortality lead system and corticosteroids that higher immunity of for mutations since the use used account viral enhancing The into be in by useful taken also restricted be can be are to Selenium also appear but and D choice Zinc used. and treatment C, being deficiencies. 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FDA care, and no supportive is as there such Currently, factors by (76). confounded unclear be regimens, remains may drug therapeutic and Conclusion adverse method other immunoglobulin serious this intravenous with No been of co-administrated and primary (75). is steroids, efficacy has and later agents, TPE the it virus than antiviral as and the illnesses, rather stabilize However, levels weak of viral and 76). first entrance antibody most (75, the state the the reported of in between hypercoagulable effective been week gap and the more has the first viremia be reaction reset fill of the can can to suppression response in and TPE, the response seems system peaks of immune through also administration viremia immune act early Since TPE intense to that more suggested seems (77). 77). to medication membranes patients (27, This endothelial due from storm the antibodies (76). acquired cytokine receiving plasma periods of the patients Convalescent longer the titers in managing as last higher stay kept 76). can been have hospital (75, so has and might epidemics TPE and rate disease MERS virus. mortality Ebola severe and reduced the SARS with against a used during confirmed been treatment studies has it this previous 2014 and Exchange in Plasma as resort Therapeutic approach last novel storm. cause a in cytokine not may the infection is managing tocilizumab of (TPE) way tract Taking another the is respiratory Therapy (74). of Plasma upper Convalescent blocker syndrome and a patients release ill is cytokine thrombocytopenia, severely Tocilizumab (37). in In patients leukopenia, therapy. molecule some (31). of edema, key infection part of peripheral a important risk an is hypertension, increased become which either, an has don’t ideal to receptor, not storm lead IL-6 CDC is cytokine and other tocilizumab) and system of are immune treatment (e.g. WHO there immunosuppressants the the unless of suppress the use plan can the coronavirus, treatment it Whilst, illness as against COVID-19 usage(42). functions their early for in system indications routinely immune corticosteroids using of recommend importance the coronavirus the to Regarding Associated decrease antiviral Syndrome not (Meropenem), Release did antibiotics Cytokine azithromycin(73). antibiotics Managing received mention death multiple 5- patients not cardiac of did most of article administration cases, This risk The fatal rate. increased 85 treatments. mortality of of glucocorticoid study association lymphocytopenia and retrospective an thrombocythemia, (Arbidol), a dehydrogenase, prolongation revealed lactate In channels, studies increased ion recent cause (37). potassium may and azithromycin affecting Taking happen through may (28). macrolides, interval other QT like However, of disease(29). the of 7 Posted on Authorea 6 May 2020 — CC BY 4.0 — https://doi.org/10.22541/au.158879190.06083691 — This a preprint and has not been peer reviewed. Data may be preliminary. 9 uJ hoS egT bal E h ,XeL ta.Sseai oprsno w Animal-to- Two of Comparison Systematic al. et L, Xie 2020;12(2). W, Zhu Viruses. SARS-CoV. AE, and Abdalla SARS-CoV-2 symptom T, onset Coronaviruses: Teng as Human S, diarrhoea Transmitted induced Zhao Human SARS-CoV-2 J, al. Xu et J, 2020. 19. Xia J, Gut. Zhang COVID-19. YL, Chu with Clinical XL, patient and 2020. Shi Features P, in Epidemiologic Jama. Liu Y, al. Singapore. 2020. Song et in J, Lancet. 18. Loh SARS-CoV-2 The SY, With Tan women? Infected JG, pregnant Low Patients S, in of Kalimuddin infection Course associated SWX, COVID-19 COVID-19 Ong of BE, of Young risks findings 17. Pathological the are 2020. al. What et Medicine. J. C, Respiratory Qiao Zhang Lancet L, 16. The Huang syndrome. J, Zhang distress Y, respiratory Wang acute L, Mecha- with Shi From Z, 2020. Responses: Xu Sinica. Inflammatory 15. Virologica SARS-CoV-2-Mediated Tools. 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