Introduction
The spread of SARS-CoV-2 has rapidly spread all over the world
generating a pandemic that the whole world is fighting to stem it as
soon as possible. The researchers studied the SARS-CoV-2 virus and it
was discovered that not all exposed people are infected and not all
infected patients develop serious respiratory diseases. SARS-CoV-2
infection has been shown to be divided into three phases: phase 1,
asymptomatic or mildly symptomatic incubation period that does not
require hospitalization with or without detectable virus; phase 2,
period not severely symptomatic with presence of the virus; phase 3,
severe respiratory symptomatic phase with high viral load and
generalized hyperinflammatory state. Phase 3 is the most serious and
dangerous phase; generalized hyperinflammatory was caused by a sudden
release of cytokines in the circulation defined as ”cytokine storm” (CS)
which leads to death from pneumonia.
These are three phases with increasing gravity and for each phase a
specific treatment can be indicated or avoided, always personalized for
the clinical characteristics of each individual patient.
- Phase 1 (or non-severe phase): A non-serious phase lasting
about 7 days and the immune system begins to react against the virus.
If the immune response is not specific for breaking down the virus,
disease progression occurs in the severe stages. Increasing immune
responses could certainly be important together with the use of an
antiviral to prevent virus replication. The antivirals used in this
phase are remdesivir, lopinavir / ritonavir, chloroquine and
hydroxychloroquine. If the infection is contained in this phase and
the virus is defeated, it does not go to the next more serious phases.
- Phase 2 (moderate): The second stage of infection begins when
the immune system has been unable to defeat the virus and this has
repercussions on the respiratory tract and lungs.
In this phase, hospitalization begins and the administration of oxygen
with probable heart problems and coagulation with a moderate increase
in pro-inflammatory markers.
The treatment that could be indicated is a continuous use of antiviral
drugs, oxygen support and / or the use of anti-inflammatory drugs,
antibiotics and the administration of LMWH-
(Low-partial-weight-heparin) to prevent thromboembolic events.
- Phase 3 (severe): The third stage is the most serious and
pruned to the patient’s death. At this stage there is a hyperactive
and systemic inflammatory state called Cytokine Storm (CS) with
limited respiration. In this phase the values of the inflammation
markers (IL-2, IL-6, GCSF, TNF-alpha, D-dimer, ferritin, etc.) are
very high.
The patient may have severe respiratory failure and heart shock.
Immunological therapies such as corticosteroids, anti-interleukin 6
(tocilizumab and sarilumab), IL-1 receptor antagonists (anakinra or
canakinumab), JAK inhibitors are required at this stage. The prognosis
for patients at this stage of the disease is very serious (1-13)