The Importance of Understanding the Stages of COVID-19 in Treatment and Trials
Daniel O. Griffin 1, Denise Brennan-Rieder 2, Binh Ngo 3, Pierre Kory 4, Marco Confalonieri 5, Leland Shapiro 6, Jose Iglesias 7, Michael Dube 3, Neha Nanda 3, Gino K. In 3, Daniel Arkfeld 3, Preet Chaudhary 3, Vito M. Campese 3, Diana L. Hanna 3, David Sawcer 3, Glenn Ehresmann 3, David Peng 3, Miroslaw Smorgorzewski 3, April Amstrong 3, Eivind H. Vinjevoll 8, Rajkumar Dasgupta 3, Fred R. Sattler 3, Cristina Mussini 9, Oriol Mitjà 10, Vicente Soriano 11, Nicolas Peschanski 12, Gilles Hayem 13, Maria Carmela Piccirillo 14, António Lobo-Ferreira 15, Iraldo B. Rivero 16, Ivan F. H. Hung 17, Marc Rendell 18, Stephen Ditmore 19, Joseph Varon 20, Paul Marik 21
1 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; 2 CoronaTracker Community Research Group,; 3 Keck School of Medicine, University of Southern California, California, USA; 4 Pulmonary and Critical Care Medicine, Aurora St. Lukes Medical Center, Milwaukee, WI, USA; 5 Azienda Ospedaliero-Universitaria di Trieste, Trieste, Italy; 6 Rocky Mountain Regional Veterans Affairs Medical Center in Aurora, CO and University of Colorado Anschutz Medical Campus in Aurora, CO, USA; 7 Jersey Shore University Medical Center, Neptune NJ, Hackensack Meridian School of Medicine at Seton Hall, Hackensack University, NJ, USA; 8 Volda Hospital HMR, Volda, Norway; 9 University of Modena and Reggio Emilia, Modena, Italy; 10 Hospital Universitari Germans Trias i Pujol, Badalona, Spain; 11 UNIR Health Sciences School and Medical Center, Universidad Internacional de La Rioja, Madrid, Spain; 12 University Hospital of Rennes, Rennes, France; 13 Hôpital Paris Saint-Joseph, Paris, France; 14 Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy; 15 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; 16 Department of Clinical Investigations, Center for Genetic Engineering and Biotechnology, Havana, Cuba; 17 Ivan FN Hung, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong; 18 The Rose Salter Medical Research Foundation, Newport Coast, CA, USA; 19 Parkchester Times; 20 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; 21 Eastern Virginia Medical School|, Department of Internal Medicine, Chief, Pulmonary and Critical Care Medicine, Norfolk, VA, USA
*Correspondence: António Lobo-Ferreira, Email not available
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.
