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COVID 19 (SARS-CoV-2) Updates, Speculation and Information

Review the most up to date literature published and speculations/anecdotes and cited articles from around the globe.


  • Pulmonary edema and infiltrates are being caused by coronavirus binding of pulmonary ACE, causing capillary leak and upregulation of ACE-2.
  • Based on the sequence similarities of the RBM between SARS-CoV-2 and SARS-CoV, several independent research groups investigated if SARS-CoV-2 also utilizes ACE-2 as a cellular entry receptor.
  • anti-ACE-2 antibodies or could be used to block SARS-CoV-2 binding to the receptor. Additionally, TMPRSS2 inhibitors could be used to prevent SARS-CoV-2 entry into host cells. Camostat has been used to treat chronic pancreatitis in Japan and is currently undergoing Phase 1/2 trial testing in the United States.26 If deemed safe, camostat could be a potential treatment option of CoV infections.27 It is also possible that antibodies developed during SARS-CoV infection could help prevent or treat COVID-19. Hoffmann et al. showed that sera from recovering SARS patients reduced SARS-CoV-2 S protein-driven entry into Vero-E6 cells.21 However, future studies are needed to determine whether any of these options are effective in disrupting the interaction between virus and receptor in vivo.

Clinical presentations and concerns

  • Acute respiratory distress syndrome (ARDS) is a major complication in patients with severe disease. In the study of 138 patients ARDS developed in 20 percent after a median of eight days, and mechanical ventilation was implemented in 12.3 percent ]. In another study of 201 hospitalized patients with COVID-19 in Wuhan, 41 percent developed ARDS; age greater than 65 years, diabetes mellitus, and hypertension were each associated with ARDS
  • Some information from Europe is that there appears to be severe myocarditis and/or severely depressed LVEF <10% occurring in some patients with rapid decline around the 7-9 day mark after symptomatic infection.
  • in the setting of severe cardiogenic shock, may suffer VT/VT or PEA and ultimately pass once this state is reached. In europe this presentation was more rare, however improved in some patients with IVIG and glucocorticoids.

Investigational treatments

  • no controlled data supporting the use of any of these agents, and their efficacy for COVID-19 is unknown (22).
  • Remdesivir – Remdesivir is a novel nucleotide analogue that has activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro and related coronaviruses (including SARS and MERS-CoV) both in vitro and in animal studies (22).
  • Chloroquine/hydroxychloroquine – Both chloroquine and hydroxychloroquine inhibit SARS-CoV-2 in vitro (22) .
  • Lopinavir-ritonavir – protease inhibitor, for HIV infection, has in vitro activity against the SARS-CoV [30]
  • Tocilizumab – Treatment guidelines from China’s National Health Commission include the IL-6 inhibitor tocilizumab for patients with severe COVID-19 and elevated IL-6 levels (31).
  • Others include IVIG, steroids, oseltamivir, interferon beta and convalescent serum. No published data as of yet.

Other data:

  • March, 2020, the WHO declared the COVID-19 officially a Pandemic.
  • Per ACOG ” The approach to prevention, evaluation, diagnosis, and treatment of pregnant women with suspected COVID-19 should be similar to that in nonpregnant individuals”
  • (ACOG) specifies that infants born to mothers with confirmed COVID-19 should be considered a patient under investigation and appropriately isolated and evaluated (32).

EMRAP link to LIVE and ongoing COVID updates

Centers for Disease Control and Prevention (CDC)

Real time link to the Coronavirus map and current Published global cases:


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  2. Centers for Disease Control and Prevention (n.d.) Common Human Coronaviruses
  3. Yang, Y. et al. (2020) J. Autoimmun. [Epub ahead of print].
  4. Gu, J. and C. Korteweg (2007) Am. J. Pathol. 170:1136.
  5. Zhou, P. et al. (2020) Nature [Epub ahead of print].
  6. Schoeman, D. and B.C. Fielding (2019) Virol. J. 16:69.
  7. de Wit, E. et al. (2016) Nat. Rev. Microbiol. 14:523.
  8. WHO (2003) Summary of Probable SARS Cases with Onset of Illness from 1 November 2002 to 31 July 2003.
  9. WHO (2020) Coronavirus Disease 2019 (COVID-10) Situation Report – 50.
  10. Lu, R. et al. (2020) Lancet. 395:565.
  11. Li, F. (2016) Annu. Rev. Virol. 3:237.
  12. Wan, Y. et al. (2020) J. Virol. [Epub ahead of print].
  13. Li, W. et al. (2003) Nature 426:450.
  14. Riordan, J.F. (2003) Genome Bio. 4:225.
  15. Kuba, K. et al. (2010) Pharmacol. Ther. 128:119.
  16. Jinag, F. et al. (2014) Nat. Rev. Cardiol. 11:413.
  17. Ksiazek, T.G. et al. (2003) N. Engl. J. Med. 348:1953.
  18. Harmer, D. et al. (2002) FEBS Lett. 532:107.
  19. Leung, W.K. et al. (2003) Gastroenterology 125:1011.
  20. Tikellis, C. and M.C. Thomas (2012) Int. J. Pept. 2012:256294.
  21. Hoffmann, M. et al. (2020) Cell [Epub ahead of print].
  22. Belouzard, S. et al. (2009) Proc. Natl. Acad. Sci. U.S.A. 106:5871.
  23. Matsuyama, S. et al. (2010) J. Virol. 84:12658.
  24. Iwata-Yoshikawa, N. et al. (2019) J. Virol. 93:e01815.
  25. Huang, L. et al. (2003) J. Biol. Chem. 278:15532.
  26. Ramsey, M.L. et al. (2019) Trials 20:501.
  27. Zhou, Y. et al. (2015) Antiviral Res. 116:76.
  29. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China JAMA 2020
  31. Reuters. China approves use of Roche drug in battle against coronavirus complications. (Accessed on March 11, 2020).
  32. American College of Obstetricians and Gynecologists. Practive Advisory: Novel Coronavirus 2019 (COVID-2019). (Accessed on February 26, 2020).
  33. Seattle: COVID-19 patients compromised by comorbidities

Stefan Meyering DO FAAEM FACEP

Academic EM Attending Physician | APD @ Ft Worth EM | Director of Translational Research & Education | Interests: Graduate Medical Education, Risk Management and Legal Medicine, POCUS, Free Open Access Medical Education (FOAMed), Physician Wellness

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Article Peer Reviewed By:
Anant Patel DO FACEP @AnantPatels

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