Emergency Management of Severe Covid-19 Cases: A Narrative Review

Abstract

Introduction: With several media and public health agencies warning of a continued global outbreak and possible pandemic, there is a high probability United States hospitals will see a large influx of severe cases of COVID-19, which will overwhelm many health systems. This review aimed to collect the evidence about emergency management of severe COVID-19 cases.
Methods: We searched PubMed and preprint archives for research articles published up to 21 February 2020 using the following terms: “COVID-19”, “SARS-CoV-2”, “2019-nCoV”, “n-CoV”, and “coronavirus.” At the initial stage of screening, any articles that were published before 1 December 2019 were excluded. Research titles were independently reviewed by two authors to eliminate studies that did not meet our inclusion criteria before the full review of abstracts and full-text of selected studies. At least two authors independently extracted data using the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist.
Results: Owing to the widespread availability of diagnostic testing capacity after the summer of 2020, this living review has now focused on the therapeutic models. Of these, 29 had low risk of bias, 32 had unclear risk of bias, and 545 had high risk of bias. The most common causes for high risk of bias were inadequate sample sizes and inappropriate or incomplete evaluation of model performance. Several medications were newly developed, and many have been under investigation.
Conclusions: As with MERS and SARS, steroids should be avoided. Data from both the SARS and MERS epidemics have demonstrated worse long-term outcomes with the use of corticosteroids, and the use of steroids should only be reserved for patients requiring treatment for other disease processes. Ribavirin, however, resulted in worse SARS outcomes when comparedto case-matched control patients. In contrast, based upon limited data Ribavirin seems to be associated with improved MERS survival. Similar randomized trials evaluating lopinavir/ritonavir for MERS have been designed, but are not yet completed.