Table 1. Management of COVID-19 Patients Based on Disease Severity.

From: Case Management of COVID-19 (Secondary Version)

Definitions Place of medical care Points of medical care
Mild SpO2 > 96
With no evidence of pneumonia
Home
Medical institution (elderly, with underlying illness)
Persons should be observed from the day of onset up to 10 days. Symptoms may appear even in asymptomatic carriers. Regularly measure SpO2 in the elderly or in those with underlying illness to detect early progression to moderate or more severe disease. Olfactory and taste disorders are likely to persist.
Moderate I 93 < SpO2 < 96 Medical institution Careful follow-up is required using respiratory rate and SpO2 as indicators. In patients with decreased SpO2, oxygen administration is started, and drug therapy (a combination of remdesivir and steroids) is recommended. Screening for thrombosis is also performed. Bacterial infections are rare, and the need for antibiotics is assessed on a case-by-case basis.
Moderate II SpO2 < 93 Medical institution
Severe Requires artificial ventilation Advanced medical institution designated under the coordination of prefectures It is desirable to receive treatment at an appropriate medical institution.
Table 2. Drug Therapy for COVID-19.

From: Case Management of COVID-19 (Secondary Version)

Developmental status Drug name Target patients
Interferon antiviral drug Special approval Remdesivir (RNA-dependent RNA polymerase inhibitor) Moderate to severe cases requiring oxygen administration (less effective in severe cases)
Off-label use (compassionate use within the framework of observational studies) Favipiravir (RNA-dependent RNA polymerase inhibitor) Mild (although efficacy is uncertain)
Clinical trials Lopinavir/ritonavir, nelfinavir (HIV protease inhibitor) No efficacy in critically ill patients
Hydroxychloroquine (antimalarial drug) No efficacy
Interferon No efficacy
Ivermectin (antihelminthic drug) Unclear efficacy
Ciclesonide (inhaled corticosteroid) No efficacy
Immune modulator drugs Approved Dexamethasone (steroid) Moderate to severe cases requiring oxygen administration
Clinical trials Tocilizumab, sarilumab (genetically modified anti-IL-6 monoclonal antibody) Unclear efficacy
Immunoglobulin Clinical trials Recoveree’s plasma Unclear efficacy
Antithrombotic drugs Approved Heparin Moderate to severe cases requiring oxygen administration
Table 3. Remdesivir Clinical Trials.

From: Case Management of COVID-19 (Secondary Version)

Trials NCT04257656 ACTT-1 GS-US-540-5774 SOLIDARITY
Implementing countries (number of facilities) China (10) United States (45), Denmark (8), United Kingdom (5), Greece(4), Germany (3), South Korea (2), Mexico (2), Spain (2), Japan (1), Singapore (1) United States (45), Italy (11), Spain (9), United Kingdom (8), Germany (6), France (3), France (3), Switzerland (3), Singapore (3), Taiwan (3), Hong Kong (2), Netherlands (1) World (unknown)
Implementation period February-March 2020 February-April 2020 March-April 2020 March-October 2020
Study design Double-blind Double-blind Unblind Unblind
Number of cases Remdesivir 158
Placebo 79
Remdesivir 541
Placebo 521
Remdesivir (5 days) 197
Remdesivir (10 days) 199
Standard treatment 200
Remdesivir 2743
Standard treatment 2708
Subjects Requires hospitalization
Pneumonia patients
Requires hospitalization
Pneumonia patients
Requires hospitalization
Patients with pneumonia (SpO2 > 94%)
Requires hospitalization Patients
Results No significant difference in clinical improvement Faster clinical improvement (10 days vs. 15 days) On the 11th day of administration, the 5-day treatment group improved symptoms faster than the standard treatment group No significant difference in mortality
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