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. |
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 |
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 |