Introduction:
SARS-CoV-2 (previously named 2019-nCoV), the virus that causes the
clinical illness COVID-19, is a novel RNA virus belonging to the
coronavirus family (1). With more than three million confirmed cases
worldwide and more than 200000 deaths at this moment and growing up
these numbers constantly, various treatments are being tried clinically
or undergoing evaluation (1)(2) (3) (4). The greatest risk of spread
worldwide of Covid-19 involves serious life-threatening problems against
human security. Fever, cough, and shortness of breath are the main
symptoms of the disease that can lead to pneumonia or other organs
compromised with a mortality rate of 5% or higher (1) (2) (5).
Currently, there is only one authorized drug, but for emergency use in
critically ill patients: Remdesivir (6). There are no other approved
medications for infectious coronavirus, despite the fact that antiviral
drugs such as protease inhibitors, integrase and / or polymerase enzymes
are designed and are in advanced studies (3) (4) (7). Among these
inhibitors, antiprotease inhibitors appear to work effectively in
blocking virus replication and provide promising treatment for Covid19
disease but not yet advisable in a systematic way (3) (8) (9). The
majority of published evidence that have suggested treatments for
COVID-19 has been extrapolated from experience with SARS, MERS or
limited to case-series (10) (11). Randomized-controlled trials are
ongoing, most notably with three agents: 1. Remdesivir, actually one of
the novel investigational drugs with possible greatest potential as an
anti-Covid-19 (6)(12)(13)(14). 2. Lopinavir/Ritonavir, an
anti-retroviral used for treatment of HIV; (11)(12). 3. Chloroquine and
Hydroxychloroquine, antimalarial drugs with antiviral activity in-vitro,
especially when associated with a macrolide antibiotic, azithromycin, in
vivo (15)(16)(17). All these have probably been the most mentioned and
promising compounds for Covid19 treatment. Other agents also under
investigation including immunomodulatory drugs have been used to
attenuate COVID-19-associated cytokine storm such as tocilizumab and
sarilumab (18)(19)(20) as well as the mesenchymal stem cell therapy
described by Atluri et al (2020) (21).