Abstract

BACKGROUND COVID19 is an emerging pandemic outbreak that is changing our life causing a big challenge worldwide.[1] A major concern is being the virus highly and rapidly contagious, very protean clinical features along with the poor preparedness of global armamentarium against this “gate-crasher.” Apart from proper preventive measures, we as clinicians should find a way to cope optimally with the inflicted victims. Given the new face of a wild disease in addition to the absence adequate data on the treatment of COVID19 no standard of care is proposed so far; a great burden on health care systems. Most of the international and local guidelines on treatments are based on empirical and/or anecdotal reports with overall disappointing results and rather high morbidity and mortality.[2] These include both anti-viral and immunomodulatory modalities. Among the anti-viral agents, more populous drugs are lopinavir-ritonavir, remdesivir, favipiravir, umifenovir, and oseltamivir (abandoned to date) prescribed with different protocols. On the other hand, there are plenty of nonantiviral/supportive approaches; namely stem-cell therapy, plasma treatment, colchicine, methylprednisolone, intravenous (IV) immunoglobulin, antimalarials, interferons (alfa, beta), extracorporeal membrane oxygenation, ozonated autohemotherapy, mono-clonal antibodies (tocilizumab).[3] Considering the global burden of disease and treatment failures worldwide, this idea is to correct the proposed international guidelines,[4,5] that discourages administering glucocorticoids (GCs), due to the lack of evidence. We hope with further global investigations we would have better treatment protocols. Go to: UNIQUE IMMUNE RESPONSE IN COVID19 In viral pneumonias, lung tissue reaction is usually mild and mostly natural killer (NK) cells, and cytotoxic T-cells are involved and interferons are secreted. Interferon Type-I is secreted by infected cells with viruses, while Type-II from T-cells, NK cells, and macrophages boost the immune system against viruses.[6] A two-phase immune response for COVID19 is proposed by Yufang Shi; an initial immune defense-based protective phase in very early phase of clinical disease and postinitial inflammation-driven damaging phase. The adaptive immune response is the major mechanism for the former and the innate immune response for the latter.[7] From clinical standpoint, a majority of patients with COVID19 have positive imaging findings on computed tomography (CT) images suggestive of tissue infiltrations, fibromyxoid exudation, hyaline membrane formation, and in later stages forthcoming damage and eventual fibrosis. The full-blown immune response is presented as cytokine storm.[7]