ABSTRACT Since December 2019, coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has changed our lives. Elderly and those with comorbidities represent the vast majority of patients hospitalized with severe COVID-19 symptoms, including acute respiratory disease syndrome and cardiac dysfunction. Despite a huge effort of the scientific community, improved treatment modalities limiting the severity and mortality of hospitalized COVID-19 patients are still required. Here, we compare the effectiveness of virus- and patients-centred strategies to reduce COVID-19 mortality. We also discuss the therapeutic options that might further reduce death rates associated with the disease in the future. Unexpectedly, extensive review of the literature suggests that SARS-CoV-2 viral load seems to be associated neither with the severity of symptoms nor with mortality of hospitalized patients with COVID-19. This may explain why, so far, virus-centred strategies using antivirals aiming to inhibit the viral replicative machinery have failed to reduce COVID-19 mortality in patients with respiratory failure. By contrast, anti-inflammatory treatments without antiviral capacities but centred on patients, such as dexamethasone or Tocilizumab ® , reduce COVID-19 mortality. Finally, since the spike protein of SARS-CoV-2 binds to angiotensin converting enzyme 2 and inhibits its function, we explore the different treatment options focussing on rebalancing the renin-angiotensin system. This new therapeutic strategy could hopefully further reduce the severity of respiratory failure and limit COVID-19 mortality in elderly patients.
【저자키워드】 COVID-19, Dexamethasone, ACE2, Tocilizumab, antivirals, aging, renin-angiotensin system, Mas receptor, 【초록키워드】 Dexamethasone, Treatment, coronavirus disease, SARS-CoV-2, Coronavirus disease 2019, coronavirus, Respiratory failure, Mortality, Antiviral, Tocilizumab, severity, elderly, angiotensin converting enzyme 2, Infection, Comorbidities, hospitalized patients, severe acute respiratory syndrome Coronavirus, elderly patients, virus, angiotensin converting enzyme, Spike protein, renin-angiotensin system, Viral, Viral load, Patient, Effectiveness, Scientific community, respiratory, patients, therapeutic strategy, therapeutic options, hospitalized COVID-19 patient, angiotensin, COVID-19 mortality, acute respiratory disease, anti-inflammatory treatment, therapeutic option, death rates, death rate, dysfunction, acute respiratory syndrome, Renin, hospitalized COVID-19 patients, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, enzyme, SARS-CoV-2 viral load, syndrome, effort, anti-inflammatory treatments, severe COVID-19 symptoms, limit, bind, caused, inhibit, the disease, required, majority, hospitalized patient, the spike protein, changed, reduce, explain, replicative, patients hospitalized, severity of symptom, those with comorbidity, with COVID-19, 【제목키워드】 virus, therapeutic, reduce,