Abstract
There is an emergency need for early ambulatory treatment of Coronavirus Disease 2019 (COVID-19) in acutely ill patients in an attempt to reduce disease progression and the risks of hospitalization and death. Such management should be applied in high-risk patients age > 50 years or with one or more medical problems including cardiovascular disease. We evaluated a total of 922 outpatients from March to September 2020. All patients underwent contemporary real-time polymerase chain reaction (PCR) assay tests from anterior nasal swab samples. Patients age 50.5 ± 13.7 years (range 12 to 89), 61.6% women, at moderate or high risk for COVID-19 received empiric management via telemedicine. At least two agents with antiviral activity against SARS-CoV-2 (zinc, hydroxychloroquine, ivermectin) and one antibiotic (azithromycin, doxycycline, ceftriaxone) were used along with inhaled budesonide and/or intramuscular dexamethasone consistent with the emergent science on early COVID-19 treatment. For patients with high severity of symptoms, urgent in-clinic administration of albuterol nebulizer, inhaled budesonide, and intravenous volume expansion with supplemental parenteral thiamine 500 mg, magnesium sulfate 4 grams, folic acid 1 gram, vitamin B12 1 mg. A total of 320/922 (34.7%) were treated resulting in 6/320 (1.9%) and 1/320 (0.3%) patients that were hospitalized and died, respectively. We conclude that early ambulatory (not hospitalized, treated at home), multidrug therapy is safe, feasible, and associated with low rates of hospitalization and death. Early treatment should be considered for high-risk patients as an emergency measure while we await randomized trials and guidelines for ambulatory management.
Highlights
The epidemic viral outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection Coronavirus Disease 2019 (COVID-19) is advancing across the United States unabated despite public policy measures focussed on contagion control (McCullough et al, 2020)
Our data suggest the advancement of early home use of off-target antiviral agents, antibiotics, corticosteroids, and in the future empiric anticoagulants could markedly reduce the risk for hospitalization and potentially reduce overall death rates before and during hospitalization (McCullough et al, 2020)
Empiric multidrug treatment for ambulatory COVID-19 according to age, comorbidities, and initial severity of symptoms is feasible with close follow-up
Summary
The epidemic viral outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection Coronavirus Disease 2019 (COVID-19) is advancing across the United States unabated despite public policy measures focussed on contagion control (McCullough et al, 2020). The regulatory agencies as well as the National Institutes of Health have had their principal areas of focus being late stage hospitalized patients and vaccine development (COVID-19 Treatment Guidelines, 2020). This has left a void for the role of early ambulatory treatment of COVID-19 at home. This report discloses real world data and the clinical outcomes of early ambulatory treatment of acute COVID-19 in patients at high risk for hospitalization and death
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