A RECURRENT QUESTION FROM A PRIMARY CARE PHYSICIAN: HOW SHOULD I TREAT MY COVID-19 PATIENTS AT HOME?

Rationale and ObjectivesHow should I treat my patients with initial symptoms of COVID-19 at home? This is a recurrent question we have received from many primary care physicians, particularly in less fortunate parts of the world.Given the rising global death toll associated with the COVID-19 pandemic, in the past few months we have witnessed a race to find drugs/biologic treatments to save the lives of hospitalised, severely ill patients, as well as to develop vaccines. To this end, randomised clinical trials are underway to test experimental drug candidates or repurposed medicines. Therapeutic approaches to the early phase of COVID-19 are also being debated, and here, too, there is an emphasis on the need for randomised clinical trials. We agree that rigorous clinical trials are needed. However, there are times, like the present, when patients with SARS-CoV-2 infection are dying at home, and solutions are needed immediately, so we do not have the time to wait for robust results of trials that will take, at best, several months, or possibly up to 1 or 2 years. Thus, it is crucial to provide recommendations to primary care physicians, especially those practicing in resource-poor settings, on treating patients at home during the early phase of COVID-19 when they have mild initial symptoms. Key recommendationsWe have prepared recommendations for treatment focused on a combination of two drug classes (NSAIDs and corticosteroids) that target the most common symptoms, and prophylactic therapy (low-molecular-weight heparin) and oxygen therapy when needed. These are based on the pathophysiological and pharmacological rationale and the available clinical evidence of efficacy in COVID-19 patients, including results of published randomized clinical trials, for each of our recommended class of drugs.ConclusionThese recommendations may be even more helpful to primary care physicians in resource-poor-settings in Latin America and Africa.