Two main processes are thought to drive the pathogenesis of COVID-19.
Early in the clinical course, the disease is primarily driven by the replication of SARS-CoV-2. Later in the clinical course, the disease appears to be driven by a dysregulated-- immune/inflammatory response to SARS-CoV-2 that leads to tissue damage. Based on this understanding, it is anticipated that therapies that directly target SARS-CoV-2 would have the greatest effect early in the course of the disease, while immuno-suppressive/anti-inflammatory therapies are likely to be more beneficial in the later stages of COVID-19.
The clinical spectrum of SARS-CoV-2 infection includes asymptomatic or pre-symptomatic infection and mild, moderate, severe, and critical illness. Figure 1 provides guidance for clinicians on the therapeutic management of non-hospitalized adult patients. This includes patients who do not require hospitalization or supplemental oxygen and those who have been discharged from an emergency department or a hospital.