However, at an early stage of the infection, treatment with remdesivir in combination with SARS-CoV-2 neutralizing antibodies seems promising. and decreased anti-inflammatory cytokines in combination with hypoxia, thromboembolism and pneumonia are involved in the pathogenesis of SARS-CoV-2 contamination. Although many drugs has been tested in monotherapy regimen with varying outcome or without desirable effect, there is still hope for better results by simultaneously targeting the computer virus itself and its symptoms. Theoretically, a mixture of at least two available antiviral drugs in combination with other anti-pathogenic and immune system-enhancing drugs or combination of antiviral drugs with convalescent plasma seems likely to have much better effect than the monotherapy regimen of either of these drugs. leads to an increased pneumonia as well as microthrombi formation and pulmonary vasoconstriction, i.e., constriction of the all small pulmonary blood vessels [43]. Each of these two conditions, i.e., lack of presence of functioning ACE2 or an imbalance between angiotensin I – VII and angiotensin II by itself is reportedly associated with increased hypoxia and combination of these conditions due to COVID-infection, will dramatically increase hypoxia intensity and duration. Administration of angiotensin I – VII to counteract the unbeneficial effect of the elevated angiotensin II, could have some positive effects on preventing vasoconstriction, generation of oxygen radicals and pulmonary cell damages; however the effects might not be as efficient as the presence of anticoagulants [70]. We suggest that, as for patients admitted to ICU for other ailments receiving anticoagulants, COVID-19 patients should also be considered to be given a low dose of anticoagulants for prophylactic purposes along with other treatments, unless a contraindicated medical situation is usually prohibitive, i.e., if there is a risk of bleeding. Other Preventive Therapies Although not scientifically established, specific vitamins and antioxidants could have positive effect on a COVID-19 contamination. From a general perspective view some vitamins, e.g., vitamins C and D, as well as antioxidants such as N-acetylcysteine (NAC) are important for a proper function of the immune system. There are ample of evidence-based studies showing that vitamin C, vitamin D or NAC supplementation reduces the incidence of clinically apparent disease (NAC), the probability of sepsis progression (vitamin C), contracting respiratory tract contamination (vitamin D) caused by either bacterial or viral origin [44, 70-73]. Hence, obtaining the recommended levels of vitamins and antioxidant in blood would certainly have some effect on the prevention or mitigation of COVID-19 symptoms by improving the functionality of the immune system. The use of vitamin C in COVID-19 treatment It has been reported that people deficient in vitamin C (ascorbic acid) are more prone to develop pneumonia with respiratory infections [10, 71]. Furthermore, it is well documented that vitamin C exerts an antioxidant activity capable of reducing oxidative stress, suppressing the generation of inflammatory markers and enhancing immune cell function that subsequently should shorten the infection period, as it has been reported for the influenza epidemic [45]. It should also be CDF recalled that an adequate daily uptake of vitamin C to maintain a normal blood/plasma level is usually important for a proper collagen production by the pulmonary- and vascular-cells [46]. Vitamin C can neither prevent nor remedy SARS-CoV-2, but due to other function such as helping the immune system, vitamin C could play an important role in the overall recovery of the body during a SARS-CoV-2 contamination. We believe that daily doses of 70 – 90 mg/kg of vitamin C during hospitalization of SARS-CoV-2 patients could shorten the disease period and speed up the recovery in a similar way that has been reported for the influenza computer virus [29, 45, 47]. It should be pointed out that some clinical trials have exhibited promising data on prevention of mortality in sepsis, but more extensive studies would be necessary to validate our conclusion regarding the effect of vitamin C on SARS-CoV-2 treatment. Vitamin D and COVID-19 treatment Vitamin D (after its activation by two hydroxylations) is known to be involved in the regulation of Ca2+/PO4- homeostasis in the body; and there is ample of evidence showing that vitamin D.combination drug therapy of COVID-19 patients. much better effect than the monotherapy regimen of either of these drugs. leads to an increased pneumonia as well as microthrombi formation and pulmonary vasoconstriction, i.e., constriction of the all small pulmonary blood vessels [43]. Each of these two conditions, i.e., lack of presence of functioning ACE2 or an imbalance between angiotensin I – VII and angiotensin II by itself is reportedly associated with increased hypoxia and combination of these conditions due to COVID-infection, will dramatically increase hypoxia intensity and duration. Administration of angiotensin I – VII to counteract the unbeneficial effect of the elevated angiotensin II, could have some positive effects on preventing vasoconstriction, generation of oxygen radicals and pulmonary cell damages; however the effects might not be as efficient as the presence of anticoagulants CGS19755 [70]. We suggest that, as for patients admitted to ICU for other ailments receiving anticoagulants, COVID-19 patients should also be considered to be given a low dose of anticoagulants for prophylactic purposes along with other treatments, unless a contraindicated medical situation is usually prohibitive, i.e., if there is a risk of bleeding. Other Preventive Therapies Although not scientifically established, specific vitamins and antioxidants could have positive effect on a COVID-19 contamination. From a general perspective view some vitamins, e.g., vitamins C and D, as well as antioxidants such as N-acetylcysteine (NAC) are important for a proper function of the immune system. There are ample of evidence-based studies showing that vitamin C, vitamin D or NAC supplementation reduces the incidence of clinically apparent disease (NAC), the probability of sepsis progression (vitamin C), contracting respiratory tract contamination (vitamin D) caused by either bacterial or viral origin [44, 70-73]. Hence, obtaining the recommended levels of vitamins and antioxidant in blood would certainly have some effect on the prevention or mitigation of COVID-19 symptoms by improving the functionality of the immune system. The use of vitamin C in COVID-19 treatment It’s been reported that folks deficient in supplement C (ascorbic acidity) are even more susceptible to develop pneumonia with respiratory system attacks [10, 71]. Furthermore, it really is well recorded that supplement C exerts an antioxidant activity with CGS19755 the capacity of reducing oxidative tension, suppressing the era of inflammatory markers and improving immune system cell function that consequently should shorten chlamydia period, since it continues to be reported for the influenza epidemic [45]. It will also become recalled an sufficient daily uptake of supplement C to keep up a normal bloodstream/plasma level can be important for an effective collagen production from the pulmonary- and vascular-cells [46]. Supplement C can neither prevent nor treatment SARS-CoV-2, but because of additional function such as for example helping the disease fighting capability, supplement C could play a significant role in the entire recovery of your body throughout a SARS-CoV-2 disease. We think that daily dosages of 70 – 90 mg/kg of supplement C during hospitalization of SARS-CoV-2 individuals could shorten the condition period and increase the recovery similarly that is reported for the influenza disease [29, 45, 47]. It ought to be described that some medical trials have proven guaranteeing data on avoidance of mortality in sepsis, but even more extensive studies will be essential to CGS19755 validate our summary regarding the result of supplement C on SARS-CoV-2 treatment. Supplement D and COVID-19 treatment Supplement D (following its activation by two hydroxylations) may be engaged in the rules of Ca2+/PO4- homeostasis in the torso; and there is certainly ample of proof showing that supplement D can be an essential participant in immunomodulation [48, 49]. The reduced indicated supplement D receptor (VDR) on immune system cells normally, i.e., macrophages, monocytes, aswell as with CGS19755 B and T lymphocytes raises due to inflammatory and immunological stimuli [48 substantially, 49]. Activation of VDR by supplement D can be an essential aspect to advertise innate immune system response, by improving the creation of anti-pathogenic real estate agents such as for example cathelicidin, beta NFkB and defensins by cells macrophages [72]. Supplement D insufficiency or down-regulation of VDR enables pathogens to build up in bloodstream cells and [72], as well as the weakened innate.