Latest Insights on the Diagnostic Approaches and Treatment Strategies of COVID-19

Abstract

Background: COVID-19 has emerged as the most serious pandemic in the 21st century to date. COVID-19 patients may develop various disease symptoms that hinder the accurate clinical diagnosis.

Summary: Routine diagnosis of COVID-19 requires complementary investigations, including computed tomography, immunological assays, and molecular assays like real-time RT-PCR, loop-mediated isothermal amplification, metagenomic next-generation sequencing, and clusters of regularly interspaced short palindromic repeats-based assays. Clinically approved antiviral drugs available for the COVID-19 treatment are very limited. The most common measurements that enhance health condition and patients' viability are conservation fluid management, oxygen therapy, and antibiotics. Several therapeutic options have been developed or repurposed to prevent virus replication and/or modulate the immune response against virus infection. These options include various drugs that affect virus entry and membrane fusion, inhibit polymerase and protease activity, suppress the host pro-inflammatory cytokines, and utilize cell therapy approaches.

Key messages: In this review, we aimed to provide an up-to-date discussion on the current diagnostic options and therapeutic strategies used to control and manage COVID-19 in clinical and point-of-care settings.

Keywords: Coronavirus disease-19; Life cycle; Molecular diagnosis; SARS-CoV-2; Therapeutics.

Fig. 1

Advantages of using RT-LAMP over RT-PCR as a diagnostic method for SARS-CoV-2 detection.

Fig. 2

Schematic representation of SARS-CoV-2 life cycle and the treatment strategies for COVID-19 pandemic. An infected person with COVID-19 can infect another person through their respiratory droplets, sneezing, and coughing. The SARS-CoV-2 life cycle includes (1) binding of SARS-CoV-2 spike protein with ACE2 receptor on the host cell's surface with the aid of the host protease enzyme TMPRSS2; (2) virus entry by fusion with the plasma membrane or by endocytosis mediated by endosome formation; (3) translation of the viral machinery of replication at cytoplasmic membranes; (4, 5) genomic and sub-genomic mRNA transcription through coordinated processes of continuous/discontinuous RNA synthesis determined by the viral replicase and mediated by viral proteases (e.g., 3CLpro and PLpro) and RdRP; (6) translation of structural and nonstructural proteins by viral-encoded enzymes and host cell machinery; (7) virions components are assembled at the ERGIC and obtain their membrane envelope; and (8) viruses are directed through the host secretory pathway and released by budding from the plasma membrane. The treatment options for COVID-19 include (a) viral entry and membrane fusion inhibitors (e.g., umifenovir, camostat mesylate, ACEi, ARBs, rhACE2, hydroxychloroquine); (b) protease inhibitors (e.g., LPV/r, darunavir/cobicistat, and disulfiram); (c) RdRp inhibitors (e.g., RDV, favipiravir, and ribavirin); and (d) immunomodulatory agents (e.g., tocilizumab and sarilumab, anakinra, nitazoxanide, thalidomide, and corticosteroid). Blue arrows for the subsequent step and a red “T” sign for inhibition. ERGIC, endoplasmic reticulum/Golgi intermediate compartment.