COVID-19: Prevention — Investigational Treatments

COVID-19: Prevention & Investigational Treatments

Other names: 2019 Novel Coronavirus; 2019-nCoV; Coronavirus; Novel Coronavirus Pneumonia; SARS-CoV-2 Infection

Updated — April 22, 2020 J.Stewart BPharm

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What is COVID-19?

COVID-19 is the disease caused by an infection of the SARS-CoV-2 virus, first identified in the city of Wuhan, in China’s Hubei province in December 2019. COVID-19 was previously known as 2019 Novel Coronavirus (2019-nCoV) respiratory disease before the World Health Organization (WHO) declared the official name as COVID-19 in February 2020.

The SARS-CoV-2 virus belongs to the family of viruses called coronaviruses, which also includes the viruses that cause the common cold, and the viruses that cause more serious infections such as severe acute respiratory syndrome (SARS), which was caused by SARS-CoV in 2002, and Middle East respiratory syndrome (MERS), which was caused by MERS-CoV in 2012. Like the other coronaviruses, the SARS-CoV-2 virus primarily causes respiratory tract infections, and the severity of the COVID-19 disease can range from mild to fatal. Serious illness from the infection is caused by the onset of pneumonia and acute respiratory distress syndrome (ARDS).

Symptoms

The most common symptoms of COVID-19 include dry cough, fever, and shortness of breath. It is thought that symptoms can appear between 2-14 days after exposure although there have been isolated cases which suggest this may be longer. If you develop symptoms, you should stay at home to prevent the spread of the disease into the community. Wearing a facemask will help prevent the spread of the disease to others.
Update: March 10, 2020 — According to the latest research published in the Annals of Internal Medicine (March 10, 2020), the median incubation period is estimated to be 5 days, and almost all (

98%) patients who have been infected will develop symptoms within 12 days.
Update: April 14, 2020 — A new study suggests losing your sense of smell and taste is an early sign of COVID-19.

Transmission

The SARS-CoV-2 virus is thought to spread from person-to-person via:

  • droplet transmission (large respiratory droplets that people sneeze, cough or drip)
  • aerosol transmission (when someone coughs or sneezes in the room)
  • contact transmission (touching a contaminated surface then touching your mouth, nose or eyes)
  • direct transmission (kissing, shaking hands etc.)

Prevention

The best way to prevent infection is to avoid exposure to the virus.

The most important way to prevent COVID-19 is to WASH YOUR HANDS.

Wash your hands regularly and thoroughly with soap and water (lather for 20 seconds) OR use an alcohol based (at least 60%) hand sanitizer.

Other actions that help to prevent the spread of COVID-19:

  • avoid contact with others who are sick
  • avoid touching your mouth, nose, eyes or face
  • cover coughs and sneezes (into a tissue or into your elbow)
  • clean and disinfect surfaces (alcohol or bleach based cleaning solutions work best for coronaviruses)
  • facemasks will not protect you from COVID-19, but will help prevent the spread of the disease to others.
  • social distancing
  • self isolation

What to do if you are sick

  • Prevent the spread of COVID-19 if you are Sick(CDC)
  • Environmental Cleaning and Disinfection Recommendations(CDC)

What to do if you come into contact with someone who is sick

If you have been exposed to someone who has tested positive for COVID-19, or someone who is showing symptoms of COVID-19, it may take up to two weeks for your symptoms to present. To keep yourself and others safe, you should isolate yourself from other people for 14 days.

What does self-isolation mean?

Self-isolation means staying away from situations where you could infect other people. This means any situation where you may come in close contact with others (face to face contact closer than 3 feet for more than 15 minutes), such as social gatherings, work, school, child care/pre-school centres, university and other education providers, faith-based gatherings, aged care and health care facilities, prisons, sports gatherings, restaurants and all public gatherings.

You should not share dishes, drinking glasses, cups, eating utensils, towels, pillows or other items with other people in your home. After using these items, you should wash them thoroughly with soap and water, place them in the dishwasher for cleaning or wash them in your washing machine.

Risk Factors

Scientists are still researching risk factors for COVID-19 but data from China CDC suggest that the elderly, and people suffering from pre-existing medical conditions (such as heart disease, respiratory disease including asthma and COPD, or diabetes) have a higher risk of dying from the disease. There is research that suggests that smokers may be more susceptible to the SARS-CoV-2 virus. There is also evidence to suggest that people who use e-cigarettes (vaping) are at much higher risk of developing serious respiratory infections.
Update: March 16, 2020 — A Chinese study claims to have found that people with type A blood may be more susceptible to the novel Coronavirus (COVID-19).
Update: March 22, 2016 — CDC now includes people aged 65 years and older, people who live in a nursing home or long-term care facility, and people who are immunocompromised including those receiving cancer treatment as those who are at higher risk for severe illness. People with HIV may also be at higher risk of serious illness.

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Investigational Treatments

Currently, there are no FDA approved treatments for COVID-19.

  • Baricitinib Clinical studies are in preparation to determine the effectiveness of a Janus kinase (JAK) inhibitor called baricitinib (marketed under the brand name Olumiant for the treatment of rheumatoid arthritis) in the treatment of COVID-19 patients.
  • Bevacizumab A VEGF inhibitor called bevacizumab (marketed under the brand name Avastin for certain types of cancer) being studied as a treatment for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in critically ill patients with COVID-19 pneumonia at the Qilu Hospital of Shandong University in Jinan, China.
  • Chloroquine phosphate The older anti-malaria drug chloroquine has been shown to have a wide range of antiviral effects, including anti-coronavirus. Studies in Guangdong Province in China suggest that chloroquine may help improve patient outcomes in people with novel coronavirus pneumonia.
  • Colchicine An older anti-inflammatory drug called colchicine is being studied to prevent complications of COVID-19 in high risk patients. Colchicine has long been used in the treatment of gout.
  • EIDD-2801 A team of researchers at UNC-Chapel Hill is hopeful that a broad spectrum oral antiviral called EIDD-2801 could be used as a potential prophylactic or treatment for COVID-19 and other coronaviruses. Ridgeback Biotherapeutics has licensed EIDD-2801 and has received permission from the FDA to begin patient trials.
  • Favipiravir An antiviral drug called favipiravir which was reported February 17, 2020 to have received marketing approval in China for the treatment of influenza, was also approved for use in clinical trials as a treatment for novel coronavirus pneumonia.
    Update: March 31, 2020 — Fujifilm announced the start of a Phase 3 clinical trial of Avigan (favipiravir) on COVID-19 patients in Japan. Avigan is approved in Japan for use as an antiviral in the treatment of influenza.
    Update: April 9, 2020 — Fujifilm announced the start of a Phase 2 clinical trial of favipiravir in approximately 50 COVID-19 patients in the U.S.
  • Fingolimod An approved drug called fingolimod (marketed under the brand name Gilenya for the treatment of relapsing forms of multiple sclerosis) is being studied as a treatment for COVID-19 at the First Affiliated Hospital of Fujian Medical University in Fuzhou, China.
  • Hydroxychloroquine and azithromycin In a small study commissioned by the French government, 20 patients with COVID-19 were treated with a combination of the anti-malaria drug hydroxychloroquine and the macrolide antibacterial drug azithromycin (Zithromax). Results showed that all patients taking the combination were virologically cured within 6 days of treatment.
  • Hydroxychloroquine sulfate It was reported in the journal Clinical Infectious Diseases on March 9 that the malaria drug hydroxychloroquine was effective in killing the coronavirus in laboratory experiments. Hydroxychloroquine was first approved by the FDA in 1995 under the brand name Plaquenil, and it is also used in the treatment of patients with lupus and arthritis.
  • Ivermectin An anti-parasitic drug called ivermectin has been shown to be effective against the SARS-CoV-2 virus in an in-vitro laboratory study by researchers at Monash University in Melbourne, Australia. Further clinical trials need to be completed to confirm the effectiveness of the drug in humans with COVID-19.
  • Leronlimab A CCR5 antagonist called leronlimab has shown promise in calming the ‘cytokine storm’ in a small number of critically ill COVID-19 patients hospitalized in the New York area.
  • Lopinavir and ritonavir A drug combination called lopinavir/ritonavir approved to treat HIV under the brand name Kaletra is being studied in combination with the flu drug oseltamivir (Tamiflu) in Thailand. It was reported on February 18, 2020 that an elderly Chinese woman, the first patient to receive the «Thai cocktail» in Bangkok’s Rajvithi Hospital, had made a complete recovery after suffering from severe COVID-19-related pneumonia.
    Update: March 18, 2020 — According to a study in the New England Journal of Medicine, the lopinavir/ritonavir combination showed no benefit over standard care in hospitalized adult patients with severe COVID-19.
  • Methylprednisolone A widely used glucocorticoid called methylprednisolone is being studied for safety and effectiveness in the treatment of novel coronavirus pneumonia in a number of hospitals in the Hubei province of China.
  • Remdesivir An investigational antiviral drug called remdesivir is being studied in clinical trials in China, the United States, and the United Kingdom. Remdesivir has demonstrated in vitro and in vivo activity in animal models against the viral pathogens that cause MERS and SARS, which are coronaviruses structurally similar to SARS-CoV-2.
  • Sarilumab An interleukin-6 (IL-6) receptor antagonist called sarilumab (marketed under the brand name Kevzara for the treatment of rheumatoid arthritis) is being studied as a potential treatment for acute respiratory distress syndrome (ARDS) in patients critically ill from COVID-19.
  • Tocilizumab An interleukin-6 receptor antagonist called tocilizumab (marketed under the brand name Actemra for the treatment of rheumatoid arthritis and other inflammatory conditions) is being studied in a number of locations worldwide for the treatment of patients with COVID-19.
  • Umifenovir An antiviral drug called umifenovir (marketed in Russia under the brand name Arbidol, and also available in China for the treatment of influenza) is being studied in China and other countries as a treatment for COVID-19.

For more information

Several pharmaceutical companies and research organizations worldwide are involved in the development of potential vaccines.

  • mRNA-1273 A novel coronavirus vaccine called mRNA-1273 (Moderna, Inc.) has been shipped to the National Institute of Allergy and Infectious Diseases ready for use in a Phase 1 study.
  • CSIRO, Australia’s national science agency, announced April, 2 2020 that it has commenced the first stage of testing potential vaccines for COVID-19.
  • Tonix Pharmaceuticals Holding Corp. has announced it is researching the development of a potential vaccine against COVID-19 using its proprietary horsepox virus platform.
  • Researchers in Israel are working to adapt a vaccine that is effective against avian coronavirus Infectious Bronchitis Virus (IBV) to work as a vaccine against COVID-19 in humans.
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Cellulitis

Medically reviewed by Drugs.com. Last updated on Feb 6, 2020.

  • Health Guide
  • Disease Reference
  • Care Notes

Overview

Cellulitis (sel-u-LIE-tis) is a common, potentially serious bacterial skin infection. The affected skin appears swollen and red and is typically painful and warm to the touch.

Cellulitis usually affects the skin on the lower legs, but it can occur in the face, arms and other areas. It occurs when a crack or break in your skin allows bacteria to enter.

Left untreated, the infection can spread to your lymph nodes and bloodstream and rapidly become life-threatening. It isn’t usually spread from person to person.

Cellulitis is usually a superficial infection of the skin. But if severe or if left untreated, it can spread into your lymph nodes and bloodstream. Pictured here is mild cellulitis (left) and severe cellulitis (right).

Symptoms

Possible signs and symptoms of cellulitis, which usually occur on one side of the body, include:

  • Red area of skin that tends to expand
  • Swelling
  • Tenderness
  • Pain
  • Warmth
  • Fever
  • Red spots
  • Blisters
  • Skin dimpling

When to see a doctor

It’s important to identify and treat cellulitis early because the condition can spread rapidly throughout your body.

Seek emergency care if:

  • You have a red, swollen, tender rash or a rash that’s changing rapidly
  • You have a fever

See your doctor, preferably that day, if:

  • You have a rash that’s red, swollen, tender and warm — and it’s expanding — but without fever

Causes

Cellulitis occurs when bacteria, most commonly streptococcus and staphylococcus, enter through a crack or break in your skin. The incidence of a more serious staphylococcus infection called methicillin-resistant Staphylococcus aureus (MRSA) is increasing.

Although cellulitis can occur anywhere on your body, the most common location is the lower leg. Bacteria are most likely to enter disrupted areas of skin, such as where you’ve had recent surgery, cuts, puncture wounds, an ulcer, athlete’s foot or dermatitis.

Animal bites can cause cellulitis. Bacteria can also enter through areas of dry, flaky skin or swollen skin.

Risk factors

Several factors put you at increased risk of cellulitis:

  • Injury. Any cut, fracture, burn or scrape gives bacteria an entry point.
  • Weakened immune system. Conditions that weaken your immune system — such as diabetes, leukemia and HIV/AIDS — leave you more susceptible to infections. Certain medications also can weaken your immune system.
  • Skin conditions. Conditions such as eczema, athlete’s foot and shingles can cause breaks in the skin, which give bacteria an entry point.
  • Chronic swelling of your arms or legs (lymphedema). This condition sometimes follows surgery.
  • History of cellulitis. Having had cellulitis before makes you prone to develop it again.
  • Obesity. Being overweight or obese increases your risk of developing cellulitis.

Complications

Recurrent episodes of cellulitis may damage the lymphatic drainage system and cause chronic swelling of the affected limb.

Rarely, the infection can spread to the deep layer of tissue called the fascial lining. Necrotizing fasciitis is an example of a deep-layer infection. It’s an extreme emergency.

Prevention

If your cellulitis recurs, your doctor may recommend preventive antibiotics. To help prevent cellulitis and other infections, take these precautions when you have a skin wound:

  • Wash your wound daily with soap and water. Do this gently as part of your normal bathing.
  • Apply a protective cream or ointment. For most surface wounds, an over-the-counter ointment (Vaseline, Polysporin, others) provides adequate protection.
  • Cover your wound with a bandage. Change bandages at least daily.
  • Watch for signs of infection. Redness, pain and drainage all signal possible infection and the need for medical evaluation.

People with diabetes and those with poor circulation need to take extra precautions to prevent skin injury. Good skin care measures include the following:

  • Inspect your feet daily. Regularly check your feet for signs of injury so you can catch infections early.
  • Moisturize your skin regularly. Lubricating your skin helps prevent cracking and peeling. Do not apply moisturizer to open sores.
  • Trim your fingernails and toenails carefully. Take care not to injure the surrounding skin.
  • Protect your hands and feet. Wear appropriate footwear and gloves.
  • Promptly treat infections on the skin’s surface (superficial), such as athlete’s foot. Superficial skin infections can easily spread from person to person. Don’t wait to start treatment.

Diagnosis

Your doctor will likely be able to diagnose cellulitis by looking at your skin. In some cases, he or she may suggest blood tests or other tests to help rule out other conditions.

Treatment

Cellulitis treatment usually includes a prescription oral antibiotic. Within three days of starting an antibiotic, let your doctor know whether the infection is responding to treatment. You’ll need to take the antibiotic for as long as your doctor directs, usually five to 10 days but possibly as long as 14 days.

In most cases, signs and symptoms of cellulitis disappear after a few days. You may need to be hospitalized and receive antibiotics through your veins (intravenously) if:

  • Signs and symptoms don’t respond to oral antibiotics
  • Signs and symptoms are extensive
  • You have a high fever
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Usually, doctors prescribe a drug that’s effective against both streptococci and staphylococci. It’s important that you take the medication as directed and finish the entire course of medication, even after you feel better.

Your doctor also might recommend elevating the affected area, which may speed recovery.

Lifestyle and home remedies

Try these steps to help ease any pain and swelling:

  • Place a cool, damp cloth on the affected area as often as needed for your comfort.
  • Ask your doctor to suggest an over-the-counter pain medication to treat pain.
  • Elevate the affected part of your body.
  • Ask your doctor whether it might help to wear compression wraps or stockings.

Preparing for an appointment

You’re likely to start by seeing your family doctor or a general practitioner, who may refer you to a doctor who specializes in skin disorders (dermatologist). If you have a severe infection, an emergency room doctor may examine you first. You may also be referred to an infectious disease specialist.

Here’s some information to help you get ready for your appointment.

What you can do

  • List your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • List key personal information, such as if you’ve had any recent surgeries, injuries, animal bites or insect bites.
  • List medications, vitamins and supplements you’re taking and the dosage.
  • List questions to ask your doctor.

Preparing a list of questions can help you make sure that you cover the points that are important to you. For cellulitis, some basic questions to ask your doctor include:

  • How might I have gotten this infection?
  • What tests do I need? Do these tests require special preparation?
  • How is this treated?
  • How long before the treatment starts working?
  • What side effects are possible with this medication?
  • I have other medical conditions. How do I manage them together?
  • Are there alternatives to antibiotics?
  • Is there a generic alternative to the medicine you’re prescribing?
  • How can I prevent this type of infection in the future?
  • Do you have any brochures or other printed material that I can have? What websites do you recommend?

Don’t hesitate to ask other questions you have.

What to expect from your doctor

Examples of questions your doctor may ask, include:

  • When did your symptoms start?
  • Do you remember injuries or insect bites to that area?
  • How severe is the pain?
  • Does anything seem to improve your symptoms?
  • Are you allergic to or intolerant of any antibiotics?
  • Have you had this type of infection before?

What you can do in the meantime

You may need a prescription antibiotic to clear your infection. However, until you see your doctor, you can wash the injured area with soap and water and place a cool, damp cloth over the affected area for relief.

© 1998-2019 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. Terms of use.

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