Best Practices For Administering Monoclonal Antibody Therapy For Coronavirus (COVID-19)

ABSTRACT

COVID-19 is a clinical syndrome due to infection with SARS-CoV-2. It has been discovered in Wuhan, China, in December 2019 and spread to a pandemic level in 2020. Globally it has affected more than 168 million people, with a death toll of more than 3.5 million patients. In the United States, the number of cases is more than 32 million, and the number of people who died from COVID-19 exceeded 586,000 patients (WHO Coronavirus dashboard as of 05/28/2021). Severe Acute Respiratory Syndrome Coronavirus-2 is one of the coronaviruses, single-stranded RNA viruses with close resemblance to the SARS outbreak of 2003.[1] SARS-CoV-2 differs from MERS(middle east respiratory syndrome) and SARS(Severe Acute Respiratory Syndrome)coronaviruses by easier spread and lower fatality rate.[2] SARS-CoV-2 is transmitted by inhalation of air carrying droplets or from person to person through droplets spread by coughing, sneezing, singing, shouting, or even talking. In addition, SARS-CoV-2 has been detected on multiple services, and touching mucous membranes with hands contaminated with the SARS-CoV-2 virus may also be another transmission source. COVID -19 starts after an incubation period of around 5 days after exposure but could range from 2 to 14 days, and most of the patients can identify recent contact with COVID 19 patients. The clinical presentation varies from asymptomatic cases to severe symptoms of fatigue, headache, anosmia (loss of smell sensation), ageusia(loss of taste sensation), dyspnea, and dry cough that is persistent and may stimulate gag reflex and induce vomiting. Hypoxia that may worsen to require assisted ventilation, whether invasive or non-invasive. The physical signs include fever, tachycardia, and hypoxia, resulting in acute respiratory failure and acute respiratory distress syndrome. Extrapulmonary manifestations have been described in many COVID patients, in multiple organ systems, including but not limited tocutaneous acral lesions, cardiovascular myocardial injury and myocarditis, neurologic headache and stroke, gastrointestinal nausea, vomiting, and diarrhea, and elevated liver enzymes.[3] The national institute of Health classifies the manifestations of SARS-CoV-2 as follows Asymptomatic or Presymptomatic Infection positive testing for SARS-CoV-2 but no symptoms consistent with COVID-19. Mild Illness Individuals who have any of the various signs and symptoms of COVID-19 but do not have shortness of breath, dyspnea, or abnormal chest imaging. Moderate Illness the presence of lower respiratory disease and no hypoxia( oxygen saturation (SpO) >=94% on room air). Severe Illness Hypoxia, Spo <94% on room air, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO/FiO) <300 mm Hg, respiratory frequency >30 breaths/min, or lung infiltrates >50%. Critical Illness Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction. Mild to moderate cases of COVID-19 are usually managed on an outpatient basis. Patients requiring oxygen therapy to maintain their oxygenation are usually hospitalized and may require intensive care management for assisted ventilation, organ support, and treatment of secondary infection. Management of non hospitalized patients with COVID-19 in the outpatient setting involves triaging the severity of symptoms and oxygen requirements. Identifying patients with risk factors for deterioration and close monitoring. Patients without risk factors for deterioration are usually managed with supportive care and self-monitoring. Meanwhile, patients with risk factors for deterioration are offered Anti-SARS-CoV-2 monoclonal antibodies.