Key to successful treatment of COVID-19: accurate identification of severe risks and early intervention of disease progression

meizhu chen; changli tu; Cuiyan Tan; Xiaobin Zheng; xiaohua wang; jian wu; Yiying Huang; zhenguo wang; yan yan; zhonghe li; hong shan; Jing Liu; jin huang

The copyright holder for this preprint . https://doi.org/10.1101/2020.04.06.20054890 doi: medRxiv preprint patients on demand, improved blood oxygen and reduced the utilization rate of invasive mechanical ventilation, case fatality rate and medical burden significantly. A meta-analysis [19] shows that glucocorticoid is a more effective drug for suppressing the occurrence of inflammatory storms, and it is safe within a certain dose range. The emergence of COVID-19 inflammatory storm is often life-threatening in a short time, with a variety of inflammatory factors [3] , so the effect of single IL-6 mAb on COVID-19 should be further evaluated [20] . If the inflammatory storms could not be suppressed timely, multiple organ failure and death might be caused. So far, glucocorticoid may be unique effective medicine suppressing the progress of the inflammatory storm with appropriated and reasonable application. The application of glucocorticoids in viral pneumonia is currently controversial. A retrospective cohort study about SARS showed that glucocorticoids can reduce case fatality rate and hospital stays [21] , but there are also studies that show that glucocorticoids may increase the case fatality rate of SARS patients and delay the virus clearance time [22, 23] .In patients with Middle East Respiratory Syndrome (MERS) and influenza virus pneumonia, the use of glucocorticoids is also controversial [24, 25, 26, 27, 28] . Application indication and dosage of corticosteroid had been strictly controlled from the beginning of epidemic of COVID-19, and corticosteroid had be recommended not be used for the treatment of 2019-nCoV-induced lung injury or shock outside of a clinical trial [29] . Although this issue has always been controversial [30] ，clinical usage of corticosteroid was obviously restricted, and the role was underestimated greatly.