Non-pharmacological treatments for COVID-19: current status and consensus

Pereira, Adriano Alves; de Oliveira Andrade, Adriano; de Andrade Palis, Angélica; Cabral, Ariana Moura; Barreto, Cassiana Gabriela Lima; de Souza, Daniel Baldoino; de Paula Silva, Fernanda; Santos, Fernando Pasquini; Silva, Gabriella Lelis; Guimarães, José Flávio Viana; de Araújo, Laureane Almeida Santiago; Nóbrega, Lígia Reis; Mendes, Luanne Cardoso; Brandão, Mariana Ribeiro; Milagre, Selma Terezinha; de Lima Gonçalves, Verônica; de Freitas Morales, Victor Hugo; da Conceição Lima, Viviane

PURPOSE: COVID-19 is a disease caused by SARS-CoV-2 (coronavirus type 2 of the severe acute respiratory syndrome), isolated in China, in December 2019. The strategy currently used by physicians is to control disease and to treat symptoms, including non-pharmacological treatments, as there is still no specific treatment for COVID-19. Thus, the aim of this article is to carry out a systematic review about non-pharmacological treatments used for COVID-19, addressing current status and consensus found in the literature. METHODS: Three databases were consulted for evidence referring to the drugs indicated for COVID-19 (Cochrane Central, MEDLINE and Embase). The following terms and combinations were used: ((“2019-nCoV” OR 2019nCoV OR nCoV2019 OR “nCoV-2019” OR “COVID-19” OR COVID19 OR “HCoV-19” OR HCoV19 OR CoV OR “2019 novel*” OR Ncov OR “n-cov” OR “SARS-CoV-2” OR “SARSCoV-2” OR “SARSCoV2” OR “SARSCoV2” OR SARSCov19 OR “SARS-Cov19” OR “SARS-Cov-19”) OR “severe acute respiratory syndrome*” OR ((corona* OR corono*) AND (virus* OR viral* OR virinae*)) AND ((“lung injury”) OR (“ventilation use”) OR (“respiratory injuries” OR prone)) AND (treatment)) NOT Drugs NOT medicines NOT antivirals. RESULTS: A total of 28 articles were selected. These articles adopted one or more treatment methods for patients with severe cases of COVID-19, i.e., oxygen therapy, prone position, inhaled nitric oxide, intravenous infusion, passive immunotherapy, mesenchymal stem cells (MSC). CONCLUSION: There is still no specific treatment approved for patients with COVID-19. The available evidence is not able yet to indicate the benefits or harms of non-pharmacological treatments, but some studies show that some treatments can play an important role in relation to COVID-19. The current consensus among researchers is that several studies using a randomized clinical trial should be carried out to provide evidence of safety and efficacy of the proposed treatments.