Therapy of patients with COVID-19: clinical studies and recommendations in different countries


BACKGROUND. During 2020 coronavirus disease (COVID-19) is at the focus of many scientific studies. National approaches to the management of conditions associated with the SARS-CoV-2 can differ significantly due to socio-economic characteristics, capabilities of the health care system in different regions of the world, inertion in making regulatory decisions, as well as the variability and limitations of evidence base regarding effectiveness of various therapeutic approaches.

OBJECTIVE. To review guidelines and clinical experience in the management of patients with COVID-19 around the world.

RESULTS. National guidelines for COVID-19 management can vary significantly in different regions of the world. The governments of each country, in cooperation with leading experts and taking into account global experience, choose and constantly adjust the best ways to overcome COVID-19 epidemic in local population.

CONCLUSIONS. The choice of methods for prevention and treatment of COVID-19 is associated with the capabilities of the healthcare system, regional level of antibiotic resistance, current epidemiological conditions, socio-economic factors, etc. Over the past 5-6 months the epidemiological conditions in different regions of the world have varied significantly, which could create unequal conditions for conducting high-quality clinical trials with a large number of participants. Even within one country the conclusions and recommendations for the treatment of COVID-19 developed by different medical associations and expert groups may differ significantly. Expert organizations conduct an independent evaluation of emerging clinical experience in the treatment of COVID-19 and come to different conclusions. This phenomenon is quite normal and desirable to minimize systematic error in the context of rapidly updating clinical evidence.

Keywords: coronavirus disease, COVID‐19, SARS-CoV‐2, guideline, pathogenetic therapy, course severity.


WHO Director General’s opening remarks at the media briefing on COVID‐19 – 11 March 2020. World Health Organization, 2020. Available at:‐19-11-march‐2020

Wu Z., McGoogan J. Characteristics of and important lessons from the coronavirus disease 2019 (COVID‐19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA. 2020 Feb 24. doi: 10.1001/jama.2020.2648.

Mawaddah A., Gendeh H., Lum S., Marina M. Upper respiratory tract sampling in COVID‐19. Malays J. Pathol. 2020 Apr; 42 (1): 23-35.

Peeri N., Shrestha N., Rahman M., Zaki R., Tan Z., Bibi S., Baghbanzadeh M., Aghamohammadi N., Zhang W., Haque U. The SARS, MERS and novel coronavirus (COVID‐19) epidemics, the newest and biggest global health threats: what lessons have we learned? Int. J. Epidemiol. 2020.

Yu F., Du L., Ojcius D., Pan C., Jiang S. Measures for diagnosing and treating infections by a novel coronavirus responsible for a pneumonia outbreak originating in Wuhan, China. Microbes Infect. 2020; 22: 74-79.

Patel A., Verma A. COVID‐19 and angiotensinconverting enzyme inhibitors and angiotensin receptor blockers: what is the evidence? JAMA. 2020 Mar. doi: 10.1001/jama.2020.4812.

Fujun Peng et al. Management and treatment of COVID-19: the Chinese experience. Can. J. Cardiol. 2020 Jun; 36 (6): 915-930.

Guan W.-J., Ni Z.-Y., Hu Y. Clinical characteristics of coronavirus disease 2019 in China. N. Engl. J. Med. 2020; 382: 1708-1720.

World Health Organisation, 2020. Clinical management of severe acute respiratory infection (SARI) when COVID-19 is suspected. Available at: Accessed: March 13, 2020.

World Health Organisation, 2020. National Health Commission of the People’s Republic of China. Diagnosis and treatment protocol for novel coronavirus pneumonia (trial version 7). Available at: Accessed: February 5, 2020.

He H., Sun B., Liang L. A multicenter RCT of noninvasive ventilation in pneumonia-induced early mild acute respiratory distress syndrome. Crit. Care. 2019; 23: 300.

Carrillo A., Gonzalez-Diaz G., Ferrer M. Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure. Intensive Care Med. 2012; 38: 458-466.

Guan W.-J., Ni Z.-Y., Hu Y. Clinical characteristics of coronavirus disease 2019 in China. N. Engl. J. Med. 2020; 382: 1708-1720.

Del Sorbo L., Goligher E., McAuley D. Mechanical ventilation in adults with acute respiratory distress syndrome. Summary of the experimental evidence for the clinical practice guideline. Ann. Am. Thorac. Soc. 2017; 14: S261-S270.

Chinese Research Hospital Association of Critical Care Medicine, Youth Committee of Chinese Research Hospital Association of Critical Care Medicine. [Chinese experts’ consensus on diagnosis and treatment of severe and critical coronavirus disease 2019 (Revised Edition)]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020; 32: 269‐74 [in Chinese].

Force A.D.T., Ranieri V.M., Rubenfeld G.D. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012; 307: 2526-2533.

Huang C., Wang Y., Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395: 497-506.

Arabi Y., Fowler R., Hayden F. Critical care management of adults with community-acquired severe respiratory viral infection. Intensive Care Med. 2020; 46: 315-328.

Xu X.-W., Wu X.-X., Jiang X.-G. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-CoV-2) outside of Wuhan, China: retrospective case series. BMJ. 2020; 368: m606.

Chen N., Zhou M., Dong X. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395: 507-513.

Cao B., Wang Y., Wen D. A trial of lopinavir-ritonavir in adults hospitalized with severe COVID-19. N. Engl. J. Med. 2020; 382: 1787-1799.

Wang M., Cao R., Zhang L. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020; 30: 269-271.

Lu H. Drug treatment options for the 2019-new coronavirus (2019-nCoV). Biosci. Trends. 2020; 14: 69-71.

Dong L., Hu S., Gao J. Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discov. Ther. 2020; 14: 58-60.

China National Health Commission Press conference of the Joint Prevention and Control Mechanism of the State Council. March 17, 2020.

Liu J., Cao R., Xu M. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov. 2020; 6: 16.

Gao J., Tian Z., Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci. Trends. 2020; 14: 72-73.

Multicenter Collaboration Group of Department of Science and Technology of Guangdong Province and Health Commission of Guangdong Province for Chloroquine in the Treatment of Novel Coronavirus Pneumonia [Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi. 2020; 43: 185-188.

Russell C.D., Millar J.E., Baillie J.K. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020; 395: 473-475.

Shang L., Zhao J., Hu Y., Du R., Cao B. On the use of corticosteroids for 2019-nCoV pneumonia. Lancet. 2020; 395: 683-684.

Zhao J., Hu Y., Du R. Expert consensus on the use of corticosteroid in patients with 2019-nCoV pneumonia. Zhonghua Jie He He Hu Xi Za Zhi. 2020; 43: 183-184 [in Chinese].

Ni Qin D.C., Li Y., Zhao H.H. Retrospective study of side effects of low-dose glucocorticoids in rheumatoid arthritis. Chin. J. Clin. Infect. Dis. 2020: 43.

Wang Y., Jiang W., He Q. Early, low-dose and short-term application of corticosteroid treatment in patients with severe COVID-19 pneumonia: single-center experience from Wuhan, China [preprint]. medRxiv. 2020.03.06.20032342.

Zhou W., Liu Y., Tian D., et al. Potential benefits of precise corticosteroids therapy for severe 2019-nCoV pneumonia. Signal Transduct. Target Ther. 2020; 5: 18.

China National Health Commission, 2020. The clinical guideline of convalescent plasma treatment (trial version 2). Available at: Accessed: February 16, 2020.

Zhang Y., Wang X. 32 recovered patients donate plasma to others with coronavirus infection. China Daily. 2020 Feb 16. Available at: Accessed: February 16, 2020.

Chen N., Zhou M., Dong X. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395: 507-513.

Bhimraj A., Morgan R., Shumaker A. et al. Infectious Diseases Society of America guidelines on the treatment and management of patients with COVID-19. Published by IDSA on 4/11/2020.

Horby P., Mafham M., Linsell L., et al. Effect of hydroxychloroquine in hospitalized patients with COVID-19: preliminary results from a multi-centre, randomized, controlled trial. medRxiv. 2020.

Cavalcanti A.B., Zampieri F.G., Rosa R.G., et al. Hydroxychloroquine with or without azithromycin in mild-to-moderate COVID-19. N. Engl. J. Med. 2020.

Geleris J., Sun Y., Platt J., et al. Observational study of hydroxychloroquine in hospitalized patients with COVID-19. N. Engl. J. Med. 2020.

Magagnoli J., Narendran S., Pereira F., et al. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with COVID-19. Med. 2020.

Mahevas M., Tran V.-T., Roumier M., et al. No evidence of clinical efficacy of hydroxychloroquine in patients hospitalized for COVID-19 infection with oxygen requirement: results of a study using routinely collected data to emulate a target trial. medRxiv. 2020.

Rosenberg E., Dufort E., Udo T., et al. Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York state. JAMA. 2020.

Ip A., Berry D., Hansen E., et al. Hydroxychloroquine and tocilizumab therapy in COVID-19 patients – an observational study. medRxiv. 2020.

Cao B., Wang Y., Wen D., et al. A trial of lopinavir-ritonavir in adults hospitalized with severe COVID-19. N. Engl. J. Med. 2020.

Pan H., Peto R., Karim Q., et al. Repurposed antiviral drugs for COVID-19; interim WHO SOLIDARITY trial results. medRxiv. 2020. Available at: [Preprint: 15 October 2020].

RECOVERY Collaborative Group, Horby P., Mafham M., et al. Lopinavirritonavir in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. The Lancet. 2020; 396 (10259): 1345-52.

Freedberg D., Conigliaro J., Wang T., et al. Famotidine use is associated with improved clinical outcomes in hospitalized COVID-19 patients: a propensity score matched retrospective cohort study. Gastroenterology. 2020.

Wang Y., Zhang D., Du G., et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2020; 395 (10236): 1569-78.

WHO Rapid Evidence Appraisal for COVID-19 Therapies Working Group, Sterne J.A.C., Murthy S., et al. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis. JAMA. 2020.

Horby P., Lim W., Emberson J., et al. Effect of dexamethasone in hospitalized patients with COVID-19: preliminary report. medRxiv. 2020: 2020.06.22.20137273.

EVMS Critical Care COVID-19 management protocol. EVMS medical group. Developed and updated by Paul Marik, MD Chief of Pulmonary and Critical Care Medicine Eastern Virginia Medical School, Norfolk, VA. November 30th, 2020.

Hashimoto et al. The clinical practice guideline for the management of ARDS. Japan Journal of Intensive Care. 2017; 5: 50. DOI: 10.1186/s40560-017-0222-3.

Tamakuma S., Ogawa M., Aikawa N., Kubota T., Hirasawa H., Ishizaka A., et al. Relationship between neutrophil elastase and acute lung injury in humans. Pulm. Pharmacol. Ther. 2004; 17 (5): 271-9.

Yamakawa K., Aihara M., Ogura H., Yuhara H., Hamasaki T., Shimazu T. Recombinant human soluble thrombomodulin in severe sepsis: a systematic review and meta-analysis. J. Thromb. Haemost. 2015; 13 (4): 508-19.

Kovalenko SV. Experience in the use of methods of syndrome-pathogenetic therapy for pneumonia caused by COVID-19 in the pulmonology department. Medical newspaper "Health of Ukraine of the 21st century", 2020; 13-14 (481-482).

How to Cite
Zaikov, S. V. (2020). Therapy of patients with COVID-19: clinical studies and recommendations in different countries. Infusion & Chemotherapy, (4), 5-12.

Author Biography

S. V. Zaikov, National Medical Academy of Postgraduate Education named after P. L. Shupyk, Kyiv, Ukraine

Zaikov Sergii Viktorovych
Professor of the Department of Phthisiology and Pulmonology
Doctor of medicine
10, M. Amosova st., Kyiv, 03038, Ukraine.