Therapeutic Options and Critical Care Strategies in COVID-19 Patients: an Update

he Coronavirus Disease 2019 (COVID-19) became the deadliest pandemic in the 21st century between 2019 and 2023. More than 700 million people were infected, and over 7 million individuals died due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). During the four-year pandemic, numerous drugs and treatment methods were evaluated in various clinical trials. Although vaccines emerged as the most effective means of disease modulation, identifying a safe and effective treatment regimen posed a significant challenge. This article reviews possible effective therapeutic drugs for COVID-19, their advantages, and side effects. Considering two main phases of disease progression (viral-mediated and immune system-mediated), antiviral drugs, immune-enhancing drugs, and anti-inflammatory agents can be used based on the clinical features and the disease severity. Among the most reliable antiviral agents for treating SARS-CoV-2 infection in high-risk patients with mild disease, as well as those with moderate to severe disease, are Paxlovid, remdesivir, and molnupiravir. Systemic corticosteroids are essential in the therapeutic regimen for moderate to severe COVID-19 patients who require supplemental oxygen. For anti-inflammatory and immunomodulatory agents, baricitinib and tocilizumab may be considered first-line treatments, while abatacept and infliximab can serve as alternative options. Additionally, other drugs have shown promising effects in randomized controlled trials but require further investigation before being established as part of the COVID-19 treatment protocol.