Hypoxia may be a determinative factor in COVID-19 progression.

Area of Science:

• Medical Research
• Infectious Diseases
• Pulmonology

Background:

• COVID-19 mortality rates vary significantly globally (1.5%-9.8%).
• Leukocytosis, thrombocytopenia, and elevated D-dimers are early predictors of COVID-19 mortality.
• These hematological disturbances can result from hypoxia.

Purpose of the Study:

• To hypothesize that early hypoxia is a key determinant of severe COVID-19 progression.
• To suggest that current host-directed therapies are often initiated too late for maximum efficacy.
• To propose repurposing specific drugs for early intervention.

Main Methods:

• Review of published observations on COVID-19 hematological markers and hypoxia.
• Formulation of a hypothesis linking early hypoxia to disease severity.
• Identification of potential repurposed drugs for early treatment.

Main Results:

• Early hypoxia, possibly due to sleep apnea or blunted respiratory response, is proposed as an early determinant of severe COVID-19.
• Current treatments like anticoagulation are typically administered upon hospitalization, potentially limiting effectiveness.
• Fluvoxamine, amantadine, and N-acetylcysteine are identified as potential early treatments.

Conclusions:

• Early hypoxia is a critical factor in COVID-19 progression.
• Timely intervention targeting hypoxia and its consequences is crucial.
• Repurposing drugs for prehospital treatment and post-exposure prophylaxis warrants investigation for SARS-CoV-2 infection.