key: cord-0775118-k4n9k6wl authors: Boretti, Alberto title: Pharmacotherapy for COVID-19 infection in the countries of the Cooperation Council for the Arab States date: 2021-09-04 journal: J Taibah Univ Med Sci DOI: 10.1016/j.jtumed.2021.08.005 sha: 6b3459c0e22f67131045deb642a6a9a1aadc6e08 doc_id: 775118 cord_uid: k4n9k6wl nan Oman, 0.59% in Kuwait, 0.51% in Bahrain, 0.28% in the United Arab Emirates (UAE), and 0.26% in Qatar. In Australia, the rates are 2.56% (4% in the state of Victoria), 2.92% in Italy, 2.15% in the UK, 2.22% in Belgium, 1.84% in Canada, and 1.76% in France. The cumulative numbers of cases per million demonstrate that there are similarities in the percentages of infected persons across countries so far. The percentages are 15.86% in Bahrain, 9.80% in Belgium, 9.40% in France, 7.90% in Qatar, 7.27% in Italy, 9.44% in Kuwait, 8 .98% in the UK, 7.00% in the UAE, 5.85% in Oman, 3.83% in Canada, 1.53% in KSA, and 0.14% in Australia. While there are undoubtedly many other explanations for the marked variations in the cumulative fatality rates in various countries, the issue that we wish to highlight here is that the adoption of therapeutic approaches differs considerably between countries. Specifically, almost all of the antiviral agents used in KSA, the UAE, and the other Gulf states are unavailable in the other countries mentioned, where the local health authorities recommend against their use in accordance with the advice of the World Health Organization (WHO). 2 According to the WHO, 'all 4 treatments evaluated (remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon) had little or no effect on overall mortality, initiation of ventilation and duration of hospital stay in hospitalized patients.' The positive chemotherapeutic advances made so far in the UAE and the other Gulf states (as well as countries in other regions, such as Singapore) are ignored in many other countries, which do not allow the administration of chemotherapeutics for COVID-19 infection. The Saudi protocol for treating patients with COVID-19 infection as of January 22, 2021 3 proposes some alternatives. For mild cases in outpatient settings, 3 in early treatment, it is suggested that hydroxychloroquine (HCQ) be administered if no contraindications apply. If HCQ is unavailable, then chloroquine (CQ) may be used. Favipiravir may also be used. For severe cases, 3 physicians are urged to administer favipiravir or remdesivir. As an adjunctive therapy, dexamethasone is the preferred corticosteroid. For critical cases, 3 physicians are urged to administer favipiravir or remdesivir. Remdesivir and baricitinib are suggested for patients with severe acute respiratory distress syndrome (ARDS), on invasive mechanical ventilation with high settings, or extracorporeal membrane oxygenation (ECMO). Even more pharmacotherapy options are available in the UAE. 4, 5 Since December 20, 2020, 5 for asymptomatic COVID-19 cases that are high-risk, HCQ (CQ) has been recommended. For COVID-19-related pneumonia lasting five days, the suggested therapies include HCQ, CQ, favipiravir, and lopinavir-ritonavir, all AE camostat. For COVID-19related pneumonia lasting seven days, the suggested therapies include favipiravir þ HCQ AE camostat, favipiravir þ CQ phosphate AE camostat, and lopinavirritonavir þ HCQ (CQ) AE camostat or remdesivir. Nebulised interferon is an optional adjunctive therapy in less severe cases. For severe pneumonia resulting from COVID-19/ patients who have been critically ill for ten days, favipiravir þ camostat AE nebulised interferon a or interferon b, lopinavir-ritonavir þ ribavirin þ interferon, and remdesivir are recommended. Tocilizumab may be considered in the event of a cytokine storm. The use of combination therapies 5 in complex cases, rather than a single therapeutic agent, is also worth noting. Immune-based therapies are mostly being used as adjunctive therapies, supplementing antiviral therapies. 5 Surprisingly, the local health authorities in most countries recommend against the use of the antiviral treatments The success story of the UAE is also discussed in 7. Reference 8 finally notes that the success of the therapeutic approach of the UAE and the other countries of the Cooperation Council for the Arab States is also due to case finding, contact tracing, and disease management. In the UAE, implementing mass testing and setting up large field hospitals and a large-capacity quarantine facility has permitted physicians to find cases and treat them while easing the pressure on city-based hospitals and permitting fast responses. This has prevented the viral load build-up that occurs with lack of care, lack of therapies, sharing of overcrowded spaces, and masking of infected individuals, which then becomes a driver of higher fatality rates. We conclude that the use of antivirals, especially in the early stages of COVID-19 infection, is a determining factor in preventing the incremental growth of the viral load in late Pharmacotherapy for COVID-19 infection in the countries of the Cooperation Council for the Arab States stages, which then becomes much more difficult to manage. CQ/HCQ, remdesivir, favipiravir, lopinavir-ritonavir, and nebulised interferon are important components of the Gulf states' pharmacotherapy regimen. Based on an assessment of the efficacy of the therapies based on the percentages of fatalities, it appears that most of the Gulf states have performed well during the first year of the pandemic and have fared better than the other countries referenced and herein considered. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The author has no conflict of interest to declare. Coronavirus data explorer Available from:, ourworldindata.org/ coronavirus-data-explorer Solidarity trial reports interim results. World Health organization Saudi MoH protocol for patients suspected of/confirmed with COVID-19 supportive care and antiviral treatment of suspected or confirmed COVID-19 infection, Kingdom of Saudi Arabia Ministry of Health National guidelines for clinical management and treatment of COVID-19 1 st Abu Dhabi Public Health Center Database of all HCQ COVID-19 studies, c19study.com Analysis of the performances of the covid-19 therapeutic approaches in the United Arab Emirates Response to COVID-19 pandemic in the UAE: a public health perspective How to cite this article: Boretti A. Pharmacotherapy for COVID-19 infection in the countries of the Cooperation Council for the Arab States The authors confirm that this letter has been prepared in accordance with COPE roles and regulations. Given the nature of the letter, no IRB review was required.