As of April 15, 2020 there were 1,914,916 confirmed cases of coronavirus disease 2019 (COVID-19) responsible for 123,010 deaths throughout the world. Facing mortality rates near 5%, the global medical community is racing to develop effective therapies against this viral pandemic. Current management of COVID-19 is largely supportive, with interventions directed at prevention and treatment of severe pulmonary complications including Acute Respiratory Distress Syndrome (ARDS), the leading cause of mortality in the disease. A small epidemiologic study of an early cohort of patients with laboratory-confirmed disease suggested a correlation between cytokine-driven inflammation and disease severity with progression to ARDS.3 Here we present the case of an acutely ill patient diagnosed with COVID-19 pneumonia who was successfully treated with a supportive care regimen which included tocilizumab.   

Introduction: The recent pandemic that has been caused by the novel coronavirus, SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronovirus-2) has led to a huge burden on health, social and economic systems worldwide. There is currently no known cure. The medical fraternity is left to care for large numbers of ill patients using treatments that have not been clinically proven to be effective. The rapid spread of the virus has not allowed for large scale clinical trials to be undertaken and thus most treatment regimens have been based on observational studies. Tocilizumab has shown promise in some reports when used in the hyper inflammatory stage of the disease. Methods: Two patients who were Intensive Care Unit (ICU) requiring were administered 400 mg of Tocilizumab as a single dose after having been diagnosed with features of a Cytokine Release Syndrome. Results: Both patients responded positively with a decrease in symptomatology and inflammatory markers. Conclusion: Patients who present in the hyper-inflammatory stage of SARS-CoV-2 may be considered for Intravenous (IV) Tocilizumab therapy.

Coronavirus disease is a global pandemic which has emerged from china. It usually presents with respiratory symptoms, like flu and fever but it can also have many atypical presentations. Here we present a case of 27-years old girl who was diagnosed as having COVID-19 disease and was having mild disease which was advised a treatment. She again reported back to hospital after two weeks of diagnosis with severe shortness of breath and was diagnosed as having pulmonary embolism. 

Coronaviruses are large, enveloped, single-stranded, positive-sense RNA viruses with a genome of approximately 30 kilobases in length. The genus Coronavirus belongs to the family Coronaviridae in the order Nidovirales. They are classified into three groups. Group 1 contains various mammalian viruses including porcine epidemic diarrhea virus, porcine transmissible gastroenteritis virus, and human coronaviruses 229E and NL63. Group 2 includes canine respiratory coronavirus among other mammalian viruses and human coronavirus OC43. Human severe acute respiratory syndrome coronavirus (SARS-CoV) is considered a distant relative of this group. Group 3 contains solely avian coronaviruses. Human coronaviruses (HCoVs) cause respiratory infections, mainly, but gastroenteritis and neurological disorders may also occur. So far, at least six human coronaviruses have been described including SARS-CoV2, which was just identified in 2020, and two of these coronaviruses (OC43 and 229E) are responsible for 10-30% of all common colds. HCoV-HKU1 is mostly associated with bronchiolitis and pneumonia.

There is some evidence that viral infection can play an important role in developing hypercoagulable state leading to thrombosis. One of most important effect is developing Thrombotic Microangiopathic Anemia (TMA) which is related to direct endothelial injury by virus or antigen-antibody complex. Other etiologies for developing TMA are drugs, pregnancy and etc. Here we report a case with pregnancy and COVID-19 infection led to TMA.

The pandemic of COVID-19 pneumonia, as a new kind of pneumonia, has lasted for several months since Dec.2019 and the number of patients with COVID-19 pneumonia is still increasing at an unexpected rate across the world. Undoubtedly, both social and financial burdens from the pandemic are huge and globally, many attempts by medical institutions and hospitals are performed with the aim of seeking some effective treatment on COVID-19. As one of the most serious countries affected by COVID-19, much contributions and efforts against pandemic have been done in China and some of which have been already proven to be acceptable and effective. Therefore, a case report regarding the treatment of COVID-19 is presented, clinically, to share useful and feasible experience.