Recomendaciones del Grupo interdisciplinario intersociedades científicas e intercátedras de Uruguay
Versión de 24 de marzo de 2020
Resumen
Las recomendaciones incluidas en este documento están en continua revisión y serán modificadas de acuerdo a la situación epidemiológica. Por ello, dado el probable escenario de transmisión comunitaria sostenida de SARS-CoV-2, y para dar cumplimiento a la demanda asistencial en todos sus niveles, es fundamental asegurar la capacidad de respuesta del sistema sanitario. Enfrentamos una sobredemanda en el nivel prehospitalario, y, previendo una eventual saturación de los otros niveles de atención, se realizan las siguientes recomendaciones referidas a recursos materiales, personal de la salud, estudios diagnósticos y tratamiento específico antiviral.
Citas
(1) World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected. Interim guidance. 2020. Disponible en: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected [Consulta: 2 marzo 2020].
(2) Organización Mundial de la Salud. Brote de enfermedad por coronavirus (COVID-19). Disponible en: https://www.who.int/es/emergencies/diseases/novel-coronavirus-2019 [Consulta: 2 marzo 2020].
(3) National Institute of Allergy and Infectious Diseases. Coronaviruses. Coronaviruses. Disponible en: https://www.niaid.nih.gov/diseases-conditions/coronaviruses [Consulta: 13 marzo 2020].
(4) Colson P, Rolain JM, Lagier JC, Brouqui P, Raoult D. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. Int J Antimicrob Agents 2020. Disponible en: https://www.sciencedirect.com/science/article/pii/S0924857920300820?via%3Dihub [Consulta: 10 marzo 2020].
(5) 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:E019. doi:10.3760/cma.j.issn.1001-0939.2020.0019.
(6) Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M. et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 2020; 30(3):269-71.
(7) Dong L, Hu S, Gao J. Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discov Ther 2020; 14(1):58-60. doi: 10.5582/ddt.2020.01012.
(8) Li H, Wang YM, Xu JY, Cao B. [Potential antiviral therapeutics for 2019 Novel Coronavirus]. Zhonghua Jie He He Hu Xi Za Zhi 2020; 43(3):170-2 Disponible en: https://www.ncbi.nlm.nih.gov/m/pubmed/32023685/ [Consulta: 18 marzo 2020].
(9) U.S. National Library of Medicine. A trial of remdesivir in adults with mild and moderate COVID-19. Disponible en: https://clinicaltrials.gov/ct2/show/NCT04252664 [Consulta: 10 marzo 2020].
(10) U.S. National Library of Medicine. A trial of remdesivir in adults with severe COVID-19. Disponible en: https://clinicaltrials.gov/ct2/show/NCT04257656 [Consulta: 2 marzo 2020].
(11) Sheahan TP, Sims AC, Leist SR, Schafer A, Won J, Brown AJ, et al. Comparative therapeutic efficacy of remdesivir and combination lopinavir, ritonavir, and interferon beta against MERS-CoV. Nat Commun 2020; 11(1):222. doi:10.1038/s41467-019-13940-6.
(12) Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. N Engl J Med 2020. doi: 10.1056/NEJMoa2001282.
(13) Furuta Y, Komeno T, Nakamura T. Favipiravir (T-705), a broad spectrum inhibitor of viral RNA polymerase. Proc Jpn Acad Ser B Phys Biol Sci 2017; 93:449-63.
(14) Wang Z, Chen X, Lu Y, Chen F, Zhang W. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci Trends 2020; 14(1):64-8.
(15) Falzarano D, de Wit E, Martellaro C, Callison J, Munster VJ, Feldman H. Inhibition of novel β coronavirus replication by a combination of interferon-α2b and ribavirin. Sci Rep 2013; 3:1686. doi: 10.1038/srep01686.
(16) Hensley LE, Fritz LE, Jahrling PB, Karp CL, Huggins JW, Geisbert TW. Interferon-beta 1a and SARS coronavirus replication. Emerg Infec Dis 2004; 10(2):317-9. doi: 10.3201/eid1002.030482.
(17) Arabi YM, Asiri AY, Assiri AM, Aziz Jokhdar HA, Alothman A, Balkhy HH, et al. Treatment of middle east respiratory syndrome with a combination of lopinavir/ritonavir and interferon-β1b (MIRACLE trial): statistical analysis plan for a recursive two-stage group sequential randomized controlled trial. Trials 2020; 21(1):8. doi: 10.1186/s13063-019-3846-x.
(18) Momattin H, Al-Ali AY, Al-Tawfiq JA. A systematic review of therapeutic agents for the treatment of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Travel Med Infect Dis 2019; 30:9-18. doi: 10.1016/j.tmaid.2019.06.012.
(19) Reinke LM, Spiegel M, Plegge T, Hartleib A, Nehlmeier I, Gierer S, et al. Different residues in the SARS-CoV spike protein determine cleavage and activation by the host cell protease TMPRSS2. PLoS One 2017; 12(6):e0179177. doi: 10.1371/journal.pone.0179177.
(20) Glowacka I, Bertram S, Müller MA, Allen P, Soilleux E, Pfefferle S, et al. Evidence that TMPRSS2 activates the severe acute respiratory syndrome coronavirus spike protein for membrane fusion and reduces viral control by the humoral immune response. J Virol 2011; 85(9):4122-34. doi:10.1128/JVI.02232-10.
(21) Iwata-Yoshikawa N, Okamura T, Shimizu Y, Hasegawa H, Takeda M, Nagata N. TMPRSS2 contributes to virus spread and immunopathology in the airways of murine models after coronavirus infection. J Virol 2019; 93(6):e01815-18. doi:10.1128/JVI.01815-18.
(22) Matsuyama S, Nao N, Shirato K, Kawase M, Saito S, Takayama I, et al. Enhanced isolation of SARS-CoV-2 by TMPRSS2-expressing cells. Proc Natl Acad Sci USA 2020; 117(13):7001-3. doi: 10.1073/pnas.2002589117.
(23) Kawase M, Shirato K, van der Hoek L, Taguchi F, Matsuyama S. Simultaneous treatment of human bronchial epithelial cells with serine and cysteine protease inhibitors prevents severe acute respiratory syndrome coronavirus entry. J Virol 2012; 86(12):6537-45 doi:10.1128/JVI.00094-12.
(24) Shirato K, Kawase M, Matsuyama S. Middle East respiratory syndrome coronavirus infection mediated by the transmembrane serine protease TMPRSS2. J Virol 2013; 87(23):12552-61. doi:10.1128/JVI.01890-13.
(25) Hoffman M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; 181(2):271 80.
(26) Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395(10229):1033-4. doi: 10.1016/S0140-6736(20)30628-0.
(27) Matsuyama S, Kawase M, Nao N, Shirato K, Ujike M, Kamitani W, et al. The inhaled corticosteroid ciclesonide blocks coronavirus RNA replication by targeting viral NSP15. BioRxiv 2020. doi: 10.1101/2020.03.11.987016.
(28) España. Ministerio de Sanidad de España. Manejo clínico del COVID-19: tratamiento médico. Marzo 2020. Disponible en:
(1) https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov-China/documentos/Protocolo_manejo_clinico_tto_COVID-19.pdf [Consulta: 13 marzo 2020].
(29) Liang T, ed. Handbook of COVID-19: prevention and treatment. Hangzhou: First Affiliated Hospital, Zhejiang University School of Medicine (FAHZU),2020.(68 p.
(30) Agenzia Italiana del Farmaco. Azioni intraprese per favorire la ricerca e l'accesso ai nuovi farmaci per il trattamento del COVID-19. Roma, Italia. 17 marzo 2020. Disponible en: https://www.aifa.gov.it/-/azioni-intraprese-per-favorire-la-ricerca-e-l-accesso-ai-nuovi-farmaci-per-il-trattamento-del-covid-19 [Consulta: 20 marzo 2020].
(31) Centers for disease control and prevention. Interim clinical guidance for management of patient with confirmed coronavirus disease (COVID-19). Disponible en: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html[Consulta: 2 marzo 2020].
(32) Uruguay. Grupo Inter-Sociedades y catédras. Recomendaciones conjuntas para el manejo clínico de la infección por SAR CoV 2 y enfermedad COVID-19. Montevideo, Uruguay. 13 Marzo 2020.
(33) World Health Organization. Guidance for managing ethical issues in infectious disease outbreaks. 2016. Disponible en: https://apps.who.int/iris/bitstream/handle/10665/250580/9789241549837-eng.pdf;jsessionid=5320E78C15C4ADAC2895C80325CAE4BA?sequence=1[Consulta: 2 marzo 2020].
(2) Organización Mundial de la Salud. Brote de enfermedad por coronavirus (COVID-19). Disponible en: https://www.who.int/es/emergencies/diseases/novel-coronavirus-2019 [Consulta: 2 marzo 2020].
(3) National Institute of Allergy and Infectious Diseases. Coronaviruses. Coronaviruses. Disponible en: https://www.niaid.nih.gov/diseases-conditions/coronaviruses [Consulta: 13 marzo 2020].
(4) Colson P, Rolain JM, Lagier JC, Brouqui P, Raoult D. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. Int J Antimicrob Agents 2020. Disponible en: https://www.sciencedirect.com/science/article/pii/S0924857920300820?via%3Dihub [Consulta: 10 marzo 2020].
(5) 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:E019. doi:10.3760/cma.j.issn.1001-0939.2020.0019.
(6) Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M. et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 2020; 30(3):269-71.
(7) Dong L, Hu S, Gao J. Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discov Ther 2020; 14(1):58-60. doi: 10.5582/ddt.2020.01012.
(8) Li H, Wang YM, Xu JY, Cao B. [Potential antiviral therapeutics for 2019 Novel Coronavirus]. Zhonghua Jie He He Hu Xi Za Zhi 2020; 43(3):170-2 Disponible en: https://www.ncbi.nlm.nih.gov/m/pubmed/32023685/ [Consulta: 18 marzo 2020].
(9) U.S. National Library of Medicine. A trial of remdesivir in adults with mild and moderate COVID-19. Disponible en: https://clinicaltrials.gov/ct2/show/NCT04252664 [Consulta: 10 marzo 2020].
(10) U.S. National Library of Medicine. A trial of remdesivir in adults with severe COVID-19. Disponible en: https://clinicaltrials.gov/ct2/show/NCT04257656 [Consulta: 2 marzo 2020].
(11) Sheahan TP, Sims AC, Leist SR, Schafer A, Won J, Brown AJ, et al. Comparative therapeutic efficacy of remdesivir and combination lopinavir, ritonavir, and interferon beta against MERS-CoV. Nat Commun 2020; 11(1):222. doi:10.1038/s41467-019-13940-6.
(12) Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. N Engl J Med 2020. doi: 10.1056/NEJMoa2001282.
(13) Furuta Y, Komeno T, Nakamura T. Favipiravir (T-705), a broad spectrum inhibitor of viral RNA polymerase. Proc Jpn Acad Ser B Phys Biol Sci 2017; 93:449-63.
(14) Wang Z, Chen X, Lu Y, Chen F, Zhang W. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci Trends 2020; 14(1):64-8.
(15) Falzarano D, de Wit E, Martellaro C, Callison J, Munster VJ, Feldman H. Inhibition of novel β coronavirus replication by a combination of interferon-α2b and ribavirin. Sci Rep 2013; 3:1686. doi: 10.1038/srep01686.
(16) Hensley LE, Fritz LE, Jahrling PB, Karp CL, Huggins JW, Geisbert TW. Interferon-beta 1a and SARS coronavirus replication. Emerg Infec Dis 2004; 10(2):317-9. doi: 10.3201/eid1002.030482.
(17) Arabi YM, Asiri AY, Assiri AM, Aziz Jokhdar HA, Alothman A, Balkhy HH, et al. Treatment of middle east respiratory syndrome with a combination of lopinavir/ritonavir and interferon-β1b (MIRACLE trial): statistical analysis plan for a recursive two-stage group sequential randomized controlled trial. Trials 2020; 21(1):8. doi: 10.1186/s13063-019-3846-x.
(18) Momattin H, Al-Ali AY, Al-Tawfiq JA. A systematic review of therapeutic agents for the treatment of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Travel Med Infect Dis 2019; 30:9-18. doi: 10.1016/j.tmaid.2019.06.012.
(19) Reinke LM, Spiegel M, Plegge T, Hartleib A, Nehlmeier I, Gierer S, et al. Different residues in the SARS-CoV spike protein determine cleavage and activation by the host cell protease TMPRSS2. PLoS One 2017; 12(6):e0179177. doi: 10.1371/journal.pone.0179177.
(20) Glowacka I, Bertram S, Müller MA, Allen P, Soilleux E, Pfefferle S, et al. Evidence that TMPRSS2 activates the severe acute respiratory syndrome coronavirus spike protein for membrane fusion and reduces viral control by the humoral immune response. J Virol 2011; 85(9):4122-34. doi:10.1128/JVI.02232-10.
(21) Iwata-Yoshikawa N, Okamura T, Shimizu Y, Hasegawa H, Takeda M, Nagata N. TMPRSS2 contributes to virus spread and immunopathology in the airways of murine models after coronavirus infection. J Virol 2019; 93(6):e01815-18. doi:10.1128/JVI.01815-18.
(22) Matsuyama S, Nao N, Shirato K, Kawase M, Saito S, Takayama I, et al. Enhanced isolation of SARS-CoV-2 by TMPRSS2-expressing cells. Proc Natl Acad Sci USA 2020; 117(13):7001-3. doi: 10.1073/pnas.2002589117.
(23) Kawase M, Shirato K, van der Hoek L, Taguchi F, Matsuyama S. Simultaneous treatment of human bronchial epithelial cells with serine and cysteine protease inhibitors prevents severe acute respiratory syndrome coronavirus entry. J Virol 2012; 86(12):6537-45 doi:10.1128/JVI.00094-12.
(24) Shirato K, Kawase M, Matsuyama S. Middle East respiratory syndrome coronavirus infection mediated by the transmembrane serine protease TMPRSS2. J Virol 2013; 87(23):12552-61. doi:10.1128/JVI.01890-13.
(25) Hoffman M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; 181(2):271 80.
(26) Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395(10229):1033-4. doi: 10.1016/S0140-6736(20)30628-0.
(27) Matsuyama S, Kawase M, Nao N, Shirato K, Ujike M, Kamitani W, et al. The inhaled corticosteroid ciclesonide blocks coronavirus RNA replication by targeting viral NSP15. BioRxiv 2020. doi: 10.1101/2020.03.11.987016.
(28) España. Ministerio de Sanidad de España. Manejo clínico del COVID-19: tratamiento médico. Marzo 2020. Disponible en:
(1) https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov-China/documentos/Protocolo_manejo_clinico_tto_COVID-19.pdf [Consulta: 13 marzo 2020].
(29) Liang T, ed. Handbook of COVID-19: prevention and treatment. Hangzhou: First Affiliated Hospital, Zhejiang University School of Medicine (FAHZU),2020.(68 p.
(30) Agenzia Italiana del Farmaco. Azioni intraprese per favorire la ricerca e l'accesso ai nuovi farmaci per il trattamento del COVID-19. Roma, Italia. 17 marzo 2020. Disponible en: https://www.aifa.gov.it/-/azioni-intraprese-per-favorire-la-ricerca-e-l-accesso-ai-nuovi-farmaci-per-il-trattamento-del-covid-19 [Consulta: 20 marzo 2020].
(31) Centers for disease control and prevention. Interim clinical guidance for management of patient with confirmed coronavirus disease (COVID-19). Disponible en: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html[Consulta: 2 marzo 2020].
(32) Uruguay. Grupo Inter-Sociedades y catédras. Recomendaciones conjuntas para el manejo clínico de la infección por SAR CoV 2 y enfermedad COVID-19. Montevideo, Uruguay. 13 Marzo 2020.
(33) World Health Organization. Guidance for managing ethical issues in infectious disease outbreaks. 2016. Disponible en: https://apps.who.int/iris/bitstream/handle/10665/250580/9789241549837-eng.pdf;jsessionid=5320E78C15C4ADAC2895C80325CAE4BA?sequence=1[Consulta: 2 marzo 2020].
Publicado
2020-04-30
Cómo citar
1.
Sociedad Uruguaya de Medicina Intensiva, Sociedad de Infectología Clínica del Uruguay, Cátedra Enfermedades Infecciosas, Facultad de Medicina, Udelar, Cátedra Medicina Intensiva, Facultad de Medicina, Udelar, Sociedad Uruguaya de Emergencistas, Sociedad de Medicina Interna del Uruguay, Dpto. Medicina Familiar y Comunitaria, Facultad de Medicina, Udelar, Sociedad Uruguaya de Medicina Familiar y Comunitaria, Sociedad Uruguaya de Enfermería en Cuidados Intensivos, Clínica Médica C, Hospital de Clínicas, Facultad de Medicina, Udelar, Sociedad Uruguaya de Neumología, Asociación Latinoamericana para el Control de Infecciones, Departamento de Anestesiología Hospital de Clínicas. Facultad de Medicina, Udelar, Sociedad Uruguaya de Nefrología, Centro de Nefrología, Hospital de Clínicas, Udelar, Sociedad Uruguaya de Gerontología y Geriatría del Uruguay, Departamento de Medicina Legal y Ciencias Forenses. Facultad de Medicina, Udelar, Departamento de Farmacología y Terapéutica, Hospital de Clínicas, Departamento de Salud Ocupacional. Facultad de Medicina. Udelar, Departamento de Laboratorio de Patología Clínica. Hospital de Clínicas. Udelar. Recomendaciones del Grupo interdisciplinario intersociedades científicas e intercátedras de Uruguay. Rev. Méd. Urug. [Internet]. 30 de abril de 2020 [citado 23 de noviembre de 2024];36(2):212-8. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/542
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