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Table 1 Therapeutic options for COVID-19 with respect to lung cytokine storms by COVID-19

From: SARS-CoV-2 COVID-19 susceptibility and lung inflammatory storm by smoking and vaping

Treatment/ Prophylaxis OptionsRationaleProsConsReference
Targets from host’s immune system
(IL6 blockers: Actemra, Tocilizumab.
Monoclonal antibodies: Kevzara-sarilumab)
Preventing excessive inflammatory responses.Modulation of host’s immunopathological responses would decrease risks of ARDS.Immune-modulation could have adverse effects[48]
ACE inhibitors (e.g.Umifenovir)ACE inhibitors may target the S1 domain and ACE2 interaction thus preventing virus entry.ACE modulation has successfully been employed in treating conditions like hypertension, heart failure and atherosclerosis.Role of ACE inhibitors in COVID-19 is not clear.[9, 49]
TMPRSS2 inhibitor (e.g.Camostat, Nafamostat)TMPRSS2 inhibition could prevent the viral activation preventing virus entry.TMPRSS2 inhibition may have little on-target side effect.Proteases other than TMPRSS2 (e.g. Cathepsin L, TTSP) might have a role in viral activation.[50, 51]
Chloroquine/HydroxychloroquineIt could prevent viral entry and have other immune-modulatory effects.Its anti-inflammatory properties could help monitor immunopathological responses in patients.It is associated with side effects like nausea, headache, blurred vision, vomiting, cramps, and diarrhea.[52,53,54]
Anti-viral agents (e.g.remdesivir, favipiravir, ripavirin)They target the viral replication by inhibiting the RNA polymerase enzyme.These agents have shown promising results during initial clinical trials.Use of antivirals has the risk of developing resistance amongst some patient populations.[47, 55]
Convalescent PlasmaIt involves use of passive antibody therapy to provide viral neutralization.It can be used for both prophylaxis or treatment. Its efficacy has been tested in previous infections like SARS, Ebola, and hepatitis.It has a known risk of inadvertent infection due to blood transfer and antibody dependent enhancement of infection (ADE).[56]
Targets from viral structure (like; E protein, Mpro3CLpro, Furin-like cleavage site)Targeting viral structure would prevent viral host-cell entry and replication.This method would design SARS-CoV2-specific treatmentFinding a potential cure by this method might take some time before it reaches clinic.[57,58,59]