Arguments in favour of remdesivir for treating SARS-CoV-2 infections

Since the end of 2019, an increasing number of cases of pneumonia were reported in Wuhan, followed by other cities and provinces in China and many other countries [1], [2], [3], [4], [5], [6], [7], and the 2019 novel coronavirus (2019-nCoV) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [8], a new human pathogen, was identified as the cause of Wuhan pneumonia. The disease spectrum of SARS-CoV-2 infection, so-called coronavirus disease 2019 (COVID-19), was known to be diverse in severity, ranging from asymptomatic carriage to mild respiratory tract infection and severe or fatal pneumonia. Moreover, SARS-CoV-2 can be transmitted within the family, in the community, among cruise passengers and in hospitals, and has become a public-health emergency of international concern (PHEIC), declared by the World Health Organization (WHO) on 30 January 2020. As of 28 February 2020, laboratory-confirmed cases of COVID-19 have been reported in 56 countries and territories with more than 83 382 cases reported globally; more than 78 832 of these cases were reported from China (https://www.worldometers.info/coronavirus/). In the view of virologists, human and zoonotic coronaviruses belong to the family Coronaviridae in the order Nidovirales. Currently, there are four genera in the subfamily Coronavirinae of the family Coronaviridae: Alphacoronavirus, Betacoronavirus, Deltacoronavirus and Gammacoronavirus. Before the current COVID-19 epidemic, there were six recognised human respiratory coronaviruses, including HCoV-229E (Alphacoronavirus), HCoV-OC43 (Betacoronavirus), HCoV-NL63 (Alphacoronavirus) and HKU1 (Betacoronavirus) that often cause mild respiratory tract infection as well as SARS-CoV and MERS-CoV that in contrast can lead to severe or even fatal lower respiratory tract disease [9]. The seventh human coronavirus, SARS-CoV-2, belongs to the genus Betacoronavirus, which also contains SARS-CoV and MERS-CoV. So far, no drugs, monoclonal antibodies or vaccines have been approved to treat human infections due to coronaviruses. Several pre-existing and potential drug candidates, including chloroquine and remdesivir, have been considered [10], [11], [12]. The discovery and marketing of new compounds often require months to years. However, in the face of the global spread of COVID-19, effective interventions for severe cases of COVID-19 are urgently required. Although little is known about SARS-CoV-2, several insights may be gained from its more well-known family member, SARS-CoV [11]. Here we review the literature on an existing but not approved antiviral agent, remdesivir, which exhibits promising in vitro antiviral activity and preliminary clinical experiences in the treatment of COVID-19.