Page 7 - Mesenchymal Stem cells, Exosomes and vitamins in the fight aginst COVID

Pain Physician: March/April 2020: 23:E71-E83

2. Institute appropriate safeguards to avoid negative consequences from unscrupulous actors.
3. With proper informed consent from patients or proxy when necessary, and subject to accumulation of data in
that cohort, allow the procedure to be initiated in critically ill patients who are not responding to conventional
therapies.
Key words: Coronavirus, COVID-19, cytokine storm, multiorgan failure, expanded umbilical cord mesenchymal stem cells

Pain Physician 2020; 23:E71-E81

1.0 IntroductIon

COVID-19 was initially concentrated in two regions deaths, and the MERS-CoV originating in Saudi Arabia
of China. It has now moved to multiple other countries, with approximately 2,500 cases and 800 deaths, still
including Italy with Europe becoming the new epicen- causing sporadic cases. The new COVID-19 virus seems
ter. The novel coronavirus 2019-nCoV (COVID-19) has to be very contagious and has quickly spread globally.
reached pandemic proportions across the world after The clinical spectrum of COVID-19 varies from as-
originating in Wuhan (1-9) with a reported mortality of ymptomatic or pauci-symptomatic forms to clinical
2.3% (4) and 4.3% in hospitalized patients in China (5). conditions characterized by respiratory failure requir-
This led to extensive measures being undertaken in the ing mechanical ventilation and support in the ICU, to
United States with declarations of emergency and in- multiorgan and systemic manifestations such as sepsis,
terruption of daily lives (10). As of March 18, 2020, the septic shock, and multiple organ dysfunction (MOD)
World Health Organization (WHO) has reported almost syndromes (4-7,13). In one of the first reports on the
220,000 confirmed cases of COVID-19 globally. There disease, Huang et al (17) showed about one-third of the
have been 9,000 deaths while 85,000 patients have re- patients with pneumonia (13, 32%) required ICU care,
covered. In the United States (US), the Centers for Dis- and there were 6 (15%) fatal cases. In the United States,
ease Control and Prevention (CDC) has counted almost Arentz et al (8) published characteristics and outcomes
10,000 COVID-19 cases with over 200 deaths (11). In the of 21 critically ill patients with COVID-19 in Washington
US, several million are at high risk including the approx- State with descriptions of clinical presentation, charac-
imately 1.3 million people are living in nursing homes. teristics, and outcomes of incident cases of COVID-19
Current models regarding COVID 19 estimate hospi- admitted to the intensive care unit. Among 21 cases,
talizations of 4.8 million, 1.9 million patients requiring comorbidities were identified in 18 cases (86%), with
admission to intensive care units (ICUs), and 960,000 chronic kidney disease and congestive heart failure be-
would require mechanical ventilation (12,13). However, ing the most common. Initial symptoms included short-
the United States has approximately 4,900 acute care ness of breath (76%), fever (52%), and cough (48%),
hospitals, an estimated maximum of 550,000 staffed with mean onset of symptoms prior to presenting to
beds and 95,000 ICU beds with maximum of 200,000 the hospital of 3.5 days, and 17 patients (81%) were
mechanical ventilation units (12). Health care expendi- admitted to the ICU less than 24 hours after hospital
tures are expected to skyrocket, along with economic admission. Acute respiratory distress syndrome (ARDS)
strain on many sectors of the economy (14,15). There was observed in 15 of 15 patients requiring mechanical
have been numerous publications with widespread pre- ventilation and 8 of 15 (53%) developed severe ARDS
cautions for prevention, identification, and treatment by 72 hours. As of March 17, 2020, mortality was 67%
of these patients (16-45). and 24% of patients have remained critically illness and
On February 11, 2020, the WHO Director Gen- only 9.5% have been discharged from the ICU. This case
eral, Dr. Ghebreyesus, announced that the disease by series provided additional data for United States popu-
new CoV was a “COVID-19” which is the acronym of lation with high rate of cardiomyopathy, the causation
“coronavirus disease 2019” (13). In the past 20 years, of which may be either overwhelming critical illness or
2 coronavirus epidemics have occurred with a large- a direct cardiac complication, being investigated to bet-
scale epidemic beginning in China and involving over ter characterize this risk.
20 countries leading approximately 8,000 cases and 800 As the medical profession has recognized quickly,

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