CARACTERÍSTICAS CLÍNICAS DE PACIENTES IDOSOS COM COVID-19: UMA REVISÃO SISTEMÁTICA DE RELATOS DE CASOS

Córdova, Luisser Dainner Saavedra; Vega, Alexander Pieter Mayor; Luján-Carpio, Elmer; Parodi, José Francisco; Moncada-Mapelli, Enrique; Armacanqui-Valencia, Isai; Salvador-Ruiz, Jhonatanael; Pawer-Pucurimay, Dalia; Ydrogo-Cruz, Erickson; Chevarría-Arriaga, Mylenka Jennifer; Ganoza-Farro, Macarena; Meza-Romero, Araceli; Zegarra-Rodríguez, Cynthia Alejandra; Albán-Murguia, Pedro Gustavo; Bailón-Valdez, Zaira; Palacios-Garcia, Naheilli; Quevedo-La-Torre, Danae; Alcós-Mamani, Angelica Lizeth; Gómez-Martel, Luisa Alisson; Roca-Moscoso, Max Antonio; Gamboa-Orozco, Martin; Salazar-Granara, Alberto

doi:10.1590/1980-57642021dn15-010001

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Original Article • Dement Neuropsychol 15 (1) • Jan-Mar 2021 • https://doi.org/10.1590/1980-57642021dn15-010001 linkcopiar

CARACTERÍSTICAS CLÍNICAS DE PACIENTES IDOSOS COM COVID-19: UMA REVISÃO SISTEMÁTICA DE RELATOS DE CASOS

Autoria SCIMAGO INSTITUTIONS RANKINGS

No contexto da atual pandemia de covid-19, maior morbidade e mortalidade têm sido relatadas em idosos. Sabe-se que essa faixa etária apresenta alterações fisiológicas e condições clínicas próprias, como fragilidade, demência, entre outras.

Objetivo: Descrever as características de pacientes com covid-19, maiores e menores de 80 anos, por meio de uma revisão sistemática da literatura que descreve relatos de casos, e resumir e avaliar criticamente essas características.

Método: Revisão sistemática. O estudo foi registrado no Registro de Projetos de Pesquisa em Saúde (PRISA) do Instituto Nacional de Saúde do Peru (código EI00000631). Local: cinco bases de dados eletrônicas (Scopus, PubMed, PubMed Central, LILACS e SCIELO) foram sistematicamente pesquisadas entre 31 de dezembro de 2019 e 16 de abril de 2020. A busca se concentrou em relatos de caso, estudos de caso e séries de casos mais antigos pessoas com infecção por SARS-CoV-2 com mais e menos de 80 anos. Na seleção dos casos, a prioridade foi dada ao perfil clínico e epidemiológico, padrões laboratoriais e de imagem, e avaliação geriátrica abrangente.

Resultados: Foram identificados 1.149 artigos. Após a aplicação dos filtros, obteve-se um total de 15 publicações de relatos de caso e registros completos de 27 idosos. A faixa etária mais frequente foi de 60 a 69 anos. Há pouca literatura sobre relatos de casos de adultos com mais de 80 anos. Os parâmetros mais frequentes foram hipertensão, febre, tosse, dificuldade respiratória, vidro fosco na radiografia e tomografia de tórax. Também foram observados diminuição da PaO2 / FiO2 e linfócitos, e aumento da proteína C reativa e Interleucina 6.

Conclusões: Esta revisão sistemática encontrou poucas informações disponíveis sobre pacientes com menos de 80 anos, em quantidade ainda menor para aqueles com mais de 80 anos, além de uma ausência de avaliação geriátrica abrangente.

Palavras-chave:
infecção por SARS-CoV-2; covid-19; idosos; relatos de casos; revisão sistemática

Systematic review items
Keywords*
COVID-19, SARS-CoV-2, Wuhan coronavirus, 2019-nCoV, novel coronavirus, new coronavirus, 2019-novel coronavirus, COVID-19 pandemic, COVID-19 virus infection, coronavirus-19 disease, 2019-nCoV infection, 2019-nCoV disease, COVID-19 virus disease, Aged 80 and over, Oldest-Old, Nonagenarian, Octogenarian, Centenarian, Nonagenarians, Octogenarians, Centenarians, Frail Elderly, Aged, Elderly. Anciano de 80 o más Años, Ancianos de 80 Años y más Anciano, Anciano Frágil, Centenarios, Nonagenarios, Octogenarios, Adulto Mayor, Ancianos, Persona Mayor, Persona de Edad, Personas Mayores, Salud de la Persona Anciana, Salud de la Persona Mayor, Salud de la Tercera Edad, Tercera edad, y Longevos.
SCOPUS search strategy
(TITLE-ABS-KEY (“COVID-19”) OR TITLE-ABS-KEY (“SARS-CoV-2”) OR TITLE-ABS-KEY (“Wuhan coronavirus”) OR TITLE-ABS-KEY (“2019-nCoV”) OR TITLE-ABS-KEY (“novel coronavirus”) OR TITLE-ABS-KEY (“new coronavirus”) OR TITLE-ABS-KEY (“2019-novel coronavirus”) OR TITLE-ABS-KEY (“COVID-19 pandemic”) OR TITLE-ABS-KEY (“COVID-19 virus infection”) OR TITLE-ABS-KEY (“coronavirus disease-19”) OR TITLE-ABS-KEY (“2019-nCoV infection”) OR TITLE-ABS-KEY (“2019-nCoV disease”) OR TITLE-ABS-KEY (“COVID-19 virus disease”)) AND (TITLE-ABS-KEY (“Aged, 80 and over”) OR TITLE-ABS-KEY (“Oldest Old”) OR TITLE-ABS-KEY (“Nonagenarian”) OR TITLE-ABS-KEY (“Octogenarian”) OR TITLE-ABS-KEY (“Centenarian”) OR TITLE-ABS-KEY (“Nonagenarians”) OR TITLE-ABS-KEY (“Octogenarians”) OR TITLE-ABS-KEY (“Centenarians”) OR TITLE-ABS-KEY (“Frail Elderly”) OR TITLE-ABS-KEY (“Aged”) OR TITLE-ABS-KEY (“Elderly”))
PubMed Central search strategy
((((((“Aged, 80 and over”[MeSH Terms] OR (“aged”[MeSH Terms] OR “Frail Elderly”[MeSH Terms])) OR (((((((((“Aged, 80 and over”[Abstract]) OR Aged[Abstract]) OR “Frail Elderly”[Abstract]) OR “Oldest Old”[Abstract]) OR Nonagenarians[Abstract]) OR Nonagenarian[Abstract]) OR Octogenarians[Abstract]) OR Octogenarian[Abstract]) OR Centenarians[Abstract]) OR Centenarian[Abstract]) OR Elderly[Abstract])) OR (((((((((“Aged, 80 and over”[Title]) OR Aged[Title]) OR “Frail Elderly”[Title]) OR “Oldest Old”[Title]) OR Nonagenarians[Title]) OR Nonagenarian[Title]) OR Octogenarians[Title]) OR Octogenarian[Title]) OR Centenarians[Title]) OR Centenarian[Title]) OR Elderly[Title]))))) AND (((COVID-19[Supplementary Concept]) OR (((((((((((((2019-nCoV[Abstract]) OR COVID-19[Abstract]) OR SARS-CoV-2[Abstract]) OR “new coronavirus”[Abstract]) OR “novel coronavirus”[Abstract]) OR “2019-novel coronavirus”[Abstract]) OR “COVID-19 pandemic”[Abstract]) OR “COVID-19 virus infection”[Abstract]) OR “coronavirus disease-19”[Abstract]) OR “2019-nCoV infection”[Abstract]) OR “2019-nCoV disease”[Abstract]) OR “Wuhan coronavirus”[Abstract]) OR “COVID-19 virus disease”[Abstract])) OR (((((((((((((2019-nCoV[Title]) OR COVID-19[Title]) OR SARS-CoV-2[Title]) OR “new coronavirus”[Title]) OR “novel coronavirus”[Title]) OR “2019-novel coronavirus”[Title]) OR “COVID-19 pandemic”[Title]) OR “COVID-19 virus disease”[Title]) OR “Wuhan coronavirus”[Title]) OR “2019-nCoV disease”[Title]) OR “2019-nCoV infection”[Title]) OR “coronavirus disease-19”[Title]) OR “COVID-19 virus infection”[Title]))
PubMed (Medline) search strategy
(((((((((((((((((2019-nCoV[Other Term]) OR COVID-19[Other Term]) OR SARS-CoV-2[Other Term]) OR “new coronavirus”[Other Term]) OR “novel coronavirus”[Other Term]) OR “2019-novel coronavirus”[Other Term]) OR “COVID-19 pandemic”[Other Term]) OR “COVID-19 virus disease”[Other Term]) OR “Wuhan coronavirus”[Other Term]) OR “2019-nCoV disease”[Other Term]) OR “2019-nCoV infection”[Other Term]) OR “coronavirus disease-19”[Other Term]) OR “COVID-19 virus infection”[Other Term])) OR COVID-19[Supplementary Concept]) OR (((((((((((((2019-nCoV[Title/Abstract]) OR COVID-19[Title/Abstract]) OR SARS-CoV-2[Title/Abstract]) OR “new coronavirus”[Title/Abstract]) OR “novel coronavirus”[Title/Abstract]) OR “2019-novel coronavirus”[Title/Abstract]) OR “COVID-19 pandemic”[Title/Abstract]) OR “Wuhan coronavirus”[Title/Abstract]) OR “COVID-19 virus disease”[Title/Abstract]) OR “2019-nCoV disease”[Title/Abstract]) OR “2019-nCoV infection”[Title/Abstract]) OR “coronavirus disease-19”[Title/Abstract]) OR “COVID-19 virus infection”[Title/Abstract]))) AND ((((((((((((((((“Aged, 80 and over”[Title/Abstract] OR Aged[Title/Abstract]) OR “Frail Elderly”[Title/Abstract]) OR “Oldest Old”[Title/Abstract]) OR Nonagenarians[Title/Abstract]) OR Nonagenarian[Title/Abstract]) OR Octogenarians[Title/Abstract]) OR Octogenarian[Title/Abstract]) OR Centenarians[Title/Abstract]) OR Centenarian[Title/Abstract]) OR Elderly[Title/Abstract]) OR ((“Aged, 80 and over”[MeSH Terms] OR “aged”[MeSH Terms]) OR “Frail Elderly”[MeSH Terms])) OR ((((((((((“Aged, 80 and over”[Other Term] OR Aged[Other Term]) OR “Frail Elderly”[Other Term]) OR “Oldest Old”[Other Term]) OR Nonagenarians[Other Term]) OR Nonagenarian[Other Term]) OR Octogenarians[Other Term]) OR Octogenarian[Other Term]) OR Centenarians[Other Term]) OR Centenarian[Other Term]) OR Elderly[Other Term])))
SCIELO search strategy
(((ab:(2019-nCoV)) OR (ab:(COVID-19)) OR (ab:(SARS-CoV-2)) OR (ab:(“Wuhan coronavirus”)) OR (ti:(2019-nCoV)) OR (ti:(COVID-19)) OR (ti:(SARS-CoV-2)) OR (ti:(“Wuhan coronavirus”)))) AND (((ab:(“Anciano de 80 o más Años”)) OR (ab:(Anciano)) OR (ab:(“Anciano Frágil”)) OR (ab:(“Ancianos de 80 Años o más”)) OR (ab:(“Ancianos de 80 Años y más”)) OR (ab:(“Ancianos de 80 o más Años”)) OR (ab:(Centenarios)) OR (ab:(Nonagenarios)) OR (ab:(Octogenarios)) OR (ab:(“Adulto Mayor”)) OR (ab:(Ancianos)) OR (ab:(“Persona Mayor”)) OR (ab:(“Persona de Edad”)) OR (ab:(“Personas Mayores”)) OR (ab:(“Personas de Edad”)) OR (ab:(“Salud de la Persona Anciana”)) OR (ab:(“Salud de la Persona Mayor”)) OR (ab:(“Salud de la Tercera Edad”)) OR (ab:(“Tercera edad”)) OR (ab:(Longevos)) OR (ti:(“Anciano de 80 o más Años”)) OR (ti:(Anciano)) OR (ti:(“Anciano Frágil”)) OR (ti:(“Ancianos de 80 Años o más”)) OR (ti:(“Ancianos de 80 Años y más”)) OR (ti:(“Ancianos de 80 o más Años”)) OR (ti:(Centenarios)) OR (ti:(Nonagenarios)) OR (ti:(Octogenarios)) OR (ti:(“Adulto Mayor”)) OR (ti:(Ancianos)) OR (ti:(“Persona Mayor”)) OR (ti:(“Persona de Edad”)) OR (ti:(“Personas Mayores”)) OR (ti:(“Personas de Edad”)) OR (ti:(“Salud de la Persona Anciana”)) OR (ti:(“Salud de la Persona Mayor”)) OR (ti:(“Salud de la Tercera Edad”)) OR (ti:(“Tercera edad”)) OR (ti:(Longevos))))
LILACS search strategy (af:((tw:(2019-nCoV)) OR (tw:(COVID-19)) OR (tw:(SARS-CoV-2)) OR (tw:(“new coronavirus”)) OR (tw:(“novel coronavirus”)) OR (tw:(“2019-novel coronavirus”)) OR (tw:(““COVID-19 pandemic””)) OR (tw:(““COVID-19 virus infection””)) OR (tw:(““coronavirus disease-19””)) OR (tw:(““2019-nCoV infection””)) OR (tw:(““2019-nCoV disease””)) OR (tw:(““Wuhan coronavirus””)) OR (tw:(““COVID-19 virus disease””)))) AND (af:((af:((tw:(aged)) OR (tw:(“Anciano de 80 o más Años”)) OR (tw:(Anciano)) OR (tw:(“Anciano Frágil”)) OR (tw:(“Ancianos de 80 Años o más”)) OR (tw:(“Ancianos de 80 Años y más”)) OR (tw:(“Ancianos de 80 o más Años”)) OR (tw:(“Centenarios”)) OR (tw:(“Nonagenarios”)) OR (tw:(“Octogenarios”)) OR (tw:(“Viejísimos”)) OR (tw:(““Adulto Mayor””)) OR (tw:(““Ancianos””)) OR (tw:(““Persona Mayor””)) OR (tw:(““Persona de Edad””)) OR (tw:(““Personas Mayores””)) OR (tw:(““Personas de Edad””)) OR (tw:(““Salud de la Persona Anciana””)) OR (tw:(““Salud de la Persona Mayor””)) OR (tw:(“Aged, 80 and over”)) OR (tw:(Aged)) OR (tw:(“Health of the Elderly”)) OR (tw:(“Frail Elderly”)) OR (tw:(“Oldest Old”)) OR (tw:(Nonagenarians)) OR (tw:(Nonagenarian)) OR (tw:(Octogenarians)) OR (tw:(Octogenarian)) OR (tw:(Centenarians)) OR (tw:(Centenarian)) OR (tw:(Elderly)) OR (tw:(““Tercera edad””)) OR (tw:(Longevos)) OR (tw:(“Anciano de 60 o más Años”)) OR (tw:(“Aged, 60 and over”)))) OR (af:((mh:(“Anciano de 80 o más Años”)) OR (mh:(Anciano)) OR (mh:(“Anciano Frágil”))))))

Features			Total cases	Outpatient management cases	Hospitalization management casesÇ	ICU management cases*
Number			27	3	26	13
Age, median (IQR**)			65 (63–70)	65 (63–66)	65 (63–67.8)	66 (63–69)
Age (%/n)
	60–69		74.1/20	100/3	76.9/20	76.9/10
	70–79		22.2/6	0	19.2/5	15.4/2
	≥80		3.7/1	0	3.8/1	7.7/1
Sex (%/n)
	Women		48.1/13	33.33/1	50/13	53.8/7
	Men		51.9/14	66.7/2	50/13	46.2/6
Possible city of infection (%/n)
	Wuhan-Hubei		63/17	66.7/2	65.4/17	61.5/8
	Other than Wuhan		29.6/8	33.3/1	30.8/8	30.8/4
	No data available		7.4/2	0	3.8/1	7.7/1
Critical times
	Contact and onset of symptoms	mean±SD	6.97±3.23	–	7.43±2.57	6.56±3.84
	Contact and onset of symptoms	n	15		7	8
	Onset of symptoms and medical evaluation	mean±SD	3.50 (1.25–7.75)€	–	3 (1–4.75)€	5.83±4.63
	Onset of symptoms and medical evaluation	n	24		12	12
	Onset of symptoms and hospital admission	mean±SD	6.00 (3.00–8.00)€	–	6.09±5.17	7.08±3.94
	Onset of symptoms and hospital admission	n	23		11	12
	Onset of symptoms and appearance of dyspnea	mean±SD	7±5.29	–	4±6.08	7.75±5.08
	Onset of symptoms and appearance of dyspnea	n	15		12	3
Medical history (%/n)
	Arterial hypertension		37./9	–	–	38.5/5
	Coronary heart disease		3.7/1			0
	Heart failure		3.7/1			0
	Diabetes mellitus		14.8/4	–	–	15.4/2
	Chronic bronchitis	3.7/1	–	–	7.7/1
	Oncological diseaseβ		11.1/3	–	–	7.7/1
	Chronic kidney disease		7.4/2	–	–	7.7/1
	Non-nephrotic proteinuria		3.7/1	–	–	0
	Others^$		14.8/4			57.1/4
At least one comorbidity		51.8/14		–	–	53.8/7
Two or more comorbidities		22.2/6		33.3/1	19.2/5	7.7/1
Symptoms and Signs (%/n)
	Fever (%/n)¶		88.9/24	–	92.3/24	85.7/6
	Maximum temperature mean±SD (n)		38 (37.7–39)€	–	38.39±0.6 (9)	36.4±1.20 (2)
Maximum temperature (%/n)
	≤37.5		18.2/2	0	0	100/2
	37.51–38.3		36.4/4	0	44.4/4	0
	≥38.3		45.5/5	100/3	55.6/5	0
	Cough (%/n)		70.4/19	–	79.2/19	–
	Dry cough		31.6/6	–	–	–
	Not specified		68.4/13	–	–	–
	DyspneaΘ		59.3/16	–	57.7/15	100/13
	Myalgia		25.9/7	–	26.9/7	30.8/4
	Chills		22.2/6	–	23.1/6	30.8/4
	Fatigue		22.6/6	–	23.1/6	0
	Dizziness		7.4/2	–	7.7/2	7.7/1
	Sore throat		7.4/2	–	8.7/2	0
	Diarrhea		7.4/2	–	7.7/2	15.4/2
	Rhinorrhea		3.7/1	–	4.3/1	0
	Other symptoms		22.2/6	–	19.2/5	7.7/1
	Syncope		3.7/1	–	3.8/1	0
	Headache		3.7/1	–	3.8/1	0
	Thoracic oppression		3.7/1	–	3.8/1	0
	Nausea or vomiting		7.4/2	–	3.8/1	7.7/1
	Back pain		3.7/1	–	3.8/1	0
Symptoms leading patients to seek medical care
	Fever		44.4/12	–	–	46.15/6
	Cough		14.8/4	–	–	7.69/1
	Dyspnea		7.4/2	–	–	15.38/2
	Fatigue		3.7/1	–	–	0
	Diarrhea		3.7/1	–	–	7.69/1
	Syncope		3.7/1	–	–	1
	Dizziness		3.7/1	–	–	7.69/1
	Myalgia		3.7/1	–	–	7.69/1
	Thoracic oppression		3.7/1	–	–	0

Characteristics		Upon admission (n=27)	During hospitalization (n=27)	During ICU stay (n=13)
Chest X-ray performed (%/n)		37/10	44.4/12	57.1/4
Chest X-ray parenchymal radiopacity (%/n)
	Consolidation	40/4	16.7/2	75/3
	Ground-glass opacification	10/1	58.3/7	25/1
	No radiopacity	30/3	0	0
Affected lung (%/n)
	Right lung	10/1	0	25/1
	Left lung	10/1	0	0
	Bilateral	40/4	100/12	75/3
Injury distribution (%/n)
	Peripheral	20/2	66.7/8	0
	Perihilar	10/1	8.3/1	0
	Both	10/1	0	25/1
Injury localization (%/n)
	Basal opacities	30/3	75/9	50/2
	Apical opacities	0	0	0
	Other locations	10/1	0	25/1
Other findings (%/n)
	Pleural effusion	0	58.3/7	25/1
	Nodular lesion	0	0	50/2
	Chest CT scan performed (%/n)	37/10	66.7/18	57.1/4
Affected lung (%/n)
	Right lung	20/2	11.1/2	0
	Left lung	10/1	0	0
	Bilateral	50/5	83.3/15	75/3
Injury localization (%/n)
	Central injuries	10/1	5.6/1	ND
	Peripheral lesions	20/2	61.1/11	ND
	Both	20/2	5.6/1	ND
Main parenchymal pattern
	Ground-glass Opacification	70/7	88.9/16	75/3
	Consolidation	10/1	5.6/1	0
	Reticular	0	0	0
	Mixed	0	0	25/1
Other findings (%/n)
	Nodular lesion	10/1	16.7/3	50/2
	Thickened interlobular	20/2	22.2/4	50/2
	Nonspecific injury margin	ND	11.1/2	ND
	Crazy-paving pattern	30/3	16.7/3	50/2
	Cystic lesion	ND	ND	25/1
	Pleural thickening	ND	16.7/3	50/2
	Pleural effusion	ND	44.4/8	25/1
	Lymphadenopathy	30/3	16.7/3	50/2

		Normal values	During hospitalization (n=26)	During ICU stay (n=7)
Laboratory values mean±SD (n)
	PaO₂/FiO₂ ratio	>400	157.75±68.26	81±7.07 (2)
	Hemoglobin (g/dl)	13–17.5	13 (5)	–
	Leukocytes count (*10^9/L)	3.5–9.5	4.61 (4.13–6.73)/17€	17.54±5.87 (3)
	Lymphocytes count (*10^9/L)	1.10–3.20	0.72±0.28 (17)	0.42±0.08 (3)
	Neutrophils count (*10^9/L)	1.8–6.3	3.92±1.46	–
	Platelets count (*10^9/L)	150-450	137.46±37.87	–
	CD4 (cells/μL)	34–52	39.32±10.61	–
	CD8 (cells/μL)	21–39	17.28±5.80	–
	Myoglobin (ng/mL)	0–110	40.10 (32.7–111.9)/7€	–
	Troponin (ngmL)	0–0.1	0.012 (0.012–0.014)/(8)€	–
	Creatine phosphokinase -MB (ng/ml)	0–2.37	0.90 (0.23–42.00)/11€	–
	Lactate dehydrogenase (UI/L)	114.0–240.0	502±310.90 (14)	–
	Glutamic-oxaloacetic transaminase (GOT/AST) (UI/L)	5-40	33.6 (24.6–49.00)/13€	–
	Glutamic pyruvic transaminase (GPT/ALT) (UI/L)	5-40	26.5 (16.50–39.65)/13€	–
	Albumin (g/L)	40.0–55.0	38.28±2.99 (11)	–
	C-reactive protein (mg/L)	<10	58.26±34.42 (16)	208±93.24 (3)
	Creatinine (μmol/L)	58–110	81.90 (53.55–98.50)/13€	–
	Urea (mmol/L)	0.5-2.7	9.44±4.93 (12)	–
	Interleukin 6 (pg/mL)	<1.5	232.53±209.97 (3)	–
	D-dimer (mg/L)	<0.5	0.45 (0.30–0.60)/4€	–
	Procalcitonin (ng/mL)	0–0.5	0.09 (0.04–0.20)/8€	–

Treatments (%/n)		During hospitalization (n=27)	Destination after hospitalization			During ICU stay (n=13)	Destination after ICU stay
Treatments (%/n)		During hospitalization (n=27)	Medical discharge	ICU	Not specified	During ICU stay (n=13)	Medical discharge	Death	Stay in ICU
Antibiotics		14.8/4	25/1	50/2	25/1	30.77/4	50/2	25/1	25/1
Antivirals		51.9/14	14.3/2	64.3/9	21.4/3	30.77/4	50/2	25/1	25/1
Lopinavir-Ritonavir		37.5/5	20/1	60/3	20/1	75/3	66.7/2	0	33.3/1
Oseltamivir		28.6/4	0	100/4	0	0	0	0	0
Ribavirin		50/7	0	85.7/6	14.3/1	0	0	0	0
Others		85.7/12	16.7/2	58.3/7	25/3	15.4/2	0	0	0
Interferon		57.1/8	0	75/6	25/2	0	0	0	0
Umifenovir		21.4/3	66.7/2	33.3/1	0	7.7/1	0	0	100/1
Abidor		7.14/1	0	0	100/1	0	0	0	0
Remdesivir		–	–	–	–	7.7/1	0	100/1	0
Antimalarial treatment
	Hydroxychloroquine	100/2	0	100/2	0	15.4/2	100/2	0	0
	Immunological treatment	14.8/4	50/2	25/1	25/1	23.1/3	66.7/2	0	33.3/1
	Gamma globulin	75/3	33.33/1	33.33/1	33.33/1	7.7/1	0	0	100/1
	Tocilizumab	25/1	100/1	0	0	–
	Convalescent plasma	–	–	–	–	15.4/2	100/2	0	0
Other treatments
	Chinese Traditional Medicine	11.1/3	33.33/1	33.33/1	33.33/1	7.7/1	0	0	100/1
	Abidor+”Chinese Traditional Medicine”+Methylprednisolone	33.3/1	0	0	100/1	0	0	0	0
	Lopinavir/Ritonavir/Umifenovir+Shufeng Jiedu (SFJDC)	66.67/2	50/1	50/1	0	100/1	0	0	100/1
	Methylprednisolone	23.1/3	33.33/1	0	33.7/1	15.4/2	100/2	0	0

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Excerpted from Medical Subject Headings of the National Library of Medicine of the United States of America, and Health Sciences Descriptors from BIREME – Latin American and Caribbean Center for Information in Health Sciences. OR and AND are Booleans. SCOPUS: Elsevier's abstract and citation database. PUBMED CENTRAL (PMC) is a free full-text archive of biomedical and life sciences journal literature at the U.S. National Institutes of Health, National Library of Medicine (NIH/NLM). PUBMED (MEDLINE) is a database of references and abstracts on life sciences and biomedical topics of the U.S. National Library of Medicine (NLM). SCIELO: Scientific Electronic Library Online is a bibliographic database supported by the São Paulo Research Foundation (FAPESP) and the Brazilian National Council for Scientific and Technological Development (CNPq). Latin American and the Caribbean Health Sciences Literature (LILACS) is an online bibliographic database in medicine and health sciences, maintained by the Latin American and Caribbean Center on Health Sciences Information.