Novel unorthodox strategies to reduce the case fatality rate of COVID-19 in high risk groups.

Dear editors: We propose novel strategies to combat the COVID-19 outbreak, that are aimed at high-risk groups and might reduce the progression to severe forms of COVID and thus decrease the very high case fatality rate. Following the first reports of the outbreak of several cases of acute respiratory distress syndrome in the Chinese city of Wuhan at the end of December 2019, a novel beta coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or 2019-nCoV) as the main causative agent was identified while the disease associated with was named by WHO as COVID-19 (1, 2). The outbreak has rapidly spread globally with more than 150.000 cases detected in over 100 countries as of March 13, 2020. The overall case-fatality rate (CFR) of COVID-19 in China was 2.3 %, but globally it seems to be higher in the range of 3.5 % (3). At present, no specific antivirals or approved vaccines are available to combat COVID-19. Many patients however receive off-label antivirals such as lopinavir/ritonavir, ribavirin and/or chloroquine and /or interferons. Several new antivirals such as remdesivir are studied in ongoing clinical trials. Given the alarming global situation and rapidly evolving large scale pandemics, there is an urgent need for effective strategies to prevent the spread of the disease and decrease its high CFR. The gravity of the situation requires to consider even novel unorthodox strategies to control the outbreak and high lethality of COVID-19.