Conclusion
The availability of vaccines will reduce the number of acute cases of
COVID-19. However, acute cases will continue to exist, requiring
therapeutic interventions to reduce toxicities and improve survival.
Reducing the cytokine storm appears to be crucial in preventing end
organ damage which is associated with high
mortality59. Genetic and immunologic studies of
hospitalized COVID-19 subjects showed mutations yielding increased TYK2
or decreased IFNAR2 expression or inactivating mutations in interferon
pathway genes—IRF3, IRF7, IFNAR1/2, TBK1 or TLR3 or autoantibodies to
interferons had more severe disease60-62. These
subjects suffered increased inflammatory cytokines and absent anti-viral
interferons. Targeted immune regulation to reverse this state may
provide substantial benefit in SARS-CoV-2 infection. Our case suggests
that everolimus plus pegylated interferon is a potential regimen for
SARS-CoV-2 patients. This treatment combination may benefit select
patients if used early in the disease. Future studies are needed to
elucidate the potential therapeutic benefits and side effects of this
regimen.