The Need for Combination Antiviral Therapy for Effective Treatment of COVID-19

The World Health Organization (WHO) declared coronavirus diseases 2019 (COVID19) on 30 January 2020. To date, infections with Severe Acute Respiratory Syndrome Coronavirus type II (SARS-CoV2) have reached pandemic levels. Despite several clinical trials, there is no specific effective treatment for COVID19. Among the many trialed drugs with demonstrated in-vitro anti-SARS-CoV2 effects, include: HydroxylChloroquine (HCQ), Azithromycin (AZ), Antivirals (remdesivir-RDV and lopinavir–ritonavirLPV/r), and Ivermectin-IVM. Many of these have only been trialed as monotherapies. Considering the low antiviral efficacy of each monotherapy and promiscuous vulnerability of the Replication Transcription Complex (RTC) of SARS-CoV2, it becomes necessary consider combinational therapies. We propose a new combinatorial regimen comprising of HCQ/RDV/LPVr/IVM for clinical testing in the treatment of COVID-19. Other combinational therapy regimens need to be considered to optimize the desired combined in-vivo virocidal and virostatic.