Introduction
The spread of SARS-CoV-2 has rapidly spread all over the world generating a pandemic that the whole world is fighting to stem it as soon as possible. The researchers studied the SARS-CoV-2 virus and it was discovered that not all exposed people are infected and not all infected patients develop serious respiratory diseases. SARS-CoV-2 infection has been shown to be divided into three phases: phase 1, asymptomatic or mildly symptomatic incubation period that does not require hospitalization with or without detectable virus; phase 2, period not severely symptomatic with presence of the virus; phase 3, severe respiratory symptomatic phase with high viral load and generalized hyperinflammatory state. Phase 3 is the most serious and dangerous phase; generalized hyperinflammatory was caused by a sudden release of cytokines in the circulation defined as ”cytokine storm” (CS) which leads to death from pneumonia.
These are three phases with increasing gravity and for each phase a specific treatment can be indicated or avoided, always personalized for the clinical characteristics of each individual patient.
  1. Phase 1 (or non-severe phase): A non-serious phase lasting about 7 days and the immune system begins to react against the virus. If the immune response is not specific for breaking down the virus, disease progression occurs in the severe stages. Increasing immune responses could certainly be important together with the use of an antiviral to prevent virus replication. The antivirals used in this phase are remdesivir, lopinavir / ritonavir, chloroquine and hydroxychloroquine. If the infection is contained in this phase and the virus is defeated, it does not go to the next more serious phases.
  2. Phase 2 (moderate): The second stage of infection begins when the immune system has been unable to defeat the virus and this has repercussions on the respiratory tract and lungs. In this phase, hospitalization begins and the administration of oxygen with probable heart problems and coagulation with a moderate increase in pro-inflammatory markers. The treatment that could be indicated is a continuous use of antiviral drugs, oxygen support and / or the use of anti-inflammatory drugs, antibiotics and the administration of LMWH- (Low-partial-weight-heparin) to prevent thromboembolic events.
  3. Phase 3 (severe): The third stage is the most serious and pruned to the patient’s death. At this stage there is a hyperactive and systemic inflammatory state called Cytokine Storm (CS) with limited respiration. In this phase the values of the inflammation markers (IL-2, IL-6, GCSF, TNF-alpha, D-dimer, ferritin, etc.) are very high. The patient may have severe respiratory failure and heart shock. Immunological therapies such as corticosteroids, anti-interleukin 6 (tocilizumab and sarilumab), IL-1 receptor antagonists (anakinra or canakinumab), JAK inhibitors are required at this stage. The prognosis for patients at this stage of the disease is very serious (1-13)