Pathogenesis of COVID-19 as a basis for selecting inexpensive and readily available combination of indomethacin, famotidine and azithromycin providing anti-inflammatory, anti-platelet and anti-viral components of ambulatory management via telemedicine

The key pathogenetic mechanisms of COVID-19 involve tissue damage, inflammation, and thrombosis. Based on pathogenetic mechanisms of this disease, our initial literature search, prior to the first wave of COVID-19, identified well-known, inexpensive, and widely available medications (indomethacin, famotidine and azithromycin), which could target multiple components of pathophysiologic process triggered by SARS-CoV-2. We describe three adult patients managed via telemedicine, discuss details of treatment, including medication dosages, and propose ambulatory implementation of this approach for preventing progression of the disease to a stage requiring hospitalization. We discuss some key goals related to prompt delivery of treatment to adult patients facilitated by telemedicine, aimed at reducing risks of spread of infection, and accelerating treatment initiation.