The SARS-COV-2 rapid spread caused an international public health emergency with unprecedented rates of morbidity and mortality. Post COVID-19 condition occurs as a spectrum of symptoms that present four or more weeks after acute infection with SARS-CoV-2. Most published data to date state 50-70% of hospitalized patients experienced at least one post-acute COVID-19 symptom up to 3 months after discharge. Commonly reported symptoms include; neurocognitive post COVID-19 (fatigue, dizziness, inattention, and brain fog), respiratory post-COVID (dyspnea, chest pain, and cough), and mental health related symptoms (insomnia, depression, and post-traumatic stress disorder). Additionally, gastro-intestinal post COVID-19 (diarrhea, vomiting, and abdominal pain) along with decline in quality of life and decreased ability to perform activities of daily living were reported. The response to post COVID-19 symptoms is still in its infancy despite being an emerging crisis as scientific evidence and robust data are nonetheless required for clear definition, identification of time frame, classification and management of the condition. New studies are needed to identify total and individual incidence/prevalence rates of different clinical presentations of post COVID-19 symptoms. These future studies will help us to o improve early recognition of long term symptoms after acute infection of COVID-19.

The pandemic corona virus disease 19 (COVID-19), caused by (SARS-CoV-2) a single stranded-RNA virus, has been spread rapidly worldwide with high rate of morbidity and mortality. Few months after the spread of the pandemic, few medications have proven to be efficient in human clinical trials. Several antiviral drugs have been used outside the scope of their initial medical use, such as lopinavir, hydroxychloroquine or azithromycin. Recent researches were done to show the efficacy of ivermectin in reducing SARS-CoV-2 viral RNA within 2 days. The use of ivermectin in in vitro studies has proven its efficacy against Corona virus. Based on the potency of ivermectin in in vitro studies, various clinical trials including patients infected with COVID-19 have been started; most of them have not been completed yet. Since the way how the virus infects the cells in vitro and in vivo is different, a decisive comment about how the ivermectin could exactly be beneficial to the patients has not been proven yet. Nevertheless, if ivermectin is compared to the other therapeutic treatments available for COVID-19 management, ivermectin has proved to have leverage over them. New randomized controlled clinical trials to assess the effectiveness of ivermectin the management of COVID-19 are strongly and urgently needed.

Coronaviruses (CoVs) are a broad family of potentially serious RNA viruses that are now causing an outbreak of respiratory disease known as CoV disease 2019 (COVID-19). Melatonin is a pineal hormone that is predominantly produced and released at night from the amino acid tryptophan. Melatonin and its metabolites are also important in immunomodulation, and they have antioxidative properties due to their capacity to scavenge reactive oxygen species both directly and indirectly. COVID-19 leads to changes of altered consciousness levels in about 15% of hospitalized patients, starting from somnolence to disorientation, delirium, stupor, and coma. Melatonin can decrease the molecules that cause delirium in the elderly and central respiratory depression, such as benzodiazepines and antipsychotics. Melatonin may help alleviate infection-induced acute respiratory distress as well as its diverse effects, which include anti-inflammatory, antioxidative, and immune-enhancing properties. Its supplemental dose may be able to prevent SARS-COV-2 infections by reversing aerobic glycolysis via suppression of both HIF-1 and mTOR, allowing pyruvate dehydrogenase complex activity to be suppressed and acetyl-coenzyme A to be produced. When mitochondrion-produced and parenteral melatonin are combined, the cytokine storm is reduced, and COVID-19 infection-induced damage is alleviated. In conclusion, melatonin could have an important role in the management of COVID-19.