The President of the United States who was infected with Corona and began to show symptoms in a difficult situation, received an experimental antibody cocktail. Research doctors from the University of Virginia detail what are the effective treatments against Corona, and what are the promising treatments that are in clinical trials
By William Petrie, Professor of Medicine, University of Virginia and Jeffrey M. Stark, Assistant Professor of Medicine, University of Virginia, The Conversation. Translation: Avi Blizovsky, editor of the knowledge site
With 74-year-old President Trump and 50-year-old First Lady Melania Trump testing positive for the coronavirus (and the president's condition even worsening as of this writing AB), what are the best proven treatments for them and other patients?
We are both physician-scientists at the University of Virginia. We treat COVID-19 patients and conduct research to find ways. Better to diagnose and treat the disease.
Here we share what doctors have learned in the last eight months in treating the various stages of this disease. At the beginning of the year, there were few known treatments for people showing severe COVID-19 symptoms other than putting them on ventilators. Now, a few months later, there are already a handful of treatments, including drugs that give doctors much better tools to treat patients, especially very seriously ill patients.
Who is most at risk of getting seriously ill with COVID-19?
Men are 1.5 times more likely to die than women, and an 80-year-old person has a 20-fold higher risk of dying than a 50-year-old person. In addition to age and male sex, obesity; diabetes mellitus; recent cancer diagnosis; chronic heart, lung and liver disease; Embed; and dementia are all associated with an increased risk of dying from COVID-19. Based on these criteria, the president falls into a higher risk category due to being an advanced age male.
Is the treatment different depending on the severity of the disease?
The approach to treatment differs depending on the stage of the disease. It is therefore important not only to diagnose COVID-19 but also to define whether the infection is asymptomatic or pre-symptomatic. Also, knowing how sick a person is - whether it is a mild, moderate, severe or critical case - changes the way the patient is treated.
What treatment is there for an asymptomatic or pre-symptomatic infection?
An asymptomatic or pre-symptomatic patient is defined as someone who has had a positive diagnostic test for COVID-19 (PCR or antigen detection test) without symptoms of infection. Currently there is no known effective treatment for this stage. A person with an asymptomatic or pre-symptomatic infection should isolate themselves at home for ten days so as not to infect others.
What are the symptoms of mild illness, and what treatments work?
The list of symptoms of mild COVID-19 infection can include fever, cough, loss of taste or smell, muscle pain, headache, nausea, vomiting, diarrhea, congestion and runny nose.
Mild COVID-19 patients do not have shortness of breath, chest pain, or evidence of pneumonia during a chest X-ray. The exception to this is children with mild disease who may still be able to see something abnormal on a lung x-ray.
There are no treatments for the mild patients.. However, such patients should be well versed in the symptoms of moderate disease so that they and others can recognize if they are progressing toward a moderate condition. This is important information because the deterioration to a more serious disease can be fast - usually five to ten days after the initial symptoms.
moderate disease
Moderate disease is characterized by shortness of breath, chest pain, evidence of pneumonia on a chest X-ray but no hypoxia (low oxygen levels in the blood). Currently there is no known effective treatment for moderate disease.
Hard Disease
A serious illness is characterized by a rapid breathing rate (more than 30 breaths per minute) or low oxygen levels in the blood, - hypoxia. Also, medical findings showing pneumonia affecting more than half of the lungs, as diagnosed in a chest x-ray, are a sign of a serious case.
Controlled clinical trials have shown that the antiviral drug remdesivir speeds recovery for patients with severe but not critical disease.
In addition, dexamethasone - an anti-inflammatory steroid drug (prednisone) reduces mortality.
Patients in critical condition
Critical illness occurs when the patient becomes so ill that their vital organs begin to fail and require drugs or other treatments to support these vital functions. If the lung failure is severe enough, doctors may put the patient on a mechanical ventilator or give them high amounts of oxygen. There is no evidence that remdesivir treatment is beneficial at this critical stage. Dexamethasone is still recommended for treatment because it has already been shown to reduce mortality.
What treatments don't work or are still being tested?
There are several treatments that have been shown to be effective including chloroquine and hydroxychloroquine. Other potential treatments are in clinical trials to see if they are effective. These include plasma from recovered patients containing antibodies that are supposed to bind to the virus and prevent it from entering cells.
There are also drugs that try to regulate the immune response, such as interferons and IL-6 inhibitors, which in some cases may prevent a harmful overreaction of the immune system, commonly known as a cytokine storm.
There is currently no approved treatment for asymptomatic or mild to moderate corona patients, but that seems to be changing, with the publication by the pharmaceutical companies Eli Lilly and Regeneron of clinical trial data that tested the effect of antibodies developed in the laboratory against a glycoprotein found in Thorns" of the new Corona virus.
In this approach, as in the administration of plasma from embryos, the antibodies work by binding to the virus and blocking it from entering the cells and replicating. This can be particularly effective early in the infection before the disease becomes severe. Preliminary findings from the clinical trial show that COVID-19 carriers who received an injection of a cocktail of antibodies against the glycoprotein protein remained symptomatic for seven days instead of 13 on average. The amount of virus remaining in the upper part of the throat behind the nose has also decreased.
An update from the president's doctor on the afternoon of October 2nd (midnight Israeli time between October 2nd and 3rd) indicated that the president had received an infusion of Rahneron's prophylactic antibody cocktail. This approach and others like it are undergoing high-priority testing by the National Institutes of Health (NIH) to determine if the treatments are safe and effective.
Editor's note: Since the outbreak of the epidemic in China and its spread around the world, Trump has tried to downplay its severity, and to blame China for not providing him with timely information. As of the last week (end of September and beginning of October 2020) the number of deaths from Corona around the world passed the mark of one million people (and this is an underestimate because many countries are unable to report the true number of deaths from Corona. In the USA itself 200 thousand people have already died, i.e. About a fifth of the world Trump also avoided wearing masks and keeping his distance and used to hold mass election rallies.
For an article in The Conversation
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