6 COVID-19 treatments that help patients survive


A a year ago, when US health authorities issued their first warning that it would cause COVID-19 severe “alteration of daily life” doctors did not have effective treatments to offer beyond supportive care.

There is still no rapid cure, but thanks to an unprecedented global research effort, several treatments are helping patients survive COVID-19 and stay out of the hospital.

Objective of COVID-19 treatments two big problems: the ability of the coronavirus to spread throughout the body and damage to the body immune system response. When the virus enters the body, it seizes the cells and uses them to replicate. In response, the body sends out inflammatory signals and immune cells to fight the virus. In some patients, this inflammatory response can continue even after the virus is controlled, causing damage to the lungs and other organs.

The best tool is prevention, including use facial masks and vaccines. Vaccines train the immune system to fight attackers. With a lower risk of uncontrolled infection, they can reduce the risk of COVID-19 death close to zero. But the supply of vaccines is limited, even with one the third vaccine is already authorized for use in the US, so treatments for infected patients remain crucial.

How doctors who work with COVID-19 patients, we have been following drug trials and success stories. Below are six treatments that are currently commonly used for COVID-19. As you can see, time is of the essence.

Treatments that can keep you out of the hospital

Two promising types of treatments are to inject antiviral antibodies into patients with high-risk COVID-19 before the person becomes seriously ill.

Our body naturally creates antibodies against recognize foreign invaders and help fight them. But the production of natural antibodies takes a few days and SARS-CoV-2 (the coronavirus that causes COVID-19) replicates quickly. Studies show that injecting antibodies into patients shortly after symptoms begin can help protect patients from a serious infection.

Monoclonal antibodies: These laboratory-designed antibodies can bind to SARS-CoV-2 and prevent the virus from entering cells and infecting them. They include Bamlanivimab and combination therapy casirivimab / imdevimab developed by Regeneron. The United States Food and Drug Administration emergency use permit granted for these therapies because they have been found to protect high-risk patients from hospitalization and death. However, once patients are sick enough to need hospitalization I have not found any proven benefit of them.

Convalescent plasma: Another way to administer antibodies is to draw blood from patients who have recovered from COVID-19. Convalescent plasma occurs primarily in research settings because clinical trials to date are mixed. Some essays prove it benefits early on from the disease. Other studies have it no benefit has been shown in hospitalized patients.

There may be a role for convalescent plasma as a supplemental therapy for some patients due to growing threat of mutated SARS-CoV-2 variants, which can elude monoclonal antibody therapy. However, careful research is needed.

Treatments for hospitalized patients

Once patients get so sick that they have to be hospitalized, treatments change.

Most hospitalized patients have difficulty breathing and low oxygen levels. Low oxygen content occurs when the virus and the corresponding immune response injure the lungs, causing swelling in the lung air sacs that restricts the amount of oxygen entering the blood. Patients hospitalized with COVID-19 usually need supplemental medical oxygen to help them breathe. Doctors frequently treat patients with oxygen with the antiviral agent remdesivir and anti-inflammatory corticosteroids.

Remdesivir: Remdesivir, originally designed to treat hepatitis C, prevents coronavirus from reproducing interfering with their genetic blocks. He has proved it shorten the length of hospital stays, and doctors can prescribe it to patients with oxygen shortly after arrival at the hospital.

Corticosteroids: Steroids calm the body’s immune response and have been used for decades to treat inflammatory disorders. They are also widely available, inexpensive, and well-studied drugs, so they were one of the first therapies to introduce clinical trials on COVID-19. Several studies have shown that low-dose steroids reduce deaths in patients hospitalized with oxygen, including the sickest patients in the intensive care unit or ICU. After the findings of the milestone RECOVERY i REMAP-CAP In COVID-19 studies, steroids are now the standard of care for hospitalized patients with COVID-19 who are treated with oxygen.

Anticoagulants: Inflammation during COVID-19 and other viral infections may also increase the risk of blood clots, which can lead to heart attacks, cops and dangerous clots in the lungs. Many patients with COVID-19 receive heparin or enoxaparin anticoagulants to prevent clots from occurring. First data of a large trial of patients with COVID-19 suggests hospitalizing patients benefit from higher doses of blood thinners.

Some patients with COVID-19 get so sick that they need an ICU for high levels of oxygen support or a ventilator to help them breathe. There are several therapies available for ICU patients, however No benefit was found for patients with ICU from high doses of blood thinners.

Treatment of the sickest patients

ICU patients with COVID-19 are it is more likely to survive if they have received steroids, studies have been found. However, low-dose steroids alone may not be enough to curb excessive inflammation.

Tocilizumab: Tocilizumab is a laboratory-generated antibody that blocks the interleukin-6 pathway, which can cause inflammation during COVID-19 and other diseases. New results of the REMAP-CAP trial that have not yet been peer-reviewed, suggest that a single dose of tocilizumab administered one or two days after being placed on respiratory support reduced the risk of death in patients already receiving steroids. at low doses. Tocilizumab has also been shown to benefit patients with high levels of inflammation in the early outcomes of the disease. another trial.

These innovative therapies can help, but careful care in support of the ICU is also crucial. Decades of extensive research have defined basic management principles to help patients with severe lung infections who need ventilators. This includes avoiding subinflation and overinflation of the lung by the ventilator, treating pain and anxiety with low levels of sedative drugs and periodically placing certain patients with low oxygen levels in the abdomen, among many other interventions. Probably the same key principles apply patients with COVID-19 to help them survive and recover from a critical illness that can last for weeks or months.

Medical progress since the onset of the pandemic has been impressive. Doctors now have vaccines, antiviral antibodies for high-risk outpatients, and various treatments for hospitalized patients. Continued research will be crucial to improving our ability to fight a disease we have already claimed more than 2.5 million lives all over the world.

William G. Bain, Assistant Professor of Medicine, University of Pittsburgh; Georgios D. Kitsios, Assistant Professor of Medicine, University of Pittsburgh, i Tomeka L. Suber, Assistant Professor of Medicine, University of Pittsburgh

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