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COVID-19 Treatment Updates; Notable progress, medicines that can prevent patients from becoming severely infected; the facts

Progress in treatment of Covid-19 From Feb 2020 to June 2020

As time passes in a pandemic there's a greater chance of survival for those getting infected 3 months later like June 2020 than those who got infected 3 months earlier say February 2020. I will list *5 important things* that we know now that we didn't know in February 2020 for your understanding.

Each point may be true perfunctorily but the FACT CHECK I followed up with, shows all 5 points are much more complicated and nuanced than is outlined by Dr. Yu Kang.

1. COVID-19 was initially thought to cause deaths due to *pneumonia- a lung infection*- and so Ventilators were thought to be the best way to treat sick patients who couldn't breathe. *Now we are realising that the virus causes blood clots in the blood vessels of the lungs* and other parts of the body and this causes the reduced oxygenation. Now we know that just providing oxygen by ventilators will not help but we have to prevent and dissolve the micro clots in the lungs. This is why we are using drugs like *Asprin and Heparin ( blood thinners that prevents clotting) as protocol in treatment regimens in June 2020. *

1. FACT CHECK

EXCERPT: ā€œThe early use of aspirin in covid-19 patients, which has the effects of inhibiting virus replication, anti-platelet aggregation, anti-inflammatory and anti-lung injury, is expected to reduce the incidence of severe and critical patients, shorten the length of hospital duration and reduce the incidence of cardiovascular complications. https://clinicaltrials.gov/ct2/show/NCT04365309

Managing Coagulopathy in Patients with COVID-19 ( HEPARIN)

EXCERPT: ā€œSelection of Anticoagulant or Antiplatelet Drugs for Patients with COVID-19:13

Any time anticoagulant or antiplatelet therapy is being used, consideration must be given to potential drug-drug interactions with other concomitant drugs (AIII). The University of Liverpool has collated a list of drug interactions.ā€œ https://www.covid19treatmentguidelines.nih.gov/adjunctive-therapy/antithrombotic-therapy/]

2. Previously patients used to drop dead on the road or even before reaching a hospital due to reduced oxygen in their blood- OXYGEN SATURATION. This was because of *HAPPY HYPOXIA*- where even though the oxygen saturation was gradually reducing the COVID-19 patients did not have symptoms until it became critically less, like sometimes even 70%. **Normally we become breathless if oxygen saturation reduces below 90%. **This breathlessness is not triggered in Covid patients and so we we're getting the sick patients very late to the hospitals in February 2020. Now since knowing about happy hypoxia we are monitoring oxygen saturation of all covid patients *with a simple home use pulse oxymeter and getting them to hospital if their oxygen saturation drops to 93% or less*. This gives more time for doctors to correct the oxygen deficiency in the blood and a better survival chance in June 2020.

2. FACT check:

https://www.houstonmethodist.org/blog/articles/2020/aug/can-an-oximeter-help-detect-covid-19-at-home/

EXCERPT: ā€œNot everyone who tests positive for COVID-19 will develop low oxygen levels. There are people who may have a very uncomfortable bout with fever, muscle aches and GI upset at home, but never demonstrate low oxygen levels.

Ultimately, people should not think of a pulse oximeter as a screening test for COVID-19. Having a normal oxygen level does not mean that you are free of infection. If you are concerned regarding exposure, formal testing is still required.

Q: So, can a pulse oximeter be a helpful tool for monitoring COVID-19 at home?

Dr. Connolly: If a person has a mild case of COVID-19 and is self-treating at home, an oximeter can be a helpful tool for checking oxygen levels so that low oxygen levels can be caught early. In general, the people who are theoretically more at risk for oxygen issues are those with pre-existing lung disease, heart disease and/or obesity, as well as active smokers.

In addition, since "happy hypoxia" can be present in people who might otherwise be regarded as asymptomatic, a pulse oximeter can help ensure that this clinically silent early warning sign is not missed.ā€œ

pulseoximetry.pdf

3. We did not have drugs to fight the corona virus in February 2020. We were only treating the complications caused by it... hypoxia. Hence most patients became severely infected. ```**Now we have important medicines **``` Which are ANTIVIRALS that can substantially weaken the corona virus-the drugs inhibit viral entry. By using these two medicines we can prevent patients from becoming severely infected and therefore help them BEFORE THEY GO TO HYPOXIA. This knowledge we had in JUNE 2020... not in February 2020.

3. FACT CHECK

Antiviral Therapy - https://www.covid19treatmentguidelines.nih.gov/antiviral-therapy/

EXCERPT: ā€œSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication leads to many of the clinical manifestations of COVID-19. Antiviral therapies are being investigated for the treatment of COVID-19.

These drugs inhibit viral entry (via the angiotensin-converting enzyme 2 [ACE2] receptor and transmembrane serine protease 2 [TMPRSS2]), viral membrane fusion and endocytosis, or the activity of the SARS-CoV-2 3-chymotrypsin-like protease (3CLpro) and the RNA-dependent RNA polymerase.

1. Because viral replication may be particularly active early in the course of COVID-19, antiviral therapy may have the greatest impact before the illness progresses into the hyperinflammatory state that can characterize the later stages of disease, including critical illness.

2. For this reason, understanding the role of antivirals in treating mild, moderate, severe, and critical illness is necessary to optimize treatment for people with COVID-19. ā€œ

4. Many Covid-19 patients die not just because of the virus but also due the patients own immune system responding In an exaggerated manner called *CYTOKINE STROM*. This stormy strong immune response not only kills the virus but also kills the patients. In February 2020 we didn't know how to prevent it from happening. Now in June 2020, we know that *easily available medicines called Steroids,* that doctors around the world have been using for almost 80 years *can be used to prevent the cytokine storm in some patients*.

4. FACT CHECK:

https://www.covid19treatmentguidelines.nih.gov/immune-based-therapy/immunomodulators/corticosteroids/

EXCERPT: ā€œPatients with severe COVID-19 can develop a systemic inflammatory response that can lead to lung injury and multisystem organ dysfunction. It has been proposed that the potent anti-inflammatory effects of corticosteroids might prevent or mitigate these deleterious effects.ā€œ

The Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial, a multicenter, randomized, open-label trial in hospitalized patients with COVID-19, showed that the mortality rate was lower among patients who were randomized to receive dexamethasone than among those who received the standard of care.1*

This benefit was observed in patients who required supplemental oxygen at enrollment. No benefit of dexamethasone was seen in patients who did not require supplemental oxygen at enrollment. Details of the RECOVERY trial are discussed in Clinical Data to Date below.1*ā€œ

1*- RECOVERY Collaborative Group, Horby P, Lim WS, et al. Dexamethasone in hospitalized patients with COVID-19ā€”preliminary report. N Engl J Med. 2020. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32678530.

Clinical Trials LATEST INFORMATION: https://clinicaltrials.gov/ct2/results?cond=COVID-19&term=Corticosteroids&cntry=&state=&city=&dist=

EXCERPT: Several clinical trials to evaluate corticosteroids for the treatment of COVID-19 are currently underway or in development.

5. Now we also know that people with hypoxia became better just by making them lie down on their belly- known as prone position. Apart from this a few days ago Israeli scientists have discovered that a chemical known as Alpha Defensin produced by the patients White blood cells can cause the micro clots in blood vessels of the lungs and this could possibly be prevented by a drug used over many decades in the treatment of Gout. So some patients may have a better chance at surviving the COVID-19 infection.

5. FACT Check:

https://www.covid19treatmentguidelines.nih.gov/critical-care/

EXCERPT: ā€œFor patients with persistent hypoxemia despite increasing supplemental oxygen requirements in whom endotracheal intubation is not otherwise indicated, the Panel recommends considering a trial of awake prone positioning to improve oxygenation (CIII).

The Panel recommends AGAINST using awake prone positioning as a rescue therapy for refractory hypoxemia to avoid intubation in patients who otherwise require intubation and mechanical ventilation (AIII).ā€œ

More here on Prone position: https://www.covid19treatmentguidelines.nih.gov/critical-care/oxygenation-and-ventilation/

Going forward there's less need to panic about Covid-19 if we remember that a person who gets infected later has a better chance at survival than one who got infected early.

FACT CHECK: But it is all on a case by case basis and no universal ā€™one fits all therapyā€™ is yet available. That may just be a vaccine.

Let's all follow simple precautions like

  • 6 feet distancing from others -Wear proper masks -
  • Work from home whenever possible -Order delivery and take away of food groceries and vegetables
  • Stay at home during lockdown
  • Hand wash & hygiene. These precautions will definitely help curb the spread of the Coronavirus.

If someone tells you every one is going to get infected, tell them that you are willing to and can afford to wait a bit longer... as each day passes we understand more about COVID infection.

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