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6 COVID-19 treatments helping patients survive
New treatments target different stages of COVID-19, including before patients get sick enough to need a hospital. Juan Monino via Getty ImagesA year ago, when United States health officials issued their first warning that COVID-19 would cause serious “disruption to everyday life,” doctors had no effective treatments to offer other than supportive care. There is still no cure, but thanks to an unprecedented global research effort, several treatments are helping patients survive COVID-19 and stay out of the hospital. COVID-19 treatments target two major problems: the ability of the coronavirus to spread throughout the body and the damage caused by the body’s immune system response. When the virus enters the body, it takes control of the cells and uses them to replicate itself. In response, the body sends inflammatory signals and immune cells to fight the virus. In some patients, this inflammatory response can continue even after the virus is under control, causing damage to the lungs and other organs. The best tool is prevention, including the use of face masks and vaccines. Vaccines train the immune system to fight offenders. With less risk of uncontrolled infection, they can reduce the risk of death from COVID-19 to almost zero. But vaccine supply is limited, even with a third vaccine now authorized for use in the United States, so treatments for infected patients remain crucial. As doctors working with COVID-19 patients, we have been following drug tests and success stories. Here are six treatments commonly used today for COVID-19. As you will see, time is important. Treatments that can keep you out of the hospital Two promising types of treatment involve injecting antiviral antibodies into high-risk COVID-19 patients before the person becomes seriously ill. Our bodies naturally create antibodies to recognize foreign invaders and help fight them. But natural antibody production takes several days, and SARS-CoV-2 – the coronavirus that causes COVID-19 – replicates quickly. Studies show that injecting antibodies into patients soon after symptoms start can help protect patients from serious infections. Treatments for COVID-19 and its time. Georgios D. Kitsios, CC BY-ND 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 the combination therapy casirivimab / imdevimab developed by Regeneron. The US Food and Drug Administration has granted emergency use authorization for these therapies because they have been found to protect high-risk patients from hospitalization and death. Since patients are sick enough to need hospitalization, however, studies have not found a proven benefit from them. Convalescent plasma: Another way to administer antibodies involves blood collected from patients who have recovered from COVID-19. Convalescent plasma is administered primarily in research settings because the clinical evidence so far is mixed. Some studies show benefits at the beginning of the disease. Other studies have shown no benefit in hospitalized patients. There may be a role for convalescent plasma as a supplement therapy for some patients due to the growing threat of mutated variants of SARS-CoV-2, which may escape therapy with monoclonal antibodies. However, careful research is needed. Treatments for hospitalized patients Once patients become so ill that they need to be hospitalized, treatments change. Most hospitalized patients have difficulty breathing and low oxygen levels. The lack of oxygen occurs when the virus and the corresponding immune response damage the lungs, resulting in a swelling in the lung air sacs, which restricts the amount of oxygen that reaches the blood. Patients hospitalized with COVID-19 generally need supplemental medical oxygen to help them breathe. Doctors often treat patients using oxygen with the antiviral agent remdesivir and anti-inflammatory corticosteroids. Most hospitalized COVID-19 patients have difficulty breathing and obtaining sufficient oxygen. AP Images / David Goldman Remdesivir: Remdesivir, originally designed to treat hepatitis C, prevents the coronavirus from replicating by interfering with its genetic building blocks. It has been shown to shorten hospital stay, and doctors can prescribe it for patients who receive oxygen soon after arriving at the hospital. Corticosteroids: Steroids soothe the body’s immune response and have been used for decades to treat inflammatory diseases. They are also widely available, are cheap and well-studied drugs, so they were one of the first therapies to enter clinical trials for COVID-19. Several studies have shown that low-dose steroids reduce deaths in hospitalized patients taking oxygen, including the sickest patients in the intensive care unit or ICU. Following the findings of the RECOVERY and REMAP-CAP COVID-19 studies, steroids are now the standard of care for patients hospitalized with COVID-19 who are treated with oxygen. Anticoagulants: Inflammation during COVID-19 and other viral infections can also increase the risk of blood clots, which can cause heart attacks, strokes and dangerous clots in the lungs. Many patients with COVID-19 are given the anticoagulants heparin or enoxaparin to prevent clots from forming before they occur. The first data from a large trial with COVID-19 patients suggest that hospitalized patients benefit from higher doses of anticoagulants. Some patients with COVID-19 become 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, but ICU patients have not benefited from high doses of anticoagulants. Treating the most sick patients ICU patients with COVID-19 are more likely to survive if they receive steroids, studies have found. However, steroids in low doses may not be enough to contain excessive inflammation. Tocilizumab: Tocilizumab is an antibody generated in the laboratory that blocks the interleukin-6 pathway, which can cause inflammation during COVID-19 and other diseases. New results from the REMAP-CAP study that have not yet been peer-reviewed suggest that a single dose of tocilizumab administered within one to two days after being placed on respiratory support reduced the risk of death in patients who were already receiving low-dose steroids. doses. Tocilizumab has also been shown to benefit patients with high levels of inflammation in the initial results of another study. These innovative therapies can help, but careful supportive care in the ICU is also essential. Decades of extensive research have defined the basic management principles to help patients with severe lung infections who need ventilators. This includes avoiding the underinsufflation and hyperinflation of the lung by the ventilator, the treatment of pain and anxiety with low levels of sedative medications and the periodic placement of certain patients with low oxygen levels on their stomachs, among many other interventions. The same key principles are likely to apply to 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 beginning of the pandemic has been inspiring. Doctors now have vaccines, antiviral antibodies for high-risk outpatients and a variety of treatments for hospitalized patients. Continuous research will be crucial to improving our ability to fight a disease that has claimed more than 2.5 million lives worldwide. This article was republished from The Conversation, a non-profit news site dedicated to sharing ideas from academic experts. It was written by: William G. Bain, University of Pittsburgh; Georgios D. Kitsios, University of Pittsburgh, and Tomeka L. Suber, University of Pittsburgh. Read more: What are monoclonal antibodies – and why we need them, as well as a vaccine. I am a pulmonologist testing the blood plasma of COVID-19 survivors as a treatment for patients – a century-old idea that could be a quick route to treatment William G. Bain receives research funding from the United States Department of Veterans Affairs; the National Institutes of Health; the Institute of Vascular Medicine at the University of Pittsburgh, the Western Pennsylvania Hemophilia Center; and the Institute for Transfusion Medicine. Georgios D. Kitsios received research funding from the National Institutes of Health, the Clinical and Translational Science Institute at the University of Pittsburgh, and Karius, Inc. Tomka L. Suber receives research funding from the National Institutes of Health, Burroughs Wellcome Fund, and the Samuel and Emma Winters Foundation.