How was new coronary pneumonia treated before the vaccine was successfully developed?
Keywords: new coronavirus; treatment; evidence
The new coronavirus (SARS-CoV-2) has caused more than 15.6 million people worldwide to be infected with COVID-19, of which 630,000 have died, and there are still more than 280,000 new cases every day.
In the face of a raging epidemic, even the fastest vaccine will have to wait until October to obtain, and the specific preventive effect is still unknown.
In this case, how to treat COVID-19 clinically?
We have been closely tracking the development of the new crown vaccine, reading and pushing almost all important documents in this field, combined with the New York Times report, to give an overview of the current COVID-19 treatment situation.
Because the data is constantly updated, this tweet is limited to editing based on the information we have already obtained. It will be updated every two weeks in the future.
Classification of COVID-19 treatment options
There is currently no cure for COVID-19. To classify the current treatment programs in use, they can be divided into:
Widely used treatment: It has been widely used clinically to treat patients hospitalized for respiratory diseases, including COVID-19.
Evidence-effective treatment: That is, studies have already proven its effectiveness, but more research is needed. It is required that at least one randomized controlled trial (RCT) shows that the incidence, fatality rate and recovery rate of COVID-19 have been improved.
Insufficient evidence of treatment: that is, to prove its effectiveness in observational studies, but needs to be verified by RCT studies.
Proven ineffective treatment: that is, proved ineffective in RCT studies.
Pseudoscience/fraudulent treatment: Researchers have never considered these treatment options, and experts warn that these treatment options are ineffective or even harmful.
U.S. Food and Drug Administration (FDA) emergency use authorization: It is a diagnosis and treatment guidance made by the U.S. FDA based on existing evidence, such as mechanical ventilation and remdesivir treatment of critically ill patients.
Classification of treatment options
The existing treatment strategies mainly include symptomatic and supportive treatment, antiviral therapy, viral immunotherapy, immunosuppressive therapy, etc.
Antiviral treatment: Antiviral drugs that can fight against the new coronavirus invading the human body or killing the virus. Such as Remdesivir.
Viral immunotherapy: drugs that help the human body to eliminate viruses. Such as convalescent plasma.
Immunosuppressive therapy: The important mechanism of COVID-19 death is that the virus causes an excessive immune response, so suppressing the excessive immune response is meaningful for saving lives. Such as glucocorticoids.
Symptomatic and supportive treatment: assisting the body or compensating part of the body's functions. Such as a ventilator to assist breathing.
Widely used treatment
Prone position breathing
It is very valuable for critically ill and critically ill patients. It can improve patients with breathing difficulties to a certain extent, and even help some patients avoid using ventilators.
Ventilator and other respiratory support therapies
Obtained US FDA emergency use authorization. Including nasal oxygen inhalation or mask oxygen for critically ill patients with decreased pulse oxygen saturation, and ventilator or even extracorporeal membrane oxygenation (EMO) for critically ill patients with severe respiratory distress.
The above two widely used methods are part of symptomatic and supportive treatment.
Effective evidence treatment
Remdesivir
Belongs to antiviral therapy.
It is the first drug to be authorized by the FDA for emergency use and is produced by Gilead Sciences. It works by preventing virus replication. RCT studies have shown that Remdesivir can reduce the recovery time of hospitalized COVID-19 patients from 15 days to 11 days. The RCT study did not show a statistical difference in reducing the mortality rate of COVID-19, but a retrospective study published in July showed that Remdesivir can reduce the mortality rate of patients with severe COVID-19.
Dexamethasone
Belongs to immunosuppressive therapy.
Dexamethasone has been widely used in China's anti-SARS. Although there are many controversies in the treatment of COVID-19, most European and American scholars believe that it is ineffective or even harmful. However, the large sample RCT RECOVERY study led by the University of Oxford in the UK shows , Low-dose dexamethasone can reduce the fatality rate of 1/3 critically ill patients (using ventilator) and 1/5 of critically ill patients (needing oxygen).
Dexamethasone is currently the only drug shown to reduce the mortality rate of COVID-19 patients. And dexamethasone is very cheap and easily available, so after the results were announced at noon, European and American countries began to update clinical treatment guidelines in the afternoon, which played a key role in saving the lives of COVID-19 patients.
Insufficient evidence treatment
Favipiravir (favipiravir)
Belongs to antiviral therapy.
Favilavir is a drug used to treat influenza, which prevents the virus from replicating. A small sample size study conducted in March showed that favilavir may help the human respiratory tract to clear the new coronavirus.
But it needs RCT research and verification.
EIDD-2801:
Belongs to antiviral therapy.
EIDD-2801 is also an anti-influenza drug. In vitro experiments and animal studies have shown that it is effective, but it needs to be validated by patients.
Restructuring ACE-2:
Belongs to antiviral therapy.
For coronavirus to enter human cells, it needs to be combined with the ACE-2 protein on human cells to complete. Based on this mechanism, scientists have created a synthetic ACE-2 protein to bind to the new coronavirus.
Recombinant ACE-2 protein has shown encouraging results in cell experiments, but it has not been studied in animals or humans.
Recovered plasma:
Belongs to viral immunotherapy. FDA authorizes the treatment of severe COVID-19 patients.
The recovered plasma is obtained from the plasma of recovered COVID-19. The neutralizing antibody can bind to the virus, so it has potential curative effects in prevention and treatment.
There are clinical trial results, but RCT research evidence is needed. The RECOVERY research is currently doing a large sample size RCT research.
Monoclonal antibodies
Belongs to viral immunotherapy.
There are many kinds of antibodies in the plasma of recovered patients, some of which are neutralizing antibodies. Through research, find the most effective neutralizing antibody in the plasma of recovered patients, and on this basis, synthetic molecules become monoclonal antibodies.
Currently, the monoclonal antibodies of Regeneron and Eli Lilly are undergoing clinical trials, and Vir Biotech is also undergoing research and development of monoclonal antibodies.
Interferon
Belongs to viral immunotherapy.
The human body has type 1 interferon. The interferon α and β have antiviral effects, and part of the normal flora of the human body can also be produced.
Therapeutic interferons α and β have been widely used in the treatment of autoimmune diseases such as multiple sclerosis or hepatitis B and C.
At present, there are small-sample clinical trials for a variety of interferons to show their effectiveness. But it needs RCT research and verification.
Cytokine inhibitor
Belongs to immunosuppressive therapy.
As mentioned earlier, dexamethasone is effective in treating critically ill and severe COVID-19, and how effective are other immunosuppressive agents. At present, the most attention is paid to cytokine inhibitors, but the IL-6 monoclonal antibody treatment has failed recently.
Cell adsorption
It is an immunosuppressive treatment and has been authorized by the US FDA for emergency use.
Cell adsorption can filter cytokines from the blood to reduce tissue damage caused by cytokine storms. After a small sample size study in March showed that it was effective, the FDA has obtained emergency use authorization for COVID-19 treatment. Further clinical trials are currently underway.
stem cell
Stem cells for immunosuppression can secrete anti-inflammatory factors.
There are currently more than ten clinical trials in progress to see if it is effective in treating COVID-19.
Anticoagulant
It belongs to the field of symptomatic support treatment.
A wide range of microemboli appeared in patients who died of COVID-19, causing serious tissue damage. Some trials are currently studying whether anticoagulant therapy is effective.
Proven treatment
Lopinavir/Ritonavir
Belongs to antiviral therapy.
This is a medicine to treat HIV. At first, researchers discovered that it can prevent the replication of the new coronavirus in vitro. But clinical trials showed no effect. Especially in the RECOVERY study of the University of Oxford, the large sample size RCT study confirmed that lopinavir/ritonavir is ineffective in the treatment of COVID-19.
Chloroquine/Hydroxychloroquine
Belongs to antiviral therapy.
Originally a drug to prevent malaria and treat lupus, the Wuhan Institute of Virology of the Chinese Academy of Sciences discovered for the first time that remdesivir and chloroquine can inhibit the new coronavirus in an in vitro cell experiment. However, Nature's study on July 22 showed that the kidney Vero cell line used in the previous study did not express a serine protease called TMPRSS2, while the expression of TMPRSS2 in lung epithelial cells can help the new coronavirus enter the lung cells.
The most critical evidence is also provided by Oxford University’s RECOVERY study. A large-sample RCT study showed that hydroxychloroquine is ineffective in treating COVID-19 hospitalized patients. The Brazilian study published by NEJM on July 23 further proved that hydroxychloroquine is not effective in treating mild to moderate COVID-19.
Pseudoscience/fraudulent treatment
Drinking or injecting bleach and disinfectant
U.S. President Trump mentioned this therapy at a press conference in April, but then scientists and medical staff fought.
Despite this, the U.S. Attorney General accused four Florida men of selling bleach to treat COVID-19 in July.
Ultraviolet rays
It was also first speculated to be valid by US President Trump. However, scientists have proved that ultraviolet rays can disinfect surfaces in the laboratory, but they cannot kill the virus in patients, and direct exposure can damage the skin.
silver
A number of American television promoters and presenters have been warned by the FDA to promote silver-based products to treat COVID-19.
summary:
The core result of the current research is "2-2-2", two are recognized, two are valid, and two are invalid.
The clinically recognized and widely used treatment method is prone breathing for critically ill patients and mechanical ventilation for critically ill patients.
Effective evidence-based treatment options are Redecivir treatment for critically ill patients and low-dose dexamethasone treatment for critically ill patients.
It has been confirmed that lopinavir/ritonavir and chloroquine/hydroxychloroquine are ineffective in treatment.
There are ten treatment methods that require further clinical verification.
https://www.redsunmedizone.com/2020/07/28/how-was-new-coronary-pneumonia-treated-before-the-vaccine-was-successfully-developed/