Covid-19 the essentials of prevention and treatment

A review

Hailemeskel Mekonnen ( PhD fellow, CDT-AFRICA/AAU)

What is fundamental to an infectious disease? The bottom line is to treat the cause of disease. For COVID-19, antiviral therapy is a top priority, in both mild and severe cases. Without treatment and intervention for its cause, other treatments are very passive, so everyone is trying their best to suppress the virus at work. In fact, what we have observed is that the existence and detoxification times of coronavirus in the body are very long, and a number of body autopsies show a large number of virus particles and virus inclusion bodies in the alveolar cavity and pulmonary septum of the patient. Can other treatments work without clearing away the virus in severe patients? In addition, if the inflammation is due to excessive inflammation caused by the virus, if you do not get rid of the virus, can only immunosuppressive agents be effective? Respiratory support is an excellent tool to provide patients with valuable recovery time. But not every patient is so lucky. Lung damage in some patients is so severe that even ECMO cannot reverse it. This should remind us that etiology is the most important part of the treatment. At present, there is no effective antiviral drug. α-interferon inhalation can be tried (adults 5 million IU each time, adding 2mL of sterilized water for injection, twice a day) as a treatment course of at least 5 days, but no immediate effect of α-interferon atomization has been observed so far.

Notably, the interferon atomization must be performed with an air compression pump, because it can make the particles smaller—such as PM2.5 or PM5 levels—so that they can reach the alveoli. Lopinavir (200mg) and ritonavir (50mg) were originally used for the combination treatment of HIV, being HIV protease inhibitors and active peptide inhibitors, respectively, and the latter can increase the drug concentration of the former. Because lopinavir/ritonavir is a protease inhibitor with the ability to inhibit the formation of viral nucleic acids and has been used to treat HIV, it is also considered as a candidate drug for treating COVID-19, and has been pub4989/lished. This study is the first clinical trial for the treatment of COVID-19 published in the world’s top medical journal since the start of the outbreak. It is also one of the few clinical trials of a drug published during the outbreak of a new infectious disease, including SARS, in the last 20 years. The accompanying NEJM editorial hailed Chinese researchers as heroes for conducting rigorous clinical trials in the midst of such a difficult outbreak.

After a rigorous and scientific RCT study, it has been proved that this drug has a certain effect, but its effect is not significant. In terms of safety evaluation, the lopinavir/ritonavir group had a higher incidence of gastrointestinal adverse events. According to the results of this study, more than 40% of patients who received lopinavir/ritonavir did not have their viral nucleic acid turn negative after the 2 weeks of observation, suggesting that the antiviral effect of lopinavir/ritonavir may be limited or the course of the treatment is insufficient. On the other hand, the virus may be infectious for a long time. Some clinical observations have shown that the average time of virus turning negative is 20 days—not as short as we expected. Moreover, we initially observed that the nucleic acid turns negative after more than 30 days. In the future, detailed observations should be made, including multisite sampling, to see if viral nucleic acids persist for a longer time. This is the disease pattern that we need to understand further. Does the course of lopinavir/ ritonavir treatment need to be extended? An extension may be necessary until viral nucleic acids become negative. According to data from the clinical study, lopinavir/ritonavir is effective, has some side effects, but can be tolerated; in addition, the course of the treatment may need to be longer.