After the vaccine, the Tour of the Treatments arrives against the Covid-19

Each COVID-19 infection is a double challenge. The Coronavirus succeeds if it exceeds the barrier of our defenses and comes out of our body or modified by the

After the vaccine, the Tour of the Treatments arrives against the Covid-19

Each COVID-19 infection is a double challenge. The Coronavirus succeeds if it exceeds the barrier of our defenses and comes out of our body or modified by them. Meanwhile, we face a lottery we play without seeing what number we wear. Although there are risk groups, we do not know if we will pass the disease without problems or leave us sequels (in the form of persistent Covid), we will survive through the hairs or die.

With the vaccines the panorama that is drawn is another well different. The immunized are barely complicated or a fatal outcome is unlikely. But the rules of the game are still the same. The virus is not forbidden to mutate, human diversity constitutes its training camp, the vaccine does not prevent 100% contagion or at present at all. There are still exhaust pathways. Scientists know it and watch them. As an example, today we have what has meant the origin of omicron and the tsunami that is assuming to face a new pathogen of the family of SARS-COV-2.

Some point with atomic resolution microscopes to each of their molecules. Others track their genetic sequence to locate mutations. Pharmaceuticals rehearse different remedies, while medical personnel applies in hospitals authorized by drug agencies to heal. At first they worked blindly. Today, the therapeutic arsenal against Covid's disease provides its fruits.

We have vaccines, anti-inflammatory, anticoagulants, antivirals. But not all options are good for some patients and not everyone responds the same. By age or by previous pathologies, some people do not generate antibodies even if they are vaccinated. In addition, the virus has a cycle and, as in all illness, it is not the same to take it on time to do it later.

Hence the search for new drugs for different cases and moments: for newly infected patients, when they develop serious illness or when their options are exhausted. "There are four pillars in the treatment of Covid: oxygen, anti-inflammatories, anticoagulation and antivirals," said José Ramón Arribas, head of the Internal Medicine Section of the University Hospital La Paz (Madrid) and expert. The Spanish Society of Infectious Diseases and Clinical Microbiology.

SARS-COV-2 constitutes a coronavirus that causes acute respiratory syndrome. Infected through the respiratory tract. In a first phase (up to sixth day) the virus is multiplied. "In the second phase, inflammation of lungs predominates," explains Arribas.

"When the patient goes wrong, inflammation prevents from absorbing oxygen". According to its evolution, the battle for oxygenation is climbing, the nasal goggles will first be placed, then it will go to non-invasive ventilation or by intubation and as a last resort will come mechanical ventilation.

The first effective drug against Covid's disease that hospitals had was an anti-inflammatory. "Dexamethasone," says Arribas, a steroid that "decreases inflammation in the lung". It is located in the list of recommendations of the World Health Organization (WHO) in hospitalized patients who need oxygen. If they do not improve, the next anti-inflammatory would be tocilizumab.

Another complication that develops in SARS-COV-2 infection is produced by the immune system by activating blood coagulation. At this point, there is therapeutic arsenal to deal with this new sequel. In this case, anticoagulant therapy is launched, such as heparin, which prevent thrombi to form and unleash cerebrovascular and cardiological complications. Therefore, the treatment also applies preventively in risk patients.

As for antivirals, given that the virus responsible for the infection, SARS-COV-2, is multiplied until the seventh day after the infection, the first week is crucial and by very promising that these drugs are, its effectiveness is Limited to a concrete temporary window, so in the end it becomes a career to counterreloj. Therefore, early detection plays a crucial role. «We recommend starting the antiviral in the first 48-72 hours, because if it is no longer effective," he warns Arribas.

The first antiviral employee in our hospitals was the remadesivir (developed by Gilead Sciences). "It is more effective as soon as possible the patient is administered," he emphasizes Arribas. It applies to hospitalized patients with symptoms of less than seven days, intravenously. At present, the Gilead Science Laboratory works in the development of its oral form.

Expectations are in what is already reached, the oral antivirals MOLNUPIRAVIR (from Merck) and Paxlovid (from Pfizer). They have a primary characteristic, they are attributed to them the condition that they are presumably sterilizing as manufacturers announce. What does this mean? They are capable of stopping viral replication, "could avoid transmission from the virus," says Arribas.

In this way, the first MOLNUPIRAVIR data points out that the fifth day of treatment does not grow viruses in patient crops. And, over, Paxlovid is a viral protease inhibitor, a type of effective drug in HIV.

Being oral, they are presented in the form of a tablet, their price will be affordable and its administration will not require a hospital as an intermediary. But still "it is important that they take right in the first days when the disease be cured, which requires that they are very accessible, that if you start with symptoms you can go to the physician fast, who do the test at once and that you It takes it as soon as possible, "says Arribas.

Not all vaccinates produce antibodies and according to what pathologies the vaccine is discouraged. With age, the immune system ages and is not as effective as before, as in immunosuppressed people, whose body's defensive assets offer little resistance, which causes the virus to have a window of more time to replicate and variants arise with many Mutations At present, the best example illustrates omicron.

For both situations, they are put into practice through the treatments as the conveynce plasma (with antibodies of people who have exceeded the disease), beneficial in the first days but not in the form of severe Covid.

In these cases, monoclonal antibodies are also found as the therapeutic option, which are allocated for those people with risk factors or poor prognosis of infectious disease (immunosuppressed, diabetes, cardiopathies). When "these individuals are infected early, they need a treatment that prevents from progress infection," says Rafael Cuervo, GSK's medical officer in Spain of Covid-19 treatments.

Generated in a laboratory from the most effective antibodies produced by patients who exceed Covid's disease, this kind of artificial defenses of the organism are "directed against specific antigens and could help our immune system stop diseases such as Covid And its variants, "says Cuervo. Its administration would be intravenous and less affordable as an oral antiviral, but it is possible to "provide immediate immunity that can work in hours or days, instead of weeks", an important time in these groups of patients.

Updated Date: 07 December 2021, 15:55

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