Wednesday, October 20

Even with vaccines, we still need treatments for Covid. So what works? | Coronavirus

Vaccines may have been described as the great escape route from the Covid pandemic, but treatments, which are reducing death rates, will be needed more than ever in the age of injections because the virus is not expected disappear in the foreseeable future. , the experts say.

“It’s going to take a long time to vaccinate the world,” said Peter Horby of Oxford University, lead investigator of the Covid treatments recovery trial and chair of the New and Emerging Respiratory Virus Threat Advisory Group (Nervtag). “I don’t know what the estimates are, but we’ve already seen issues with scaling up manufacturing and difficulties in delivering to scale.

“In addition to that, there are failures in vaccines, there is an interval between vaccination and protection when it can be infected, a proportion of people do not get a good response to vaccines or get sick and that can be especially true in the elderly who they are particularly vulnerable. And now you have the tension variation. “

Professor Martin Landray, co-chair of Recovery, said that both vaccines and treatments are of vital importance. Putting one on top of the other is a bit like saying “if you don’t want your house to catch fire or burn, because you have all the fireproof materials you don’t need firefighters,” he said. “We are going to have to receive treatments. And when you are sick, whether you have been vaccinated or not, being told that prevention is better than cure is not really very helpful. “

Efforts to find new treatments that will save lives are steadily gaining ground, they said. “Things are really coming out now. Obviously steroids are the most important, but since then there has been more and more positive news, ”said Horby.

It was Recovery which showed that the cheap and widely available steroid dexamethasone saved the lives of one in eight seriously ill people on ventilators in hospitals. In July, Horby and others published an article showing that 12,000 lives in the UK and 650,000 worldwide could be saved by January through the widespread use of dexamethasone. The drug is now a standard treatment for those who use ventilators.

“I think an article … to be published soon estimates that more than half a million lives were saved,” he said.

There is other evidence that more people are recovering. An article in the journal Anesthesia shows that, globally, death rates in intensive care have steadily declined. At their highest, they were close to 60% at the end of March. “Overall, mortality in all studies is lower until the end of September (35.5%) than when we reported this until the end of May (41.6%),” say the researchers, led by Professor Tim Cook of the Royal United hospital in Bath. .

They credit steroid use, changes in the way Covid patients receive oxygen and fluid therapy, and how the risk of blood clots is managed.

Colchicine is the latest drug to produce exciting results, according to Horby. It is used to treat inflammation and pain in people with gout on the NHS; Another example, Horby notes, of a drug that is cheap, safe, taken by mouth, and readily available. A Canadian study of 4,000 outpatients stopped too early to be sure of the effects, but showed a 20% lower risk of hospitalization or death. So far, Recovery has recruited 6,000 hospital patients for its trial of the drug.

There are enough positive results from monoclonal antibody studies to keep people from getting seriously ill, he said, although there are concerns about the effectiveness of drugs against variants of the virus. A trial of Recovery of tocilizumab, a monoclonal antibody given to patients with rheumatoid arthritis, has shown a benefit and will be reported in a few weeks.

Landray said that monoclonal antibodies were vulnerable to changes in the virus. “If there’s variation in that part of the spike protein, these things just don’t stick at all. It’s like having the wrong screwdriver for the screws. It just doesn’t work. And so in the future, in terms of drug development, we will have to think very carefully, “he said. It would probably mean that drug developers would have to select different antibodies to keep up with mutations, adjusting drugs as we may need to adjust vaccines.

Medications to prevent blood clots look promising. Clotting is a big problem in severe Covid as a result of inflammation, which was initially a surprise. “We have aspirin in the trial, so I’m pretty excited because it will be another dexamethasone if it works, cheap and cheerful,” Horby said.

In January, a trial in the US reported that the full dose of heparin, an anticoagulant, given to people who were moderately ill in hospital reduced the likelihood that they would need ventilation and life support.

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