As Viktor Maleev, adviser to the Research Institute of Epidemiology of Rospotrebnadzor, told RBC, effective means have not yet been created in the world and doctors use combinations of existing ones to treat coronavirus. The Ministry of Health specified which ones in the list of recommended drugs. These included hydroxychloroquine, interferon, lopinavir and ritonavir.
At the beginning of September, the Ministry of Health released the updated, eighth version of recommendations for the prevention, diagnosis and treatment of the new coronavirus infection COVID-19. Available infographics are published on the ministry’s website.
As experts note, the drugs umifenovir and recombinant interferon alpha (IFN-α) can be used to prevent coronavirus. After contact with someone infected with SARS-CoV-2, you should take hydroxychloroquine.
The material was commented on and checked by Natalya Valerievna Polenova, candidate of medical sciences, family doctor, cardiologist, pediatric cardiologist, nutritionist at GMS Clinic.
What we know about COVID-19
COVID-19 is an infectious disease caused by the coronavirus SARS-CoV-2. Discovered in China at the end of 2021, by May 15 it had infected 4.4 million people worldwide. Most of those with symptoms complain of fever, cough and difficulty breathing. Special medications and vaccines against COVID-19 have not yet been developed. However, virologist and head of the MIPT genome engineering laboratory Pavel Volchkov said that the first effective cure for coronavirus infection may appear in the fall.
In general, the Ministry of Health recommends the use of six drugs to treat coronavirus. these are favipiravir, remdesivir, umifenovir, hydroxychloroquine, azithromycin and interferon alfa.
Hydroxychloroquine and mefloquine
Doctors have been using drugs based on chloroquine for more than 70 years to treat malaria and autoimmune diseases (for example, systemic lupus erythematosus). Scientists have found that the active substance is also effective against the SARS-CoV-2 virus. In March, the Chinese holding Shanghai Pharmaceuticals provided Russia with the drug hydroxychloroquine (a derivative of chloroquine) for the treatment of COVID-19. The Ministry of Health did not identify any contraindications and allowed its use, donating more than 68 thousand packages to hospitals, despite the fact that hydroxychloroquine is not registered in Russia.
Scientists are still arguing about the validity of using hydroxychloroquine. Research by French infectious disease specialist Didier Raoult showed positive results. But the Associated Press published data from American studies. An analysis of medical records of patients treated with the drug showed that hydroxychloroquine was less effective than standard treatments.
In April, the Federal Medical and Biological Agency of the Russian Federation conducted clinical trials of mefloquine (an analogue of hydroxychloroquine approved in Russia). Scientists found out how effective and safe this antimalarial drug is. According to preliminary data from a study involving 347 patients, after using mefloquine, positive dynamics were noted in 78% of cases. The FMBA will provide its final conclusions at the end of May.
How I received treatment
And so it began. One tablet per day, preferably at the same time, with plenty of water. According to the instructions, side effects could appear in the first week of treatment: headache, rash and itching, fatigue and a few other non-serious symptoms. But according to my doctor, none of her patients have encountered them.
And I didn’t feel anything at all. I swallowed the pill like a piece of chalk, following a signal on my phone, and forgot about the treatment for a day. There were so many new sensations that, closer to the two-week mark, the thought began to itch: “Have they really been bred into a dummy?”
Two weeks later I went for the first control test. There are several of them: after 2, 4, 12 weeks, and then, after the end of treatment, after six months and a year. I took a qualitative PCR test, a test that determines the presence of a virus in a blood sample. It is the fact of presence itself, and not its quantity. I would like to note right away that I took all the control tests at my own expense in commercial laboratories, since I did not officially undergo treatment and there were no grounds for prescribing tests under the compulsory medical insurance contract. Depending on the laboratory and current promotions, I paid from 500 to 700 RUR for each sample.
The doctor explained that the first test, two weeks after the start of treatment, can be either positive or negative. The analysis after four weeks should already be negative, like all subsequent ones. If not, you need to supplement the treatment regimen or interrupt it.
And now my first two weeks are over. I really hoped that I would receive confirmation that everything was not in vain. But the analysis turned out to be positive. And although I knew that the virus could still be detected at the first cutoff, after this result I began to openly worry about success. The next two weeks were the hardest. I still spent hours taking pills, dieting, giving up alcohol completely, and dreading the next test. And finally he waited.
For the first time in 17 years, the test did not detect HCV in my body. My “everything is lost” mood instantly changed to “hurray, we are breaking, the Swedes are bending.” And although I knew that sometimes the virus returns several months after treatment, it was at that moment that I believed that everything would work out for me. I already automatically took the therapy and did not feel any side effects. At the end of the course, the test again did not detect the virus in my blood.
The course ended, and I began to get used to living without hepatitis. I still couldn’t believe that the once incurable disease was gone. And I felt that I had left for good, even though there were still two control tests ahead.
By the first half of the year without hepatitis, I began to feel the effect of the treatment. The bitter taste in my mouth stopped bothering me. The feeling of bloating in the right hypochondrium disappeared, sleep improved, and performance increased. I had one last control test left to say with a clear conscience: I had cured hepatitis C.
This is how my epic with the treatment of hepatitis C ended. The legacy of the disease left antibodies in my blood, which are now always with me. Therefore, now it makes no sense for me to carry out ELISA - an antibody test to diagnose hepatitis - and doctors need to be warned about this. At the same time, despite the presence of antibodies, after treatment, immunity to the virus is not developed, so I can catch this infection in the second round. There are also problems with the gallbladder - cholecystitis has not disappeared. But you can live with it, it can be treated, and you can’t infect anyone with it.
My first positive test after two weeks from the start of treatment
The first “minus” four weeks after the start of treatment
12 weeks from the start of treatment - no virus detected
Six months after treatment: still no virus
A year after treatment - no virus, hurray!
Lopinavir and ritonavir
A combination of antiviral drugs called kaletra is used to treat HIV. According to WHO, the use of the drug in combination with other medications is effective in the fight against coronavirus. At the end of January, the Ministry of Health included lopinavir with ritovinar in the list of drugs recommended for COVID-19 as antiviral therapy. As a result, the demand and sales of kaletra increased tenfold. Experts warn that uncontrolled use of the drug without a doctor's prescription can cause harm to health, including diarrhea and liver damage.
Chinese scientists have found that lopinavir and ritonavir are not effective in treating mild to moderate COVID-19. Taking medications does not improve the clinical picture; moreover, it may cause side effects. The experiment involved 86 patients, of which 34 people took a combination of lopinavir and ritonavir, and 17 patients did not receive any drugs. After two weeks, both groups showed similar results, but those taking the medications experienced side effects.
Types of medications for fever
There are four groups of antipyretics:
- With paracetamol as an active ingredient. The substance belongs to non-narcotic painkillers. It affects the production of prostaglandins, therefore it can reduce fever and pain. It does not have a damaging effect on the gastrointestinal mucosa and has a weak anti-inflammatory effect. A safe dose for adults is 4 g per day.
- With ibuprofen, which has a triple effect - relieves pain, relieves fever, fights inflammation. The effect lasts for 8 hours, after administration the effect begins within 30 minutes. It is one of the safest NSAIDs, but may have a negative effect on the gastrointestinal tract. The maximum amount for adults is 1.2 g per day.
- With acetylsalicylic acid. A less popular group, not prescribed to children under 12 years of age, can cause bleeding and erosion of the digestive organs.
- With a combined composition including paracetamol and ibuprofen. Such drugs have less toxicity and enhanced effect.
- Based on analgin. They have analgesic, anti-inflammatory and antipyretic effects. Children in the form of candles are allowed to use from 1 year. Side effects may cause allergies.
Remdesivir
Remdesivir is used to treat Ebola fever. Canadian scientists from the University of Alberta have found that the drug blocks the reproduction of coronavirus. Studies have proven the effectiveness of the antiviral agent in the treatment of MERS respiratory syndrome and SARS-CoV, the RNA structure of which is similar to coronavirus. Virologists obtained identical results in the case of SARS-CoV-2, which causes COVID-19, and concluded that remdesivir could be used for treatment. The New England Journal of Medicine also published the results of a study in which the use of the drug improved the condition of 68% of patients. Japanese Prime Minister Shinzo Abe said in parliament on April 28 that he plans to authorize the use of remdesevir to treat COVID-19. In the United States, the drug was successfully tested, and on May 2, the Department of Sanitary Inspection issued an emergency permit for its use.
APN01
The Austrian biotechnology company APEIRON Biologics AG has begun clinical trials of the drug APN01, which was developed in the early 2000s. Scientists have discovered that the ACE2 protein, which is part of it, suppresses infections caused by viruses of the SARS group. It also helps protect the lungs during respiratory failure.
The authorities of Austria, Germany and Denmark agreed to conduct clinical trials of the drug. During the study, 200 patients with COVID-19 will receive APN01. Then virologists will evaluate the effect of the drug, and also analyze its effectiveness and safety for patients who require artificial ventilation.
Ribavirin
It is quite difficult to assess the effectiveness and safety of ribavirin. On the one hand, this drug inhibits the reproduction of the vast majority of viruses, on the other, the mechanism of action of ribavirin is not fully understood. At the end of January, the Ministry of Health recommended the use of this antiviral drug to treat coronavirus. It is prescribed to children for respiratory syncytial infection (a rare type of acute respiratory viral infection), which causes severe lung damage. The drug is used for severe influenza, for measles in children with immunodeficiency, and in combination with interferon ribavirin to treat viral hepatitis C.
However, Academician of the Russian Academy of Sciences Alexander Chuchalin criticized the recommendations of the Ministry of Health. When prescribing the drug to adults, it is necessary to take into account its teratogenicity (threat of disruption of embryonic development), therefore ribavirin is strictly contraindicated during pregnancy. Despite the fact that the drug inhibits the reproduction of many viruses, it is very toxic and causes many side effects.
At the end of March, the Ministry of Health excluded ribavirin from the list of recommended drugs for the treatment of COVID-19.
Interferon preparations for the prevention of coronavirus
Another group of drugs that can be offered to prevent respiratory infections, including COVID-19, are interferons. The activity of parenteral interferon alpha-2a has been demonstrated against MERS-CoV, the coronavirus that causes severe Middle East respiratory syndrome, an outbreak of which was reported in 2012 [5]. The effectiveness of interferon has also been studied during SARS infection: studies published in 2009 confirmed that interferon alpha promotes the production of its own interferon, the production of which is blocked by coronavirus [6].
The domestic temporary recommendations of the Russian Ministry of Health on COVID-19 describe the intranasal administration of a solution of recombinant interferon alpha for the prevention of the disease in both children and adults, including pregnant women, as well as the treatment of mild forms in patients under 60 years of age without concomitant chronic diseases [1 ].
The mechanism of the antiviral and immunomodulatory action of interferons is based on the ability to prevent viral infection of cells and suppress viral replication. In addition, interferon alpha enhances the phagocytic activity of macrophages and increases the secretion of antibodies.
What can you offer?
As drugs to enhance the immune response, including during the COVID-19 pandemic, nasal drops or a nasal metered spray of interferon alfa-2b can be recommended.
What should you tell the buyer?
Preparations of human recombinant interferon alpha-2b have antiviral and immunomodulatory properties and are used for the prevention and treatment of acute respiratory viral infections. They are usually well tolerated and are approved for adults, including pregnant and lactating women, and children, including young children.
Therefore, during a pandemic, it is advisable to prevent COVID-19 disease with interferon alpha-2b preparations. If necessary (for example, if the pandemic drags on), the preventive course can be repeated.
Bibliography:
- Prevention, diagnosis and treatment of new coronavirus infection [COVID-19]. Temporary guidelines. Version 5
- Zhang J. et al. Therapeutic and triage strategies for 2019 novel coronavirus disease in fever clinics //The Lancet Respiratory Medicine. 2020
- Khamitov RA, Loginova S, Shchukina VN, Borisevich SV, Maksimov VA, Shuster AM. Antiviral activity of arbidol and its derivatives against the pathogen of severe acute respiratory syndrome in the cell cultures. Vopr Virusol 2008
- Zhou P. et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin //Nature. 2020
- Omrani AS et al. Ribavirin and interferon alfa-2a for severe Middle East respiratory syndrome coronavirus infection: a retrospective cohort study //The Lancet Infectious Diseases. 2014
- Kuri T. et al. Interferon priming enables cells to partially overturn the SARS coronavirus-induced block in innate immune activation //The Journal of general virology. 2009; 90 : 2686
- Jin YH et al. A rapid advice guideline for the diagnosis and treatment of 2021 novel coronavirus (2019-nCoV) infected pneumonia (standard version) //Military Medical Research. 2020
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Ivermectin
Australian scientists from Monash University and the Royal Melbourne Hospital have discovered an antiparasitic agent that virtually destroys the SARS-CoV-2 virus within 48 hours, reducing its presence by 99%. According to researchers, the use of ivermectin will help avoid severe complications of COVID-19, as well as prevent the spread of the virus. During the experiments, ivermectin was added to cells infected with SARS-CoV-2. After 24 hours, the proportion of viral RNAs decreased by 93%, and after 48 hours, the presence of the virus decreased by 99%.
A single treatment with ivermectin can reduce the virus by 5 thousand times in 48 hours, scientists say. The drug is approved by WHO.
How do antiviral drugs work?
Once in the body, the virus enters the cell and begins the production of viral particles. When the concentration of viruses reaches a critical value, they come out, infect other cells, and thus the cycle repeats. Drugs that fight viruses act at different stages of this cycle. Some prevent the virus from entering healthy cells, while others destroy the viral particles themselves, blocking their production and exit from infected cells.
Also, some drugs aimed at fighting viruses can activate the body’s own antiviral defense system by increasing the production of interferon, thereby strengthening the immune system and helping to cope with the virus.
The drug against viral diseases that is closest to ideal is capable of influencing both the stages of viral development in cells and stimulating the body’s own immune activity. The medicine should be convenient and easy to take. It is also good if the medicine is suitable for the treatment and prevention of the entire family, including children, adults and the elderly. And, of course, such a drug should have a minimum number of contraindications.
Nelfinavir
Nelfinavir is used in combination with other antiviral drugs to treat HIV. The study was carried out by Japanese scientists. According to the data obtained, the drug is able to block the reproduction of SARS-CoV-2. Virologists studied nine similar drugs and found that nelfinavir is effective even in small doses. Therefore, it is recommended to include it in the list of potentially effective drugs for the treatment of COVID-19.
What to do while there is no vaccine
- wear medical masks when visiting public places;
- on the street and in crowded places, maintain a distance of at least 1.5 m from others;
- avoid contact with people who have been exposed to the virus;
- stay at home if possible;
- wash your hands thoroughly with soap;
- use a disinfectant with an alcohol content of at least 60%;
- do not touch your face;
- monitor hygiene in the house.
Expert commentary
What medications, besides antiviral drugs and antibiotics, are recommended for the treatment of COVID-19 by the Russian Ministry of Health?
According to the eighth version of the resolution “Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)” of the Ministry of Health of the Russian Federation, patients infected with the SARS-CoV-2 virus should receive pathogenetic and supportive symptomatic therapy if necessary. The first group of drugs includes, first of all: glucocorticosteroids (GCS), interleukin inhibitors (tocilizumab, canakinumab), anticoagulants (enoxaparin, fraxiparin).
Glucocorticosteroids are able to prevent the release of cytokines, substances responsible for the development of a violent inflammatory reaction, which can lead to a very dangerous complication “cytokine storm”. GCS may be useful in the treatment of severe forms of COVID-19 to prevent irreversible tissue damage and uncontrolled multiple organ failure.
It should be noted that for mild to moderate severity of the disease, that is, for patients not receiving oxygen, GCS are not indicated. So there is not the slightest need to buy hormones from pharmacies for use at home.
Drugs from the group of cytokine inhibitors are used when the lung parenchyma is damaged by more than 50%, that is, stage CT-3, CT-4 in combination with signs of increasing intoxication: long-term fever, very high levels of inflammatory markers in the blood.
In groups of patients at high risk of thrombus formation, for the prevention of so-called coagulopathies, it is advisable to prescribe anticoagulants used subcutaneously. Evidence of the effectiveness of oral anticoagulants for COVID-19 is not yet sufficient, however, if the patient was taking them before the disease, the drug should be continued until then. High-risk groups include patients with cardiovascular pathology, diabetes, and obesity.
How is symptomatic treatment of coronavirus carried out?
Drugs for symptomatic treatment of COVID-19 include antipyretic drugs, antitussive drugs that improve sputum discharge. Paracetamol is recognized as the safest antipyretic drug.
There is no need to wait until a certain level of fever is reached before using an antipyretic drug. In the presence of headache and muscle pain, poor tolerance to symptoms of intoxication and fever, it is possible to use drugs even at a relatively low body temperature.
What can you take to prevent coronavirus?
The most important characteristics of a diet that helps strengthen the immune system are: adequate daily calorie intake, sufficient intake of protein and a number of micronutrients, especially vitamin C, D, A, iron and zinc, increased intake of dietary fiber and, if necessary, probiotics, maintaining water balance. According to the clinical recommendations of the Russian Association of Endocrinologists, to prevent vitamin D deficiency in adults aged 18-50 years, it is recommended to receive at least 600-800 IU of the vitamin per day. People over 50 years old - at least 800-1000 IU of vitamin D per day.
There are some indirect indications of zinc's potential antiviral effect against COVID-19, although their biomedical relevance remains to be explored. Based on recent data on the clinical course of the disease, it appears that zinc may have protective effects against COVID-19 by reducing the incidence of pneumonia, preventing ventilator-induced lung injury, and improving antibacterial and antiviral immunity, especially in older adults.
Ascorbic acid (vitamin C, AA) takes part in such vital physiological processes as hormone production, collagen synthesis, stimulation of the immune system, etc. The latter effect can be due to both the direct antiviral effect of AA and its anti-inflammatory and antioxidant properties.
Mechanisms of action of antipyretic drugs
The main effect of antipyretic drugs is to lower the thermoregulation set point in the hypothalamus, a region of the brain that regulates all human life processes. This leads to a decrease in heat generation and increased heat transfer through the skin, after which the fever disappears. The effectiveness of drugs depends on the dose of the drug and the rate of its absorption in the intestine. As a rule, the higher the readings on the thermometer, the greater the reduction caused by the medicine.
However, no drugs that fight fever can affect the causes that caused it. Such drugs by themselves, without combined use with antiviral drugs, do not reduce the total duration of the febrile period during ARVI, but, on the contrary, lengthen the period of virus clearance. Uncontrolled use of antipyretic drugs in young children adversely affects the development of the immune system, since the drugs inhibit the natural anti-infective defense.
Do I need to take an antipyretic at a temperature of 38
Very often, parents try to stop a child’s fever even when the thermometer reading is far from 38 °C. Pediatricians often prefer to play it safe by prescribing antipyretic drugs to a child without good reason. Experts say that in this way they are trying to prevent the development of seizures in the child. Doctors also refer to the need to eliminate discomfort associated with fever. Although children, especially young children, experience discomfort much less often than adults, and with a thermometer reading of about 38 ° C they can behave quite actively.
Adults use antipyretic medications in an attempt to avoid what they perceive as complications. Also, many people see antipyretics as a panacea that will help them recover faster and return to their normal lifestyle. But actually it is not. All types of drugs that fight fever do not shorten the period of illness. And if used incorrectly, they can harm the health of both children and adults.
Contraindications and side effects of antipyretics
The most common side effects after taking antipyretic drugs: allergic reactions, nausea, abdominal pain, erosions and ulcers of the gastrointestinal mucosa.
Among the main contraindications of antipyretic drugs: individual intolerance, exacerbation of gastric and duodenal ulcers. Some substances to which you are not intolerant can be given by injection by your doctor.
Important information
- Elevated body temperature is a protective reaction of the body; it is permissible to reduce it only according to indications. If your health is good and the child and adult do not have chronic diseases, you should not rush to take antipyretic drugs.
- First of all, the safety of antipyretics and the correct dose are important. You should not try to take several tablets at once, even if taking the drug is justified by the patient’s condition. Most often, to improve the condition, it is enough to reduce the readings by 1-1.5 °C. Start with the lowest possible dose of medication.
- Antipyretic drugs should never be taken for more than three days without consulting a doctor.
- If the readings on the thermometer reach 40 °C or higher in an adult, you need to call an ambulance and not take anything yourself. A small child may require immediate medical attention if the readings are above 38.5 °C.
