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COVID-19 - Prevention and Treatment

Published on Aug 31, 2020 and last reviewed on May 03, 2021   -  16 min read

Abstract

This article includes the various vaccines and medicines under trial to prevent and treat COVID-19. Also, read about the preventive tips.

Contents
COVID-19 - Prevention and Treatment

To date, there are no approved vaccines or medicines that can prevent or cure COVID-19 (Coronavirus Disease-2019). The best we can do to prevent this infection is by following strict hand hygiene and maintaining social distancing. Clinical management includes infection control and supportive care. Earlier this week, it was announced that Dexamethasone reduces the mortality rate in critically ill patients. This new finding has made doctors across the globe to consider a change in treatment protocols.

There was a lot of hype surrounding the use of Hydroxychloroquine and Chloroquine for the treatment and prevention of COVID-19. But, FDA (U.S. Food and Drug Administration) removed the emergency use of these drugs on 15th June 2020. The FDA decided that the risks of using these drugs outweigh their benefits, and they were found to be an ineffective treatment for COVID-19.

We will be discussing ways to prevent infection caused by the new coronavirus (SARS-CoV-2) and various treatment options for COVID-19 symptoms. We have also listed ways to treat this infection at home and ongoing treatment and vaccine studies.

Understanding COVID-19:

The infection caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), which was first identified in Wuhan, China, is called COVID-19. This infection was previously referred to as the 2019 Novel Coronavirus (2019-nCoV) respiratory disease. The World Health Organization (WHO) then declared COVID-19 as the official name of this infection on 11th February 2020.

This new coronavirus belongs to the family called coronaviruses, which comprises other strains that result in the common cold to more serious infections like severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). Similar to these strains, SARS-CoV-2 also primarily affects and infects the respiratory tract. The severity of the infection can be mild to fatal. Most infected patients, about 81 %, show only mild symptoms. Only the rest 19 % of patients develop moderate to severe symptoms due to pneumonia and acute respiratory distress syndrome (ARDS).

Transmission of SARS-CoV-2:

The new coronavirus can spread from one person to another through:

  1. Large respiratory droplets or aerosols generated when an infected person sneezes, coughs, talks, sings, or drips.

  2. Kissing or shaking hands with someone who is infected.

  3. Touching your mouth, eyes, or nose after touching a contaminated surface.

Signs and Symptoms:

Dry cough, fever, and shortness of breath (breathing difficulty) are the most common symptoms of COVID-19. These symptoms can start between 2 and 14 days after exposure (incubation period).

According to research published in the Annals of Internal Medicine, the median incubation period (the period between exposure to the virus and the appearance of first symptoms) is said to be 5 days. Almost 98 % of infected individuals will develop symptoms before 12 days.

Another study suggests that a loss of smell and taste is an early sign of the new coronavirus infection. They also found that patients who developed loss of smell and taste before any other symptoms of COVID-19 usually suffered from mild infection.

On 27th April 2020, the CDC added six new symptoms, which include:

Risk Factors:

The CDC has included the following group of people in the list of people who are more prone to develop life-threatening complications if they get infected with the new coronavirus:

A recent study suggests that people who smoke may be more susceptible to this virus. Evidence also suggests that those who use e-cigarettes are at a higher risk of developing severe respiratory infections.

Preventive Measures:

As there are no vaccines or medicines available, avoiding exposure to the virus is the best way to prevent the spread of COVID-19. Some of the most effective preventive measures are:

What to Do If You Came in Contact With a COVID-19 Infected Person?

If you came in contact with a person who later tested to be COVID-19 positive, the best thing you can do is self-isolate yourself. Stay home, as it might take 2 to 14 days for you to show symptoms. So to prevent the spread, isolate yourself from others for 14 days.

What to Do If You Develop Symptoms of Influenza-Like Illness?

In case you develop fever, cough, or other mild symptoms of COVID-19, do not panic. People with mild symptoms have been known to get better at home. But, call and talk to your doctor, keep track of your symptoms, and look out for warning signs.

If you are sick and exhibiting symptoms of influenza-like illness, follow these steps to prevent the spread of the virus:

  1. Isolate yourself at home and avoid going out to public places, except for medical care.

  2. Take rest, and keep drinking water or fluids to keep yourself hydrated.

  3. For fever, you can take over-the-counter medicines like Paracetamol (Acetaminophen).

  4. Stay in a separate room, and do not come in contact with others at home.

  5. Use a separate bathroom if possible.

  6. Wear a face mask to cover your nose and mouth if you are around your caregiver and pets. You can choose not to wear a mask when you are alone.

  7. Keep taking your temperature and note down all the other symptoms.

  8. Cover your mouth and nose with a tissue when you sneeze or cough. Immediately throw away the tissue in a closed bin and wash your hands.

  9. Keep washing your hands with soap and water.

  10. Do not share personal items, such as your dishes, glasses, eating utensils, and bedding with people in your home.

You should stay away from others and isolate yourself for at least 10 days, beginning from the day of the first symptom.

When to End Self-Isolation or Self-Quarantine?

According to the CDC, people with COVID-19 symptoms can end self-isolation if:

  1. It has been 10 days since the first symptom.

  2. It has been 10 days since they were tested positive.

  3. No fever for 3 consecutive days without medications.

How Are COVID-19 Patients With Severe Symptoms Managed?

The treatment options for critically ill patients are:

When to Consult a Doctor?

If you or any of your relative shows the following signs and symptoms, seek immediate medical care:

Before visiting the hospital, call the hospital and inform them that you are bringing in someone with possible COVID-19 symptoms. Also, when you call for an ambulance, please notify the operator that you want emergency medical care for someone who may have COVID-19.

Approved Vaccines For COVID-19:

1. Moderna (National Institutes of Health) - It is a two-dose mRNA vaccine (mRNA-1273) that started testing in March 2020. This vaccination is given in 2 doses at a period of 28 days. In clinical trials, typical side effects were noted, which were only mild. These kinds of effects were noted in the first seven days after vaccination. The vaccines do not contain any live coronavirus, so it is impossible to develop COVID-19 due to a vaccination.

2. BioNTech, Pfizer, and Fosun Pharma - The pharmaceutical company Pfizer, in collaboration with BioNTech (a German biotech company) and Fosun Pharma, produced a two-dose mRNA vaccine (Tozinameran or BNT162b2). After administering this vaccine to adults on 9th November 2020, the company's data showed that the vaccine was 90 % effective. The FDA then reported that the Pfizer vaccine, after the first dose, gave some protection and almost full protection after the second dose on 8th December 2020, and on 11th December 2020, this vaccine was given the EUA by the FDA. Reports showed an allergic reaction in a healthcare worker. The usage of this vaccine is recommended in people who are over 16 years of age.

3.Gamaleya Research Institute - It is a Russian institute, which developed a vaccine (Sputnik V or Gam-COVID-Vac) that has two ingredients, a recombinant adenovirus type (rAd26) and type 5 (rAd5) vectors. In August 2020, the vaccine received a "conditional registration certificate." The ongoing clinical trial in Russia involves 40,000 volunteers, and clinical trials have been announced in the UAE, India, Venezuela, and Belarus. Phase I and II trials, found that the vaccine showed an immune response with mild side effects. The Sputnik V vaccine is 91.4 % efficient with mild side effects, and its vaccine efficacy against severe cases of Coronavirus is 100 %. After assuring all the safety standards, Data and Safety Monitoring Board (DSMB) recommended a shift to phase III from phase II. Phase III approval for conducting trials in India was approved recently. Sputnik V depends on the virus's genetic instructions for developing the spike protein. Sputnik V uses double-stranded DNA, unlike the Pfizer-BioNTech and Moderna vaccines, which build the instructions in a single-stranded RNA.

4. AstraZeneca and the University of Oxford (Covishield in India) - In April 2020, AstraZeneca and the University of Oxford announced the development of a recombinant adenovirus vaccine (AZD1222). It was based on a chimpanzee adenovirus that takes coronavirus proteins in the body. Phase III clinical trials began in Brazil, the U.S., and South Africa in August 2020. When a volunteer developed transverse myelitis (a spinal inflammatory disorder), the study was halted in September 2020. A week later, the trials restarted in the U.K. and Brazil, and the FDA authorized the U.S. trial to resume in October 2020. It was reported in November 2020 that the vaccine produced a strong immune response in a clinical trial involving participants over 70 years of age. But, the data released on 8th December 2020 showed that the vaccine was only 70% effective. The efficiency was identified to be around 62% when administered in two separate and full doses. An increase in efficiency up to 90% was achieved when the vaccine was given a half dose followed by a full dose. Leaving a more extended gap between the first and second doses improves the jab's overall effectiveness (it was seen in a sub-group who were given the vaccine this way), and it was observed to be 70% effective after the first dose.

5. Bharat Biotech, Indian National Institute of Virology, and Indian Council of Medical Research - The inactivated virus vaccine (BBV152 or Covaxin) produced by the Indian company Bharat Biotech in collaboration with the Indian National Institute of Virology began the phase III trial in October 2020. The report on Phase I trials showed the vaccine to be safe and produce antibodies against SARS-CoV-2. More than 26,000 participants were involved in phase III trials, and now Covaxin has been declared the first official vaccine in India. This whole virion inactivated COVID-19 vaccine candidate confirmed a temporary vaccine efficiency of 81% in its Phase 3 clinical trial. The trials comprised 25,800 subjects, the largest ever conducted in India, in conjunction with the Indian Council of Medical Research.

6.Sinovac Biotech - This is a Chinese company that developed an inactivated SARS-CoV-2 vaccine (CoronaVac). The phase III trials began in Brazil, Indonesia, and Turkey. The vaccine was granted emergency approval by the Chinese government for use on individuals at high risk of developing severe COVID-19 infection. The United Arab Emirates, which supported the Sinopharm vaccine earlier this month, said that the vaccine was 86% effective, according to interim results of its stage three trial. Sinovac said that the COVID-19 vaccine is safe in children between the ages of 3 to 17.

7. Wuhan Institute of Biological Products and Sinopharm- The vaccine BBIBP-CorV, an inactivated virus vaccine, is being tested by the Chinese company Sinopharm and developed by the Wuhan Institute of Biological Products. As the phase I clinical trial showed positive results, phase III trials began first in UAE and then in Morocco and Peru, which showed an efficacy of 86%. Bahrain and UAE have already approved the vaccine for use.

8. Johnson & Johnson - In February 2021, the U.S. Food and Drug Administration announced an emergency use authorization (EUA) for the third vaccine for the restriction of coronavirus disease 2019 (COVID-19) induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The EUA supports the Janssen COVID-19 Vaccine to be administered (single-shot) in the U.S. for use in people who are above 18 years of age. Thailand also cleared Johnson & Johnson's single-shot COVID-19 vaccine for local emergency use, the third manufacturer to win the approval.

Approved Medicines:

Approved Drugs for COVID-19:

Virafin, the antiviral drug from Zydus Cadila, a Cadila Healthcare Limited, received Emergency Use Authorization in India. The Drug Controller General of India (DCGI) granted the emergency use of Virafin in moderate COVID-19 infections as it reduces the use of oxygen demand. Virafin is a Pegylated Interferon alpha-2b (PegIFN), which is helpful in treating moderate COVID-19 infections in the adult. These interferons are said to be the first line of defense for our body as it fights against viral infections. Especially the production capacity of interferon-alpha in elderly people is reduced when subjected to viral infections, thus resulting in a higher death rate. Virafin is a safe drug, and we well know its safety profile as it is used in the treatment of chronic cases of hepatitis B and C. And now it is used in the treatment of moderate cases of COVID-19. It is said that a single subcutaneous dose of Virafin, when administered during the early stages of the disease, will help with reduced COVID-19 complications and with faster recovery to the patients. The drug reduces the multiplication of the virus on early administration and makes the treatment more convenient. Various trials of Virafin were conducted across India, and the results showed up with:

The International Journal of Infectious Diseases published the results of the phase 2 trial of the Virafin drug. Out of 20 participants who were under control arm and received standard of care, the clinical improvement was 68.42% on the 13 th day, and 19 people had further improvement (95%) on the 15th day. It was found that:

Phase 2 trial also resulted in mild adverse reactions. Phase 3 trial showed better clinical improvement in moderate COVID-19 cases as the drug reduced supplemental oxygen usage to 56 hours from 84 hours, and 91.15% of patients administered with the Virafin drug were RT-PCR negative by the 7th day.

Investigational Medicines:

At present, the FDA has not approved any drug for the treatment for COVID-19. Various studies are ongoing to understand the effectiveness of the following drugs:

  1. Dexamethasone - a steroid used to reduce inflammation and swelling in various conditions. Researchers at the University of Oxford found this drug to reduce fatality rates in critically ill COVID-19 patients (by 1/3rd). A moderate dose of Dexamethasone decreased the death rate of people hospitalized with COVID-19 on a ventilator and people taking supplemental oxygen but not on a ventilator.

  2. Hydroxychloroquine and Azithromycin - A study where 20 COVID-19 patients were given these drugs showed them to be virologically cured within 6 days. Clinical trials are going on.

  3. Hydroxychloroquine Sulfate - On 9th March 2020, the journal called Clinical Infectious Diseases suggested that Hydroxychloroquine (a malaria drug) effectively killed the coronavirus in lab experiments. After issuing an emergency use authorization (EUA) in March 2020, the FDA revoked the EUA on 15th June 2020.

  4. Ivermectin - a study conducted in Australia showed this anti-parasitic drug to be effective against SARS-CoV-2. Clinical trials are going on.

  5. Lopinavir, Ritonavir, and Oseltamivir - this combination of drugs is said to have helped an old Chinese woman to recover from severe COVID-19 pneumonia completely. But, a study presented in the New England Journal of Medicine showed no benefit.

  6. Interferon-beta-1a - a drug used in the treatment of multiple sclerosis.

  7. Bemcentinib - it has been reported to exhibit antiviral action against the Ebola virus, Zika virus, and other enveloped viruses. Its effectiveness in the treatment of hospitalized COVID-19 patients is in progress.

  8. Bevacizumab - studies to determine its effectiveness as a treatment for lung injury and acute respiratory distress syndrome (ARDS) in severely ill COVID-19 patients are ongoing.

  9. Colchicine - an anti-inflammatory drug, which is being studied in preventing COVID-19 complications in high risk patients.

  10. Favipiravir - an antiviral drug used as a treatment for influenza, is being used in clinical trials as a treatment for pneumonia caused by the new coronavirus.

  11. Fluvoxamine - This drug is previously used to treat people with obsessive-compulsive disorder. In mid-November 2020, a study with 152 participants stated that the medication is adequately easing symptoms of COVID-19. In early February 2021, a study showed Fluvoxamine could help prevent moderate COVID-19 symptoms from turning more dangerous.

  12. Kaletra - This is a combination of two drugs - Lopinavir and Ritonavir, that works against HIV. Clinical trials are done to understand whether this drug combo also fights against SARS-CoV-2. There have been mixed results.

  13. AT-527 - This drug was produced by Boston biotech Atea Pharmaceuticals and is being advanced in partnership with drugmaker Roche. Atea started a phase II trial in May 2020, examining the medication in people hospitalized with moderate COVID-19. The company intends to test the drug next year outside the hospital environment and test to see if it can work in people freshly endangered to the coronavirus.

  14. EIDD-2801 - This drug was designed by scientists at a nonprofit biotech company controlled by Emory University. Research in mice has revealed that it can decrease replication of multiple coronaviruses, including SARS-CoV-2. Pharmaceutical companies Merck and Ridgeback Biotherapeutics LP approved an agreement in May 2020 to improve this drug. In April 2020, a phase I trial of this drug began in the UK, which was followed by a phase II trial in July 2020. Unlike Remdesivir, EIDD-2801 can be administered orally, which would make it possible for a more significant number of people.

  15. Merimepodib (VX-497) - This is produced by ViralClear Pharmaceuticals Inc. This drug has been earlier shown to have antiviral and immune-suppressing results. It was tested on hepatitis C but had only moderate effects. A phase II trial of this drug was started, where people with severe COVID-19 will be given either Merimepodib with Remdesivir or Remdesivir with a placebo. This phase II trial was stopped in October 2020 over concerns about this drug’s security.

  16. Niclosamide - ANA Therapeutics began a phase II and III trial in October 2020 of oral Niclosamide, a drug used for years to treat tapeworms. Initial studies showed the drug to have antiviral and immune-modulating actions.

  17. Umifenovir (brand name Arbidol) - This antiviral was tested along with the drug Lopinavir/Ritonavir to treat COVID-19. In mid-April 2020, it was reported that this combination of drugs did not improve the outcomes for hospitalized patients with mild to moderate COVID-19. A July 2020 review of 12 studies showed that Arbidol did not improve people's results with COVID-19.

  18. Monoclonal Antibodies - Monoclonal antibodies trigger the immune system to combat the virus. Similar to antibodies produced by the body's immune system, these lab-made particles target a specific attacker, such as SARS-CoV-2. In late July 2020, researchers at Columbia University in New York published some immediate success in using a mix of antibodies like REGN-COV2, a neutralizing Antibody cocktail (passive vaccine), to treat COVID-19 patients. These antibodies were collected from people hospitalized with the SARS-CoV-2 infection. The drug mixtures experimented on human cells as well as hamsters. If proven reliable and practical, the antibodies would be given via blood transfusions to people who freshly contracted the virus.

  19. Apilimod: In late July 2020, Yale University published a trial with AI Therapeutics on a drug known as Apilimod. Yale officials said the medication had been proven reliable in managing autoimmune diseases and follicular lymphoma. They said primary research shows that Apilimod can prevent the cellular entry of the new coronavirus. The FDA has awarded the drug fast-track status.

  20. Arthritis Drugs: In early January 2020, hospital administrators in the United Kingdom announced that Tocilizumab and Sarilumab, drugs used to treat arthritis, can decrease the length of time spent in a hospital by ten days. They added that the two drugs could lessen the risk of death from COVID-19 by 24 percent for severely ill people with the disease.

  21. Blood Thinners. In mid-September 2020, U.S. researchers published that they had started two clinical trials to see at the occasion of utilizing blood thinners to treat COVID-19. In mid-February 2021, a study informed that blood thinners administered as a preventative treatment to a person within 24 hours of their hospitalization for COVID-19 overcame the disease's risk of death.

  22. Cannabinoid Drug ARDS-003. In mid-September 2020, officials at Canada-based Tetra Bio-Pharma stated that they had received FDA approval to begin a phase I trial of a synthetic cannabinoid drug to manage COVID-19. Company officials said that the medication might protect patients from ARDS, which is the frequent cause of death for people with severe COVID-19.

  23. Celltrion - This South Korean company began a phase III trial in October 2020 of its monoclonal antibody treatment, CT-P59. It is being tested in people who have been in close association with a person with COVID-19 to inspect whether the drug can prevent infection.

  24. Edesa Biotech Inc - This has received permission to perform a phase II trial of its monoclonal antibody drug, EB05. The company believes its medication could decrease the overactive immune responses correlated with acute respiratory distress syndrome.

  25. Eli Lilly - In early October, Eli Lilly announced that a new treatment comprising two antibodies revealed promising outcomes in reducing SARS-CoV-2 levels. The treatment was administered to people with COVID-19 who were not hospitalized.

Other drugs that are under trial or studied for its possible use against SARS-CoV-2 are Umifenovir, Tocilizumab, STC3141, Sarilumab, Baricitinib,EIDD-2801, Methylprednisolone, and Leronlimab. There are more than 20 vaccines that are under development, or human trials are ongoing.

THESE DRUGS ARE NOT APPROVED. AVOID SELF-MEDICATION.

Patients with mild to moderate symptoms can stay at home while their body fights this infection. Medical intervention and hospitalization are only required for people with severe symptoms.

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Last reviewed at:
03 May 2021  -  16 min read

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