Corona Virus Treatments

Since The pandemic influenza outbreak of 1918, Corono Virus, COVID19( coronavirus disease) caused by novel severe respiratory syndrome coronavirus (SARS-COV-2) represents the greatest global health crises and challenges to scientists to investigate potential therapies for COVID-19. It is an unprecedented challenge to discover or identify effective drugs for prevention and treatment for this infection. This novel coronavirus belongs to a family of coronaviruses including SARS and MERS. This virus is similar to severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus(MERS-CoV). Based on its genetic proximity it is considered to likely originate from bat corona viruses spread through the unknown intermediate host to mammal causing it to be endemic first then epidemic and finally pandemic. Below are some Corona Virus Treatments aka Covid 19 Treatments.

Pathophysiology

Nasal and paranasal cavities are recognized as a major role in disease transmission and symptoms propagation. At the initial 1 to 2 days virus attached to nasal cavity and replication of virus starts, ciliated epithelium of nasal mucosa is primary cells infected in conducting airways. Recent studies have shown that the virus utilizes its S1 spike glycoprotein, which resides in the virus' envelope, for attachment to and infection of host target cells. Infection by COVID 19 is likewise dependent on two host proteins for cellular entry and infection. Angiotensin‐converting enzyme 2 (ACE2) serves as the cell surface receptor for SAR‐CoV‐2, which binds to the S1 spike glycoprotein and is required for cellular entry of the virus through endocytosis. A second protein, known as transmembrane protease serine 2, it is a protease that resides in the endosomal compartment and is required for priming/cleavage of the S1 spike glycoprotein, which then allows fusion of the viral envelope with the endosomal compartment (with the introduction of the viral contents, including genetic material, into the cytoplasm of the host target cell).

After a few days virus propagates and migrates down the respiratory tract and triggers the host’s immune system. For about 80% of the infected patients, the disease will be mild and mostly restricted to the upper and conducting airways. These individuals may be monitored at home with conservative symptomatic therapy.

Unfortunately, 20% of patients will progress to develop pulmonary infiltrates and developed very severe disease.

Treatment

Clinicians need accurate evidence regarding effective medical treatments for this infection. For centuries so many pandemics have affected the world like cholera polio, measles influenza, etc but none of them exist too long. Either vaccines controlled them or they lost their virulence after a particular time hence becoming pandemic to epidemic to endemic.

Because there are no proven effective therapies for this virus currently exist. Number of drugs until expanding knowledge can be potential targets but still, no one is approved by US food & drug authority and currently, they are in ongoing randomized trials. This COVID-19 pandemic represents the greatest global health crises, the speed and volume of clinical trials launched to investigate therapies for this disease should produce high-quality evidence during pandemic no therapies found to be effective to date.

More than 300 active clinical trials are underway. This literature review regarding major purposive treatment provides a summary of current clinical experiences for this novel pandemic.

Agents used to treat SARS & MERS are potential targets against this disease while results with influenza and HIV have also shown effectivity for some patients. There are no clear benefits to any specific regimen. Below are the published clinical experiences of some drugs with promising results.

CHLOROQUINE AND HYDROXYCHLOROQUINE

China reported the use of chloroquine successfully in almost 100 patients but still, there is no high-quality evidence regarding therapeutic efficacy against COVID-19 .chloroquine and hydroxychloroquine are used for decades for treatment and prevention of malaria also it has effectiveness against rheumatoid arthritis and systemic lupus erythematosus. It appears to block viral entry into host cells also these agents have immunomodulatory effects for reducing cell autophagy and lysosomal activity thus preventing cytokine storm which is a major cause of death in critically ill and ventilated patients in most of the cases it improves radiological findings viral clearance and reduced disease progression.

ANTIVIRALS

A combination of ritonavir/lopinavir is used for HIV in very limited clinical studies it is found to be reduced mortality and intubation rates in patients it showed its effectiveness in the early period of infection i.e. 7 to 10 days while delayed therapy has no clinical outcome.

Umifenovir is a promising antiviral agent for influenza that is currently approved by China and Russia to treat influenza. this agent is of more interest to treating COVID-19 based on data for treating SARS. with limited clinical experience in China, Umifenovir was associated with an increased discharge rate and lower mortality rates.

NITAZOXANIDE

Nitazoxanide, an antihelminthic, has broad antiviral activity with an increased safety profile. It has in vitro activity against MERS and SARS-CoV-2. Due to its antiviral effects and safety profile, it warrants further study for treatment options for SARS-CoV-2.

REMDISIVIR

Remdisivir’s first clinical use was for EBOLA however it has also shown its effectiveness for COVID-19 its clinical trials regarding safety and efficacy are ongoing.

FAVIPIRAVIR

Limits viral replication. It has broad antiviral activity and its most preclinical data derived from influenza and ebola activity. Limited clinical experience is reported supporting the use of favipiravir for COVID-19 and needs further investigation for the treatment of COVID-19 

SUPPORTIVE TREATMENTS

Due to the lack of proven medicines the care for corona patients remains with supportive care from symptomatic outpatient till full intensive support among these corticosteroids, immunomodulatory and immunoglobulins are the mainstay of treatment.

Corticosteroids decrease the host's immune response and prevent lung failure and acute respiratory distress but its adverse effects must be considered before its rationale use including delayed viral clearance hyperglycemia psychosis and no improved survival in SARS and MERS.

Immunomodulatory agents or monoclonal antibodies are key for survival and prevent a potent host’s immune response that is cytokine storm. Tocilizumab is used with an improvement rate of 90 percent in just one dose.

Immunoglobulins are another potential adjunctive therapy to treat corona patients with the plasma of recovered patients.