Mosial due to coronavirus: 92% of 70-year-olds will survive even without HELLAS treatment

The course of treatments against the new coronavirus pandemic is mentioned in a new post on Facebook by Elias Mosialos, Professor of Health Policy at the London School of Economics.

Among other things, Mr. Mosialos emphasizes that the best possible management will be needed in the Intensive Care Units (ICU), while also referring to dexamethasone and monoclonal antibodies, a treatment that structurally recognizes the virus and prevents its adherence. to cells.

At the same time, the LSE professor emphasizes that the vast majority of 70-year-olds (more than 92-93%) will escape even without treatment for the coronavirus, citing the case of Donald Trump as an example.

Elias Mosialos’ post in detail:

News on the evolution of treatments: ICU management, dexamethasone and monoclonal antibodies.

You may recall that I mentioned in January that due to the lack of treatment approaches and the distance that separates us from vaccines, public health interventions would buy us valuable time. Because, to defeat the pandemic without sacrificing human lives, we will need an arsenal of pharmacological interventions and the best possible management in the ICU.

Let’s evaluate the course of these months and see where we are now with coronavirus treatments.

Several studies focused on coronavirus mortality in ICUs have shown that there has been a great advance in hospital management compared to the first period. In May, total mortality in the ICU had fallen by almost 10% compared to March (DOI: 10.1111 / anae.15201). Gradually, it became clear from the result that a better choice could be made as to who needed oxygen only and who should be intubated and mechanically ventilated. Furthermore, in ICU patients who were in critical condition, the anterior position appeared to further improve oxygenation of the lungs by increasing ICU treatment and discharge rates.

The rapid publication of clinical results – and therefore the dissemination of experience – has led to better management of patients in the ICU and, ultimately, to a reduction in hospital mortality in critical cases. This percentage reduction varies depending on the period of time in which the pandemic “hit” each country.

Subsequently, there was a greater reduction in mortality in the ICU. Specific studies on the use of anti-inflammatory drugs have shown that corticosteroids, such as dexamethasone, administered orally or intravenously, reduce mortality by almost 20% in people who need oxygen and by almost a third in those who need respiratory treatment . support (DOI: 10.1056 / NEJMoa2021436).

Dexamethasone is a very powerful drug and can save patients who are in a very serious or critical condition, where tissues such as the cardiovascular system or the lungs can be very inflammatory. In the UK, the use of a lower dose of dexamethasone in children will be studied in the context of large trials (recovery trials). Therefore, we await results for dexamethasone from more comparative studies.

At the same time, for the management of patients we have the use of remedisivir, which does not help to reduce the mortality of hospitalized patients, but it does show a moderate reduction in hospital stay. This is also important, as discharge from hospital beds also helps to better manage the pandemic.

But now we have newer ones for the category of therapies, called monoclonal antibodies, that are undergoing clinical trials for both prevention and treatment. The use of monoclonal antibodies is an expensive treatment and its production takes a long time, so remember that initially we will have a small number of doses available.

How do they work; They structurally recognize the virus, prevent it from adhering to cells, that is, they do not allow the virus to infect cells, and then inactivation of the virus by the immune system begins. Several companies are developing new monoclonal antibodies to neutralize the coronavirus and 4 are already in phase III clinical trials.

So what do these first results show by listing the companies in alphabetical order?

• AstraZeneca has developed AZD7442, a long-acting antibody (LAAB), and will conduct two phase III clinical trials in more than 6,000 participants within and outside the United States. LAABs are designed to increase resistance to treatment for six to 12 months after a single administration.
• An interim analysis of Eli Lilly’s BLAZE-1 clinical trial showed that combination therapy with two of the virus’s neutralizing antibodies (LY-CoV555 and LY-CoV016) reduced viral load, symptoms, and even intake, and even in the emergency unit. The randomized (double-blind) study positively evaluated the administration, for the treatment of symptomatic COVID-19 and the management of outpatients.
• GSK / Vir also launched the COMET-ICE Phase II / III trial of VIR-7831, which will enroll approximately 1,300 patients worldwide and explore the drug as a way to prevent hospitalization of high-risk people affected by coronavirus. This study will evaluate the ability of VIR-7831 to prevent serious illness in high-risk people. According to preclinical tests, the antibody showed a high degree of potency to neutralize resistance to coronavirus and the immune response to kill infected cells.
• Regeneron announced the first data from a small descriptive analysis of a Phase 1/2/3 Seamless test of the REGN-COV2 cocktail. Treatment has been shown to reduce viral load and the time to relieve symptoms in non-hospital COVID-19 patients. REGN-COV2 has also shown positive trends in reducing medical visits.

So if monoclonal antibodies prove through randomized clinical trials in the coming months that they work effectively, they will also be considered as prophylactic treatment. That is, they will be tested in healthy people but at high risk of getting sick because they work in a healthcare setting or have been exposed to infected people.

So the news is encouraging, but it takes moderate optimism and not over-optimism. President Trump, who has neither research nor clinical training, said he escaped because he was given the monoclonal antibodies. However, we do not know if this is true because dexamethasone and remedisivir were administered at the same time. Also, none of these drugs can be responsible for recovery. In other words, they may not have had any effect on the president.

Why am I saying this?

Because there is a false impression that if you are seventy you are doomed to die if you contract a coronavirus. But this is not true. The vast majority of people in their 70s (over 92-93%) will survive even without treatment. If they were all presidents of the United States and had the care of the current president of the United States, the percentage of those who would survive even without drugs would be higher.

So how do we finally evaluate the course of these months?

We knew from the beginning that effective hospital management, drugs and vaccines had to be added to public health interventions. In March we started building a wall. The wall to imprison the coronavirus, not us.