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After a sobering experience seventeen years ago in the wake of the severe acute respiratory syndrome (SARS) epidemic, Yuen Kwok-Yung advocates an aggressive approach to hospitalization and treatment to minimize viral infections and deaths. Last Friday, Hong Kong recorded a death rate much lower than the global COVID-19 average of 2 percent. – gives weight to this method.
Most treatments for SARS-CoV-2 are approved for seriously ill patients, and some of these treatments are based on research that still raises questions. Yuen Kwok-Yung, a fifteen-year professor of infectious diseases at the University of Hong Kong, receives patients with minimal symptoms of the disease and seeks to be isolated, monitored and, if necessary, treated.
“In places like the UK and the US, when you usually have mild symptoms, no one is hospitalized at all – you just have to wait at home and you will only be hospitalized if you are feeling very bad or short of breath.” he explained via Zoom from his office.
“But we usually go to the hospital and isolate patients, even those with almost no symptoms. This strategy slows the spread of the virus in society and allows patients to participate in a clinical trial and receive experimental treatment immediately as soon as there is fever or other signs of deterioration, ”said Yuen Kwok-Yung.
According to him, this is very important because the amount of SARS-CoV-2 virus or “viral load” in the patient’s body reaches a peak at the time of the onset of symptoms, similar to influenza.
Yuen Kwok-Yung, who graduated from the University of Hong Kong in 1981 and who, as a rare that specializes both in microbiology and as a surgeon and physician-therapist, has been at the forefront for a decade as the city has to respond outbreaks of infections.
In 1998, he and his colleagues described the first 10 patients with the H5N1 strain of bird flu. Five years later, they recorded SARS for a patient who visited Hong Kong from Guangzhou, China.
Photo by Yuen Kwok-Yungas, microbiology.hku.hk
Yuen Kwok-Yung recalls the entire process at the time and the mistakes involved in rescuing patients from SARS, as well as the coronavirus caused. Some time later, he identified a “targeting bomb” linked to environmental and social conditions that he predicted would inevitably trigger outbreaks of an even more devastating coronavirus.
And the prophecies came true in December when the first cases of mysterious pneumonia became apparent in Wuhan, Hubei province, China. Hong Kong has responded to the new coronavirus by preparing tests and advising citizens to wear masks.
Meanwhile, Yuen Kwok-Yung’s lab conducted research that helped herald the first group among family members when the first person-to-person transmission of the new coronavirus occurred. In February this year, he joined a joint mission of the World Health Organization (WHO) and China to investigate the country’s initial response; Since then, his lab has reported a number of important findings, including the first confirmed recurrence of SARS-Co-V-2.
Frustration lesson
“All this, our experience during 2003. The continuation of the SARS pandemic, said Yuen Kwok-Yung.” We have nothing to boast about, because we learned a lot from SARS in 2003. “
The emergence of an unknown virus to which no one has immunity has raised the urgent need to develop an effective treatment. Hong Kong doctors are using several experimental therapies, including treating coronavirus-infected patients with plasma and injection of interferon, an immune system protein. They also use the antiviral drugs ribarivine and Kaletra, although a preliminary WHO-led study involving 11,266 patients from 30 countries, published Thursday, found that the drugs did not reduce patient mortality. According to Yuen Kwok-Yung, he is not surprised by the results of the WHO study, as the drugs were not prescribed to patients immediately after the illness.
“No antiviral medication will help if it is given to the patient too late,” he said. Also, the drugs were given separately, one at a time, not as a combination of several drugs to enhance the effects, he said.
“Minimum active”
“We know that one drug is not suitable because they are all minimally active on their own,” said Yuen Kwok-Yung. “We need a primary cocktail therapy to get good results.”
In the first week of treatment, the combination of ribavirin, Kaletra, and interferon helped clear the infection in six days and reduce hospital stays for a full week, compared to Kaletra alone, Yuen Kwok-Yung and colleagues reported in his May study.
The trial, published in the medical journal The Lancet, involved 127 patients between February 10 and March 20, more than half of the COVID-19 cases reported in Hong Kong during this period. Patients started treatment approximately five days after the first symptoms appeared.
“Before the flashback of the 2003 SARS pandemic, the majority of COVID-19 patients in Hong Kong agreed to be treated with antiviral drugs, which explains why so many people were asked to participate in the trials,” Yuen wrote. Kwok-Yung and his team. . Sixteen years ago, he and most members of the same group demonstrated that ribavirin and the Kaletra “cocktail” prevented severe illness and death in SARS patients.
Researchers from Saudi Arabia announced in early October that Kaletra, administered in combination with interferon, had helped hospitalized patients survive an epidemic of coronavirus infection in the Middle East respiratory syndrome. The greatest effect was felt when treatment was started one week after the onset of the first symptoms, the authors said, emphasizing “the significant effect of switching to treatment time on mortality.”
Interferon reaction
There is growing evidence that the use of interferon in the early phase of the disease is crucial for some patients. Studies published in the journal Science in September showed that about 14 percent of COVID-19 patients with severe conditions have insufficient amounts of this substance to “perform” a defense against viral pathogens.
If the body elicits an adequate interferon response when the “viral load” is low, subsequent replication of the virus may be limited and meningitis can be prevented, Yuen Kwok-Yung said. But a delayed or delayed response from interferon to high levels of the virus can cause a lot of damage to the lungs.
“It’s a real disaster,” he said. As a result, interferon injections become the “backbone” of primary therapies.
Some doctors outside of Hong Kong agree with Yuen Kwok-Yung’s approach. Early use of antiviral drugs can suppress the viral load in the blood and prevent a severe hyperinflammatory reaction that can occur in some patients in the second week of illness, said Richard Russell, a pulmonologist and senior clinical research specialist in the Department of Medicine of Naffield of the University of Oxford, who also 19 patients.
Yuen Kwok-Yung’s strategy highlighted how a variety of antiviral drugs can be adapted for other purposes and used in conjunction with immunomodulatory drugs as a linker until vaccines with protective effects are available, said Steven Opal, professor of clinical medicine at Brown University. in Providence. , Rod Island.
In June, dexamethasone, a cheap, generic anti-inflammatory drug, was found to reduce deaths by almost a third among COVID-19 patients undergoing mechanical ventilation. An Oxford University study confirmed what Yuen Kwok-Yung observed in a study of SARS patients in 2003: that the drug can suppress a hypersensitive immune response, sometimes called a cytokine storm, in patients who feel ill and show signs of inflammation.
Dexamethasone and remdesivir, developed by Gilead Science Inc., help patients in the later stages of the disease, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “One important thing we need to achieve is more intervention in the early stages of infection so that as few people as possible need hospitalization,” he said in an interview with the American Lung Association in October.
Antibodies that are specifically designed to fight the coronavirus can also help, Fauci said. The president of the United States, Donald Trump, when he was diagnosed with a coronavirus in early October, linked his recovery to the experimental combination of the two antibodies from Regeneron Pharmaceuticals Inc.
Leprosy medicine
Yuen Kwok-Yung’s team is also investigating clofazimine, an inexpensive antibacterial drug discovered 50 years ago that is on the WHO list of essential drugs against leprosy and its potential. Experiments in hamsters have shown that this drug can defeat SARS-CoV-2 and prevent infection.
Hong Kong has responded to COVID-19 with extreme urgency and determination, particularly on the “legacy” of SARS, Yuen Kwok-Yung said. He hopes that others will learn from the current crisis and realize the importance of being prepared for future pandemics and mitigating their risks.
“It was the experience of 2003 that allowed us to advance earlier,” said Yuen Kwok-Yung. “I hope the whole world realizes this time that more and more new infectious diseases can be expected from now on.”
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