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What will be the longer term impact of COVID on the future of health care? People often say to me that the answer to new viral pandemics is to develop vaccines.  This is clearly nonsense since it takes months to develop a vaccine, months more to test, years to vaccinate the world at vast cost, and the vaccine itself may not produce long term immunity, or may be overtaken by new mutations.

That is why for two decades now I have been warning of the need to develop next-generation antivirals.

We still don't have a single antiviral today that is as powerful and effective as penicillin was against bacteria when first discovered over 80 years ago.

But one benefit of vaccines is buying us time to learn about new viruses so we can reduce death rates with better therapy.

What we have learned about treating COVID-19

Research falls mainly into three areas: antivirals, immune modulators and drugs to prevent blood clotting.  Here are some examples - this area of medical research is growing at astonishing speed.

Thousands of clinical trials are under way, many reporting some early findings that are promising but yet to be proven in impact or safety.

Aspirin

Low dose (75mg) seems to reduces the risk by over 40% of someone with COVID-19 being admitted to hospital or going on a ventilator. Aspirin helps prevent widespread clotting of small blood vessels which is a common complication. Published research in Anaesthesia and Analgesia 17 March 2021.

Dexamethasone

It's been estimated that by March 2021, over a million lives had been saved in intensive care units of people very sick with COVID-19. Dexamethasone dampens down the immune response which can go into overdrive in the second week or beyond, after the first phase of infection ends.  NHS UK announcement 23 March 2021.

Tocilizumab

Saves an extra 1 in 25 people who are given dexamethasone for severe COVID-19 illness. RECOVERY trial in UK - preliminary results announced 11 February 2021.

Budesonide 

Pulmicort, manufactured by AstraZeneca for asthma patients - appears to reduce risk of ending up in hospital by 90% if you become infected by COVID-19. Oxford University research - preliminary results announced 9 February 2021

EXO-C24

Experimental Phase 1 clinical trial drug - Israel research - suggests that 95% of patients are cured of COVID-19 inn a few days.  Exosomes are packed with CD24 particles which are inhaled straight into the lungs where they damp down cytokine storms (immune over-reaction).  Preliminary annoucement 8 February 2021.


Drugs being investigated include:


Antivirals

Remdesivir

Chloroquine/hydroxychloroquine

Lopinavir/ritonavir combination

Favipiravir

Umifenovir

Ribavirin

EIDD-2801

Niclosamide

Oseltamivir

Ivermectin


Immune modulators

Dexamethasone

Hydrocortisone

Convalescent plasma

Budesonide (inhaled)

AZD7442

Azithromycin

Doxycycline

Interferons

Tocilizumab

Sarilumab

Canakinumab

Anakinra

Baricitinib

Ruxolitinib

Acalabrutinib

Brensocatib

Ravulizumab

Gemtuzumab ozogamicin

Namilumab

Infliximab

Adalimumab

Otilimab

Medi3506


Antiviral antibody cocktail

Leronlimab

LY-CoV555

LY-CoV016

Risankizumab

Lenzilumab

IMU-838


Other or multiple mechanisms

Colchicine

Dimethyl fumarate

Angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers

Statins

Aspirin

Clopidogrel

Anticoagulants

Bemcentinib

Omeprazole

Famotidine

Zilucoplan

Ascorbic acid/vitamin C

Vitamin D3

Aviptadil

Opaganib

Tradipitant

AZD1656

Nitric oxide

Razuprotafib

Fluvoxamine

Proxalutamide



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