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SARS veterans urge early treatment of Covid-19 to save patients’ lives

Yuan Kai

Photographer: Isaac Lawrence/AFP, Getty Images

Hong Kong’s top epidemiologists believe that intensive care of tens of thousands of Covid-1

9 patients is a way out: let them avoid getting into the first place.

After a thought-provoking outbreak of severe acute respiratory syndrome 17 years ago, Yuan Guorong advocated early active hospitalization and treatment to minimize serious illness and death.Hong Kong’s As of Friday, the Covid-19 mortality rate is 2%, which is well below The global average helps this method.

Most therapies for SARS-CoV-2 have been approved for severely ill patients, and in some cases are supported by research. Professor Huo Wen F of the University of Hong Kong has been a professor of infectious diseases for 15 years. recognitionIsolate the least ill patients so that they can be isolated, monitored, and treated when needed.

“In places like the UK and the US, usually if you have mild symptoms, you won’t recognitionGo to the hospital completely-you just have to wait at home feel Very bad, or you are short of breath,” he explained on Zoom in the office. “But we basically recognition Any patient, even if there are not too many symptoms, must be sent to the hospital for isolation. “

Yuen said that this strategy reduces the spread in the community, allowing patients to enter clinical trials and receive experimental treatment soon after they have a fever or show other signs of worsening disease. This is critical, because when a patient has symptoms, the number of SARS-CoV-2 virus or “viral load” peaks at the peak of symptoms, similar to flu.

Microbiologist, surgeon, physician

Yuan Graduated from the University of Hong Kong in 1981 as a microbiologist, surgeon and physician. This is a rare achievement that has been at the forefront of the city’s response to infectious disease outbreaks for decades. In 1998, he and his colleagues Describes the first patients with the H5N1 avian influenza strain.Five years later, they SARS was reported in a patient who visited Hong Kong in Guangzhou, China.

Yuen recalled the trial and error of saving SARS patients caused by the coronavirus. Soon after, he discovered “He predicted that the “time bomb” will inevitably lead to a more deadly coronavirus outbreak.

The forecast was realized in December, when A mysterious pneumonia was discovered in Wuhan, Hubei Province, China. In response to the new coronavirus, Hong Kong has prepared tests and advised citizens to wear masks.

At the same time, ongoing research in Yuen’s laboratory has led to This is the first report of human-to-human transmission of the new coronavirus between family members. In February, he joined the WHO-China joint mission to investigate the country’s early response. Since then, his laboratory has reported many important findings, including the first confirmed SARS-CoV-2 Re-infection.

Hard lesson

“All of this is an extension of our 2003 experience,” Yuen said. “We have nothing to brag about because we learned a bitter lesson from SARS in 2003.”

There is an urgent need for an effective treatment method. No one is immune to the emergence of this unknown virus.Hong Kong doctors are using several experimental infusions, including Convalescent plasma-a mixture of factors extracted from the blood of recovered patients-and interferon (an immune system protein).

They also use the antiviral drugs ribavirin and caletra, Preliminary results released on Thursday A trial led by the World Health Organization involving 11,266 patients in 30 countries found that these trials did not reduce patient deaths. Yuen said he was not surprised by the results of the WHO study because these drugs were not taken immediately after the patient fell ill.

He said: “If you are late, antiviral drugs will not work.” He said that these drugs are also used alone, rather than in combination, which may increase its impact.

“Moderately active”

Yuen said: “We know that a drug is not good because all these drugs have very low activity.” “We need early cocktail therapy to achieve good results.”

Compared with Kaletra alone, the combined use of ribavirin, Kaletra and interferon in the first week of the disease can reduce the time to clear the virus by six days and shorten the length of hospital stay by one week. Study in May.

The trial, published in the medical journal The Lancet, recruited 127 patients from February 10 to March 20, accounting for more than half of the Covid-19 cases reported in Hong Kong during that period. Treatment started about five days after the patient developed symptoms.

Yuen and his team wrote: “To commemorate the SARS pandemic in 2003, most Covid-19 patients in Hong Kong received antiviral treatment, which explains our high recruitment rate.”

Sixteen years ago, Yuan and many people came from the same group The results show that ribavirin and Kaletra cocktails can prevent severe illness and death in SARS patients.Saudi Arabian researchers said earlier this month that Caletra had given interferon It also improves the survival rate of hospitalized patients with Middle East respiratory syndrome caused by the coronavirus. The authors say that when treatment is started within one week of the onset of symptoms, the effect is greatest, noting that “the impact of important treatment time on mortality.”

Interferon response

There is increasing evidence of early use of interferon in some patients. A blockbuster study published in Science magazine last month showed that about 14% of key Covid-19 patients have insufficient levels of this substance in their bodies to resist viral pathogens.

Read more: Doctor Covid finds a turning point in life-threatening cases

If you sit well Yuen said that when the viral load is low, the interferon response limits subsequent viral replication and prevents dangerous inflammation. However, the late or delayed response of interferons to high viral loads may cause severe lung damage. He said: “This is really catastrophic.” This makes interferon injections the backbone of early treatment.

Some doctors outside Hong Kong also agreed with Yuan’s treatment. Richard Russell, a respiratory physician and senior clinical researcher at Oxford University Newfield, said that early use of antiviral drugs can suppress viral load and prevent some patients from experiencing severe high inflammation in the second week after illness. . Studies are also conducted on Covid-19 patients.

Yuen’s strategy has pointed out that there may be multiple antiviral drugs Steven Opal, a clinical professor of medicine at Brown University in Providence, Rhode Island, said the drug can be repurposed and cooperated with immunomodulatory drugs until a protective vaccine is obtained.

Dexamethasone is a cheap general anti-inflammatory drug, The study found that among Covid-19 patients who received mechanical ventilation in June, the number of deaths decreased by nearly a third. A study by the University of Oxford confirmed Yuen’s observations of SARS patients in 2003: The drug can calm the immune overreactions of worsening patients showing signs of inflammation, sometimes called a cytokine storm.

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