COVID-19 Treatment & Prevention

 We are experiencing a global war with one common enemy COVID-19 – Coronavirus. We need to collaborate to find the Covid-19 Treatments that are proving to be most effective. All of the scientists, not only from the US and western hemisphere but Asia as well. Particularly China and South Korea have enormous knowledge and experience as they seem to have put a lid to the spread of the disease. They definitely have tremendous wisdom, obtained from their trial and error‘s, their ability to not only halt the progress of the coronavirus but effectiveness.

Looking at them and the effectiveness of the treatments they have tried is key. This is not the time for China and the US to fight. Politicians need to put aside their egos for the leadership of the world. President Trump and President Xi Need to consult the scientists and doctors to share the knowledge about the cures and prevention of the spread of the virus. This is of paramount importance.

Humility goes a long way, it’s very disappointing that we have not received any guidance from South Korea either. They are supposed to be our allies. Finally, we are delighted to note the FDA has approved Hydroxychloroquine & Remdesivir after weeks of recommending these drugs. The time is now to take swift and decisive action to help heal the world. In the US this treatment needs to be broadcasted to World Leaders and the WHO as the first line of defense until a more effective treatment is recognized and until the revolving spread can be contained. 

The diagnostic criteria follow the Protocol for the Diagnosis and Covid-19 Treatment. A confirmed case is based on epidemiological history (including cluster transmission), clinical manifestations (fever and respiratory symptoms), lung imaging, and results of SARS-CoV-2 nucleic acid detection and serum-specific antibodies. 

Prof. Tingbo LIANG is the Chairman of The First Affiliated Hospital, Zhejiang University School of Medicine. Below you will find some notes from the handbook he has written on the prevention and covid-19 treatment information. It is highly recommended you download the handbook below and read through from a doctor who has been at the forefront of this fight since the spread in China.

Clinical Classifications: 

1.   Mild Cases 

The clinical symptoms are mild and no pneumonia manifestations can be found in imaging. 

2.   Moderate Cases 

Patients have symptoms such as fever and respiratory tract symptoms, etc. and pneumonia manifestations can be seen in imaging. 

3.    Severe Cases 

Adults who meet any of the following criteria: respiratory rate; 30 breaths/min; oxygen saturations; 93% at a rest state; arterial partial pressure of oxygen (PaO,)/oxy- gen concentration (FiO,) s; 300 mmHg. Patients with> 50% lesions progression within 24 to 48 hours in lung imaging should be treated as severe cases. 

4.    Critical Cases 

Meeting any of the following criteria: occurrence of respiratory failure requiring mechanical ventilation; the presence of shock; other organ failures that require monitoring and treatment in the ICU. 

Critical cases are further divided into early, middle and late stages according to the oxygenation index and compliance of the respiratory system. 

• Early-stage: 100 mmHg <oxygenation index s;lSO mmHg; compliance of respiratory system ;;,30 m l/ cmH,O; without organ failure other than the lungs. The patient has a great chance of recovery through active antiviral, anti-cytokine storm, and supportive treatment. 

• Middle stage: 60 mmHg < oxygenation index s;lOO mmHg; 30 mL/cmH,O > compliance of respiratory system ;;el 5 mL/cmH,O; may be complicated by other mild or moderate dysfunction of other organs. 

• Late-stage: oxygenation index s; 60 mmHg; compliance of respiratory system <15 mL/cmH,O; diffuse consolidation of both lungs that require the use of ECMO; or failure of other vital organs. The mortality risk is significantly increased. 

Antiviral Treatment for Timely Elimination of Pathogens With Regards to Covid-19 Treatments

Early antiviral treatment can reduce the incidence of severe and critical cases. Although there is no clinical evidence for effective antiviral drugs, currently the antiviral strategies based on the characteristics of SAR-CoV-2 are adopted according to Protocols for Diagnosis and Treatment of COVID-19: Prevention, Control, Diagnosis, and Management. 

1. Antiviral Covid-19 Treatment 

At FAHZU, lopinavir/ritonavir (2 capsules, po q12h} combined with arbidol (200 mg po ql 2h) were applied as the basic regimen. From the treatment experience of 49 patients in our hospital, the average time to achieve a negative viral nucleic acid test for the first time was 12 days (95% Cl: 8-15 days). The duration of negative nucleic acid test results (negative for more than 2 times consecutively with interval<! 24h} was 13.5 days (95% Cl: 9.5 – 17.5 days). 

If the basic regimen is not effective, chloroquine phosphate can be used on adults between 18-65 years old (weight<! so kg: 500 mg bid; weight ~so kg: 500 mg bid for first two days, 500 mg qd for following five days). 

Interferon nebulization is recommended in Protocols for Diagnosis and Treatment of COVID-19. We recommend that it should be performed in negative-pressure wards rather than general wards due to the possibility of aerosol transmission. 

Darunavir/cobicistat has some degree of antiviral activity in viral suppression test in vitro, based on the treatment experience of AIDS patients, and the adverse events are relatively mild. For patients who are intolerant to lopinavir/ritonavir, darunavir/ cobici- stat (1 tablet qd) or favipiravir (starting dose of 1600 mg followed by 600 mg tid) is an alternative option after the ethical review. Simultaneous use of three or more antiviral drugs is not recommended. 

2. The Course of Covid-19 Treatment 

The treatment course of chloroquine phosphate should be no more than 7 days. The treatment course of other regimens has not been determined and is usually around 2 weeks. Antiviral drugs should be stopped if nucleic acid test results from sputum specimens remain negative for more than 3 times.