Ιατρικές κατακτήσεις στ θέμα τ Covid-19 (μια ιστορική αναδρομή έως τ Μάρτιο 22)

[Argirios Argiriou]

Αντιγράφω και μεταφράζω στα Αγγλικά από το εβδομαδιαίο Σουηδικό Ιατρικό Περιοδικό (Läkartidningen 31/03/2022):

CARE AND TREATMENT OF COVID-19

First wave 2020

Abdominal position: Placing patients with respiratory failure in the abdominal position - or protruding sideways - to facilitate oxygenation is a method that began to be used more widely in the late 1990s. Abdominal position for covid patients was started by the healthcare staff already during the first wave, and it turned out to work both outside and on ICU. In ordinary wards or in intermediate care, these patients have often also had a supply of oxygen through a high-flow halter. Patients with these needs usually receive abdominal position therapy for at least 16 hours a day.

Oxygen: Many patients cared for covid-19 have problems with oxygenation. When the usual oxygen treatment (low flow) is not sufficient, treatment with a so-called high-flow halter - a device that makes it possible to give patients a maximum flow of oxygen - can be started. The high-flow halter is moistened so that patients do not become dry or sore in the airways.

Coagulation prophylaxis: For patients with severe covid-19, there is an increased risk of blood clots. Anticoagulants are used prophylactically to reduce that risk.

First and second wave 2020

Cortisone treatment: Cortisone preparations are used when the disease has entered the inflammatory phase, and reduce care time and risk of mortality. Such preparations began to be used in the care of seriously ill covid patients already during the first wave. In June 2020, the large Recovery study in the UK also confirmed that treatment with the corticosteroid dexamethasone improves covid-19 survival.

Second wave 2020/2021

Antiviral drugs: Antivirals can reduce the amount of virus in the body if they are used early in the course of the disease. In this way, the disease can be alleviated. The antiviral drug Veklury (remdesivir) became the first with demonstrated clinical effect against covid-19, and on 3 July 2020, the Swedish Medicines Agency granted a conditional approval.

Vaccines: The first mRNA vaccines - Pfizer / Biontech and Moderna - were approved by the EMA, the European Medicines Agency, in December 2020 and January 2021. The vaccination campaign in Sweden began at the end of the second wave. Later, two virus vector vaccines from Astra Zeneca and Janssen were also approved - however, these are no longer used in Sweden, following reports of severe side effects.

Third wave 2021

Monoclonal antibodies: Monoclonal antibodies (mab) are laboratory-produced proteins that prevent the virus from entering the cells and slow down the virus' growth. Five antibody treatments are currently approved by the EMA. They are mainly given to patients with weakened immune systems. As recently as last week, Evusheld (tixagevimab / cilgavimab) was approved by Astra Zeneca. The drug consists of two long-acting monoclonal antibodies that can also be used as preventive treatment.

Third and fourth wave

Anti-inflammatory drugs: JAK and IL-6 receptor inhibitors against rheumatism have also been used during the pandemic in addition to cortisone. The WHO began recommending such in the latter part of 2021. Several studies have shown that these drugs can shorten the duration of illness and reduce mortality. One hypothesis is also that the drugs may reduce the overreaction of the immune system during the inflammatory phase in severely ill covid patients.

New antivirals: There is now also a new antiviral drug from Pfizer: Paxlovid (nirmatrelvir / ritonavir), against covid-19. It is approved by EMA, but is not yet available in Sweden. Another new antiviral, Lagevrio (molnupiravir), has been developed by Merck and is under review by the EMA. The new antivirals should be taken within five days after the onset of symptoms.

New vaccine: The new protein-based vaccine from Novavax was approved by the EMA in December 2021 and is now used in Sweden. To date, there are five covid-19 vaccines that have been approved by the EMA. In Sweden, only the two mRNA vaccines and the recently approved protein vaccine are used. Pfizer / Biontech and Moderna are working to develop modified vaccines that are adapted to new virus variants.

Sources: National Care Program for covid-19; Magnus Gisslén, Sahlgrenska University Hospital; Skåne University Hospital; EMA

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