The COVID-19 Treatment Landscape: A South African Perspective on a Race Against Time

Abstract

The pandemic caused by SARS-CoV-2 has infected more than 94 million people worldwide (as of 17 January 2020). Severe disease is believed to be secondary to the cytokine release syndrome (CRS or “cytokine storm”) which causes local tissue damage as well as multi-organ dysfunction and thrombotic complications. Due to the high mortality rates in patients receiving invasive ventilation, practice has changed from “early-intubation” for acute respiratory distress syndrome (ARDS) to a trial of non-invasive ventilation (NIV) or high flow nasal cannula (HFNC) oxygen. Reports indicating the benefit of NIV and HFNC have been encouraging and have led to more than 20,000 such devices being manufactured and ready for roll-out in South Africa (SA) as of July 2020. The need to identify drugs with clear clinical benefits has led to an array of clinical trials, most of which are repurposing drugs for COVID-19. The treatment landscape reflects the need to target both the virus and its effects such as the CRS and thrombotic complications. Conflicting results have the potential to confuse the implementation of coordinated treatment strategies and guidelines. The purpose of this review is to address pertinent areas in the current literature on the available medical treatment options for COVID-19. Remdesivir, tocilizumab, and dexamethasone are some of the treatment options that have shown the most promise, but further randomized trials are required to particularly address timing and dosages to confidently create standardized protocols. For the SA population, two healthcare sectors exist. In the private sector, patients with medical insurance may have greater access to a wider range of treatment options than those in the public sector. The latter serves >80% of the population, and resource constraints require the identification of drugs with the most cost-effective use for the greatest number of affected patients.

Uso De Anticorpos Monoclonais Por Pacientes Com Covid-19 Interfere Na Concentração Sérica De Angiotensina Ii?

“…A partir dos resultados obtidos nesse estudo, foi possível perceber que grande parte dos anticorpos monoclonais têm seu mecanismo de ação centrado no combate aos efeitos inflamatórios exacerbados que decorrem da resposta imunológica intensa, a qual é protagonizada pelas citocinas inflamatórias. No entanto, nem todos os anticorpos analisados possuíam uma ação inativadora direta sobre as citocinas inflamatórias -tal como ocorre com os anticorpos anti-IL-6 4,9,10,12,13,[15][16][17]19,[21][22][23][24][25]27,29,30,32,33,35 , anti-IL-17 6 , anti-TNF-α 9 e anti-IFN-γ 9 .…”

“…TocilizumabInibe a ação da IL-6Receptor da IL-6 ciência plural Dos 29 artigos analisados, 20 abordaram4,9,10,12,13,[15][16][17]19,21,25,27,29,30,32,33,35 a possível utilização de anticorpos monoclonais bloqueadores do receptor da citocina IL-6 para o tratamento de formas graves da COVID-19. Destes vinte trabalhos, 90% apontaram que o anticorpo monoclonal Tocilizumab (anti-IL-6R) é um forte candidato para o combate às tempestades de citocinas em pacientes que manifestam reações 6 (anti-IL-17), Adalimumab 9 (anti-TNF-α) e Emapalumab 9 (anti-IFN-γ).…”

Community-based management of a five-arm randomised clinical trial in COVID-19 outpatients in South Africa: challenges and opportunities

“…In Africa, without a vaccine and limited access to hospital treatment, the urgent need was for affordable COVID-19 drugs that could be given safely in the community at symptom onset to reduce the risk of disease progression, hospitalisation, and death [ 18 ]. To achieve these aims, clinical trials of repurposed drug candidates in African populations was a priority.…”