Updated April 20, 2021, 3:59 p.m.
- The whole world is talking about the vaccine against the corona virus, iThe number of infections continues to rise.
- Which drugs help against Covid-19? Which therapies are used in the clinics?
- We explain what is currently being researched and how you can protect yourself against infection.
Of all those infected with corona, between five and ten percent of the patients have to be treated in a clinic because of a severe course of COVID-19. So most patients will have to get through the infection at home. In many cases, the course is comparable to a cold with flu-like symptoms, often accompanied by a loss of taste and smell.
The therapies for improving the condition are unspecific and symptomatic. The drugs used are used to relieve symptoms. “Paracetamol, Novalgin or ibuprofen, for example, can be prescribed for people with a high fever, headache and body aches,” explains Caroline Isner. She is chief physician at the Clinic for Internal Medicine and Infectious Diseases at the Vivantes Auguste Viktoria Clinic in Berlin.
Ibuprofen can now be taken again without hesitation, even during the acute phase. “The initial assumption that it can negatively affect the course of the disease has not been confirmed in further studies,” says the infectiologist. On the other hand, outpatient prophylaxis with acetylsalicylic acid (ASA) is currently not recommended.
Coronavirus: two phases of the disease – two therapies
Warning signs that the disease is getting worse are shortness of breath, chest pain, confusion, blue discoloration of the skin and lips or nail bed. These are signs of an oxygen deficiency. In this case, a severe course is indicated and with it the need for hospital care.
In outpatient therapy, doctors largely rely on drugs that have been developed for other diseases. There is not just one effective drug. Because COVID-19 runs in several phases, in which the medical treatment depends on completely different aspects.
At the beginning of the infection, the virus enters and multiplies. “Antiviral drugs and antibody therapies are mainly used here to intercept and weaken the virus,” explains Caroline Isner.
Around six to ten days after infection, the phase of immune dysregulation begins in patients with severe disease, which leads to uncontrolled overreactions of the immune system. Anti-inflammatory drugs are used in therapy, especially cortisone. In particular, the drug dexamethasone is used, explains Dr. Thomas Grünewald, Head of the Infection and Tropical Medicine Clinic at the Chemnitz Clinic. “Otherwise, symptom-oriented therapy is predominantly used.”
Frequently used drug is immune inhibitor
Dexamethasone is known for its immune-inhibiting effect, which is also used in other autoimmune diseases. “In large-scale randomized studies, mortality was reduced by 25 to 35 percent, which is the best study result of all known therapies against Covid-19 so far,” says Caroline Isner. However, dexamethasone is only useful in patients who need oxygen therapy during the course of the disease.
Another problem faced by COVID-19 patients is vitamin D deficiency. According to a Spanish study at a clinic in Santander, more than 80 percent of the sick are affected. Vitamin D is important for a strong immune system, calcium balance and bone health. With cortisone therapy, high-dose vitamin D is therefore administered in clinics to maintain bone health. “There are also indications that a vitamin D substitution leads to faster virus elimination and reduced mortality,” says the Berlin infectiologist, but emphasizes that there is not yet sufficient certainty for this.
The immune dysregulation also leads to an increased tendency to thrombosis in some patients, which is why heparin is used to intensify anticoagulation when admitted to hospital. The doctor points out, however, that according to the current study situation, outpatient Covid patients do not benefit from heparin therapy.
Remdesivir disappointed: What helped less or not
So much for the current status. In the fight against COVID-19, numerous other drugs were used last year. For example, the anti-malarial drug chloroquine, the HIV drug lopinavir / ritonavir, the anti-inflammatory antibiotic azithromycin, and the gout drug colchicine, all of which showed no benefit in studies.
“As a virus inhibitor, we used the only drug approved for COVID-19, Remdesivir, which was initially promising, but disappointed in subsequent studies,” says infectiologist Isner. Ultimately, the World Health Organization (WHO) also spoke out against the use of remdesivir at the end of last year. The study of the anti-inflammatory drug tocilizumab also produced contradicting study results.
Drug research against COVID-19 is ongoing worldwide
Research is being carried out around the world on new drugs against Covid-19. The American Milken Institute and the Association of Research-Based Drug Manufacturers (VfA) provide an overview of ongoing projects on their website, which is constantly updated.
The research focuses on four groups.
- Antiviral drugs are designed to prevent the viruses from entering cells in the body or from multiplying there
- Cardiovascular drugs are designed to protect blood vessels and organs from complications from COVID-19
- In the advanced stages of the disease, inhibitory immunomodulators are intended to limit the body’s defense reactions so that they do not cause more damage than the viruses themselves
- Drugs for lung function are supposed to help the lungs to maintain their function during the acute infection and to regenerate afterwards with as little consequence as possible
When it comes to medication, hope is based on nasal sprays. Scientists at Oxford University were able to show the effectiveness of an asthma nasal spray with the cortisone budesonide against COVID-19. According to the study published in the magazine “The Lancet”, the probability of a severe course of the disease was reduced by 90 percent in patients who inhaled the active ingredient.
Such anti-inflammatory sprays are only useful at an early stage. Hospital patients who are very ill are also given cortisone – albeit via the vein or in tablet form in a significantly higher dose than what asthma sprays contain.
What antibodies are supposed to do
Antibody therapies are another means of curbing virus replication. They are administered intravenously in the form of synthetically produced antibodies or human antibodies, for example by blood plasma transfusions. “Some antibody therapies are showing promising results, while others have shown no benefit in the initial study results,” says Caroline Isner. When using these therapies, the very early point in time of administration is also important.
A US study showed great benefit among nursing home residents who were given antibodies as soon as an outbreak became known. However, these therapies are very expensive and have to be critically checked before use, according to the doctor. “The use appears to be particularly useful for patients who have an increased risk of serious illness and a very weak immune system, such as the elderly, lung patients, obese and diabetics.”
It can also be read that high-dose vitamin C should help against COVID-19. Some study results suggest that it shortens the duration of illness and reduces the risk of death in seriously ill patients with pneumonia. However, these high-risk patients often have a vitamin deficiency anyway. It is therefore uncertain whether the high-dose vitamin C provides additional protection against the viruses or just compensates for a vitamin deficiency in the patient.
Reducing stress can protect against corona
And how can healthy people – in addition to observing distance and hygiene rules – protect themselves from a corona infection? “Essential factors that contribute to strengthening the immune system and are often underestimated are avoiding or reducing stress and getting enough sleep,” says Caroline Isner. Permanently elevated stress hormones in the body lead to a poorer immune defense. “During sleep, we break down these hormones and help the immune system to regenerate,” she says.
Regular exercise and a healthy diet to avoid obesity also help to strengthen the body’s defenses. Chemnitz infectiologist Thomas Grünewald also recommends avoiding the everyday drugs alcohol and nicotine.