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Coronavirus in Argentina: one year later and in the middle of the second wave, there is no 100% effective treatment to save lives

2021-04-04T19:31:34.905Z


Not the basic treatment. Not the plasma. Not ivermectin. Not equine serum. Neither in Argentina nor in the world is there a consensus on how the disease should be treated.


Emilia vexler

04/04/2021 16:04

  • Clarín.com

  • Society

Updated 04/04/2021 16:04

You have to wait for how your own body reacts.

You have to see how it defends itself only from the virus.

Not the basic treatment.

Not the plasma.

Not ivermectin.

Not equine serum.

One year after the coronavirus pandemic, and with the second wave over the country,

there is no scientific consensus

in Argentina that will end the uncertainty about which is the

most effective treatment

against the coronavirus.

Given the shortage of vaccines -which at times seems total if the population at risk is compared with the doses that are unloaded from Aerolineas Argentinas planes-, the immune system of each person continues to be at the forefront in

a battle at the cellular level against the Covid-19

.

At the time of contagion, it is the immune defenses themselves that become vital to prevent the development of a serious SARS-CoV-2 picture. 

The respiratory disease of the pandemic.

The foregoing does not indicate that various treatments developed in the country are not encouraging. 

But it does mark that people should not be infected, because it is bilateral pneumonia that fills the intensive care beds.

And, once there, the favorable evolution of each patient is not guaranteed by any of these treatments.

In turn, in these hours it was known that in the City the average age of the newly infected ranges from 15 to 40 years.

An age group that, if it is not about patients with comorbidities,

is very far from the priorities for vaccination

.

The arrival of the second wave is a local "catch" of the pandemic that shows that intensive care units have already reached an occupancy level of 59% and that people vaccinated with the two doses do not reach 700,000 and those vaccinated with one they are just over 3.2 million. 

There is also the reality of the treatments: none works as an "antidote."

The basic treatment against Covid

The first thing that is administered to a person who is hospitalized with bilateral pneumonia (for Covid it is always in both lungs and it is not only respiratory distress but also low oxygenation and the consequent fever of the infection) is what is called

"basic treatment "or" base

.

There is no doubt that it is "initial".

What to do before the first complications. 

"They are administered oxygen, with a (non-invasive) mask. The patients are evaluated and if they do not progress well they have to be placed on invasive ventilation, orotracheal intubation (the well-known respirator)," explains

Clarín

Rosa Reina, president of the Argentine Society of Intensive Care (SATI).

Then comes the medication.

"The fundamental thing is to start with 6 milligrams of corticosteroids - it is

dexamethasone

- for 10 days. It is proven that it greatly improves evolution and lowers mortality," he explains.

But the problem, the uncertainty, is

if that doesn't work

.

"If the person worsens, they insist on improving ventilation, the respiratory part, oxygenation, which is what deteriorates the most. Patients can suffer a shock, their pressure begins to drop a lot," he details.

In the jargon of intensivists, when a person with Covid

shock

needs vasopressor medication, a central intravenous route, infusion pumps, hydration and, of course, more corticosteroids daily.

The image is critical, but it can be worse.

"When it worsens much more, the patient is placed face down - it is said 'pronar' -, intubated," says the expert.

It is one of the few "physical" measures against the virus.

As the infection is in the back of the lungs, the rotated person, who does not put pressure on the area, would oxygenate better.

Up to here, the basic treatment.

With small changes, such as the rotation of intubates, it

is the same from the start of the pandemic

.

Ibuprofen

A nebulization of ibuprofen

On July 17, Química Luar, the laboratory that develops the formula for ibuprofenate - which is strong in sodium and in a format suitable for nebulization - presented all the results and the protocol for the clinical trial developed by a group of researchers in Córdoba.

Just now the ANMAT approved it for further study on the subject.

Ibuprofen therapy proposes that, thanks to nebulization through a helmet, the drug acts as a "soap" against Covid-19.

"The ANMAT authorized us to enter Phase II. That is very important for the advancement of this treatment. It is the study of when it is compared with placebo and that shows the efficacy and safety of the drug. Other countries have also contacted us and we are in Phase II in the Dominican Republic. We started the dialogues with Peru and Chile. Like all pharmacological development, it is slow ", details to

Clarín

Nestor García, the Conicet researcher who developed the project at the Center of Excellence in Products and Processes of Cordoba (Ceprocor).

Ibuprofen has a bactericidal effect.

But, as we know it, it is insoluble in water.

In Córdoba they succeeded in making it so.

That's

Sodium Ibuprofenate

.

The brand name is Luarprofen or "50 mg nebulizable ibuprofen per spray".

Seeks to test its potential to

reduce respirator use

.

For now, the ibuprofen therapy protocol must be approved by the bioethics committee of each health institution that wishes to apply it.


In Cordoba it has already been administered to

more than 8,000 patients

.

Also in Mendoza, where this ibuprofen continues to be sent weekly, and in Buenos Aires, at the Independencia Clinic.

"In Cordoba and Mendoza it has been taking place to avoid hospitalization and thus prevent the collapse of the system. Now that the incidence of cases is much lower in those provinces, shipments have dropped. Hopefully we remain calm (with the shipments of Luarprofeno). But my wishes will not be fulfilled, seeing the reality of the second wave ", closes García.

Ivermectin

The World Health Organization (WHO) is about to announce whether or not it recommends ivermectin to treat Covid.

But Roberto Hirsch, head of the Infectious Diseases Department of the Muñiz Hospital and who led the first study in South America on this antiparasitic, assures

Clarín

that the body

"is not going to recommend it

.

"

Hirsch, like Héctor Carvallo, former director of the Hospital Zonal General de Agudos de Ezeiza and who was also in charge of the ivermectin study in the country, remain firm in the positive results published in April: "

Lethality decreases by 80% in severe patients

and mild symptoms do not end in

hospitalization

".

But, anticipates the expert, "the WHO is going to continue saying that studies are lacking."

Plasma, another possibility

While the health agency of the European Union has already objected, there are five Argentine provinces that have authorized its use in the country as a clinical trial: Jujuy, Salta, Tucumán, Misiones and La Pampa. 

"It was also tested for nine months (retrospectively) in 162 people of the Health personnel, totally exposed to Covid, and none were infected. The ANMAT says that there is not enough evidence, it is guided by the WHO, and the WHO is not going to approve it. nor as a drug to prevent infection (as a barrier against the protein that functions as a key to enter cells) because it

is a power struggle between laboratories,

"he slides, without giving further details.

The National Administration of Medicines, Food and Medical Technology (ANMAT) clarified that in Argentina

the use of ivermectin is authorized only as an antiparasitic

.

The sale is by prescription.

Plasma 

"Plasma turns coronavirus into a cold."

It was said by Fernando Polack, the infectologist who led the largest plasma study carried out so far in the world.

The results showed that, in time, it could stop the development of serious covid pictures in people over 70 and even if they had pre-existing risk diseases against the virus.

By protocol, after this study by the Infant Foundation,

plasma is applied in two instances

: the first is aimed at those over 65 years of age with comorbidities and all those over 75. They should be given plasma up to, at most, the third day from the onset of symptoms.

"Plasma is going to be the best strategy until the vaccines arrive," Polack said.

But, in practice, plasma today is not the solution even for the age-risk group in the face of a shortage of vaccines.

"There are the guides made by the City Government and those made by the Nation, which indicate the use of plasma. If the question is whether this is something that is universalized, both in the City's hospital network and at the national level. country, I believe that

the applicability for practical purposes is being very scarce,

"

Diego Wappner

tells

Clarín

.

He was with Polack in the follow-up of the study.

Why is plasma not the "lifesaver" strategy in the face of vaccine shortages?

Because in Argentina there is no accessibility to plasma.

"There is no national collection campaign for convalescent (recovered) plasma," says Wappener.

But it is not that alone.

"There is no

standardization of this plasma either

. The standardization of the plasma resides in the fact that it has to have a certain series of titers (of antibody concentration). For that, the

method of measurement of that plasma

has to be standardized

," he explains.

And there is a third factor that causes plasma to not be used as it should.

"There is no campaign that indicates that those over 75 in general or those over 70 with comorbidities, as our study says,

should consult between 48 and 72 hours

before the first symptoms of Covid. And the health system has to be prepared to administer the plasma at that time. "

Wappener assures

Clarín

that there are hospitals in the City that, in case an elderly person requires it, can have the result of a swab in two hours.

You cannot say in how many hours, or days, that person will receive at least one bag of plasma that he needs.

Nor if in one of those bags the antibody titer (the high concentration) that would save his life is checked.

Equine serum

300 treatments can be obtained from each blood draw.

The hyperimmune equine serum was approved by the ANMAT on December 22.

So far about a thousand treatments have been administered.

And it is not at the federal level.

Only Corrientes, Formosa, Misiones, Santiago del Estero, San Juan, San Luis, Santa Fe and Neuquén acquired it.

According to sources from the Immunova laboratory, the cost of this treatment is 100,000 pesos per patient.

The official recommendation indicates that equine serum

can be administered

"in patients with severe disease with up to 10 days from the onset of symptoms, with a confirmed diagnosis of Covid." It is not a preventive treatment for bilateral pneumonia or general inflammation that COVID-19 could cause the greatest impact of equine serum was in patients with severe Covid-19.

The approval of the ANMAT was based on the positive results of the phase 2/3 clinical study, which was carried out in 19 hospitals and clinics in the City of Buenos Aires, Province of Buenos Aires, Neuquén and Tucumán.


In critically ill patients, the application of this therapy reduced mortality by almost half (45%), while it decreased it by 40% in the total population.

The goal of equine serum is also to prevent those infected from reaching intensive therapy.

But it is given when the "ventilator or not" decision is already being debated by therapists.

It is very far from being a vaccine.

GS

Look also

Second wave of Covid: in full shortage of vaccines, the demand for plasma tripled and donors are missing

Coronavirus: WHO also recommended not to use ivermectin treatment that is applied in several provinces

Source: clarin

All life articles on 2021-04-04

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