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Dr David Oshinsky, a leading medical historian at NYU Langone Health (where I’m a doctor), recently told me that he expected this pandemic to be mostly remembered not in terms of fierce politics. that divided us, but rather in terms of the incredible advancements in biotechnology that saved us.
He’s starting to sound like he’s right.
The real science has been amazing. Consider what we discovered in just 18 months.
First, rapid tests have been produced that can detect the coronvirus early before symptoms even develop.
DR. MARC SIEGEL: WHY COVID WILL STILL GO TO US
We still need to make them much more widely available.
Second, masks have been studied in large populations and shown to have at least a modest effect in decreasing the spread, but we need them to be surgical grade or better rather than soft fabric masks.
Third, vaccines, while overly politicized, have been shown to be very effective and safe, working by transmitting messages to cells to produce the virus’s spike proteins which then cause our immune systems to respond with an array of protective cells. The genetic flagger (Messenger RNA) is usually cleared from the body quickly in just a few days.
MRNA vaccines have already been used in over a billion people and have enormous potential for other viruses and pandemics.
Fourth, therapeutics have changed a lot during the pandemic. Aspirin and vitamin D have both been studied and found to be effective in reducing the risk of serious consequences from COVID. As Senator Rand Paul, MD, wrote on these pages this week, inhaled steroid budesonide has been studied and found to reduce the risk of acute medical care needed for COVID while improving recovery time when is given at the onset of the disease.
Other treatments reassigned with antiviral properties, including zinc, hydroxychloroquine and ivermectin, have been tried with positive results, but these results have not been confirmed.
Other early treatments that have garnered a lot of attention include convalescent plasma, which includes antibodies from recovered COVID patients, and monoclonal antibodies, a synthesized version that targets the peak protein of the virus.
These two treatments have the same goal, neutralizing the virus as much as possible at the onset of the disease.
Monoclonal antibodies appear to perform much better, and convalescent plasma results unconvincing, but there is still a great shortage of Lilly and Regeneron antibodies.
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The goal of vaccines and treatments is to stop the virus from taking hold, to stop it from replicating to the point of triggering inflammation that affects almost every organ in the body.
At this later stage, we have steroids (dexamethasone) to help calm the rabies process and improve the chances of survival. We also have tocilizumab, a targeted antibody that can help block inflammation and reduce mortality from COVID when given early, and baricitinib, an anti-inflammatory drug for rheumatoid arthritis that lowers the risk of dying. nearly 50% COVID for patients on treatment. fan.
But to really stop the virus from wreaking havoc, we need targeted antivirals given very early in the course or even when someone at risk is exposed but not yet sick. There is also some promising news here.
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Fifth, the first gateway drug was Gilead’s remdesivir, which was developed not to fight SARS VOC 2 per se, but RNA viruses in general, by interfering with viral replication.
It was developed in coordination with the US Army Institute for Infectious Disease Medical Research and was initially shown to have some effect against Ebola in 2015. It is administered intravenously, and many studies have shown that it has an effect on decreasing the severity of COVID. infections, more recently demonstrating an 87% reduction in hospitalizations and deaths.
But it is not a pill, so its use is limited.
Sixth, the first oral drug to directly target SARS VOC 2 will be molnupiravir from Merck. In a trial of 775 patients, it reduced hospitalization by 50 percent. The results should be even more dramatic if the drug is combined with rapid tests so that it can be given very early or even as post-exposure prophylaxis in high-risk patients.
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This may be the pill we’ve been waiting for, although some scientists are nervous about how it mutates and destroys the virus.
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Could it spread to normal cells? We have to make sure the answer is no.
The way out of the pandemic is clear; a vaccine in each arm, a free rapid test in each household, a pill to take if you are at risk of getting sick, and scalable solutions for more rare serious illnesses.
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