Hong Kong’s best pandemic doctor sees a way out of intensive care for thousands of Covid-1
After sobering up 17 years ago with the outbreak of severe acute respiratory syndrome, Yuen Kuok-Jung advocated early, aggressive hospitalization and treatment to minimize devastating illness and death. Hong Kong 2% mortality from Covid-19 on Friday, well below global average, gives weight to the approach.
Most therapies for SARS-CoV-2 are approved for use in severely ill patients, in some cases supported by studies that are still in question. Yuen, a professor of infectious diseases at Henry Fock University in Hong Kong for 15 years, is admit itsick patients with minimal disease so that they can be isolated, monitored and treated if necessary.
“In places like the UK and the US, usually if you have mild symptoms, you are not admit itin a hospital at all – just wait at home until you do I feel it very bad or you have shortness of breath – he explained to Zoom from his office. “It simply came to our notice then admit it all patients, even without many symptoms, should be admitted to the hospital for isolation. “
The strategy reduces transmission in the community and allows patients to enter a clinical trial and receive experimental treatment soon after they develop a fever or show other signs of worsening the disease, Ewan said. This is crucial because the amount of SARS-CoV-2 virus or the ‘viral load’ in patients peaks around the time the symptoms appear – similar to the flu.
Microbiologist, surgeon, doctor
Yuen, who graduated from the University of Hong Kong in 1981 and has a rare distinction as a microbiologist, surgeon and physician, for decades has been at the forefront of the city’s response to outbreaks. In 1998, he and colleagues described the first ten patients affected by the H5N1 strain of bird flu. Five years later they reports SARS in a patient visiting Hong Kong from Guangzhou, China.
Ewan recalls the trial and error of rescuing SARS patients, also caused by the coronavirus. Shortly afterwards, he identified “time bomb ”of the environmental and social conditions he predicts will inevitably lead to more deadly outbreaks of coronavirus.
This prediction came true in December, when the first cases of a mysterious pneumonia came to light in Wuhan, in the Chinese province of Hubei. Hong Kong has responded to the new coronavirus by preparing tests and advising citizens to wear masks.
Meanwhile, Yuen’s lab was conducting research that led to for the first time, a cluster of family members in which the new coronavirus has been transmitted from person to person has been reported. He joined the WHO-China Joint Mission in February to investigate the country’s early response, and his laboratory has since reported a number of important findings, including the first confirmed SARS-CoV-2. reinfection.
A bitter lesson
“It’s all a continuation of our experience in 2003,” Ewan said. “We have nothing to boast about because we learned bitterly from SARS in 2003.”
The emergence of an unknown virus to which no one is immune has created a desperate need for effective treatment. Hong Kong doctors use several experimental infusions, including restorative plasma – a combination of factors derived from patients’ reconstituted blood – and interferon, a protein of the immune system.
They also use the antiviral drugs ribavirin and Kaletra preliminary results released on thursday A study by the World Health Organization, involving 11,266 patients in 30 countries, found that they did not reduce patient mortality. Ewan said he was not surprised by the results of the WHO study, as the drugs were not administered soon after the patients became ill.
“No antiviral drug will work if it is given late,” he said. The drugs are also being administered individually, rather in combinations that could contribute to their effects, he said.
“We know that one drug is not good because they are all very modestly active,” Ewan said. “We need early cocktail therapy to get good results.”
Giving a combination of ribavirin, Kaletra and interferon to patients in the first week of the disease reduced the time to clear the virus by six days and shortened hospitalization by one week, compared with giving Kaletra alone, Yuen and colleagues showed in survey in May.
The study, published in the medical journal The Lancet, recruited 127 patients from February 10 to March 20, more than half of the Covid-19 cases reported in Hong Kong during that period. Patients started treatment about five days after the onset of symptoms.
“With the memory of the 2003 SARS pandemic, most patients with Covid-19 in Hong Kong received antiviral treatment, which explained our high recruitment rate,” Ewen and his team wrote.
Sixteen years earlier, Yuen and many of the same group showed that a cocktail of ribavirin and Kaletra prevents serious illness and death in patients with SARS. Researchers in Saudi Arabia said earlier this month that Kaletra was given interferon improved survival in patients hospitalized with respiratory syndrome in the Middle East, also caused by coronavirus. The effect is greatest when treatment is started within a week of the onset of symptoms, the authors say, noting “an important effect of treatment time on mortality.”
There is growing evidence of early use of interferon in some patients. Blockbuster studies published by the journal Science last month show that about 14% of critical patients with Covid-19 have insufficient levels of the substance that organizes protection against viral pathogens.
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If the body mounts well the interferon response, when the viral load is low, can limit subsequent viral replication and prevent dangerous inflammation, Yuen said. However, a late or delayed interferon response to a high viral load can cause serious lung damage. “It’s really catastrophic,” he said. This made injections of interferon, the “backbone” of early treatments.
Some doctors outside Hong Kong agree with Yuen’s approach. Early use of antiviral drugs can suppress viral load and prevent the severe hyperinflammatory response that some patients develop in their second week of illness, said Richard Russell, a respiratory physician and senior clinical researcher at Nafield Medical School in Oxford. patients with Covid-19.
Yuen’s strategy indicates how numerous existing antivirus tools can be reassigned and partnered with immunomodulatory drugs as a bridge until protective vaccines became available, said Stephen Opal, a clinical professor of medicine at Brown University in Providence, Rhode Island.
Dexamethasone, a cheap, common anti-inflammatory, was found in June to reduce deaths by almost a third among Covid-19 patients receiving mechanical ventilation. A study by the University of Oxford confirms what Ewan observed in patients with SARS in 2003: that the drug can suppress an immune overreaction, sometimes called a cytokine storm, in aggravated patients showing signs of inflammation.
Dexamethasone and Gilead Science Inc. Remdezivir helps patients with more advanced disease, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “The only thing we really need to do is do a bunch of early infection interventions to prevent people from needing hospitalization,” he said. interview with the American Lung Association this month.
Antibodies specifically designed to fight the coronavirus can also help, Fauci said. US President Donald Trump is lending Regeneron Pharmaceuticals Inc. Antibody Treatment with his recovery from infection.
Leprosy from leprosy
Yuen’s team is also exploring the potential of clofazimine, a cheap, 50-year-old antimicrobial that is on the WHO list of essential medicines for leprosy. Studies in hamsters have shown that it can fight SARS-CoV-2 and prevent infection.
Hong Kong has taken swift and decisive action in response to Covid-19 over the SARS legacy, Yuen said. He hopes others will learn from the current crisis about the need to prepare for and mitigate the risks of future pandemics.
“This is the experience of 2003 that allowed us to travel another mile earlier,” Ewan said. “I hope that everyone in the world will learn this time that the emerging infectious disease is something that would happen more and more often. “