I’ll give you good news, good news, as my grandmother used to say: we are close to early treatment to prevent Covid from getting worse.
Among us, the political use of chloroquine, presented as a miracle drug in the fight against coronaviruses, diverted attention from the possibility of emerging antivirals capable of preventing the disease from getting worse.
Insisting on the infamous Covid kit, after all the methodologically well-conducted studies have shown that chloroquine and ivermectin were just fruitless attempts, is a matter for unprepared doctors, uninformed people or smart-ass with subordinate interests.
The armed political confusion in this area, however, did not prevent the pharmaceutical industry from testing drugs that could be indicated in the earlier stages of the infection.
You, dear reader, could argue that the flu virus has been with us for centuries, without having really effective antivirals against it. Why wouldn’t it be like this with SARS-CoV-2?
Because in the flu, the condition is already installed with all the symptoms — sore throat, fever, muscle pain, weakness, loss of appetite, etc. The first days are just the worst, you start to improve on your own after the third or fourth day, there would be no time for the medication to interfere with the evolution.
Coronavirus infection, on the other hand, offers a window of opportunity: installation is more insidious, it is rare for someone to need hospitalization in the first few days. Symptoms usually get worse by the end of the first week, even in severe cases. Due to the lack of one, two medications now appear with documented activity in the initial phase of the disease.
One of them is molnupiravir developed by Merck, a molecule capable of incorporating itself into the genetic information of the virus, causing mutations that interrupt its multiplication. Last month, the company announced that a five-day course of treatment, given shortly after the onset of symptoms, reduces the risk of hospitalizations by 50%.
The specialists’ concern is with the theoretical possibility of acquiring mutations that may facilitate the appearance of resistant or more contagious viral strains. As there is so far no evidence of this undesirable effect, the United Kingdom has approved the indication of molnupirvir for people at increased risk of complications from the disease. It is the first oral medication approved to stop progression to the severe forms of Covid.
The other belongs to the class of protease inhibitors, drugs endowed with the property of inhibiting the action of an essential enzyme for the multiplication of several viruses, which revolutionized the treatment of AIDS.
The first clinical trial with this inhibitor was carried out in unvaccinated patients, in which symptoms had been present for at most three days. Participants were randomly divided into two groups: placebo versus five days of medication. All had at least one risk factor for the most severe forms of the disease.
The group of independent researchers in charge of monitoring the data stopped the study early because the results among those receiving the drug were so superior that it would be unethical to proceed with it.
Although partial, the numbers released by Pfizer are overwhelming: of the 389 people treated from the first three days after the onset of symptoms, only 3 (0.8%) were hospitalized, against 27 (7%) in the placebo group.
In a parallel study, the antiviral was started a little later: within the first five days after the onset of symptoms. Of the 607 patients treated, only 6 (1%) were hospitalized, compared to 41 (6.7%) among the 612 in the placebo group.
In total, ten deaths occurred in the placebo group; zero in the drug group.
Pfizer has already started studies in patients without risk factors, as well as in contacts who share a home with someone who is infected. The company is about to present these results to the FDA, the American agency corresponding to our Anvisa.
If these and other antivirals are released at affordable prices, everything indicates that we will enter another era. The pandemic will be controlled when we vaccinate as many people as possible and treat those who have not been immunized and those who have been infected despite vaccination early with effective drugs.
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