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Research Review – What Treatment Works Best for Covid-19?

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Research Review – What Treatment Works Best for Covid-19?

Bolster Immunity and Reduce the Risk of Contracting Covid-19

With the wait for a vaccine that can be deployed en masse likely to take us into 2021 at the earliest, everyone should be focused on prevention and immune support such as:

  • Personal hygiene including washing your hands frequently
  • Using surgical antimicrobial scrub to disinfect their hands and surfaces
  • Adopting social distancing measures
  • Eating a nutritious, healthy, anti-inflammatory diet
  • Maintaining high levels of fitness, including cardiovascular fitness
  • Maintaining optimal bodyfat to avoid the immune suppression, poor glucose management and other Covid-19 risk factors excess fat causes.
  • Supplementing with evidence based nutrients shown to support immunity, or else those that show antiviral properties, such as oxymatrine, berberine and ecklonia cava (found in the product Elixir).

In a nutshell, by maximising fitness and health, reducing excess bodyfat, and limiting systemic inflammation caused by excess bodyweight and inflammatory diets, individuals can minimise their risk of adverse effects if they do contract Covid-19.

Read our research review to learn what nutrients best support immune system response

hand washing

Herd Immunity, and Vaccines Under the Microscope

Unfortunately, there always exists a chance that you could end up contracting Covid-19 regardless of how diligently you work to prevent that happening. Similarly, while everyone should seek to maintain an optimal immune system response, the SARS-CoV-2 virus is a new pathogen which your body has never encountered before meaning that it could potentially overwhelm even a healthy, fit individual’s immune system before your body produces sufficient antibodies to fight the infection.

Herd Immunity – An Unlikely Option

It has been suggested that given how infectious the disease is, countries are likely to eventually acquire herd immunity, a situation where the outbreak dissipates due to the inability of the virus to find new hosts to infect and those who have previously been infected obtaining immunity. Recent evidence from rhesus monkeys suggests that in the short term at least, previous exposure does build up immunity to a subsequent infection.1

However, if SARS-CoV-2 (the virus that caused Covid-19) works similarly to the coronaviruses that cause the common cold, any immunity acquired would last for a few months rather than years. In this situation, it is predicted that if an individual contracted the disease a second time, their previous bout with the virus would make their bodies better equipped to raise antibodies to fight it in future. However, that does not change the fact that contracting the virus the first time around has the potential to cause permanent damage or death to the unlucky individual who is otherwise in exceptional health.

Vaccines – A Distant Prospect

Vaccines are the only realistic option to establish herd immunity in a population safely. Unfortunately, a vaccine could take over a year to develop still and given the propensity of coronaviruses to mutate, it may not be the panacea we hope for given we still have no vaccine for the common cold, MERS or SARS, other viruses in the same family as SARS-CoV-2.

A Review of Treatments Being Used for Coronavirus

If neither vaccines or riding it out until herd immunity is present in the population are realistic options, we are left with adopting measures to prevent contracting Covid-19 and bolstering our immune system.

However, what happens if we contract it despite these measures? On this front there is growing optimism we have some potential treatments that can be used to combat Covid-19. This section will review the evidence we have showing which drugs or nutraceuticals have shown the greatest promise in aiding patients in recovering from Covid-19 with a focus on those treatments which have published studies documenting their use in Covid-19 patients.

drug development

Is Managing Blood Glucose Critical to Covid-19 Outcome?

We previously discussed how a number of natural nutrients including oxymatrine, berberine and ecklonia cava have shown broad antiviral capabilities, including inhibition of respiratory tract infections caused by coronaviruses and influenza infections. For detailed information on this read about the research on these ingredients in our review of the research evidence on nutraceuticals.

Interestingly, all these nutrients work to regulate glucose optimally, so less stays in the blood and is more effectively shuttled to muscle cells. In short, they help to improve insulin sensitivity with respect to nutrient ingestion. Is it realistic that four distinctly different nutrients have some innate antiviral action then or could the key to their success with infections be linked to something deeper?

CDC Confirm Link Between Glucose Management and Covid-19

Diabetes of course is a disease which involves the body being unable to regulate blood glucose properly. We also know that those who carry more bodyfat are less efficient at regulating blood glucose and that overweight individuals have less effective immune systems and are more likely to contract severe illness with Covid-19.

Now, look at what has been cited by the US Centers of Disease Control as the number 1 risk factor for those with Covid-19 (obesity seems not to be covered, that would have been interesting to see, we suspect it would be highly correlated to deaths from Covid-19). We delve into this topic further in our article discussing the link between overweight and Covid-19.

Can it be a coincidence that the natural ingredients shown to have the greatest effect in research looking at immune response to respiratory tract infections, all happen to be ingredients which optimise blood glucose management and which also happen to optimise body composition?

Given the established link between excess bodyfat, poor blood sugar management, and Covid-19, it certainly paints a fascinating picture which we would love to see researchers follow up, to see if improving body composition and optimising blood sugar management can accounts for the antiviral properties shown in the research for ingredients like berberine, oxymatrine and ecklonia cava.

For now, for those interested in trialling these ingredients for either their body composition or health properties, all three are found in the product Elixir.

Remdesivir – Failed with Ebola but Promising for Covid-19

Remdesivir is an antiviral drug which has been around for several years. Initially introduced to treat the Ebola Virus, remdesivir was found to be less effective than other treatments leading to the drug disappearing from view largely. However, recently, remdesivir has been used in a number of small scale trials of patients with Covid-19.

The results of these early trials have been mixed, with some of the drug’s side effects leading to doubt being cast on its potential utility as a treatment for Covid-19. Despite this, there are clinical trials waiting to be published on remdesivir both in China and the USA10 which could make it a potential treatment option for Covid-19. Additionally, the manufacturer, Gilead, has begun phase 3 trials in the United Kingdom.11

One complicating factor remains. Since the drug was never previously used to treat Ebola, Gilead, are likely to struggle to produce enough remdesivir in the short run. Currently, remdesivir is being used on a compassionate basis in the United States but due to the very limited supplies Gilead have made its use conditional on treating only children and pregnant women. Additionally, with the drug not being license for any medical condition anywhere in the world, it is likely to take upto a year or more for it to be able to be used on a large scale to treat Covid-19 even if it shows stellar results in the soon to be published clinical trials.

Lopinavir/Ritonavir – HIV Antiretroviral

This drug combination, sold under the brand name Kaletra, is an established antiretroviral drug combination with an established history of use in patients suffering from HIV. At present though, its use in patients with Covid-19 has led to it being unlikely to be used as a treatment option in the long run with trials showing disappointing results, indeed showing no results at all according to the latest study.12

Favipiravir – Japanese Flu Antiviral

Another antiviral drug, favipiravir is licensed as a flu treatment in Japan under the trade name Avigan. Outside of Japan, its notable toxicity has led it to fail to be licensed in either Europe or the USA but a recent study conducted in China demonstrated it could potentially be an effective treatment option for Covid-19 after a trial with 340 patients in Shenzhen showed it was able to turn infected patients negative for Covid-19 with a median of just four days.13

However, its results were qualified by the Japanese ministry of health who remarked that it had not shown efficacy in treating patients with more severe forms of Covid-19 and failed in studies in Japan itself when given to over 70 patients. Coupled with its relatively greater level of toxicity, favipiravir will need to show much more if it is ever to become a primary treatment for those suffering with Covid-19.

Plasma Therapy – Using Antibodies to Treat the Sick

The last treatment on our list is not a drug at all, nor is it a nutraceutical. At the same time, it holds perhaps the greatest promise of all the treatments in our review. Plasma therapy is the practise of using antibodies from patients who have recovered from Covid-19 and injecting them into those who are currently infected still.

Plasma therapy in general has been used widely to treat a great number of diseases, indeed it was plasma therapy that proven to perform better than remdesivir in the treatment of ebola, that led to remdesivir being discontinued as a treatment modality for ebola.

When it comes to treating Covid-19 the research is as new as it gets with the research being published on the same day this research review is being written – April 1, 2020.14 These researchers concluded that plasma therapy showed great promise as a treatment, especially given its successful use with other viral infections including the SARS outbreak of 2003. This study followed up a study published on March 27, 2020 which demonstrated the successful use of plasma therapy on five patients.15

What makes plasma therapy perhaps the most exciting treatment option of all the ones covered is that this study, while admittedly involving only a very small sample size, involved its successful use in five patients who had been critically ill. Moreover, these patients were all suffering various forms of organ failure, all were intubated and reliant on extracorporeal membrane oxygenation machines (ECMO). ECMO machines are essentially a way of providing oxygen to the body in patients whose hearts and lungs are unable to provide enough to sustain life.

The results from this study were nothing short of stunning. Within three days, body temperature was normalised in four out of five patients, and viral loads decreased and became negative twelve days after the plasma transfusion while three patients were weaned off ventilators within two weeks. Three of the patients were discharged from the hospital after near two month long stays while the remaining two remained in stable condition.

Clearly, this study requires further corroboration from larger trials, but nothing else holds quite the same promise as plasma therapy, being both the most effective treatment to date while also being safer than the use of antiviral drugs in particular – a critical consideration for those who are very sick. The one downside with this type of treatment is that during a pandemic it is likely to prove very difficult to scale due to ever growing numbers of people falling sick far outstripping the numbers of those choosing to donate a limited amount of blood.

However, in time, as numbers of infected stabilise, and further studies demonstrate the same benefits, plasma therapy offers more hope than perhaps any vaccine or medicinal drug for treating Covid-19.

Treat Fever and Cough

Some of you may be fortunate enough to only contract mild Covid-19 symptoms that can be managed at home. For these individuals, several options are available to ease these so that you can focus on resting and recovering with nutrient dense foods and plenty of fluids while in self-isolation (7 days is recommended from experiencing symptoms, 14 days for the rest of the household who are asymptomatic). Medicines that we would suggest having at hand, even as precautionary measures, include paracetamol for temperature and aches, and pholcodine or codeine linctus (also available in a sugar free option) for coughing.

Paracetamol (Acetaminophen) - Paracetamol, something we are all likely familiar with, is a painkiller in the analgesic family of medicines that can also relive body aches and fever. Paracetamol is affordable, fast acting (effects are noticed within the hour) and can be purchased over the counter. Paracetamol can be combined with other non-paracetamol containing painkillers and cold and flu remedies for enhanced effects but do remember that presently the NHS is advising not to use ibuprofen alongside paracetamol for Covid-19 symptoms while they conduct further research.

Pholcodine - Pholcodine is a viscous syrup classed as an opioid cough suppressant. It helps to supress irritating coughs associated with upper respiratory tract infections within an hour of taking by clearing mucus, dust and bacteria from the throat and lungs where present. It does contain morphone codeine derivitives so pholcodine can cause some drowsiness so do be aware of this before taking. Dose every 4 hours for up to 3 days before seeking further medical attention. 

Codeine Linctus - The National Institute for Health and Care Excellence (NICE) recommend Codeine Linctus specifically as a first choice of treatment for a Covid-19 related cough if or when it becomes distressing. Codeine Linctus is an alternative syrup given to adults to relieve a dry or tickly cough. ‘Codeine’ is the active ingredient, whereas ‘Linctus’ indicates a thick medicine, usually a cough syrup. Codeine is metabolised by the liver to morphine. Like most paracetamols, it is advised to space doses 4 hours apart, with a maximum of 4 doses given per day (unless advised differently by your GP or healthcare professional) for up to 3 days only due to the risk of addiction. 

Codeine Linctus Sugar Free - For those who are conscious of their sugar intake, either because of their physique goals or because of a medical condition such as diabetes, Codeine Linctus is available as a sugar free syrup. Expect all the same great benefits of Codeine Linctus discussed above, but with the substitution of low-calorie sweeteners. Do not combine multiple codeine containing medications (for example, Codeine Linctus and Pholcodine cannot be taken together).

If symptoms persist and become unbearable, the current advice is to call the NHS on 111 for further guidance.

References

  1. https://www.newscientist.com/article/mg24532754-600-can-you-catch-the-coronavirus-twice-we-dont-know-yet/
  2. http://www.chictr.org.cn/searchproj.aspx?title=%E6%B0%AF%E5%96%B9&officialname=&subjectid=&secondaryid=&applier=&studyleader=ðicalcommitteesanction=&sponsor=&studyailment=&studyailmentcode=&studytype=0&studystage=0&studydesign=0&minstudyexecutetime=&maxstudyexecutetime=&recruitmentstatus=0&gender=0&agreetosign=&secsponsor=®no=®status=0&country=&province=&city=&institution=&institutionlevel=&measure=&intercode=&sourceofspends=&createyear=0&isuploadrf=&whetherpublic=&btngo=btn&verifycode=&page=1
  3. Potential interventions for novel coronavirus in China: A systematic review (2020): Lei Zhang Yunhui Liu
  4. https://cen.acs.org/biological-chemistry/infectious-disease/initial-remdesivir-data-tell-us/98/i13
  5. https://www.sciencemediacentre.org/expert-reaction-to-beginning-of-phase-3-randomised-studies-of-remdesivir-in-the-uk-announced-by-gilead-sciences-in-patients-with-moderate-or-severe-covid-19/
  6. A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19 (2020): Bin Cao, M.D., Yeming Wang, M.D., Danning Wen, M.D., Wen Liu, M.S., Jingli Wang, M.D., Guohui Fan, M.S., Lianguo Ruan, M.D., Bin Song, M.D., Yanping Cai, M.D., Ming Wei, M.D., Xingwang Li, M.D., Jiaan Xia, M.D
  7. https://www.theguardian.com/world/2020/mar/18/japanese-flu-drug-clearly-effective-in-treating-coronavirus-says-china
  8. Convalescent plasma as a potential therapy for COVID-19 (2020): Long Chen Jing Xiong Lei Bao Yuan Shi
  9. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma (2020): Chenguang Shen, PhD1; Zhaoqin Wang, PhD1; Fang Zhao, PhD1; et al

 


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