Pay attention to the high-risk groups of the new crown
The new crown epidemic is about to end its third year.
From a global perspective, the new crown pneumonia epidemic is still in the pandemic stage. According to the latest data released by the World Health Organization on October 20, 2022, the cumulative number of confirmed cases of new crowns worldwide exceeds 620 million, and the cumulative death toll exceeds 6.55 million.
During the epidemic, pharmaceutical companies have given full play to their own advantages and continued to promote innovation in the prevention and treatment of the new crown. Through global cooperation, human beings are no longer completely helpless against the new crown virus.
The long-term impact of the new crown cannot be ignored
After the outbreak of the new crown epidemic, discussions surrounding the sequelae of the new crown have been hot.
”Don’t be complacent” “Don’t prematurely declare victory over the pandemic”. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical adviser to the president, issued a warning in an exclusive interview published by the British “Guardian” on October 18, saying that the United States is in a “latent” public health emergency Situation – Millions or even tens of millions of people are affected by “long-term COVID-19”. This neglected crisis and the possible imminent new wave of winter epidemics are in stark contrast to the US’s current almost “flat” anti-epidemic attitude.
On April 29, 2021, in New Delhi, India, a woman infected with the new coronavirus is receiving treatment.
On February 4, 2022, in Seoul, South Korea, people queued up for nucleic acid testing.
”Long COVID” (Long COVID), a new term in the scientific community, is also known as “post-COVID syndrome”. It is similar to the sequelae of the new crown, and it is also a variety of long-term symptoms that can continue to attack various organs of the human body after the infected virus is cured.
Compared with the short-term pain of contracting the new coronavirus, the symptoms of various diseases that persist for a long time after turning negative are the “last straw” that crushes countless ordinary people. A team led by Accrami, a neurologist at University College London, found as many as 205 different symptoms in more than 3,500 people who had been infected with the long-term new crown. The most common of these symptoms are fatigue, post-exercise discomfort, and cognitive impairment. What’s even more frightening is that these symptoms will continue to fluctuate, and people often have more severe symptoms after they get better.
In the “Guardian” report, the World Health Organization believes that 10% to 20% of people infected with the new coronavirus are left with symptoms such as dyspnea, fatigue and cognitive dysfunction, which may last long after the acute infection is cured. long time. An estimated 7.5 million to 23 million Americans have developed “long-term COVID-19.”
Since the “long-term new crown” has had a great impact on the life activities of normal people, last year, the Americans with Disabilities Act (ADA) included it in the scope of disability, which can be classified as a physical disability or a mental disorder.
The fact is that the spread of the new coronavirus may not end in the short term, and the long-term new crown syndrome will always affect a small number of patients, which is another public health crisis hidden in the pandemic that cannot be ignored.
To this end, scientists are actively exploring the mysterious disease known as “long-term new crown”, trying to find answers for the world. Last year, “Nature” magazine published an article called “The four most urgent questions about long COVID” (The four most urgent questions about long COVID), providing answers to some questions –
The spread of the new crown virus may not end in the short term, and the long-term new crown syndrome will always affect a small number of patients, which is another public health crisis hidden in the pandemic that cannot be ignored.
First, how many people will have “long-term new crown” symptoms? The Office for National Statistics (ONS) found that of the 20,000 people who tested positive for the virus in April 2020, at least 13.7% still reported symptoms 12 weeks later, and they persisted.
Second, who is at greater risk of getting a “long-term new crown”? The statistical results show that “long-term new crowns” are more common among women and middle-aged people. At the same time, it should be noted that children can also be infected with the new crown virus for a long time.
Third, what can the biological basis of the “long-term new crown” tell us? Studies have shown that many people who have been infected with the new coronavirus for a long time have problems in multiple organs in the body, suggesting that the “long-term new crown” is a multi-system disease with multiple diseases combined, or it is very likely an autoimmune disease. .
Fourth, what is the relationship between “long-term new crown” and other types of post-infection syndrome? A study of 253 patients diagnosed with certain viral or bacterial infections found that 12% reported persistent symptoms after six months, a percentage similar to the “long-term Covid-19” infection observed by the ONS The percentages are strikingly similar. That said, the existence of “long-term COVID-19” has general similarities to other post-infection syndromes.
The article concludes with a question of widespread interest: “What can we do to help those chronically infected with COVID-19?” Unfortunately, the options are quite limited at the moment – people are generally vaccinated to prevent and reduce the occurrence of these symptoms .
On March 25 this year, the latest article in “Nature” “Can drugs reduce the risk of long-term new crown?” “(Can drugs reduce the risk of long COVID? What scientists know so far”) also proved that among people infected with the new crown after vaccination, vaccination can reduce the risk of long-term infection with the new crown virus by about half
. So far, there are still no clinically effective drugs that can give targeted treatment, but according to the current research speed, it is believed that these studies will usher in new progress in the near future.
Clinical experience emphasizes early use of antiviral drugs
According to statistics, the ratio of deaths to the total number of infected people in the outbreak caused by the variant strain of Omicron is still much higher than that of seasonal flu, especially middle-aged and elderly patients with underlying diseases who are severely ill with new coronary pneumonia high-risk groups.
”In the final analysis, various immune functions are low. The virus cannot be completely cleared in the body, resulting in continuous viremia and organ failure.” Lu Hongzhou, director of Shenzhen Third People’s Hospital, said that if it is a tumor patient, a patient with immunodeficiency, For patients with insufficient organs, the comprehensive immune function cannot effectively clear the virus, and the viremia of the virus in the body may lead to a large amount of viral inflammation, leading to the failure of many functional organs, and finally leading to serious complications in patients.
According to experts, the principle of small-molecule antiviral drugs is to inhibit a specific enzyme of the virus. After this enzyme is inhibited, the virus cannot replicate. Because the enzyme site is relatively conservative, at present, even if the virus continues to mutate, existing drugs will still be effective. The Third People’s Hospital of Shenzhen Municipality has used the first batch of oral drug Naimatevir Tablets/Ritonavir Tablets (PAXLOVID TM ) to be used in the treatment of patients from March 24, 2022, and a total of 43 patients received the treatment. This medicine treats. Through comparative studies, it is found that the period of negative conversion is significantly shortened for infected patients who are treated with antiviral drugs. The current medication is safe and has no obvious side effects.
Lu Hongzhou said that no matter what kind of mutated new coronavirus, the clinical manifestations caused by the virus have a common feature. In the first week after the nucleic acid test is positive, most of the patients are asymptomatic or mild. , the vast majority of the virus in the patient’s body has been cleared and recovered. However, people with underlying diseases, immune deficiencies, obesity, pregnant women, etc. may have aggravated symptoms at this time, and even multifunctional organ failure. “We make early predictions on these patients, and treat those who are likely to develop severe disease with antiviral drugs in advance even if they are asymptomatic.” Lu Hongzhou said that without viruses, there will be no damage, and there will be no multifunctional organs. Organ failure, no virus, no infectivity. After 3 to 5 days of antiviral drug treatment, the virus will not be detected, and the nucleic acid will turn negative, and the patient will not develop severe disease. Therefore, early treatment is advocated. The sooner the treatment, the better the effect .
According to experts, the principle of small-molecule antiviral drugs is to inhibit a specific enzyme of the virus. After this enzyme is inhibited, the virus cannot replicate. Because the enzyme site is relatively conservative, at present, even if the virus continues to mutate, existing drugs will still be effective.
On November 26, 2021, Madrid, Spain, medical staff treat patients with new crown.
Professor Xiang Tianxin, chief public health expert at the First Affiliated Hospital of Nanchang University, said that Omicron must not be regarded as a large flu. From the point of view of individual cases, the symptoms are milder than before. Omicron infection is mainly mild, but many of them are symptomatic.” For people with low immune function, once infected, the disease will worsen in a cliff-like way. We The country has a large base of people with low immune function and long-term bed rest with cerebral infarction. If many people are infected with the virus, the absolute death toll will be very large. Judging from the overseas cases currently being treated, the virus is still mutating, and the patients are more contagious, and sometimes the symptoms will be more serious. There are still many uncertainties and uncertainties.
At present, prevention and control measures and diagnosis and treatment plans are constantly being optimized and adjusted as the epidemic situation changes. New drugs for the treatment of new coronary pneumonia have been launched one after another, and the treatment experience and treatment methods have been further enriched. In the future, with the help of the continuous increase in the vaccination rate of the new crown, better vaccines and vaccination strategies, the implementation of widely available oral drugs, and the implementation of hierarchical diagnosis and treatment strategies, it will help overcome the new crown pneumonia epidemic.
Looking forward to more new drugs
In fact, as the biggest public health event in recent years, in the past three years, the new crown vaccine and related drugs have been a must for almost all pharmaceutical giants.
In the hot new crown oral drug track, Pfizer’s PAXLOVID TM is undoubtedly the most eye-catching. Pfizer’s official website reviewed the development process of PAXLOVID TM . PAXLOVID TM is composed of the 3CL protease inhibitor nematevir (PF-07321332) and ritonavir. Nematevir inhibits the replication of the new coronavirus, and ritonavir prolongs its effective in vivo by inhibiting the metabolism of nematevir in vivo. Blood concentration.
On April 14, 2022, the phase II/III clinical data of PAXLOVID TM were published in the New England Journal of Medicine. A total of 2,246 patients participated in the study, who were randomized 1:1 to receive PAXLOVID TM or placebo treatment, administered every 12 hours One time, continuous treatment for 5 days. On the 28th day after the start of treatment, 66 cases in the placebo group were hospitalized, 12 of which died; 8 cases in the treatment group were hospitalized, and there was no death event, and the risk of hospitalization or death was significantly reduced.
In addition, in the second quarter of this year, PAXLOVIDTM has become the most widely used new crown small molecule drug. In the first half of the year, the sales volume has reached nearly 10 billion US dollars. The number of prescriptions in the United States has increased by 5 times, and the market share has reached more than 90%.
In 2022, the new coronavirus Omicron mutant strain will be prevalent around the world. This mutant strain has the characteristics of fast transmission, strong infectivity, weak pathogenicity, and strong concealment. It is not conducive to early detection, and it is easy to cause diffusion and spillover. People can’t help but ask, will the existing antiviral specific drugs be effective in the future as the virus strains continue to mutate?
Lu Hongzhou said in an interview with “Xinmin Weekly” in April this year that the principle of small molecule antiviral drugs is to inhibit a specific enzyme of the virus. After this enzyme is inhibited, the virus cannot replicate. Because the enzyme site is relatively conservative, at present, even if the virus continues to mutate, existing drugs will still be effective.
According to Lu Hongzhou, other specific antiviral drugs are also being developed. The Third People’s Hospital of Shenzhen has adopted a very simple and accelerated method for patients with early-stage COVID-19—nasal irrigation. He explained that the Omicron variant mainly infects the upper respiratory tract and rarely invades the lungs. The study found that the time for patients with mild symptoms who underwent nasal irrigation was significantly shorter than that of patients who were not rinsed, and the hospitalization time was also reduced by 5 days.
Liang Wannian said frankly that at this stage, we need to make more efforts to further increase the vaccination rate, especially the vaccination rate of vulnerable groups and the elderly; at the same time, speed up the research and development and production of drugs, especially oral ones. Some of the medicines used, “these are what we look forward to.”
With the deepening of research and the enrichment of drugs, Lu Hongzhou believes that the treatment effect of the new crown will be more optimistic in the future. Effective treatment is the prerequisite for society to return to normal operation, so more new drugs and new methods will be added to the treatment of new crown program.
Epidemic prevention and control needs to work harder
In addition to new drugs, the treatment plan for new coronary pneumonia has always been the focus of clinical attention.
On April 21, WHO updated the treatment guidelines for new coronary pneumonia in the British Medical Journal.
Professor Zhang Weijie, director of the Department of Infectious Diseases of Jilin Provincial People’s Hospital, further analyzed that there are certain differences between the treatment guidelines for new coronary pneumonia issued by the WHO and the domestic “Diagnosis and Treatment Program for Novel Coronavirus Pneumonia (Trial Ninth Edition)” (hereinafter referred to as “Diagnosis and Treatment Program”).
First of all, in terms of clinical classification, WHO guidelines divide patients into non-severe, severe and critical cases, of which non-severe cases include mild cases and asymptomatic infections, while the ninth edition of the domestic “Diagnosis and Treatment Program” has classified asymptomatic infections remove.
In terms of treatment, both guidance documents include Naimatevir Tablets/Ritonavir Tablets in the treatment method, and my country’s “Diagnosis and Treatment Plan” indicates that the applicable population is mild and common type within 5 days of onset and accompanied by progression to severe disease Patients with high-risk factors, while the applicable population in the WHO guidelines are non-critically ill patients with a very high risk of hospitalization.
On the evening of October 12, Liang Wannian, leader of the expert group of the National Health and Medical Commission’s Epidemic Response and Disposal Work Leading Group, said in an exclusive interview with CCTV’s “News 1+1”: Dynamic zeroing is a general policy. It is based on “people first, The core issue established under the anti-epidemic concept of “life first” is not the elimination of the virus, nor does it mean that no case can occur, but the elimination of the epidemic. To put it simply, if an epidemic is discovered, it will be extinguished so that there will be no continuous community transmission and large-scale rebound. This is dynamic clearing.
Liang Wannian said frankly that at this stage, we need to make more efforts to further increase the vaccination rate, especially the vaccination rate of vulnerable groups and the elderly; at the same time, speed up the research and development and production of drugs, especially oral ones. Some of the medicines used, “these are what we look forward to.”
