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A Drug Cocktail Hastens Recovery in Some Coronavirus Patients A Drug Cocktail Hastens Recovery in Some Coronavirus Patients
(25 days later)
Patients with mild to moderate Covid-19, the illness caused by the coronavirus, appeared to improve more quickly if they were treated with a three-drug cocktail, compared with a group receiving just a two-drug combination, scientists reported on Friday.Patients with mild to moderate Covid-19, the illness caused by the coronavirus, appeared to improve more quickly if they were treated with a three-drug cocktail, compared with a group receiving just a two-drug combination, scientists reported on Friday.
With vaccines still months, maybe years, into the future, researchers are rushing to determine whether existing drugs can be used to treat the coronavirus. In the United States, only one — remdesivir — has been shown to be effective in speeding recovery.With vaccines still months, maybe years, into the future, researchers are rushing to determine whether existing drugs can be used to treat the coronavirus. In the United States, only one — remdesivir — has been shown to be effective in speeding recovery.
In the new study, published in The Lancet, researchers at six public hospitals in Hong Kong and the University of Hong Kong followed 127 adults with Covid-19, including 86 on the three-drug cocktail and 41 in a comparison group.In the new study, published in The Lancet, researchers at six public hospitals in Hong Kong and the University of Hong Kong followed 127 adults with Covid-19, including 86 on the three-drug cocktail and 41 in a comparison group.
Their study was a preliminary Phase 2 trial, intended to see if a treatment works. (It does not determine whether the treatment is better than other options, but there are few other options for the coronavirus.)Their study was a preliminary Phase 2 trial, intended to see if a treatment works. (It does not determine whether the treatment is better than other options, but there are few other options for the coronavirus.)
The patients who were started on the cocktail within seven days of having their first symptoms stopped shedding the virus — meaning they were recovering and no longer infectious — earlier than patients in the comparison group, the researchers found.The patients who were started on the cocktail within seven days of having their first symptoms stopped shedding the virus — meaning they were recovering and no longer infectious — earlier than patients in the comparison group, the researchers found.
In Hong Kong, even those with mild disease are hospitalized. The patients on the triple-drug combination also appeared to get better faster, and they had significantly shorter hospital stays than the comparison group, according to the study.In Hong Kong, even those with mild disease are hospitalized. The patients on the triple-drug combination also appeared to get better faster, and they had significantly shorter hospital stays than the comparison group, according to the study.
Included in the cocktail were three antiviral drugs: lopinavir-ritonavir (sold under the brand name Kaletra), taken orally; ribavirin, an antiviral drug used to treat hepatitis C, also taken orally; and interferon beta-1b, an injectable drug used to treat multiple sclerosis that regulates inflammation and suppresses viral growth.Included in the cocktail were three antiviral drugs: lopinavir-ritonavir (sold under the brand name Kaletra), taken orally; ribavirin, an antiviral drug used to treat hepatitis C, also taken orally; and interferon beta-1b, an injectable drug used to treat multiple sclerosis that regulates inflammation and suppresses viral growth.
Some experts have suggested interferon may boost the body’s ability to fight the new coronavirus.Some experts have suggested interferon may boost the body’s ability to fight the new coronavirus.
Participants in the comparison group of the trial were treated only with lopinavir-ritonavir, which some physicians have stopped using after a recent clinical trial found it did not significantly improve outcomes in severely ill Covid-19 patients.Participants in the comparison group of the trial were treated only with lopinavir-ritonavir, which some physicians have stopped using after a recent clinical trial found it did not significantly improve outcomes in severely ill Covid-19 patients.
Patients given the three-drug cocktail tested negative for the coronavirus within seven days, on average, compared with an average 12 days among those treated with the one drug. The cocktail also cut the duration of Covid-19 symptoms in half, to four days from eight days.Patients given the three-drug cocktail tested negative for the coronavirus within seven days, on average, compared with an average 12 days among those treated with the one drug. The cocktail also cut the duration of Covid-19 symptoms in half, to four days from eight days.
“This is good news,” said Dr. Sarah Shalhoub, an infectious disease specialist at Western University in Ontario, Canada, who wrote a commentary accompanying the article. “It tells us that patients get better faster, and the time they need to be hospitalized is shorter, and their viral shedding is of shorter duration.”“This is good news,” said Dr. Sarah Shalhoub, an infectious disease specialist at Western University in Ontario, Canada, who wrote a commentary accompanying the article. “It tells us that patients get better faster, and the time they need to be hospitalized is shorter, and their viral shedding is of shorter duration.”
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But she cautioned that all of the patients in the study had mild to moderate disease, and the important question is whether the drug combination will benefit critically ill patients.But she cautioned that all of the patients in the study had mild to moderate disease, and the important question is whether the drug combination will benefit critically ill patients.
“Whether these results will be reproducible in the patients who require a lot of oxygen and end up in the intensive care unit is a different story,” Dr. Shalhoub said.“Whether these results will be reproducible in the patients who require a lot of oxygen and end up in the intensive care unit is a different story,” Dr. Shalhoub said.
“We can’t extrapolate from these results and assume they would apply to patients on ventilators or those who are expected to go on a ventilator soon.”“We can’t extrapolate from these results and assume they would apply to patients on ventilators or those who are expected to go on a ventilator soon.”
The study was designed as a randomized trial: Patients who enrolled were assigned at random to the triple-drug therapy group or the comparison group, and the participants in the two groups were similar.The study was designed as a randomized trial: Patients who enrolled were assigned at random to the triple-drug therapy group or the comparison group, and the participants in the two groups were similar.
Updated June 1, 2020
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
The triple-drug treatment appeared to be safe. There was no difference between the two groups in side effects, which included fever, nausea and diarrhea, though one patient in the comparison group had to discontinue treatment because of liver problems.The triple-drug treatment appeared to be safe. There was no difference between the two groups in side effects, which included fever, nausea and diarrhea, though one patient in the comparison group had to discontinue treatment because of liver problems.
A limitation of the study was that it was an open-label trial, meaning that both the researchers and the patients knew which drugs were being given. This can subtly bias assessments of the data. In addition, some patients who were admitted seven days or more after their symptoms started were not offered interferon, but were analyzed as part of the combination group.A limitation of the study was that it was an open-label trial, meaning that both the researchers and the patients knew which drugs were being given. This can subtly bias assessments of the data. In addition, some patients who were admitted seven days or more after their symptoms started were not offered interferon, but were analyzed as part of the combination group.
Previous research has found that a combination of lopinavir-ritonavir and ribavirin significantly reduced respiratory failure and death in patients with another coronavirus, the SARS virus. Interferon beta-1b has been shown to reduce viral load and improve lung problems in animal studies of the MERS virus, also a coronavirus.Previous research has found that a combination of lopinavir-ritonavir and ribavirin significantly reduced respiratory failure and death in patients with another coronavirus, the SARS virus. Interferon beta-1b has been shown to reduce viral load and improve lung problems in animal studies of the MERS virus, also a coronavirus.
The authors plan to conduct a larger trial to examine the effectiveness of the cocktail in critically ill Covid-19 patients, and they may also evaluate the effectiveness of interferon alone.The authors plan to conduct a larger trial to examine the effectiveness of the cocktail in critically ill Covid-19 patients, and they may also evaluate the effectiveness of interferon alone.