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All together with what the World Health Organization defined as the "greatest public enemy of the moment: the coronavirus. Not only health workers, politicians or citizens, but also scientists and pharmaceutical companies, who are working against the clock to study the safety and efficacy of up to 30 antiviral drugs (to cure) and four vaccines to deal with Covid-19 (to prevent).

Meanwhile, the number of infected in Spain exceeds 17,000 cases and in the world, almost reaches 222,000. Fortunately, 80% have mild symptoms, such as a cold, and do not require specific treatment beyond common anti-inflammatory drugs. The infection heals on its own. It is the remaining 20% ​​who are having major symptoms and need hospital admission and around 5% are serious patients who require special care in the Intensive Care Unit (ICU).

Fever, dry cough, respiratory distress ... This is how respiratory infection with this coronavirus (SARS-CoV-2) begins to manifest itself. Especially older people and those who suffer from other diseases, such as high blood pressure, cardiovascular problems or diabetes, are at greater risk that the involvement of their lungs (bilateral pneumonia) will worsen to the point of even dying. The fatality rate of this virus is estimated to be between 2% and 3%.

For this part of the population that requires hospital care, supportive treatment is essential. It is about facilitating "respiratory assistance, serums, correcting metabolic disorders ... The objective is to keep the patient nourished and in the best possible conditions," explains Javier Cobo, head of the Infectious Diseases section of the Ramón y Cajal Hospital in Madrid. "Many of them get ahead thanks to this care."

There is no approved effective medication for this type of pneumonia, caused by the Wuhan coronavirus. However, "we are using some treatments that seem to have had some efficacy in the previous coronaviruses (SARS and MERS)," argues José María Miró, expert in Infectious Diseases at the Hospital Clínic de Barcelona. "Although the data we have is very preliminary, it is encouraging."

An antiretroviral (lopinavir, from Abbvie), interferon beta, hydroxychloroquine, and the antiviral remdesivir (from Gilead). These are the four therapeutic routes "that we are administering to the patients who are most at risk," says Cobo. They are part of a list of compounds published by the World Health Organization (WHO) that alone or combined could boost the immune response of the most severe cases. It is a purely experimental use, without sufficient levels of scientific evidence, still pending investigation.

Lopinavir inhibits an enzyme (protease) that both HIV and coronavirus use to replicate within the body. According to an article published in the journal 'The Lancet', it showed "substantial clinical benefits" in the treatment of patients with SARS in 2003. "In combination with interferon , in some patients and in animal models, they have shown some efficacy," he points out. I look. " The mechanism of action of each is different. Possibly together they are stronger than separate ." Lopinavir prevents cell multiplication, hydroxychloroquine (for malaria and rheumatoid arthritis) blocks the entry of the virus into the cell, and remdesivir works by inhibiting the synthesis of the RNA code.

The latter is already in a clinical trial. It was used experimentally to treat some cases of Ebola and, in fact, managed to deliver the first child free of this disease in Guinea when his mother was infected. "Remdesivir has demonstrated in vitro and in vivo activity in animal models against MERS and SARS, which are also structurally similar to coronavirus SARS-CoV-2," says Vice President of Clinical Research at Gilead Sciences, Diana Brainard. If confirmed, it would be the first specific for this infection and in record time.

These treatments are being administered for a period of 10 days. As the Ramón y Cajal specialist recalls, "we are testing. We hope that in the coming weeks we will be able to learn more ."

These options may be joined by new ones. According to the International Federation of the Pharmaceutical Industry (Ifpma), there are "up to 30 antiviral drugs under study to see their efficacy against Covid-19 and up to four pharmaceutical companies are investigating the efficacy of a possible vaccine."

Work is also underway to develop a drug derived from blood plasma . But this pathway depends on donating plasma from people who have recovered from Covid-19 or who have been vaccinated when immunization develops. "These convalescent donors have antibodies against the virus that could mitigate the severity of the disease in patients with the infection and possibly prevent it," says Silvia Sánchez Ramón, head of the San Carlos de Madrid Clinical Hospital.

Waiting for the vaccine

What is certain is that we will have drugs before vaccines against Covid-19. As much as the science machinery accelerates, there will be no immunization until well into 2021. "It is not a medicine for a small number of people. The use of a vaccine is wide and widespread and requires a long process to guarantee the safety and efficacy . You cannot skip any step, "says Benito Almirante, spokesman for the Spanish Society of Infectious Diseases and Clinical Microbiology (Seimc).

In the words of Adolfo García Sastre, co-director of the Global Health & Emerging Pathogens Institute and the Mount Sinai School of Medicine in New York, "when a prototype has already been designed in the laboratory, it first has to be tested in an animal model. It takes at least a couple of months, and then I transfer it to a clinical trial to see if it's safe and if it works in humans. " As recognized by the WHO last February, there will not be an immunization for 18 months.

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