The Three Phases of Coronavirus (COVID-19) and How to Approach Treatment | Remdesivir Update | Hydroxychloroquine Update | Monoclonal Antibodies
When we look at the disease progression, we can break Coronavirus (COVID-19) into 3 phases :
Infection, Early and Late Phases. And understanding each of them can help us develop risk scoring systems so we know who is more likely to get severe complications and when to start treatment like Remdesivir, Hydroxychloroquine, Leronlimab and other monoclonal antibodies.
Remdesivir is a broad spectrum antiviral medication developed by Gilead Sciences. Most evidence suggests that Remdesivir like most antiviral medications is most effective in the early phases of coronavirus (COVID-19) when viral titers are the highest. The later phases of coronavirus (COVID-19) are dominated by a hyperinflammatory state called “cytokine storms” and early indications are that monoclonal antibodies might have the greatest impact in this phase.
And many prominent researchers and physicians feel the jury is still out on Remdesivir. From his own slides and presentation, Dr. Otto Yang, a top physician researcher at UCLA said Remdesivir that
can cut median time to recovery of coronavirus (COVID-19) from 15 to 11 days
, but that there are minimal survival benefit
s and most likely helped patients who were going to recover anyways recovery faster.
When I looked at a lot of the data from various hospitals, I see most coronavirus (COVID-19) patients didn’t present to the hospital until 5-7 days after the onset of symptoms which tells me that antivirals will have a minimal effect and that monoclonal antibodies might have the greatest effect in decreasing the mortality in late stage COVID-19 patients.
During the infection stage of coronavirus (COVID-19), virus uses the respiratory system as point of entry meaning it enters your mouth, nasal passages and eyes. There is some research going into finding a prophylactic anti-viral to prevent the infection stage but realistically having a balanced immune system that is supported by normal levels of vitamin and essential minerals is key. Preventative measures like wearing masks, social distancing and minimizing contact especially if you are in the high risk category is also advised.
The Early Phase of coronavirus (COVID-19) is the first 7-10 days when most of the symptoms are virally induced. We also know that viral titers are the highest in the earliest phases of infection. It is in this phase where antivirals can be the most effective by inhibiting viral entry and viral replication. Early phase symptoms range from no symptoms to fever, cough, shortness of breathe, myalgia, loss of taste and smell.
As the coronavirus (COVID-19) infection progresses into the later phases, your body enters a hyperinflammatory state oftentimes referred to as “the cytokine storm”. I believe that most of the mortality of COVID-19 infections can be traced to the cytokine storm and many physicians treating these patients have severely underestimated the impact of cytokines. This is why I think antivirals like Remdesivir are showing little effectiveness compared to immunomodulators like leronlimab and tocilizumab in the later stages of the infection .
Dr. Yo.
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