Pharmacological secondary prophylaxis of COVID 19
Currently clinical workers who experience a needle stick injury when treating a patient with a viral infection, such as, HIV, HBV or HCV positive and several other conditions often receive pharmacological prophylaxis to prevent progression of infection in the healthcare worker, followed by testing for the infection. This takes place after cutting and puncturing by contaminated medical instruments.
Clearly, the infection of COVID 19 is not equivalent to a blood borne viral infection and the current classifications and categories attributed to needle stick injuries are- depth of cut, puncture wounds or by being contamination of mucous membranes or non-intact skin.
However, perhaps we should consider COVID 19 exposure by healthcare professionals as comparable to a needle stick injuries by offering post exposure antiviral prophylaxis to those in close contact with patients using the current most effective drugs, so far found to reduce COVID 19 viraemia in patients. Some suggested drugs are remdesiver, lopinavir and ritonavir, used in China recently. These are tested in human populations so do not require clinical trials.
It has been reported that hospitalised patients often have a higher viral load and this has caused severe infections in otherwise healthy young healthcare workers, despite personal protective measures in some cases. Some patients have been described as ‘super shedders’ with enhanced ability to transmit the infection. Dr Li Wenliang who warned China about COVID 19 may be an example of this and nine doctors have died in the Philippines. Forty Italian healthcare worker have died of the virus, 37 of which were doctors.
The current COVID 19 outbreak scenario requires very rapid responses by the healthcare community and biotech industries.
Himmelreich H, Rabenau HF, Rindermann M, et al. The management of needlestick injuries. Dtsch Arztebl Int. 2013;110(5):61–67. doi:10.3238/arztebl.2013.0061
Kruse RL. Therapeutic strategies in an outbreak scenario to treat the novel coronavirus originating in Wuhan, China. F1000Res. 2020;9:72. Published 2020 Jan 31. doi:10.12688/f1000research.22211.2
I think post-exposure antiviral prophylaxis Should be considered for healthcare workers exposed to patients with high viral load COVID 19 infection.
Healthcare workers have a high risk of occupational exposure, more so in developing countries, with high incidence of pandemic diseases (Avian Influenza, HIV, SARS, MERS, and SARS-CoV-2), and prevalence of unsafe practices. Most of the occupational transmission can be prevented by both effective pre-exposure and post-exposure prophylaxis though proper guidelines still do not exist for SARS-CoV-2 infections. Antiviral drugs administered shortly after COVID-19 symptom onset can reduce infectiousness to others by reducing viral shedding in the respiratory secretions of patients (SARS-CoV-2 viral load in sputum peaks at around 5–6 days after symptom onset and lasts up to 14 days), and targeted prophylactic treatment of contacts could reduce their risk of becoming infected (DOI:https://doi.org/10.1016/S2214-109X(20)30114-5). COVID-19 confirmed patients were treated with interferons-α nebulization, broad-spectrum antibiotics, and few antiviral drugs to reduce the viral load (Shereen et al., 2020; Wang et al., 2020b). So post-exposure antiviral prophylaxis should be considered for healthcare workers exposed to patients with high viral load COVID 19 infection.
I opine that post-exposure antiviral prophylaxis be considered for healthcare workers exposed to patients with high viral load COVID 19 infection.
The use of PPE is of utmost importance.
The vaccine if developed should be prioritized to health care worker
That said, with no proven efficacy of drugs at present and considering side effects and a false sense of security, I do not think it is justified to recommend PEP at present
I agree with Dr. Art Krieg and the use of Oligonucleotides to prevent disease from this virus until the vaccine system is ready.
From Argentina, for several years I have been studying the actions of oligonucleotides and I know that they can help fortify the immune system against severe infections. I write some links and transcribe some of their writings::
https://www.oligotherapeutics.org/oligonucleotide-therapies-and-covid-19/
Oligonucleotide and COVID-19 therapies
In response to the COVID-19 pandemic, scientists from around the world have come together to apply their skills and technologies to combat this global threat. Some of the most promising technologies to combat coronavirus are based on oligonucleotide therapeutics. In an effort to promote public awareness of these drugs and how they might stop SARS-CoV-2, the Oligonucleotide Therapeutics Society (OTS) has released two informative videos, one for the general public and one for scientists. Many of our members, who are at the forefront of this work, contributed to these videos that were presented by former OTS President Dr. Art Krieg. Scroll down to see both videos.
Videos:
https://youtu.be/2Fn2-_nIjgI
https://youtu.be/7a0UxemrAow
Thank you, Teresita for these very interesting videos about the future of COVID 19 vaccines.
Further suggestions for COVID 19 post -exposure- prophylaxis (PEP) to prevent severe infection complications for healthcare workers exposed to high viral loads.
There are about 300 clinical trials being carried out as antiviral therapies for COVID 19 infection. Post or pre exposure prophylaxis of rifampicin and oseltamivir is recommended by WHO for people at high risk of COVID 19 infection during the pandemic.
Some obvious PEP considerations should be vitamins D and C to ensure strong and effective immune responses to neutralise the virus.
Chloroquine and hydroxychloroquine are hugely controversial at the moment due to hasty and inappropriate understanding of literature from public leaders in USA and there are no statistically significant results for the study and serious complications indicated, including, cardiac toxicity, QT prolongation, and ventricular arrhythmias. Clinical trials continue in China with some promising indications but not statistically significant.
Nitrazonxanide combined with azithromycin is tentatively suggested as a safe and available regimen to consider as a preventative antiviral therapy. Tizoxanide is the active metabolite of nitrazonxanide and is potent against COID 19 in vitro and has broad-spectrum antiviral activity.
Further trials are required to assess the efficacy of Invermectin as an antiviral against COVID 19. It is actually an antiparasitic but was able to reduce COVID 19 viral RNA and disrupts the immune invasion mechanism.
Antihistamines have beneficial effects on immune dysregulation and tissue remodelling during COVID 19 infection? The protective barriers of mast cells of the submucosa in the respiratory tract are activated by the virus and release histamine and protease and later activate IL-1 and IL-33. Histamine, as well as affecting vascular and bronchial responses, is increasingly identified with modulation of immune responses, including a variety of lymphocytes, such as T cells. A recent trial took place in France where antihistamines were given to patients displaying COVID 19 symptoms and none developed severe infection in the cohort. Third generation antihistamine is an over the counter drug that is extremely well tolerated.
ARBs are also being investigated as inhibitors of viral attachment to ACE2.
Thank you Annwyne, very important what you explain in each paragraph ...
The idea is correct, but there is no proven effective anti viral till date..
And the drugs are costly, have side effects, thereby risk benefit ratio does not support.
Hence it is not justified till date
In theory it could be an adequate strategy. In practice we do not yet know which antiviral guarantees a certain effectiveness ...
I would like to point out that even contact with patient's tears could transfer the virus to healthy subjects (“output” ocular route), or contact of infected biological materials (e.g. bioareosol) with the ocular surface of healthy people (“input“ ocular route) may allow human-human transmission. In these cases, I would recommend the use of eye drops based on oxidizing disinfectants.
Please see the following paper of our group: Article The Ocular Surface and the Coronavirus Disease 2019: Does a ...
Prompt treatment or prophylaxis is important. However it is better to prevent it from happening in the first place by implementing social distancing, Mandatory mask rules and proper hygiene
I completely agree about prevention.
There is some evidence and conceptual thinking in immunology about the benefit of reducing mast cell expression of histamine and thus reducing the severity of COVID 19 symptoms by administering antihistamine drugs when early symptoms of a SARSCoV-2 infection are observed and a positive test for the virus infection.
How can we test this hypothesis using readily available ‘off the shelf products’ products?
Clearly, success in this treatment regimen this would be of great advantage in reducing the severity of the pandemic but also of financial benefit to your company. A centre in France has already tried this concept on a group of patients who were positive for COVID 19, with significant success.
Pathological and environmental factors drive the immunological repertoire, in response to the virus, influencing innate immune cell activation, cytokine-balance and T cell differentiation, determined by age, comorbidity, vitamin D status and ethnicity related factors. Homeostasis of the immune system plays an important role in the development of COVID-19 pneumonia.
Mast cell activation and release of histamine is important to the cytokine driven T-cell differentiation as the adaptive response.
An example of anti-inflammatory medication used for other causes, although there are no officially approved drugs to treat dengue disease, for example, MC stabilisation can be achieved with the antihistamine drug ketotifen reversed many of the responses due to MC activation, including reducing the effects of histamine.