It is indeed difficult in the midst of a raging pandemic to see any silver lining to the dark COVID clouds, but two sets of observations are emerging on an optimistic note.
Let me start with a true story of a 34-year old otherwise healthy young man who came down with fever for 8 days, initially suspected to be typhoid, that refused to subside with several courses of strong antibiotics.
By the time he reached a nearby hospital, he was found to be breathless requiring oxygen therapy (requirement 4 liters/minute). A COVID test was sent, but as no beds were available, he was asked to go to another hospital. After much pleading, he was kept in the emergency hold area on supportive care waiting for a bed to fall vacant.
Over the next 2 days his fever and breathlessness deteriorated (requiring 15 liters/minute), while his COVID test came positive. He could luckily be shifted to a single ICU bed of a nearby hospital that fell vacant, just in time to be put on a ventilator.
In the subsequent days, several new “emerging” therapies were used to quell or block the cytokine storm that was stiffening and drowning his lungs. After 7 days of suspense, he could be weaned off the ventilator two days ago, and is now being shifted out of ICU.
Medical scientists are now recognizing two distinct phases of COVID illness. The first is the infective or viral phase where the Corona virus invades the body and initiates symptoms like sore throat, fever and body aches, to which the body’s immune cells mount a defense response. If effective the activated cells and the products they release called Cytokines, helps clear the virus and usher recovery.
The second phase, which in a minority causes lung or organ damage, is caused by an over reactive immune system running amok and pumping cytokines (chemicals that stimulate inflammation, swelling and blood clotting) that usually causes severe complications and kills.
While the painful wait for an effective vaccine or a magic bullet continues, medical scientists are gaining expertise in understanding and managing patients better.
A study published last week showed that an affordable drug called dexamethasone, a steroid, that is easily available and has been widely used for treating a wide variety of “immune mediated” diseases, helped pull back many very sick COVID patients who were on ventilators or oxygen therapy from the brink, and has now got approval as a “life saving” drug.
Scientists are now exploring and using several therapies in severe and critical patients to fight the second phase. Apart from steroids (dexamethasone or methyl prednisolone) tocilizumab and anticoagulants are also often being used.
We therefore now have several approaches gaining ground: Hydroxychloroquine for prevention of infection, anti-virals to kill the virus (Remdesivir, Favipiravir, Ritonavir), plasma therapy, and cytokine blockers (such as steroids and biologics) in use.
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