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Finding the right treatment

GEORGE TOWN: A team of medical experts here has been putting in endless hours to carry out tests to find the right drugs to treat patients afflicted with Covid-19, the disease caused by the novel coronavirus that has claimed many lives and ravaged economies around the world since January.

Penang Hospital infectious disease consultant Dr Chow Ting Soo (pic), who is leading the team of 16 physicians and pharmacists, said they were gathering data and comparing the safety and effectiveness of four treatment protocols using different combinations of remdesivir, lopinavir/ritonavir, interferon beta, chloroquine and hydroxychloroquine.The team’s effort is a research initiative by the World Health Organization (WHO) under the Solidarity Trial.

In April, the Health Ministry and WHO announced that Malaysia had been selected to participate in the global trial to test drugs to treat Covid-19.

“It is still too early for us to conclude which of the treatments is effective.

“There is no proven antiviral or medication for Covid-19 so far.

“The previous treatment using repurposed medication such as hydroxychloroquine, lopinavir/ritonavir had shown to be not effective in treating the disease,” she said.

In an interview with The Star, Dr Chow said the main findings from all studies consistently showed that the elderly, patients with underlying chronic medical illnesses and obesity were at risk of developing severe Covid-19 that required care in the intensive care unit (ICU).

She said more studies were needed to come out with a severity score and proper monitoring to help reduce mortality among Covid-19 patients.

Judging by the recent scale of the spread of the Sivagangga and Ulu Tiram clusters, Malaysia has managed to isolate the virus with D614G mutation.

(The Sivagangga cluster started with a restaurant owner in Kedah who had visited the town in India while the Ulu Tiram cluster involved a religious centre in Johor.)“But some researchers in San Diego have reported that it has the potential to increase the number of spike proteins on the coronavirus and hence, boost the ability to infect human cells by a factor of 10.

“Those patients who had recovered from the earlier Covid-19 may not have the immunity to fence this strain, and may be infected again.

“It is still too early to make any conclusion whether the reinfection will give a more severe course of disease. In other words, this mutation may reduce the effectiveness of vaccines,” explained Dr Chow.

She said her local cohort had found that the disease transmission was likely to occur a few days before and after the onset of symptoms.

“More research is needed to understand whether an asymptomatic person can transmit the disease.”

She said an airborne transmission could occur in healthcare settings where specific medical procedures could generate small droplets called aerosols.

“Some outbreak reports related to indoor confined space with crowded people may be due to aerosol transmission,” she said.

Dr Chow said the newly recruited participants needed training and were required to have strong communication skills.

“In the process of data collection and procedures to deal with investigation products, everything must be thorough and complete because one single mistake will create a major catastrophe to the outcome of the study.

“Therefore, when doing clinical trials, protected time must be given to the investigators and full concentration be applied in dealing with the study,” she said.

Dr Chow also said that in this era of pandemic, the virus would be here to stay as there was still no effective vaccination programme.

To help break the chain of transmission, she reiterated the importance for everyone to adhere to the new norms of avoiding confined or crowded spaces, keeping close conversation short, and using face masks and hand sanitisers.

“We must all revisit the old school of infection prevention and control. Stay away when sick, wear a mask, especially when sick, and adopt good hand hygiene,” she said.

On the availability of vaccine for Covid-19, Dr Chow admitted that it was not easy following the occurrence of D614G mutation.

“One must refrain from promoting any agent to be applied on patients based on gut feelings, and all pharmacological agents must be evidence-based and safe to be consumed,” she added.–The Star

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