Norwegian doctors' new weapons: How to treat covid-19

The intensive care unit at Rikshospitalet in Oslo is responsible for treating some of the very sickest coronary patients. Photo: Stian Lysberg Solum / NTB

Resett - Of NTB -January 23, 2022 | 09:51

Specially designed medicines are about to change the fight against covid-19 in the hospitals in Norway.

- We have come a lot further, says Marius Trøseid.

He is the chief physician in infectious disease medicine at Oslo University Hospital (OUS) and one of Norway's foremost experts on drugs against covid-19ad

At the beginning of the pandemic, doctors used everything from HIV medicine to malaria medicine against the coronavirus - preparations that later proved to be without effect.

- But during 2022, we will probably have three to four immunosuppressive drugs, and then we may have a similar number of virus drugs that work, Trøseid tells NTB.

In Norwegian hospitals, several of the new medicines are already in use.

Two angles of attack.

Trøseid explains that the doctors attack the virus from two different angles.

- When people are admitted to hospital with covid-19, some will be affected by a viral disease, and quite a few will be affected by the body's inflammatory reaction to the virus. This means that there are two main strategies we follow. One is antiviral treatment, the other is anti-inflammatory treatment.

Børre Fevang is the chief physician at Rikshospitalet, which has had treatment responsibility for many of the sickest patients. He says the choice of treatment strategy depends on how far the disease has come.

- There are two things happening, says Fevang to NTB.

- To begin with, you have an active phase of infection where the virus multiplies, and it can be important to give antiviral drugs. Then the disease at some point enters an inflammatory phase where the immune system often shoots over targets.

Anti-inflammatory drugs

In the inflammatory phase, the goal is to curb the overactivation of the immune system.

Here, doctors have found several drugs that seem to work:

* Dexamethasone: This is a cortisone preparation that has been used for many years against a number of inflammatory conditions, autoimmune diseases, and cancer. Already in 2020, doctors discovered that dexamethasone also seemed to reduce the risk of death in seriously ill patients with covid-19.ad

* Tocilizumab: This is an immunosuppressive drug that has been used for arthritis. Tocilizumab is given intravenously to selected patients who are hospitalized with severe covid-19.

According to Fevang, tocilizumab is perceived as a narrower preparation than dexamethasone.

- Dexamethasone provides a broad suppression of the immune system, but it also has a number of side effects. Tocilizumab basically has fewer side effects, at the same time as it has a more targeted effect.

Trump cocktail

The second treatment strategy is to attack the virus itself.

- Then the starting point has been that it is important to get started very early in the process if it is to have any effect, Trøseid says.

When the pandemic started, the doctors were on bare ground. But today they have several innovations from the pharmaceutical industry in the arsenal.

One such innovation is so-called monoclonal antibodies. These are designed specifically to bind to the coronavirus' spike protein so that the virus does not enter the body's cells.

Perhaps the most famous preparation is Ronapreve, the antibody cocktail that was given to then US President Donald Trump when he became ill with covid-19 in October 2020.

Norway has so far received at least 100 doses of the Trump cocktail. An additional 400 doses will be delivered by March.

In other words, access is very limited. But doctors believe that monoclonal antibodies may have something to offer when given at the right time.

- These are not magic medicines, says Fevang.

- But we have had some patients where we clearly perceive that they have had an effect.

The Joker omikron

An important element of uncertainty is the new virus variant omikron. Trøseid calls omikron a joker who, in the worst case, can put several of the specially designed medicines out of play.

- Many of the antibodies that have been developed against the virus target the parts of the spike protein that have unfortunately been changed in the omicron variant. This makes it uncertain whether these antibodies will have an effect on the omicron, he explains.

This is especially true of Ronapreve.

- It is probable that Ronapreve will not work against omikron, says Trøseid.

- That is why Norway has ordered a new type of antibody called sotrivimab. We believe it should work.

Pills

Another innovation is the so-called corona pills. These contain antivirals that are meant to strengthen the immune system.

The corona pills are not yet in use in Norway, but the Norwegian Directorate of Health has ordered 41,000 doses of Paxlovid from Pfizer. In addition, the Norwegian Directorate of Health has ordered 8,640 treatments with the corona pill Lagevrio from Merck, but this pill has an uncertain effect and will be stored until further notice.

Trøseid believes that such pills will be particularly relevant for patients who are not hospitalized, but who have a high risk of developing a serious illness. It can be the elderly, people with weakened immune systems - or people who have chosen to give up the vaccine.

- But it will be important to prioritize who should have them, says Trøseid.


Summary of the Spanish Flu

  • The reason modern technology has not been able to pinpoint the killer influenza strain from this pandemic is that influenza was not the killer.
  • More soldiers died during WWI from disease than from bullets.
  • The pandemic was not flu. An estimated 95% (or higher) of the deaths were caused by bacterial pneumonia, not influenza/a virus.
  • The pandemic was not Spanish. The first cases of bacterial pneumonia in 1918 trace back to a military base in Fort Riley, Kansas.
  • From January 21 – June 4, 1918, an experimental bacterial meningitis vaccine cultured in horses by the Rockefeller Institute for Medical Research in New York was injected into soldiers at Fort Riley.
  • During the remainder of 1918 as those soldiers – often living and traveling under poor sanitary conditions – were sent to Europe to fight, they spread bacteria at every stop between Kansas and the frontline trenches in France.
  • One study describes soldiers “with active infections (who) were aerosolizing the bacteria that colonized their noses and throats, while others—often, in the same “breathing spaces”—were profoundly susceptible to invasion of and rapid spread through their lungs by their own or others’ colonizing bacteria.” (1)
  • The “Spanish Flu” attacked healthy people in their prime.  Bacterial pneumonia attacks people in their prime. Flu attacks the young, old and immunocompromised.
  • When WW1 ended on November 11, 1918, soldiers returned to their home countries and colonial outposts, spreading the killer bacterial pneumonia worldwide.
  • During WW1, the Rockefeller Institute also sent the anti meningococci serum to England, France, Belgium, Italy, and other countries, helping spread the epidemic worldwide.


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