Treatment and preventive approaches to combat coronavirus disease in Pakistan

There is plenty of literature and electronic resources available on the treatment options of COVID-19. Here we are summarizing this information for the general public awareness. This can be used for our families, neighbors, relatives, and friends.

Special care is required as COVID-19 has explosive spread potential. China has learned how to deal with and lifted the lockdown. The COVID-19 (Corona Virus Disease-19), caused by SARS-CoV-2, is a zoonotic disease. It mainly infects the respiratory system (primarily lungs), later on, it may involve heart as well. Children are relatively resistant as few percentages have been infected, and children may act as a carrier). Old age, cancer, transplant, cardiovascular, diabetic, and immunocompromised patients are relatively at higher risk.

So, the first and foremost precaution is to stay at home, no handshaking, and practice social distancing.

Useful tips to help combat COVID-19

1. Keep throat moist with Zinc lozenges (Trade name: Cold-Eeze lozenges (Proven/chewing tablets) or any other lozenges.
2. Take frequent mouthfuls of warm water or hot drinks (tea, coffee, drinks, Joshanda, ginger mixed, etc (take smell/inspire steam of hot drinks as well — lung congestion — to avoid hypoxia-difficulty in respiration). Hot drinks, do not allow the virus to stay in the throat, the virus will go to the stomach. Gastric enzymes can neutralize the virus.
3. Take specially prepared steam.
4. Gargles with antiseptic saline/ginger/herbal/mustard/haldi (turmeric) mixed water etc (home remedies are in vogue/social media/as per advice). As the virus stays in the throat/sinuses before going to lungs-pneumonia/detailed clinical signs).
5. It is very important to keep your immune system healthy — exercise, avoid stress/fear/panic. Take full sleep, this will boost your immunity.
6. Immune boosters: Frequently drink Citrus juice or Vit. C (Trade name: CaC 1000 or other medicines), fruit juice having Vit. C or Zinc lozenges (Cold-Eeze lozenges etc.) or Zinc supplementation (Vidaylin Z, Cerbex Z, etc).
7. In case of fever take Paracetamol or Panadol, avoid Brufen, Diclofenac, smoking, Steroids (decrease immunity). Observe fever for three days for related signs or as per medical advice.

Treatment and prevention of COVID-19

Treatment approach

1. Maintain airway, breathing, and circulation.
2. Isolation
3. Supportive care
4. Antiviral (earlier used against SARS COV-1, MERS, Hepatitis B & C, Human Papillomavirus, HIV) based on in-vitro studies, limited clinical trial).
5. Antimalarial drugs etc
6. Electrolyte balance
7. Herbal/other drugs
8. Oxygen (when <55%)
9. Mechanical ventilation etc.
10. Medical Management
11. Mild illness without risk factors of progression of disease no need for treatment — quarantine suggested.
12. Moderate and severe illness with hypoxia (difficulty in respiration) or radiographic evidence of pneumonia (Supportive care or may consider for Lopinavir/Ritonavir or hydroxychloroquine (if the risk of progression is present).

Medicines/therapeutics/biologicals/vaccines

Antivirals

• Interferon Alfa-2B — being produced in China, by a Cuban-Chinese joint venture ChangHeber. Considered one of the stars of the Cuban biotechnology boom, the drug has reportedly been effective in the treatment of HIV, human papillomavirus, Hepatitis B and C.
• Remdesivir, currently in vogue at various medical institutes in Wuhan, China, earlier proved effective against MERS-CoV.
• Lopinavir or Ritonavir (used against HIV treatment) or Favilavir for 10 days AND/OR Hydroxychloroquine for 5 days (Recommendations of CDC, WHO and Cleveland Clinic, Ohio, USA; file attached).

Kalonji (black seeds)

It is effective against bacterial, fungal, parasitic, and viral infections — have traditional/ethnic medicinal properties (may be used with almost no side effects).

Antimalarials

Chloroquine phosphate: Tablet 500mg twice per day for 10 days, proved effective in mild, moderate and severe cases of Coronavirus pneumonia.

Trade names of some Chloroquine phosphate in Pakistan (Some Doctors recommend Chloroquine with Azithrocin (Azithromycin).

Syrup: Nivaquin 60 ml (Sanofi Aventis, Pakistan) (composition 50mg/5ml)
Tablet: Remoquin 200 mg

Trade names of some Chloroquine in the USA:

Tablet: Aralen 250 and 500 mg
Hydroxychloroquine (lesser toxic than Chloroquine), Trade name: Plaquenil

Hyperimmune serum/convalescent sera

It is obtained from recovered patients/persons — some reports say may help more in the prevention of high risk than treatment or both — trial results yet to come — use with caution/reaction as well as the phenomenon of antibody-dependent enhancement.

Monoclonal antibodies

Monoclonal antibodies may also be an option (under consideration).

mRNA vaccine

It is still under consideration/development. Vaccine development has limitations of the phenomenon of antibody-dependent enhancement (ADE) — efforts on-going for identification of vaccine target.

Note: Information should strictly be discussed and followed by the advice/supervision of medical doctors.

Author: Dr. Farhan Ahmad Atif, Associate Professor, University of Veterinary and Animal Sciences,  CVAS, Jhang-Pakistan