A pandemic transits the orb (3)

Por: José Antonio Michelena


The pandemic unfeded by The Covid-19 has shocked the world and made it clear that despite all the technological advancement we have come to, nature can charge us dearly for our mistakes, and that globalization is excellent for expanding viruses.

As each nation has charted its strategies, its own crisis management, we have convened a group of intellectuals from diverse countries to put into context, from their respective nations, this current, globalized scourge of humanity.

They are scientists, professors, writers, journalists, communicators, who will leave their voices here to transmit their experiences, information, opinions. By sharing them, they encourage us to feel that protection that knowledge and ideas provide, something we need very much at this hour.


Alejandro Madrigal
Alejandro Madrigal

By Alejandro Madrigal*

The new coronavirus has become a serious problem, and now it’s a pandemic. It’s gone out of control, it’s grown at a rate we weren’t prepared for. To respond, with new treatments and drugs at the rate this virus expands on our planet, there has been a massive and global attempt to develop new therapies. This has generated innovations, but there is still a long way to go.

Therapeutic measures to treat it have been divided into:

Vaccine production (which would be ideal).
Decreased transmission of the virus (which depends rather on almost medieval measures, such as quarantine and isolation).
Therapeutic measures to affected patients, from simple treatments, including simple medicines; and options to treat severe respiratory syndrome, ranging from symptomatic, such as oxygen, bronchodilators, some caroteid pulse measurements, corticosteroids, etc., and subsequently more specific scanning, with antiviral medications.

Several of them [antivirals] have been attempted, such as remdesivir, which is very prominent, although recently in Japan studies have been done with other antivirals such as favipiravir; there are other results with lopinavir-ritonavir, which came back negative in New England.

Then come the drugs that can be called immunoregulators, because it has been seen that the inflammatory response is not only due to the effect that the virus produces, but there is a very important response from the body, of the immune system of the organism trying to reject the virus.

This response has been seen under other conditions, for example in so-called cytokine release syndrome, with patients receiving new therapeutic measures, such as shocked patients. There are a large number of substances that the body produces trying to respond, such as interlechins, in particular interlequine 6 (IL-6), which lead to a severe inflammatory process that affects the lung.

Another theory is that the virus also greatly affects oxygen transmission at the erythrocyte level, and this alters systemic oxygenation. In this way there are drugs that try to attack this problem, such as immunoregulators, such as tosiluzumab, an antibody that blocks IL-6.

Subsequently, slightly stronger measures are already coming, which try to decrease inflammatory processes.

On one side of them has developed what is called cell therapy. There are several studies that are trying to apply Mesenchimal cells that are obtained from the umbilicar cord preferably, and that have an immune modulating effect. There are clinical trials with the use of these cells in Spain, France, and other countries, after initial results in China, which showed, in six patients, a favorable response.

There are other studies with serums of patients who have recovered after infections, to treat infected patients. The results are still in clinical trials. Their effectiveness remains to be seen, but they are very promising.

There are other medicines that try to protect the endothelium, such as Defibrotid, which is being tested. And then there are the drugs that have a little more recognition at the press level, such as hydroxychloroquine, and others, which seem to be promising, but their role is not yet clear.

Recently the company Gilead has released the communication of a drug called remdesivir. According to what has been published in The Times, the response of this drug is impressive, according to a study that has been done in Chicago.

All this is proving that we don’t have control yet. However, the massive response of science has generated more than 180 clinical trials. There are a lot of measures being done, but there are also other things that are not indicated, for example, there were people who said that with Vitamin C and other measures they could prevent it. You have to be very cautious about this.

The end point is that any drug, any drug used should be under critical rigor of clinical trials. They are the ones who have to actually show that there is a benefit and not fall into errors, as happened earlier with pandemics like influenza and other types of viruses, where drugs were used that were subsequently seen not to be effective.

London, 17 April 2020

*ALEJANDRO MADRIGAL FERNANDEZ (born 1953), a specialist in haematological and bone marrow transplants, is scientific director of the Anthony Nolan Research Institute, a centre specializing in blood cancer, and holder of the Chair of Hematology at the Royal Free Hospital & UCL Medical School in London. He has been president, since 2010, of the European blood and Marrow Trasplantation Society. His research is reflected in more than five hundred articles cited thousands of times.

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