We distinguish 3 types of laboratory detection
- Rt-PCR kits with primers and nuleic acid control Nattrol Sras-Cov2
- Elisa kits currently in development March 23, 2020, scheduled for April
- IgG / IgM antibody detection by cassette
Thoracic radio examination
This is the most characteristic test of the Sras-Cov2
Covid-19: Which are the possible interventions to mitigate the epidemic?
Everything and nothing has been said about the coronavirus, its prevention and its treatment. And although quarantine remains the only proven health measure today, some resources at the individual level can add value based on experience with other coronavirus outbreaks such as SARS-CoV and MERS-CoV .Lieven Gevaert
Dr. Lei Zhang and Dr. Yunhui Liu (Shenyang, China) wanted to study these adjuvant or support agents by examining the literature on the subject.
Some call it the anti-infective vitamin, reducing morbidity and mortality from measles, infectious diarrhea, measles pneumonia, HIV infections and malaria, resulting in less severe infectious complications. An interesting potential has been demonstrated in animal models against certain diseases linked to coronaviruses and could be an interesting option in the prevention of pulmonary infections with Sras-CoV2. However, no study on this subject has been conducted and no case study has been published.
The vitamin B12 associated with UV can reduce the concentration of MERS-CoV in humans, while vitamin B3 promotes the destruction of Staphylococcus aureus. These vitamins also inhibit the infiltration of neutrophils into the lungs and have an anti-inflammatory action in the event of lung damage after assisted ventilation. Finally, vitamin B6 deficiency is often found in viral diseases. This makes it an interesting addition, according to the authors …
As an antioxidant, this vitamin strengthens the resistance of chicken to coronavirus infections and acts on the symptoms of the upper respiratory tract: rhinorrhea, sneezing, blocked sinuses. It can reduce the incidence of pneumonia in humans under certain circumstances and reduce the frequency of lower respiratory tract infections.
The immune profile of this “hormonal” vitamin is known and its protective effect against infections has been proven in cattle. Because the elderly must stay indoors because of the epidemic and because it is winter, they are often deficient in vitamin D and can probably benefit from supplementation to “strengthen” their immunity.
Researchers have previously reported an indirect link for this vitamin, as supplementation has not yet proven to be effective. However, vitamin E deficiency is a risk factor for infection with coronavirus and other bovine viruses.
Polyunsaturated omega-3 fatty acids
HIV-infected patients are deficient in omega-3 fatty acids. In addition, protectin-1, a lipid mediator derived from omega 3, considerably weakens the replication of the influenza virus by acting on the RNA machinery. Adding it to peramivir, an antiviral, significantly reduces influenza mortality in a mouse model. Certain polyunsaturated fatty acids also have a beneficial effect on the hepatitis C virus. Therefore, the authors believe that the combination of omega 3 and protectin-1 can have a positive effect on the coronavirus.
We know the negative effect of a selenium deficiency in viral infections, because selenium modifies the viral genome (and thus reduces the risk of mutations) and reduces its virulence. Selenium also plays an important role in immune defense and acts in combination with vitamin E as a coenzyme in many reactions. In chickens, it has a beneficial effect on the protection against coronavirus bronchitis in combination with ginseng. We can therefore consider the product as a supplement to respiratory infections.
Zinc deficiency causes a dysfunction of the innate and acquired immune system, which increases susceptibility to infections. Preclinical studies have shown that the administration of zinc can alter the replication processes of many viruses by inhibiting RNA – dependent RNA polymerase (RdRp) which Sras-Cov2 uses when it replicates with its own polymerase. When added to pyrithione, it also inhibits replication of the SARS coronavirus, suggesting that it can act on the gastrointestinal and respiratory symptoms of COVID-19.
What about immune stimulants?
Type I interferons, especially alpha and beta interferons , in combination with antiviral agents can inhibit replication and infection with SARS-CoV. More specifically, interferon alfa-2b, used to treat chronic hepatitis C, is believed to protect pneumocytes from coronavirus infections in macaques when given 3 days before infection. A pilot study suggested the therapeutic efficacy of the recombinant E. coli form. This form, combined with ribavirin, also improved the death rate from MERS-CoV, which makes it a very attractive potential candidate in the fight against COVID-19. Beware of allergy sufferers who produce Histamine which inhibits interferron. You should take your antihistamines absolutely during viral infections of which Sras-Cov2 is no exception.
Gamma globulin iv. IgG
Despite its effectiveness, this treatment is not without side effects, as was demonstrated during the SARS epidemic in 2003. In addition, one third of patients have experienced thromboembolic side effects despite prophylactic treatment with low molecular weight with heparin.
A thymic peptide hormone, thymosin alfa-1, restores the homeostasis of the immune system. It has helped control the spread of the disease during the SARS epidemic and does not appear to produce any major side effects, provided it is used before the onset of cortisone.
This pentapeptide, which is synthesized from thymopoietin, restores the production of antibodies in mice. Some suggest that it can be done in humans at a dose of 3 sc injections of 50 mg / week. It is used as an adjuvant in non-responders to the hepatitis B vaccine.
Levamisole, the first compound in a new therapeutic class capable of improving cellular immune functions in healthy laboratory animals, would have an immunostimulatory or immunosuppressive action, depending on the dose and the injection time proposed. In combination with vitamin C, it would reverse the lymphocytic imbalance of measles infection in vitro. Today, it has the greatest chance of being studied in the framework of COVID-19.
Since cyclophyllin A is a cellular receptor for cyclosporin A and could play a role in the assembly of viral particles, it seems advantageous to use non-immunosuppressive derivatives of cyclosporin A to avoid viral replication. However, this has not yet been demonstrated for COVID-19.
Glycyrrhizin, the active ingredient in licorice, and baicalin, found in various skate species, have an in vitro effect against SARS-CoV, as do the saponins in the ginseng leaf. According to some experts, that would be enough to study it in a crisis situation.
Specific treatments for coronavirus
- Coronavirus protease inhibitors, namely chymotrypsin-like protease and papain-like protease, can play a critical role in inhibiting viral replication. Cinanserin, which inhibits the chymotrypsin-like protease, and certain flavonoids (herbacetin, riopholine and pectolinarine) act at the same level and block the enzymatic activity of MERS-CoV. Diaryl heptanoids, which inhibit the papain-like protease, are being considered for acute treatment in combination with the two preceding agents.
- Spike (S) protein-angioconvertin-enzyme-2 (ACE2) has specific receptors for ACE2 in SARS-CoV, which allow the virus to enter cells that infect it, while protein S is the fusion between the virus and the host membranes mediate. Blocking the binding of protein S to ACE2 may be a solution for the future.
- Human monoclonal antibodies directed against the S1 domain of protein S in SARS-CoV could be another avenue of research.
- Chloroquine, a drug against malaria, has the biochemical properties of an antiviral drug. An effect has also been demonstrated with SARS-CoV infection due to interference with ACE2 at the locations of protein S on the membrane surface of this virus.
- Emodin, an anthraquinone that kills viruses, can also block the link between protein S and ACE2.
- Promazine, an antipsychotic with a chemical structure similar to that of emodin, could prevent SARS-CoV from entering cells by the same mechanism.
- Nicotianamine also inhibits the angiotensin converting enzyme.
- Ribavirin, a broad-spectrum antiviral commonly used in the treatment of hepatitis C, does not appear to have specific activity against SARS-CoV in vitro, and many patients also report side effects. However, it works in synergy with interferon alfa and can therefore be useful.
- The antiretroviral agent lopinavir / ritonavir has been used in MERS-CoV. It may be useful in combination with interferon alfa-2a.
- Remdesevir, a GS-5734 nucleoside analogue, appears to be effective against coronavirus zoonoses and reduces the severity of acute respiratory syndrome. It may work better than lopinavir / ritonavir. Researchers are examining it with great interest.
- Nelfinavir, an HIV protease inhibitor, could also be studied further.
- Arbidol, a small molecule derived from indole, is used in China and Russia for the prophylaxis of influenza and other respiratory infections. It blocks the fusion of influenza A1 and B and the hepatitis C virus (would be blocked to enter and replicate in vitro). In a culture, arbidol mesylate decreases the reproductive capacity of the SARS virus.
- Nitric oxide, which interacts with superoxides to form peroxynitrite, can promote bactericidal and cytotoxic reactions. In addition, it has an effect on respiratory function and inhibits the synthesis of viral proteins and RNA.
- Alpha lipoic acid, long known for its action in the treatment of polyneuropathy and liver disease, is also an antioxidant. It also increases intracellular GSH levels and decreases susceptibility to 229E coronavirus infection. It also inhibits the replication of HIV-1, which makes it an attractive option in the current indication.
- Estrogens and phytoestrogens, which are believed to be of interest because women are generally more resistant to the virus (except when they have had an oophorectomy) also play a role in reducing the replication of the influenza virus in epithelial cells of the nose. Resveratrol is certainly also an option. Fennel contains phytoestrogens.
- Mucroporin-M1, a peptide derived from scorpion venom, offers high antiviral activity, in particular against measles virus, H5N1 viruses and SARS-CoV.
Vaccination still offers the greatest hope. One candidate is the H strain of avian IBV virus (avian infectious bronchitis). This is structurally similar to the SARS-CoV strain which has been used to treat SARS since 2005. We also know that children are not so often affected by COVID-19 or SARS-CoV. This is likely due to their vaccination schedule, which has sparked interest in a combined measles, polio, Japanese encephalitis and rabies vaccine or a recombinant measles vaccine that expresses protein S. Short-term , we may be able to prevent viral infection through passive immunotherapy. This is being tested today with human IgG1 monoclonal antibodies, as well as with plasma from patients recovered for passive immunotherapy.
What do we learn from this overview?
There are many candidates for possible treatments. So far, none has really proven useful in acute care, but some may be important in prevention. None of these have yet been specifically studied for COVID, and most of the authors have based their conclusions on case descriptions in SARS-CoV and MERS-CoV. It therefore seems essential to assess the nutritional status of infected patients, as this could affect their future. For vitamin or nutritional supplements, we find here an interesting indication, not to lose sight of. In the meantime, quarantine still seems to be the most effective preventive treatment, and effective intensive care and resuscitation services remain the most useful curative treatments.