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| LETTER TO THE EDITOR |
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| Year : 2022 | Volume
: 4
| Issue : 1 | Page : 3 |
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Less is more in Corona Virus Disease 2019
Jingjing Xu1, Kai Kang2, Fu Li1, Dongsheng Fei2, Wei Yang2, Changsong Wang1, Kaijiang Yu2
1 Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang Province, China
2 Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Harbin, Heilongjiang Province, China
| Date of Submission | 20-Oct-2021 |
| Date of Acceptance | 28-Dec-2021 |
| Date of Web Publication | 27-Jan-2022 |
Correspondence Address:
Dr. Changsong Wang
Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150001, Heilongjiang Province
China
Dr. Kaijiang Yu
Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Harbin 150001, Heilongjiang Province
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/JTCCM-D-21-00019
How to cite this article:
Xu J, Kang K, Li F, Fei D, Yang W, Wang C, Yu K. Less is more in Corona Virus Disease 2019. J Transl Crit Care Med 2022;4:3 |
To the Editor:
We would like to focus on the treatment of Corona Virus Disease 2019 (COVID-19). For more than 1 year, COVID-19 has been a troubling problem for people worldwide. It brought an enormous impact on public health, economy, and society and became a global emergency.
Unfortunately, we found that lots of clinical trials had not achieved a good result for the treatment.[1] Antiviral therapy could not decrease mortality in COVID-19. Lopinavir/ritonavir VERSUS standard care in COVID-19, no significant benefit was seen in either overall mortality or reduction in viral load; antimalarial treatment has reported both beneficial clinical and virological outcomes, but this study lacked randomization and blinding,[1] and there was a clinical trial reported that interferon beta-1b and hydroxychloroquine had no differences in clinical outcomes[2]: discharges (65.9% vs. 68.9%; P = 0.764) and overall mortality (11.4% vs. 13.3%; P = 0.778); immunosuppressants/immunomodulators including adalimumab (anti-tumor necrosis factor), meplazumab (anti-CD147), sarilumab (anti-interleukin-6), and camrelizumab (anti-PD-1) are being tested in several clinical trials. One of those studies reported that meplazumab improved clinical and virological outcomes, but only 17 patients with COVID-19 were in this study; plasma-based therapy: Use of plasma from patients who have recovered from COVID-19 has been a potential therapy for COVID-19. However, a study for Ebola found no associated improvement in survival, and another study showed that among critically ill adults with confirmed COVID-19, treatment with convalescent plasma had no significance of providing improvement in the number of organ support-free days and mortality rate.[3] Convalescent plasma is not recommended. Further study is needed to investigate the function of plasma.
According to those clinical trials, we think the treatment for COVID-19 should be less is more.
How to achieve “less is more”?
It has been more than 1 year since the outbreak of COVID-19, and there was no effective treatment for the disease. Now, we have some different ideas for the treatment of COVID-19. First, according to the results of clinical trials,[1],[4] antiviral therapy cannot be used in COVID-19; second, antibiotics are not necessary to use, if the patients without a definite bacterial infection. Then, systemic glucocorticoids are recommended in both the World Health Organization guidance for the clinical management of COVID-19 and the National Institutes of Health COVID-19 treatment guidelines. However, the effect of glucocorticoid on patients with COVID-19 is controversial. According to a study,[5] dexamethasone group VS standard care group was no significant difference in mortality, intensive care unit-free days, or mechanical ventilation duration. Hence, glucocorticoid is not to use regularly. Finally, according to the above review, immunotherapy or targeted therapy is not recommended for now. We need more clinical trials for immunotherapy in COVID-19 to guide us to personalized use. Contrary, what we think needs to be done: Proper nutritional support is another important therapy for COVID-19, enteral nutrition, the earlier the better; then, anticoagulant therapy is necessary to prevent thrombosis. There are lots of studies that reported that thromboprophylaxis was associated with a lower risk of death and a lower cumulative incidence of thromboembolic events, especially with high doses.[6] In addition, the fever, cough, and other symptoms of the patient should be treated by symptomatic treatment. For oxygen, perform in the prone position and tidal volume for ventilation (<10 ml/kg). Last but not least, organ support such as a ventilator, continuous renal replacement therapy, and extracorporeal membrane oxygenation are in clinical trials,[1] the results are being expected.
In conclusion, we have confronted a long-term coexistence situation with COVID-19. We do not want an excessive treat for COVID-19 and less will be more in the treatment for COVID-19.
Financial support and sponsorship
Nil.
Conflicts of interest
Kaijiang Yu is the Editor-in-Chief of the journal. Changsong Wang is the Editorial Board Member of the journal. The article was subject to the journal's standard procedures, with peer review handled independently of these members and their research groups.
| References | |  |
| 1. | Lythgoe MP, Middleton P. Ongoing clinical trials for the management of the COVID-19 pandemic. Trends Pharmacol Sci 2020;41:363-82.  |
| 2. | Khamis F, Al Naabi H, Al Lawati A, Ambusaidi Z, Al Sharji M, Al Barwani U, et al. Randomized controlled open label trial on the use of favipiravir combined with inhaled interferon beta-1b in hospitalized patients with moderate to severe COVID-19 pneumonia. Int J Infect Dis 2021;102:538-43. |
| 3. | Writing Committee for the REMAP-CAP Investigators; Estcourt LJ, Turgeon AF, McQuilten ZK, McVerry BJ, Al-Beidh F, et al. Effect of convalescent plasma on organ support-free days in critically ill patients with COVID-19: A randomized clinical trial. JAMA 2021;326:1690-702. |
| 4. | Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe COVID-19. N Engl J Med 2020;382:1787-99. |
| 5. | Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: The CoDEX randomized clinical trial. JAMA 2020;324:1307-16. |
| 6. | Lavinio A, Ercole A, Battaglini D, Magnoni S, Badenes R, Taccone FS, et al. Safety profile of enhanced thromboprophylaxis strategies for critically ill COVID-19 patients during the first wave of the pandemic: Observational report from 28 European intensive care units. Crit Care 2021;25:155. |
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