INTERNATIONAL JOURNAL OF CLINICAL AND MEDICAL CASES (ISSN:2517-7346)

Coronavirus is causing health, economic, and social crisis all over the world. If it is not stopped soon in this way, otherwise it is feared that it will kill tens of thousands of people and degrade all humanity to a severe and prolonged recession.

For the time being, the war in Covid 19 is mainly conducted through an effort to isolate people and prevent further adherence and by providing supportive care (especially the provision of fluids and oxygen) to those who have become ill and have respiratory distress. It is noteworthy: the infectious agents that can cause severe symptoms of the disease are mainly elderly and patients suffering from background diseases such as diabetes, cardiovascular diseases. For example, are high blood pressure and respiratory diseases such as asthma and Chronic Obstructive Pulmonary Disease (COPD). However, reports of mortality also obtained in young patients who were without risk factors and no background disease.

At the same time, there is a widespread effort in the world to develop both a vaccine for the disease and to find drugs that will cure patients. The effort in the field of medicine is dealing with mainly two: an effort to develop new drugs for the disease and an attempt to test existing drugs that may also be effective in the treatment of Corona-illness [1].

In the context of drugs, the public raises other questions: Can the drug treatment that many people receive for other non-corona problems aggravate the c Covid 19? Are there any particular recommendations for patients who consume medication regularly?

To date, there is no effective anti-coronary drug treatment, but the efficacy of existing drugs - some on the shelf - that are being used to treat other diseases is being investigated. Information on the efficacy of these drugs for the treatment of Covid 19 comes mainly from laboratory studies, but also from human clinical studies.

People with pre-existing heart disease are more at risk for severe cardiovascular and respiratory complications from COVID-19. Similarly, research has shown that influenza virus infection poses a more serious threat to people with heart disease than those without heart problems. Studies have also shown that respiratory infections like the flu can actually trigger heart attacks.

People with previously undiagnosed heart disease may present with quiet heart symptoms that were previously not obscured by the viral infection. In people with preexisting cardiovascular obstruction, infection, fever, and inflammation can undermine the stability of asymptomatic lipid plaque that previously existed in the heart vessels. Heat and inflammation also make the blood more prone to blood clotting, interfering with the body’s ability to dissolve blood clots - a one-two punch similar to gasoline injection on the coals of the wind [2].

Health officials from WHO have noted that Gilead’s remdesivir has demonstrated efficacy in treating the coronavirus infection.Health officials from WHO have noted that Gilead’s remdesivir has demonstrated efficacy in treating the coronavirus infection.

Remdesivir is a broad spectrum antiviral drug originally intended for Ebola. Researchers have found that remdesivir is most effective in fighting the new coronavirus. This treatment has not yet been approved in humans, but two clinical trials of this drug have been implemented in China. One clinical trial was also recently approved by the FDA in the United States.Chloroquine.

WASHINGTON - The US is fast-tracking the anti-malarial drug chloroquine for use as a treatment against the new coronavirus, US So said President Donald Trump on Thursday.

Trump told reporters that “we can get this drug almost immediate, and that’s where the FDA [Food and Drug Administration] was so big”[3].

Doctors can also use a number of different treatments to limit the immune system’s response to viruses, such as fever and inflammation, which can sometimes cause more harm to the patient than the virus itself. Anti-inflammatory drugs such as corticosteroids and chloroquine are most commonly used to reduce these symptoms. Chloroquine, a widely-used anti-malarial and autoimmune disease drug, has recently been reported as a potential broad spectrum antiviral drug.

Chloroquine is known to block virus infection by increasing endosomal pH required for virus/ cell fusion, as well as interfering with the glycosylation of cellular receptors of SARS-CoV [4-7].

“Chloroquine, a relatively safe, effective, and inexpensive drug used to treat many human diseases, including malaria, embiosis, and human immunodeficiency virus, is effective in inhibiting infection and spread of SARS CoV in cell culture. Post-infection offers possible preventative and therapeutic use.”

Chloroquine is a drug used to fight malaria and autoimmune diseases. It has been in use for over 70 years as a source material and is considered to be safe. Researchers have found that this drug is effective in fighting the SARS-CoV-2 virus in in vitro studies. At least 10 close-source clinical studies are currently examining the potential use of chloroquine as an option to fight the new coronavirus (Figure 1).

Gilead Sciences has partnered with Chinese health authorities to conduct a randomized Phase III clinical trial to evaluate the use of the antiviral drug candidate study (GS-5734) for the potential treatment of the corona virus.

According to a publication published in the New England Journal of Medicine (NEJM), the drug was found to show encouraging results when given to the first U.S. patient infected with the Wuhan virus.

The US patient was re-treated for compassion on the seventh day of illness and his clinical condition was confirmed to improve on day eight.

In Beijing, China, the new placebo-controlled third phase trial of Gilad’s drug will be performed at Friendship Hospital. The study should enroll 270 patients with mild to moderate pneumonia caused by the corona virus. 

Severe Acute Respiratory Syndrome (SARS, COIVD 19) is a lifethreatening viral infection caused by a single-stranded, positive RNA virus from the enveloping corona virus family. Related to fever, cough and respiratory complications, the disease causes more than 15% mortality worldwide. So far, there is no cure for the disease except supportive treatments. However, the viral viral protein has recently been seen as a suitable target for drug design against SARS infection, due to its essential role in the processing of polypropylene necessary for the proliferation of the virus (Figure 2).

Lupinevir; Strong antidote for coronavirus infection: an insight from molecular docking research.

Severe Acute Respiratory Syndrome (SARS) is a life- threatening viral infection caused by a single-stranded single-stranded RNA virus from the enveloped corona virus family. Related to fever, cough and respiratory complications, the disease causes more than 15% mortality worldwide. So far, there is no cure for the disease except supportive treatments. However, the viral viral protein has recently been seen as a suitable target for drug design against SARS infection, due to its essential role in the processing of polypropylene necessary for the proliferation.

The current study in silico was designed to evaluate the effects of anti-HIV protease inhibitors, approved for clinical applications by the US FDA, on SARS proteinase inhibition.

The potential of CoVs has been well proven to cause significant human disease, with six recognized HCoVs - HKU1, OC43, NL63, 229E, SARS- CoV and MERS-CoV - causing colds, pneumonia, systemic infection and serious or fatal diseases [8]. Four of these viruses have been Only detected in the last ten years, with two, SARS-CoV and MERS-CoV, causing respiratory and systemic infection. Studies over the last decade have expanded the known phylogenetic, geographical, and species diversity of CoVs, supporting multiple CoVs occurrence events for humans from bats and other zoonotic pools.

The latest evidence of CoV transgenic movement comes from the appearance of the novel MERS- CoV. From April 2012 to June 2013, MERS-CoV resulted in 72 laboratory-approved cases and mortality of up to 50% as a result of severe respiratory and systemic disease in at least 8 countries, with evidence of human-to-human transmission. MERS-CoV is most closely related to CoVs bats HKU4 and HKU5, and recently detected dipeptidyl- peptidase 4 (receptor depteptidyl 4) in human cells and bats, and provides a compelling argument that zoonotic CoV infections may lead to more severe human events From what they previously thought.

Because of the lack of epidemiological data, it is unknown whether multiple zoonotic origin or human transmission of mild or asymptomatic disease is responsible for these ongoing cases of sporadic severe infections. However, based on the high mortality rates associated with SARS-CoV and those reported in MERS-CoV, this new virus poses a serious threat to global health for which there are currently no vaccines or treatments (Figure 3).

The signs and symptoms of COVID-19 that are at the beginning of the disease vary, but during the disease most people with COVID-19 (Table 1).

It should be stressed: All drugs currently being used to treat Corona are given only in hospitals and only in those whose condition is difficult or moderate. These drugs are not given to those who are easily defined and are not sold to the general public in pharmacies to treat Corona because they have side effects that require monitoring and supervision in a hospital.

Remdesivir presents promising results as a treatment for coronavirus, according to pharmaceutical manufacturer [9] Gilad.

The study of 1,063 patients is the largest and most rigorous study of the drug and included a comparison group that received regular treatment just so that the effects of remdesivir can be rigorously assessed.

President Donald Trump announced FDA action in the White House.

Those who received the drug managed to leave the hospital within an average of 11 days compared to 15 days for the comparison group. The drug may reduce deaths, though it is uncertain of the partial results revealed so far.

The National Institutes of Health, Dr. Anthony Pauchi, said the drug will become a new standard of care for COVID-19 patients as tricky as those in this study. The drug has not been tested in people with a milder illness. It is currently administered by injection in a hospital.

Remdesivir reduces COVID 19 disease by 31%. It is not a cure, Chinese experts say.

Because the drug failed in Ebola trials, it is too early to say whether it will work on COVID-19 patients. However, some scientists agree that remdesivir is the most promising candidate to date and looks at preclinical data where Remdesivir can clear two other infections by deadly coronaviruses, SARS, and MERS. More than the number of preclinical data is the real data that showed the full recovery of the first American patient, a 35-year-old man in Washington after drug treatment. Although this requires celebration, the actual clinical data confirming the role of remdesivir in recovery is yet to come.

However, they all seem positive for remdesivir so far, but only time will tell if it will be widely effective. 

While in Israel about half of the people died, in the West their proportion reached more than 80%. Rambam Intensive Care Manager explains what caused this and what the implications for the future.

It was discovered a new condition in the lung’s response to the respirator, in the cardiovascular system’s response to chest pressure changes, in the development of healthy blood vessels and in the immune system’s overreaction, to the extent of causing actual damage to all vital systems. We tried new and old drugs and learned while on the move what helps (gentle soul, stomach upset, anticoagulants) and what is harmful (high soul pressure, dehydration).

Why there is a gap in the mortality rate between Israel and the world.

While in Israel about half of the people died, in the West their proportion reached more than 80%. Rambam Intensive Care Manager explains what caused this and what the implications for the future are.

With the first wave of the Corona epidemic dampening, and in the background of the expectation of another wave in the winter, an interim summary can be made, comparing the results in Israel to countries in the Far East and West, learning from their experience and improving what is possible quickly.

When we first got the high mortality data from China, we thought that maybe the health system there was underdeveloped. We were wrong, and with us the whole Western world, in assessing the brutality of the virus. We found ourselves looking sadly awestruck in developed countries such as Italy, Spain and the US, where mortality rates are around 80% among respiratory patients. So far, the ability of a respirator to help the severely ill has been questioned.

Everything we have learned for decades about the soul and intensive care of patients with acute respiratory insufficiency suddenly seems inappropriate. We discovered a new condition in the lung’s response to the respirator, in the cardiovascular system’s response to chest pressure changes, in the development of healthy blood vessels and in the immune system’s overreaction, to the extent of causing actual damage to all vital systems. We tried new and old drugs and learned while on the move what helps (gentle soul, stomach upset, anticoagulants) and what is harmful (high soul pressure, dehydration).

And now, Israel after two months of war on each patient, what are the consequences? As of last Tuesday (April 29), out of 419 patients who were in serious condition in Israel, 212 died, is about 50% “only”. With all the grief and sorrow of every person lost, this is a success compared to 86% in China and 88% in New York. When examining the age of the dead and their background disease, this figure is not radically high compared to the expected mortality from severe pneumonia or inflammation.

So how are we different from the other developed western countries? Are there other patients? The drugs are different? Are our medical teams better? Probably the answer to all these questions is “no".

The answer to the big difference in mortality lies in several other factors. First, it must be said with a full mouth: the closure worked. The number of patients was less than expected. Second - all the components of the system have been well prepared, for the management of the last medical teams. And finally, our small, lean health system, stretched every winter to the limit of its ability, is normal, experienced and adept at functioning in stressful situations. We did not reach therapeutic and functional failure as in the other countries. Far from it. Each patient received full and skilled intensive care from nurses and nurses, doctors and doctors, technicians and soul technicians, all with experience and skill [9-19].

During the treatment of severely ill and respiratory patients in Israeli hospitals, the doctors learned that anticoagulant therapy helps to heal. The medicines used were: Pradaxa (Dabigatran), Xarelto (Rivaroxaban), Eliquis (Apixaban) aiming to prevent the formations of blood clots during the viral infection. This probably a result of the Harvard findings [2] regarding the heart and blood vessel damages caused by the virus (Figure 4).

1.  Kobi C. Medicines for Corona: Everything we know for now. 2020.
2.  Coronavirus and the heart. 2020.
3. US to fast-track anti-malaria drug to treat coronavirus.
4. Savarino A, Di Trani L, Donatelli I, Cauda R, Cassone A. New insights into the antiviral effects of chloroquine. Lancet Infect Dis.2006 Feb;6(2):67–69.
5. Yan Y, Zou Z, Sun Y, Li X, Kai-Feng Xu, et al. Anti-malaria drugchloroquine is highly effective in treating avian influenza A H5N1virus infection in an animal model. Cell Res. 2013;23:300-302.
6. Vincent MJ. Bergeron E, Benjannet S, Erickson BR, Rollinet PE, etal. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J. 2005;2(69).
7.  Mackenzie AH. Dose refinements in long-term therapy of rheumatoid arthritis with antimalarials. Am J Med. 1983Jul;75(1): 40–45.
8. Dayer MR, Taleb SG, Saaid MD. Lopinavir; A Potent Drug against Coronavirus Infection: Insight from Molecular Docking Study. Archives of Clinical Infectious Diseases. 2017 Sep;12(4):e13823.
9. Clinton SE, Blanc H, Vignuzzi M, Mark R. Denison. Evidence for Proofreading and Potential Therapeutics. PLOS Pathogens. 2013 Aug;9(8):e1003565.
10. Li Q, Guan X, Wu P. Early Transmission Dynamics in Wuhan,China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med.2020 Mar;382:1199-1207.
11.  Lauer SA, Grantz KH, Bi Q. The Incubation Period of CoronavirusDisease 2019 (COVID-19) From Publicly Reported ConfirmedCases: Estimation and Application. Annals of internal medicine.2020 May.
12. Chen N, Zhou M, Dong X. Epidemiological and clinicalcharacteristics of 99 cases of 2019 novel coronaviruspneumonia in Wuhan, China: a descriptive study. Lancet. 2020Feb;395(10223):507-513.
13. Huang C, Wang Y, Li X. Clinical features of patients infectedwith 2019 novel coronavirus in Wuhan, China. Lancet. 2020Feb;395(10223):497-506.
14. Wang D, Hu B, Hu C. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. Jama. 2020 Feb.
15.  Xu XW, Wu XX, Jiang XG. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS- Cov-2) outside of Wuhan, China: retrospective case series. BMJ Clinical researched. 2020 Feb;368:m606.
16.  Wu C, Chen X, Cai Y. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020 mar.
17.  Pan L, Mu M, Ren HG. Clinical characteristics of COVID-19patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020May;115(5):766-773.
18. Remdesivir Receives FDA Emergency Use Authorization After Promising Results as a Coronavirus Treatment.19. Why there is a gap in the mortality rate between Israel and the world.
19.  Why there is a gap in the mortality rate between Israel and the world.