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Novel Coronavirus SARS-CoV-2
Novel Coronavirus SARS-CoV-2

Coronavirus, also known as COVID-19, has gripped the world since it was first discovered in Wuhan China in December, 2019. There has been significant amount of research that is being done on this very important topic and more being published or announced almost on a daily basis. In this page, we will summarize all the research studies organized by the role the study plays in our understanding of the disease, pathophysiology, prevention, vaccine, treatment and or cure.

Vaccine development research

Many companies are currently working on a vaccine although it may take up to 18 months[1] before it might complete all research and be available for clinical use.

Chloroquine
Chloroquine

LATEST COMBINATION OF DRUGS FOR SARS-COV-2 (COVID-19): A COMBINATION OF DRUGS - CHLOROQUINE 200 MG THREE TIMES A DAY ALONG WITH AZITHROMYCIN 500 MG FOLLOWED BY 250 MG FOR 4 DAYS HAS BEEN USED IN A SMALL STUDY IN FRANCE WITH THE FOLLOWING PROMISING RESULTS. NEW

SUMMARY OF RESULTS - FRENCH STUDY ON CHLOROQUINE AND AZITHROMYCIN

  • 14 Patients with COVID-19 given Hydroxyhloroquine (57.1% cured)
  • 6 patients given combination of Hydroxychloroquine and Azithromycin (100% cured)
  • 16 patients given neither of the above for 4 days (12.5% cured)

Link to the French Study - Chloroquine and Azithromycin

Drug re-purposing research

There are many drugs that are previously used in other purposes that are being considered for prevention, and treatment of COVID-19 including the following. Although there are no US FDA-approved drugs specifically for the treatment of patients with COVID-19, many drugs approved for other indications as well as several investigational drugs are being studied in several hundred clinical trials that are underway around the world.

Remdesivir

SARS-CoV scanning electron microscope image
SARS-CoV scanning electron microscope image

Remdesivir is an investigational intravenous drug with broad antiviral activity that inhibits viral replication through premature termination of RNA transcription and has in-vitro activity against SARS-CoV-2 and in-vitro and in-vivo activity against related betacoronaviruses [1-3].

There are currently four options for obtaining remdesivir for treatment of hospitalized patients with COVID-19 and pneumonia in the United States:

  • A National Institutes of Health (NIH)-sponsored adaptive double-blinded, placebo-controlled trial of remdesivir versus placebo in COVID-19 patients with pneumonia and hypoxia is enrolling non-pregnant persons aged 18 years and older with oxygen saturation of ≤94% on room air or requiring supplemental oxygen or mechanical ventilation (https://clinicaltrials.gov/ct2/show/NCT04280705 Clinical trials). Exclusion criteria include alanine aminotransaminase or aspartate aminotransaminase levels >5 times the upper limit of normal, stage 4 severe chronic kidney disease or a requirement for dialysis (i.e., estimated glomerular filtration rate (eGFR) <30);
  • Two phase 3 randomized open-label trials of remdesivir (5-days versus 10-days versus standard of care) are open to enrollment in persons aged 18 years and older with COVID-19, radiographic evidence of pneumonia and oxygen saturation of ≤94% on room air (severe disease https://clinicaltrials.gov/ct2/show/NCT04292899external icon) or >94% on room air (moderate disease [https://clinicaltrials.gov/ct2/show/NCT04292730 https://clinicaltrials.gov/ct2/show/NCT04292730 Clinical trials). Exclusion criteria include alanine aminotransaminase or aspartate aminotransaminase levels >5 times the upper limit of normal, participation in another clinical trial of an experimental treatment for COVID-19, requirement for mechanical ventilation, or creatinine clearance <50 mL/min; and
  • Finally, in areas without clinical trials, COVID-19 patients in the United States and other countries have been treated with remdesivir on an uncontrolled compassionate use basis. While clinical trials are critical to establish the safety and efficacy of this drug, clinicians without access to a clinical trial may request remdesivir for compassionate use through the manufacturer for patients with clinical pneumonia.

Hydroxychloroquine and Chloroquine

Hydroxychloroquine
Hydroxychloroquine

Hydroxychloroquine and chloroquine are oral prescription drugs that have been used for treatment of malaria and certain inflammatory conditions. Chloroquine has been used for malaria treatment and chemoprophylaxis, and hydroxychloroquine is used for treatment of rheumatoid arthritis, systemic lupus erythematosus and porphyria cutanea tarda. Both drugs have in-vitro activity against SARS-CoV, SARS-CoV-2, and other coronaviruses, with hydroxychloroquine having relatively higher potency against SARS-CoV-2 [1,4,5]. A study in China reported that chloroquine treatment of COVID-19 patients had clinical and virologic benefit versus a comparison group, and chloroquine was added as a recommended antiviral for treatment of COVID-19 in China [6]. Based upon limited in-vitro and anecdotal data, chloroquine or hydroxychloroquine are currently recommended for treatment of hospitalized COVID-19 patients in several countries. Both chloroquine and hydroxychloroquine have known safety profiles with the main concerns being cardiotoxicity (prolonged QT syndrome) with prolonged use in patients with hepatic or renal dysfunction and immunosuppression but have been reportedly well-tolerated in COVID-19 patients.

Hydroxychloroquine is preferred

Due to higher in-vitro activity against SARS-CoV-2 and its wider availability in the United States compared with chloroquine, hydroxychloroquine has been administered to hospitalized COVID-19 patients on an uncontrolled basis in multiple countries, including in the United States. One small study reported that hydroxychloroquine alone or in combination with azithromycin reduced detection of SARS-CoV-2 RNA in upper respiratory tract specimens compared with a non-randomized control group but did not assess clinical benefit [7]. Hydroxychloroquine and azithromycin are associated with QT prolongation and caution is advised when considering these drugs in patients with chronic medical conditions (e.g. renal failure, hepatic disease) or who are receiving medications that might interact to cause arrythmias.

Pre and post exposure prophylaxis

Hydroxychloroquine is currently under investigation in clinical trials for pre-exposure or post-exposure prophylaxis of SARS-CoV-2 infection, and treatment of patients with mild, moderate, and severe COVID-19. In the United States, several clinical trials of hydroxychloroquine for prophylaxis or treatment of SARS-CoV-2 infection are planned or will be enrolling soon.  More information on trials can be found at:  https://clinicaltrials.gov/ Clinical trials.

COVID 19 sympoms
COVID 19 sympoms

Other drugs being considered

HIV-related protease inhibitors

Ritonavir
ASC09
Darunavir (Marketed as Prezista / Prezcobix)

Broad-spectrum agents

Favipiravir
Ribavirin
Umifenovir

Umifenovir has been recommended for COVID-19 treatment according to Chinese 7th edition guidelines

Interferons

Drugs originally developed for SARS-coV-2 protect against future infections?

Although there were some initial reports of possible re-infection ever after one is infected with SARS-coV-2, according to a research study, getting infected does provide protection against future infections.

  • APN01 (ACE2 protein decoy)

Antibiotics

Some antibiotics that have been identified as potentially repurposable as COVID-19 Treatments

== Does getting infected with SARS-2-Co

Current protocols for treatment of COVID-19

This is a rapidly changing area as new research comes almost daily.

COVID-19 treatment hospital protocol
COVID-19 treatment hospital protocol

External resources on COVID-19 research

The Lancet COVID resource center

Is COVID just like flu?
Is COVID just like flu?

NIH on COVID-19

COVID-19 genome sequence

Work and COVID-19

Coronavirus replication cycle
Coronavirus replication cycle

Telemedicine and COVID-19

Treatment of COVID-19

Facts and Myths

COVID-19 world map
COVID-19 world map

Practical guide

Prevention

Post exposure prophylaxis

Uptodate

COVID-19 prevention
COVID-19 prevention

Medical Journal Articles

Cardiology and COVID-19

ACC Clinical Guidance and Practice

SARS-CoV-2
SARS-CoV-2

Clinical Perspectives and Front-Line Experience

Case mortality - China and Italy compared

Latest dataset on COVID-19

Latest release contains papers up until 2020-03-27 with over 33,000 full text articles. (Changelog from previous release.)

Each paper is represented as a single JSON object. The schema is available here and previous versions of the dataset are available here

Specialty specific COVID-19 recommendations

Latest COVID-19 research articles list

Also see

WHO preventing coronavirus

Coronavirus: WHO declares COVID 19 a pandemic.

edit 

WikiMD Resources - Latest research on Coronavirus


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