Covid mutants today (December 11, 2016) on the page of the Medical Genome Center, Ramathibodi Hospital, Mahidol University reveals the tracking of an emerging subspecies of Omicron. and antiviral drug resistance In one message stating that Data from the World Health Organization (WHO) shows that the death rate from COVID-19 all over the world is declining In contrast to the increasing rate of new infections worldwide. Indicated for vaccine prophylaxis less efficient Even though more than 90% of the world’s population has immunity from vaccination or from natural infection. while on antiretroviral therapy have better performance The world has to turn to rely on antiviral drugs as a second line of defense, but the problem that may be faced next is drug-resistant COVID.
The Genome Center developed a genome-wide genetic decoding of COVID-19 not only to track emerging subspecies of omikrons in Thailand. But also to watch out for COVID with antiviral resistance genomes like 16 years ago that had to decode the genetic code of the HIV virus to modify antiviral drugs. until reducing the number of deaths from AIDS to the level that Thai public health can control
It is now clear that Omicron Emerging substrains such as BA.2.75, BQ.1.1 and XBB can better evade immunity from booster vaccines and immunity from natural infection better than the original “Wuhan” COVID-19, researchers from the University of Teh. Kass stated that New COVID strains that are the “grandchildren” of Omicron BA.2, such as BA.2.75 and the grandchildren of Omicron BA.5, such as BQ.1.1, as well as crossbreeds of the Omicron family, such as O. Micron XBB (BJ.1XBA.2.75*) is four times more effective at evading first-generation and second-generation vaccine immunity than Omicron BA.5, making these new viruses more viable. fast
Although it was found that the infected body has hybrid immunity naturally occurring after the booster vaccination, it can increase the protection efficiency of the new strain of COVID-19 infection to some extent, but it is not good. student In addition, the emerging subspecies of omikron are resistant to almost all “immunogenic antibody” drugs.
It is noteworthy that data from the World Health Organization indicates that The number of new omikron infections worldwide has increased markedly. But the number of patients who have to be admitted to ICU and die from COVID-19 turned down significantly, the main reason is likely to be because
1. Doctors and healthcare professionals have more experience treating COVID-19 with antiviral drugs and steroids. more systematically and standardized
2. Currently, the 2019 COVID-19 virus has not yet been found to be resistant to “antiviral pills” that are ingested to inhibit the multiplication of the virus inside the cells. The inhibition of intracellular viral replication is not related to the viral spike protein gene. While all omikron substrains are resistant to antibody injections. Ready-made type of immunity Because the injected ready-made antibodies do not bind well to the virus spike proteins. Due to the mutation of the gene that produces the thorn protein, the morphology of the thorn protein is rapidly changed from that of the original species.
for Thailand by the Medical Department Ministry of Public Health together with doctors specializing in the treatment of COVID-19 infection Both public and private sectors come together to formulate guidelines for medical practice, diagnosis, treatment, and prevention of COVID-19 infection in hospitals as a guideline for doctors across the country to make decisions in treating COVID-19 patients. with Thai and foreign medicines Both in small children, older children, adults, pregnant women. Both antiviral tablets and injections, with guidelines for choosing from andrographis paniculata, favipiravir Molnupiravir, Paxlovid, Remdesivir Mixed long-acting antibody Used for prevention before exposure to the virus that causes COVID-19. and antibiotics
Thai public health system Starting from the village health volunteers (Vor Sor Sor.) reach people in every household in the manner of knocking on the door of the house. Various volunteer organizations until the arrival of the patient for treatment in the provincial hospital It should make Thai people have good access to treatment and antiretroviral drugs. can reduce severe illness infections death
It can be estimated that from 2023 onwards around the world, including Thailand, there will be more use of anti-Covid-19 pills. Due to the mutation, ready-made vaccines and antibody drugs are ineffective in preventing infection. The question is, when antiviral drugs are widely used, will the virus mutate and become resistant to antiviral drugs?
The key question is Around the world, the COVID-19 virus has mutated into resistant to molnupiravir. Remdesivir Paxlovid or not?
Paxlovid is highly effective in treating Contains nermatrelvir, which blocks the activity of viral protease inhibitors from forming intact viral particles. Ritonavir slows down the breakdown of nermatrelvir. Makes the drug stay in the body longer An independent study published in the New England Journal of Medicine found that paxlovid could reduce hospital stay time for vulnerable patients over 65 years of age and reduce mortality. Up to 79%, data from the hospital in Israel earlier this year And according to a study by the pharmaceutical company, Paxlovid reduced the risk of hospitalization and death by 88%.
Among the antiviral drugs for COVID-19 Paxlovid is highly effective in treating It is expected to become the mainstream treatment for COVID-19 in the future. However, experts around the world believe that it will soon see COVID-19 Resistance to paxlovid is certain to occur because current treatment is still on monotherapy. (monotherapy)
SARS-CoV-2 virus that cause COVID-19 It mutates all the time like other RNA viruses, such as HIV, with drug resistance that is difficult to manage. Drugs that block the activity of many HIV proteases have in the past experienced rapid drug resistance as they are the only drug in the treatment of easily resistant strains. Until the simultaneous use of 2-3 antiretroviral drugs has been adjusted, the problem of HIV drug resistance has been resolved since 1990 to the present.
Taking multiple antiviral drugs at the same time or bringing many drugs together in one pill and eating It’s like attacking multiple virus factories at the same time, causing the virus to be destroyed quickly without the chance to mutate into resistance to antiviral drugs.
Currently, the manufacturer of Paxlovid believes that high drug concentrations and treatment times as short as five days reduce the chances of developing drug resistance. This gives the company time to develop a second-generation COVID-19 drug, which is expected to contain more than one drug in the same pill or capsule as a cocktail.
face-to-face problem solving What should be done to prevent the development of the COVID-19 resistant to Paxlovid antivirals?
1) First of all, should paxlovid be used for prophylaxis? The more single drugs are used, the faster the onset of drug resistance. As was the case with drug-resistant HIV in the past.
2) Is it appropriate to use paxlovid in young and healthy people who are unlikely to be seriously ill?
The initial solution from the US Centers for Disease Control and Prevention (CDC) to reduce the use of PaxLovid among the population. Although Paxlovid is still recommended for early treatment of COVID-19, In infected people, symptoms are mild to moderate. But it has been modified to be used in vulnerable groups who are at high risk of severe disease progression. Earlier CDC guidelines included the use of Paxlovid in adults and children under 12 years of age.
We are fortunate to have antiretroviral drugs as one of the most effective tools to treat COVID. It is the second line of defense after ineffective vaccines in preventing infection. Therefore, it is necessary to use only as necessary to avoid drug resistance. which means by prescription We need to speed up research and development to stay ahead of the virus by rapidly developing new anti-Covid-19 drugs, especially ones with different mechanisms of action from the drugs we currently use as medicines. antivirals in the form of combinations (of 2-3 drugs) because the use of antiretroviral combinations has been successfully used in the treatment of AIDS
The Genome Center develops a genome-wide genetic transcription of COVID-19 not only to track emerging subspecies of omikrons but also to investigate the antiviral resistance of the novel coronavirus 2019 in Thailand.