Medications for Covid-19: Far from the miracle cure

There is a lot of international discussion about chloroquine, an older malaria drug. Laboratory trials and clinical trials in China suggested potential efficacy. So far, however, no definitive proof of this has been provided. The European Medicines Agency (EMA) has already warned that chloroquine and the related active ingredient hydroxychloroquine should only be used in clinical tests or in emergencies in people with Covid-19.

Despite this, politicians such as US President Donald Trump and his Brazilian counterpart Jair Bolsonaro jumped on the train and propagated chloroquine as a means of combating the corona virus. “What is there to lose? Take it! ”Trump recently said at a press conference. US experts shook their heads. Not only because of its not yet proven effectiveness, but also because the drug can cause serious side effects.

Chloroquine only in individual cases

In Austria, chloroquine can be found in the Covid 19 therapy guidelines of the intensive care societies. But not for widespread use, but only for treatment in “argumentable individual cases”, said the head of the anesthesia and intensive care department at the St. Pölten University Hospital, Christoph Hörmann, to The same recommendation was also issued by German specialist societies.

APA / Helmut Fohringer

Over 260 people are currently in intensive care in Austria because of Covid-19

People with cardiovascular diseases are at particularly high risk of a CoV infection taking a severe or even fatal course. Chloroquine also has a negative effect on the heart and circulation. “The question is whether you can do much more harm with therapy that doesn’t actually work if you cause additional problems to the heart,” said Hörmann, who is also Vice President of the Austrian Society for Anesthesiology, Resuscitation and Intensive Care Medicine (ÖGARI ) is.

The use of other antivirals already available on the market is currently being tested around the world. They are supposed to inhibit the reproduction of the coronavirus and prevent it from spreading in the body. These include the active substances used in HIV therapy lopinavir and ritonavir, the anti-flu agent favipiravir and remdesivir, which was originally developed to combat the Ebola virus. A breakthrough in the treatment of Covid-19 has so far not been achieved with any of the substances. These funds should also only be used in studies or in “individual cases” in which the treating physicians have carefully weighed the benefits and risks, said Hörmann.

Bacterial super infections

In mid-March, the University Medical Center Salzburg made headlines with the announcement that it would use a cancer therapy drug to treat severe Covid 19 cases. The preparation is called tocilizumab and is also mentioned in the Covid 19 treatment guidelines of the Austrian intensive care physicians. Background: The corona virus causes inflammation of the alveoli. This releases inflammatory substances called cytokines, which can lead to organ failure. “The drug slows down this cytokine storm,” said Hörmann.

However, the drug has a strong depressing effect on the immune system. For patients who have bacterial pneumonia in addition to Covid-19, the administration of this drug would be “absolutely fatal”, says Hörmann. Such bacterial super-infections were observed in the majority of his patients, according to the intensive care doctor. Tocilizumab is a “justified drug in individual cases, where it is absolutely certain that there is no bacterial superinfection and the cytokine storm is the main problem for the patient,” said Hörmann, “but these are individual applications that have to be assessed very carefully by the treating team on site “.

Bacterial super infections can be treated with antibiotics. The body has to defeat the corona virus itself. “What we are currently doing in the intensive care unit is only symptomatic therapy for organ failure,” said Hörmann. This included ventilating patients, supporting the circulatory system with medication, and washing blood, as, like other infections, Covid-19 quickly affects kidney function.

Search for relationships

According to the Ministry of Health, as of Wednesday 267 people across Austria were in intensive care because of Covid-19 – a new high. ÖGARI recently took stock of the experiences made during the treatment. Unlike in Italy, for example, it is possible to treat intensive care patients “individually” in this country, says Klaus Markstaller, doctor at the Vienna General Hospital and President of ÖGARI. The system of intensive care units in Austria is “loaded, but not overloaded”.

Typical pre-existing diseases or risk factors that can be observed in the case of severe disease are, in addition to cardiovascular diseases, diabetes mellitus, obesity, COPD and asthma, according to Markstaller in a press release. The exact relationships between these chronic conditions and the course of Covid 19 disease are still unknown.

Number of intensive care patients in Austria increased

While the number of people treated for Covid-19 in hospital has been more or less stable for a few days, the number of SARS-CoV-2-positive intensive care patients is increasing, according to a first balance sheet by the Austrian intensive care physician.

The age of patients also seems to have an influence. However, it is by no means the case that only the very elderly Covid 19 patients receive intensive medical care, according to ÖGARI. The average age in many cases is around 70 years, but there are also younger patients under 50. In addition, it has been shown that Covid-19 takes a much more severe course in men than in women. The overhang is really clear, Hörmann told To date, it cannot be explained scientifically.

Hope for active ingredient from Vienna

An active ingredient that gives hope, according to Hörmann, is APN01. It was developed by the Vienna-based biotechnology company Apeiron Biologics of the geneticist Josef Penninger. The substance is said to prevent the virus from entering the cell and is based on Penninger’s research into the first SARS pandemic in the early 2000s. It was also triggered by a corona virus at the time. As the company announced last week, 200 patients in Austria, Germany and Denmark will receive the active ingredient as part of a study – more about this in

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