The two stages of COVID-19 illness require different treatment modalities | Roger Seheult
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One aspect of COVID-19, discovered early in the pandemic, is that the illness occurs in two well-defined phases: an early and a late phase, usually demarcated by the onset of pneumonia. A fundamental discovery revealed that early- versus late-stage COVID-19 disease often requires radically different treatment protocols. Early-stage illness dictates bolstering the innate antiviral immune response, a process governed by the action of interferon. Late-stage illness, when the body's adaptive immune system starts to kick in, requires measures geared toward dampening immune activity. In this clip, Dr. Roger Seheult describes how treatment modalities differ between the two distinct phases of COVID-19 illness.
Dr. Seheult: One of the first things that somebody needs to understand when you think about COVID is it's all about timing. It's very important that you understand that there is an early portion of the disease and there's a late portion of the disease. And the timeline that separates those two is really when you get pneumonia. I think that's probably the best way to make that demarcation. Early in the phase of COVID-19, before you have pneumonia, there's a certain set of factors that are going on in the body, we can get into detail what those are, that makes certain interventions more plausible and more efficacious. And then there's the later phase of COVID-19 where patients generally are hospitalized or on oxygen. And we see other types of interventions to be much more effective.
To give you an example of that. Steroids. So dexamethasone, that was a UK recovery trial that came out, showed without a doubt that steroids improve. Well, what they found was that patients who were not on oxygen, so in other words, early in the course of the disease did not benefit from steroids, it was equivocal, whereas those that were the sickest patients on the ventilator requiring high doses of oxygen seemed to be the ones that benefited the most from dexamethasone or steroids. The flip of that was remdesivir. So whereas steroids were very beneficial late in the course of the disease, medications like Remdesivir, it's not an anti-inflammatory, but rather an antiviral, it prevents the viral replication. The opposite was found. Remdesivir was much more efficacious early in the course of the disease, and not so much so for those patients on the ventilator.
So it's not just like this disease is a one-fits-all thing. You've got COVID. No. Is it early or late COVID?
An infectious disease caused by the novel coronavirus SARS-CoV-2. COVID-19, or coronavirus disease 2019, was first identified in Wuhan, China, in late 2019. The disease manifests primarily as a lower respiratory illness, but it can affect multiple organ systems, including the cardiovascular, neurological, gastrointestinal, and renal systems. Symptoms include fever, cough, fatigue, shortness of breath, and loss of smell and taste. Some infected persons, especially children, are asymptomatic. Severe complications of COVID-19 include pneumonia, sepsis, acute respiratory distress syndrome, kidney failure, multiple organ dysfunction syndrome, and cytokine storm. Treatments currently involve symptom management and supportive care. Mortality varies by country and region, but approximately 6 percent of people living in the United States who are diagnosed with COVID-19 expire.[1] 1
A corticosteroid drug used to treat inflammation. Dexamethasone has demonstrated effectiveness in patients with COVID-19 who are mechanically ventilated or required supplemental oxygen.
An essential mineral present in many foods. Iron participates in many physiological functions and is a critical component of hemoglobin. Iron deficiency can cause anemia, fatigue, shortness of breath, and heart arrhythmias.
An antiviral drug used to treat several viruses. Remdesivir works by interrupting viral replication. It has been used as a treatment for respiratory syncytial virus, hepatitis C virus, Ebola virus, and several coronaviruses, including SARS-CoV-1, SARS-CoV-2, and MERS.
The highest level of intake of a given nutrient likely to pose no adverse health effects for nearly all healthy people. As intake increases above the upper intake level, the risk of adverse effects increases.
Volatile organic compound. An organic chemical that has a high vapor pressure at ordinary room temperature.
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