Aleksey Vodovozov on 'Covid-19' pharmaceuticals: “There is still no anti-coronavirus pill”

The interview about the controversial medicine for coronavirus, vaccines and what we know now about Covid-19

Aleksey Vodovozov, toxicologist and one of the most famous Russian popularizers of science, has been telling his numerous subscribers the latest news about Covid-19 since the very first days of the coronavirus pandemic. About how treatment regimens have changed now, what Russian manufacturers pass off as a drug for coronavirus and why it is prohibitively expensive, about vaccines and the prospects of living next to the virus — in his interview with Realnoe Vremya.

“Arbidol doesn't work for coronavirus”

What can you say about that the clinical recommendations for the treatment of coronavirus still include Arbidol — a drug with unproven effectiveness?

Well, what can I say… If we are talking about the pharmaceutical business, it is first of all, a business, and second of all, a pharmaceutical one. And if its interests coincide with the interests of patients — this is great. But this is not as common as we would like. But if it doesn't, it's a patient problem, not a problem of the business.

Photo: gtrk.tv
We have conducted large-scale clinical studies, and we can say with a high degree of confidence: Arbidol does not work in any way with regard to the treatment of coronavirus

Are there any drugs that destroy coronavirus?

We don't know about them yet — at least not inside the human body. There are those that destroy it from the outside: any pharmacy antiseptics, for example. If they contain 70% or more of ethanol or isopropanol, they work great. Moreover, you can buy soap in any household store — it just tears viruses to shreds. Because the virus has a lipid envelope, and therefore the surfactants that make up the soap tear it apart.

But this does not mean that you need to eat soap, make a solution out of it and drink it, or administer enemas out of it, God forbid. When the virus is already in the body, completely different laws apply.

Currently, about 300 drugs that are trying to use for coronavirus are being studied around the world. Of these, only remdesivir has received at least some information confirming its effectiveness, and then there are a lot of questions and assumptions about these studies. That is, there is no anti-coronavirus pill yet.

What's wrong with the new coronavirus drug

Then where did the Russian drugs for coronavirus come from? This isn't the original formula, is it?

It is favipiravir, a drug that, like ramdevpir, was created in US military laboratories. It was once tried to be adapted to the treatment of Ebola. You may ask — what does the military have to do with it? The thing is that Ebola has long been considered a biological weapon. Therefore, in the second half of the 20th century (from the 1960s to the 1980s), the drugs that could save people from these viral misfortunes were actively studied. By the way, Ebola is still a huge problem. It has an extreme lethality rate, despite all our achievements. 70-80% of the diseased die. And we are lucky that it is transmitted exclusively by contact, and not by airborne droplets. But this possibility was considered — that this virus is somehow modified, would be given the capacity to be transmitted through the air. Therefore, the United States was looking for a way to deal with it. And we were also looking for — Vector SSC appeared for a reason, and this was also its task. Everyone was searching for such drugs. And so the Americans created two such formulas — remdesivir and favipiravir.

How do they work against coronavirus?

I've already mentioned remdesivir above: the information is contradictory, but, nevertheless, its use for emergency indications was approved in the United States.

But not for favipiravir. It's really bad with it, it didn't show any results, plus it had serious side effects. And then the US abandoned it — stopped using it and studying it. But then the Japanese took a closer look at it. They tried to make a flu drug out of it. But it didn't work out. As a result, the Japanese decided on the following case of its use: severe flu, and it is no longer treated at all, nothing helps, and only in this case you can use favipiravir.

I may ask a strange question now, but why is it so expensive with all its “advantages”?

Because they can. The companies are private, as you understand. The drug is not on the list of vital and important, and the company can set any price. But when all three of them set the price somewhere in the region of 12,000 rubles, the antimonopoly service immediately suspected collusion and initiated its review, which is logical. This drug can't cost that much. It's not new, it has a non-unique formula, you do not need to invest in development, not to mention unproven efficiency.

“It's not just viral respiratory infections — it's a systemic disease”

Now doctors know quite a lot about Covid-19. Treatment protocols are also changing. Please tell us, is there anything else besides Arbidol that raises questions in these recommendations?

Fortunately, the vast majority of drugs with unproven effectiveness have disappeared from there. If we, for example, look at the Russian recommendations of the first iterations, there was absolute trash, including a variety of homeopathy. Many things have changed for the better in the meantime. Now only Arbidol, interferon-alpha, and favipiravir are left there. There is also hydroxychloroquine — however, it is recommended to use it with a lot of reservations. It would be a good idea to banish him from there.

Hydroxychloroquine, by the way, got into the protocols of coronavirus therapy completely by accident, thanks to politicians — or rather, personally to Donald Trump, who made a significant contribution to its promotion, saying that he accepts it and recommends it to everyone. But there is the same story as with favipiravir: there are no facts confirming the effectiveness, but there are side effects.

Photo: indianexpress.com
Hydroxychloroquine, by the way, got into the protocols of coronavirus therapy completely by accident, thanks to politicians — or rather, personally to Donald Trump, who made a significant contribution to its promotion, saying that he accepts it and recommends it to everyone. But there is the same story as with favipiravir: there are no facts confirming the effectiveness, but there are side effects

What is new about this disease, and how does it help to treat it?

We finally realised that this is not just viral respiratory infections. This is a systemic disease that affects mainly small vessels located in any organs — not only the lungs suffer, but also the liver, kidneys, brain, and everything.

Therefore, when we now started using systemic anticoagulant therapy, it brought the right stream to the anti-coronavirus strategy, and many lives were saved thanks to this understanding. It is first.

And second, we began to understand that this is a systemic inflammation, a systemic inflammatory reaction. Sometimes coronavirus even manages to use our immunity against us.

Some people have a feature — delayed interferon response. And coronavirus takes great advantage of it. It can provoke the development of pathological immune responses. And we also have a long-standing drug against the hyperimmune response — dexamethasone and other corticosteroids, which, after special studies, have shown a reproducible effect. These drugs showed themselves well everywhere, the indicators changed for the better. And these were objectively measured indicators, and not just a subjective statement “the patient felt better in three days”.

And today we understand that we should not try to put a person on a ventilator at all costs. In the first days and weeks, they tried to immediately transfer the patient to the machine, but now it is more of a gesture of despair. We wait until the last moment, use any other methods of oxygenation — masks, cannulas. And while the patient's saturation is kept at an acceptable level, he or she is not put on a ventilator. Why? Because then they counted, estimated — and it turned out that only about 17-20% of people recover after a ventilator. The percentage of extubation was too low. It is clear that lung patients were not put on a ventilator, but, in general, the scheme was revised. As well as many other tactics.

That is, our treatment is still symptomatic.

Pathogenetic and symptomatic. And today, our approach to coronavirus allows us to save those patients that we would not have been saved somewhere in February.

“If teachers want to live until the next school year, it is better to get vaccinated”

What can you tell us about the vaccine? Here in Tatarstan, teachers are afraid that they will be forced to get vaccinated.

It's simple. If teachers want to live until the next school year, it is better to get vaccinated. The thing is that children are the fuel for so many epidemics. This also applies to coronavirus. Children get sick with it, very rarely go to the hospital, but they are carriers of the virus. But where are children concentrated the most? At school. Who mostly works at the school? I don't know about you, but in our city the average age of a school teacher is 50 years. In other words, this is a risk group right away. Plus, school employees may already have accumulated cardiovascular diseases, respiratory diseases, and stress — in short, school does not improve their health. And the epidemiological situation either.

So if teachers are asked to get vaccinated, I would still do it in their place. After all, teachers and doctors are particularly at risk.

But people are afraid that the vaccine is still under-researched, under-developed and terribly terrible.

Questions to the vaccines, of course, arise. But we must understand that all over the world did not invent the bicycle. We took the old one and put a new steering wheel and pedals on it. The Gamaleya Research Institute of Epidemiology and Microbiology's vaccine is made on pure adenovirus, they have been used in medicine for more than 50 years, and many vaccines are made on them. We know this tool and we know that the maximum that it gives in terms of side effects is one day of temperature and, perhaps, local reactions (redness at the injection site). There will be no additional side effects.

Photo: Maksim Platonov
So if teachers are asked to get vaccinated, I would still do it in their place. After all, teachers and doctors are particularly at risk

“As long as there is no vaccine, we will get more and more waves”

What's next? Will this coronavirus stay with us or can it be defeated?

If someone answers this question unequivocally, you can immediately hit him in the face. Because he's probably going to lie. No one now knows what will actually happen. Of course, there were a lot of people who made forecasts, models, and everything else, but I didn't see a single model that would show a reliable result even for a period of six months. No one has yet predicted what it will be like.

They said there should be a second wave. But this is understandable — as long as there is no vaccine, when we remove the next restrictions, we will receive new waves. Because coronavirus is a non-quarantine infection. We can't stop it with such measures.

But on the other hand, we have an example of a coronavirus that once caused atypical pneumonia — SARS-CoV. So, thanks to the measures that were taken at that time, it disappeared. They didn't have time to develop a vaccine against it. And it never appeared anywhere else.

This scenario is quite possible. Yes, of course, this coronavirus has taken root much better in our country. But there is another scenario — we already have four coronaviruses that we get sick with every year. They are part of the viral respiratory infections cohort. And we have been co-existing with them for a long time.

Photo: Ilya Repin
As long as there is no vaccine, when we remove the next restrictions, we will receive new waves. Because coronavirus is a non-quarantine infection. We can't stop it with such measures

And the new coronavirus can be integrated into this cohort without killing a third of the globe?

We must also remember this: a person has not only antibody immunity, but also T-cell immunity. These cells have their own recognition apparatus, they can kill infected cells in our body. Well, research shows that people who have had these human coronaviruses sometimes have cross-T-cell immunity to our new coronavirus. And this, by the way, is one of the possible answers to the question of why there are families where everyone has been ill, except for one person. These people were studied and found that they have this feature of T-cell immunity. So it is possible that the new coronavirus can thus stay with us, but not be so dangerous.

But in what direction this process will go — no one will say for sure now, it will only be known in time.

By Lyudmila Gubaeva
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