While Physicians and other members of the healthcare team are awaiting the development and approval of a vaccine in order to hopefully protect their patients from Covid-19, a review of the medical literature suggests that there may be existing options that could potentially reduce morbidity and mortality, including the use of inexpensive generic drugs
Some articles from the literature for review (not all refer specifically to coronavirus per se):
- In 2013, David S. Fedson, MD, an authority on pandemic influenza, issued a “Call to Action” with respect to the use of “several modern drugs (e.g., statins, angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors) that can modify the host response to inﬂammatory illness, and (that) laboratory and clinical studies suggest they might be used to treat pandemic patients. Unfortunately, little attention has been given to the research needed to support their use in patient care. There is no guarantee these drugs will work, but physicians will never know unless those responsible for pandemic preparedness recognize and act on the extraordinary possibility that they may save lives”
2) In 2005, researchers from China and other countries reported: “A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury” which provides a molecular explanation of why SARS-CoV infections cause severe and often lethal lung failure. The authors suggest a “rational therapy for SARS, including modulation of the renin-angiotensin system to protect individuals with SARS and possibly other respiratory disease viruses”. Note that a specific reference to use of an ARB (losartan) is included in the study.
3) In 2004 researchers reported “Observational studies conducted among Asian populations suggest that the risk of pneumonia is substantially reduced among users of angiotensin-converting enzyme (ACE) inhibitors”
4) In 2015, Chinese researchers reported: “Angiotensin II receptor blocker (ARB) as a novel therapy in acute lung injury induced by avian influenza A H5N1 virus infection in mouse”
5) in 2018 David S Fedson stated that “combination treatment with inexpensive and widely available generic drugs (e.g. statins and angiotensin receptor blockers) might change the…. host response. These drugs might work by modifying endothelial dysfunction, mitochondrial biogenesis and immunometabolism. Treating the host response might be the only practical way to reduce global mortality during the next influenza pandemic.”
In the same article (link below) Dr Fedson opined that “an effective response must include a “bottom up” approach to individual patient treatment by ordinary doctors working in ordinary healthcare systems who use ordinary, widely available and inexpensive generic drugs that modify the host response”
Given the possible benefit and low risk of harm, would you ever consider giving ACEi or ARBs in a patient with COVID-19?
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