– Dr. Carpen says the biggest challenge remains the absence of a ‘magic bullet’

By Navendra Seoraj
GUYANA has already lost 69 persons to the dreaded novel coronavirus (COVID-19) and while the loss of life is never pleasant, there has been a small but significant development in the use of the remdesivir drug, which has so far shown positive signs in the treatment of COVID-19.
Cardiologist, Dr. Mahendra Carpen, who is spearheading the trials of the drug, said it was administered to nine patients and there was no adverse effect.
“Patients responded good and three patients did not need oxygen or intubation after starting the drug,” said Dr. Carpen during an exclusive interview with the Guyana Chronicle on Monday.
According to New England Journal of Medicine (NEJM), remdesivir, a nucleotide analogue pro-drug that inhibits viral RNA polymerases, has shown in-vitro activity against SARS-CoV-2 (COVID-19).
While Guyana has been able to acquire and use hydroxychloroquine, remdesivir had been out of the country’s reach for quite some time, as the supplier has been producing only limited amounts.

Most of the drugs were being consumed by the US, but Guyana was able to acquire 240 doses of a generic version of remdesivir from India.
So far, as Dr. Carpen said, there have been no adverse effects from the drug, but one patient, who was critically ill, could not be saved despite the drug’s responsiveness. Some of the patients are still under hospital supervision, but the doctor maintained that patients have been responding well.
“In fact, three persons have been discharged so far,” said Dr. Carpen, adding: “We will use the drug continuously once we have stock… we have been applying international guidelines and protocols in the use of this drug.”

While the local trials are still in its early days, there is potential for the drug to be used constantly in the fight against COVID-19.
There are, however, other treatment methods which are being used. Among those methods is the plasma treatment. Monoclonal antibody therapy, as the treatment is called, is defined as a form of immunotherapy that uses monoclonal antibodies to bind specifically to certain cells or proteins.
The objective is that this treatment will stimulate the patient’s immune system to attack those cells. And, according to the World Health Organisation (WHO), since the last century, passive immunisation has been used for the prevention and treatment of some human infectious diseases. The serum of convalescent patients is the treatment of choice in cases of Argentine Hemorrhagic Fever.
In addition, WHO said it was used during outbreaks of Ebola in Africa and also during the SARS and MERS outbreaks, as no other therapeutic options existed.
“Patients, who meet criteria and are compatible with plasma, would receive this treatment, but our biggest challenge is the shrinking donor pool…we also have a compatibility challenge in terms of blood transfusion… but the treatment has been working,” said Dr. Carpen.

MAGIC BULLET
Despite small successes in the use of these treatment modalities, the overarching problem remains the absence of what Dr. Carpen called a “magic bullet,” an internationally accepted cure or standardised way of ensuring the best outcome for patients.
“There are many things we use that contributed in small ways to better outcomes, but there is no magic bullet, so the important thing is to wear mask and sanitise and maintain social distancing… simple things that are hard to enforce and to do,” said the doctor.
Health authorities have so far tested 12,454 persons, with 10,017 being negative, and 2,437 positive. Some 35 of those cases were recorded within the past 24 hours.
Of the total positive cases, 1,361 persons have recovered, and 68 have lost their lives. The remaining cases include 163 persons in institutional isolation, 830 in home isolation, and 16 in the COVID-19 Intensive Care Unit (ICU).

According to the WHO, COVID-19 is an infectious disease caused by a newly-discovered coronavirus. Most people who fall sick with COVID-19 will experience mild to moderate symptoms, and recover without special treatment.
The WHO had said that 81 per cent of the persons who contracted COVID-19 will have mild symptoms, while 14 per cent will have severe symptoms, and five per cent will need intensive care.

But the COVID-19 disease has proven to be “a real killer,” especially in cases involving persons who have co-morbidities such as diabetes and hypertension, among other ailments.

Persons were encouraged to take extra precautions because there is no approved cure or specific treatment for the disease. Guyanese were also reminded to observe the protocols established in the COVID-19 emergency measures.