Covid Mutants today (December 11, 2016) on the page of the Medical Genome Center, Ramathibodi Hospital, Mahidol University reveals the tracking of an emerging subspecies of Omicron. and resistance to antiviral drugs In a message stating that World Health Organization (WHO) data shows that the death rate from COVID-19 worldwide is declining In contrast to the rising rate of new infections worldwide the world. Indicated for less efficient vaccine prophylaxis Even if over 90% of the world population is immune to vaccination or natural infection. perform better while on antiretroviral therapy The world must rely on antiviral drugs as a second line of defense, but the next problem that could be tackled is drug-resistant COVID.
The Genome Center has developed a genetic decoding of the whole genome of COVID-19 not only to track the emerging subspecies of omicron in Thailand. But also beware of COVID with antiviral resistance genomes like 16 years ago that had to decode the genetic code of the HIV virus to modify antiviral drugs. all the way to reducing the number of AIDS deaths to a level that Thai public health can control
It is now clear that Omicron Emerging substrains such as BA.2.75, BQ.1.1 and XBB can better evade immunity from booster vaccines and natural infection immunity better than the original ‘Wuhan’ COVID-19, said the researchers from Teh University. New COVID strains that are grandchildren of Omicron BA.2, such as BA.2.75 and grandchildren of Omicron BA.5, such as BQ.1.1, as well as crosses of the Omicron family, such as O. Micron XBB (BJ.1XBA.2.75* ) is four times more effective at evading first- and second-generation vaccine immunity than Omicron BA.5, making these new viruses more viable.
Although it has been found that the infected body has a hybrid immunity that occurs naturally after booster vaccination, it can increase the protection efficiency of the new strain of COVID-19 infection to some extent, but it is not good. Furthermore, the emerging subspecies of omikron are resistant to almost all “immunogenic antibody” drugs.
Interestingly, data from the World Health Organization indicate that The number of new omikron infections worldwide has increased markedly. But the number of patients who need to be admitted to intensive care and die from COVID-19 declined significantly, the main reason is likely to be because
1. Doctors and healthcare professionals have more experience treating COVID-19 with antiviral drugs and steroids. more systematic and standardized
2. Currently, the 2019 COVID-19 virus has not yet been found to be resistant to “antiviral pills” that are ingested to inhibit the multiplication of the virus inside cells. The inhibition of intracellular viral replication is not related to the viral spike protein gene. While all sub-strains of omikron are resistant to antibody injections. Off-the-shelf immunity type Because injected ready-made antibodies do not bind well to the spike proteins of the virus. Due to the mutation of the gene that produces the spine protein, the morphology of the spine protein changes rapidly from that of the parent species.
for Thailand by the Department of Medicine Ministry of Public Health together with doctors specializing in the treatment of COVID-19 infection Both the public and private sectors come together to formulate guidelines for medical practice, diagnosis, treatment and prevention of COVID-19 infection in hospitals as a guideline for physicians across the country to make decisions in the treatment of COVID-19 patients. with Thai and foreign medicines Whether in young children, older children, adults, pregnant women. Both antiviral tablets and injections, with guidelines for choosing andrographis paniculata, favipiravir Molnupiravir, Paxlovid, Remdesivir Long-acting mixed antibody Used for prevention before exposure to the virus that causes COVID-19. and antibiotics
Thai public health system Starting from the village, the health volunteers (Vor Sor Sor.) reach people in every family as if they were knocking on the door of the house. Various voluntary organizations until the patient arrives for treatment in the provincial hospital It should enable Thai people to have good access to antiretroviral drugs and treatment. can reduce serious disease infections Death
It can be estimated that from 2023 onwards all over the world, including Thailand, there will be a greater use of anti-Covid-19 pills. Due to the mutation, ready-made vaccines and antibody drugs are ineffective at preventing infection. The question is, when antiviral drugs are widely used, will the virus mutate and become resistant to antiviral drugs?
The key question is Worldwide, has the COVID-19 virus mutated to be resistant to molnupiravir. Remdesivir Paxlovid or not?
Paxlovid is highly effective in treatment Contains nermatrelvir, which prevents the activity of viral protease inhibitors from forming intact viral particles. Ritonavir slows the degradation of nermatrelvir. Makes the drug stay in the body longer An independent study published in the New England Journal of Medicine found that paxlovid could shorten the length of hospital stay for vulnerable patients over the age of 65 and reduce mortality. Up to 79% , hospital data in Israel earlier this year And according to a study by the pharmaceutical company, Paxlovid reduced the risk of hospitalization and death by 88%.
Among antiviral drugs for COVID-19 Paxlovid is highly effective in treatment It is expected to become the main treatment for COVID-19 in the future, but experts around the world believe it will soon see COVID-19 Paxlovid resistance will occur definitely because the current treatment is still monotherapy. (monotherapy)
SARS-CoV-2 viruses that cause COVID-19 Continually mutate like other RNA viruses, such as HIV, with drug resistance difficult to manage. Drugs that block the activity of many HIV proteases have experienced rapid drug resistance in the past as they are the only drug in the treatment of easily resistant strains. Until the simultaneous use of 2-3 antiretroviral drugs is regulated, the problem of HIV drug resistance has been resolved since 1990 to the present.
Taking multiple antiviral drugs at the same time or packing many drugs into one pill and eating It’s like attacking multiple virus factories at the same time, causing the virus to rapidly destroy itself without the ability to mutate into resistance to antiviral drugs.
Currently, the manufacturer of Paxlovid believes that high concentrations of the drug and treatment times as short as five days reduce the chances of developing drug resistance. This gives the company time to develop a second-generation COVID-19 drug, which would need to contain more than one drug in the same cocktail pill or capsule.
face-to-face troubleshooting What should be done to prevent the development of COVID-19 resistant to Paxlovid antivirals?
1) First, should paxlovid be used for prophylaxis? The more individual drugs used, the faster the onset of drug resistance. As was the case with drug resistant HIV in the past.
2) Is it appropriate to use paxlovid in young, healthy people who are unlikely to become seriously ill?
The U.S. Centers for Disease Control and Prevention’s (CDC) initial solution to reduce PaxLovid use among the population. Although Paxlovid is still recommended for early treatment of COVID-19, In infected people, symptoms are mild to moderate. But it has been modified for use in vulnerable groups who are at high risk of severe disease progression. Previous CDC guidelines included Paxlovid use in adults and children under 12 years of age.
We are fortunate to have antiretroviral drugs as one of the most effective tools for treating COVID. It is the second line of defense after ineffective vaccines in preventing infections. Therefore, you should use it only as needed to avoid drug resistance. i.e. by prescription We need to accelerate research and development to keep pace with the virus by rapidly developing new anti-Covid-19 drugs, especially drugs with different mechanisms of action than those we currently use as drugs. -3 drugs) because the use of antiviral combinations has been successful in the treatment of AIDS.
The Genome Center develops a genome-wide genetic transcript of COVID-19 not only to track emerging omikron subspecies, but also to investigate antiviral resistance of the 2019 novel coronavirus in Thailand.
