|LETTER TO THE EDITOR
|Year : 2022 | Volume
| Issue : 1 | Page : 103-104
Unfolding pandemic of severe acute respiratory syndrome coronavirus 2 and its evolving lessons
Harish Gupta1, Ajay Kumar Patwa2, Medhavi Gautam1, Satish Kumar1
1 Department of Medicine, KG's Medical University, Lucknow, Uttar Pradesh, India
2 Department of Medicine, Med Gastroenterology Unit, KG's Medical University, Lucknow, Uttar Pradesh, India
|Date of Submission||01-Jun-2021|
|Date of Acceptance||01-Dec-2021|
|Date of Web Publication||24-Jan-2022|
Dr. Harish Gupta
Department of Medicine, KG's Medical University, Lucknow - 226 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta H, Patwa AK, Gautam M, Kumar S. Unfolding pandemic of severe acute respiratory syndrome coronavirus 2 and its evolving lessons. Indian J Health Sci Biomed Res 2022;15:103-4
|How to cite this URL:|
Gupta H, Patwa AK, Gautam M, Kumar S. Unfolding pandemic of severe acute respiratory syndrome coronavirus 2 and its evolving lessons. Indian J Health Sci Biomed Res [serial online] 2022 [cited 2022 Jul 2];15:103-4. Available from: https://www.ijournalhs.org/text.asp?2022/15/1/103/336293
Singhai et al. explore their oncology-related perceptions related to COVID-19 in May 2021, issue of the Journal. The authors assess interaction between an acute viral illness, COVID-19, and chronic cancerous illnesses. Several reports around the world indicate that patients with carcinogenic conditions-especially those who have recently received chemotherapy or surgery, are at increased risk of developing complications. Hence, we need to analyze more such studies and learn their lessons to better manage these patients.
In the third paragraph, the authors write that immune mechanisms involved in the pathogenesis reveal that after getting entry into cells, subsequent deregulation and further release of inflammatory cytokines and chemokines may lead to storm-like conditions. However, now we know much about the mechanism of viral invasion and divide the pathologies into two distinct phases. First, after infecting and multiplying in the upper airways in one subset of patients, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters the lungs and starts replicating there. It is in this subgroup of patients, there is some possible benefit of antiviral drug-remdesivir. The WHO SOLIDARITY trial concludes that when a patient is in this early phase of illness and viral load is high, therapeutic agents targeting these virological dynamics yield some improvement in median time to recovery. A Lancet comment highlights this specific point.
However, subsequently, there are two possible outcomes. In the majority of patients when viral multiplication has ceased, either there is uneventful recovery, although a few of them develop pulmonary fibrosis or some postacute complications of COVID-19. Or in some patients, immune system goes in hyperactive phase and this hyperimmune response leads to cytokine storm. It's in this second subgroup of patients, there is a benefit of providing corticosteroids. Recovery Collaborative Group discovers that dexamethasone is beneficial in those hospitalized patients with COVID-19 who have only severe disease. When patients are either on mechanical ventilator/extracorporeal membrane oxygenation or are receiving oxygen support, only then there is some benefit in odds of survival-and more in the former ones-as evident by the separation of survival curves. If these potent immunosuppressive drugs are prescribed outside these limited indications, they cause more harm than good.
Since the first wave of novel coronavirus pandemic, experts are observing and warning that overuse of corticosteroids may lead to various complications. Mehta and colleagues reported a case of rhino-orbital mucormycosis last year when the pandemic was less ferocious as compared to the current second wave. This year when there was a sudden surge, patients were unable to get hospital beds and care of physicians in person; many started to consume these drugs on their own. Resultantly, now we are observing an epidemic of mucormycosis in our hospitals. The Director of AIIMS, New Delhi, has been advising masses for a long not to consume these drugs liberally and consume only under medical supervision. Therefore, it's necessary to have a grasp of two different mechanisms of SARS-CoV-2 infection and invasion to make the best use of our therapeutics while causing the least collateral damage in the process.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Lee AJ, Purshouse K. COVID-19 and cancer registries: Learning from the first peak of the SARS-CoV-2 pandemic. Br J Cancer 2021;124:1777-84.
Young B, Tan TT, Leo YS. The place for remdesivir in COVID-19 treatment. Lancet Infect Dis 2021;21:20-1.
RECOVERY Collaborative Group; Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al.
Dexamethasone in hospitalized patients with COVID-19. N Engl J Med 2021;384:693-704.
Mehta S, Pandey A. Rhino-orbital mucormycosis associated with COVID-19. Cureus 2020;12:e10726.